Wednesday, April 13, 2016

Substance abuse and personality disorder comorbidity in adolescent outpatients: Are girls more severely ill than boys?

Substance use disorders (SUDs) constitute a major health problem and are associated with an extensive psychiatric comorbidity. Personality disorders (PDs) and SUDs commonly co-occur. Comorbid PD is characterized by more severe addiction problems and by an unfavorable clinical outcome. The present study investigated the prevalence of SUDs, PDs and common Axis I disorders in a sample of adolescent outpatients. We also investigated the association between PDs and SUDs, and how this association was influenced by adjustment for other Axis I disorders, age and gender.

The sample consisted of 153 adolescents, aged 14–17 years, who were referred to a non-specialized mental health outpatient clinic with a defined catchment area. SUDs and other Axis I conditions were assessed using the mini international neuropsychiatric interview. PDs were assessed using the structured interview for DSM-IV personality.

18.3 % of the adolescents screened positive for a SUD, with no significant gender difference. There was a highly significant association between number of PD symptoms and having one or more SUDs; this relationship was practically unchanged by adjustment for gender, age and presence of Axis I disorders. For boys, no significant associations between SUDs and specific PDs, conduct disorder (CD) or attention deficit hyperactivity disorder (ADHD) were found. For girls, there were significant associations between SUD and BPD, negativistic PD, more than one PD, CD and ADHD.

We found no significant gender difference in the prevalence of SUD in a sample of adolescents referred to a general mental health outpatient clinic. The association between number of PD symptoms and having one or more SUDs was practically unchanged by adjustment for gender, age and presence of one or more Axis I disorders, which suggested that having an increased number of PD symptoms in itself may constitute a risk factor for developing SUDs in adolescence. The association in girls between SUDs and PDs, CD and ADHD raises the question if adolescent girls suffering from these conditions may be especially at risk for developing SUDs. In clinical settings, they should therefore be monitored with particular diligence with regard to their use of psychoactive substances.

Below:  PD symptoms in adolescents with SUD and other Axis I disorders. PD Symptoms any PD criteria meeting a score of 1,2 or 3 when measured with the SIDP-IV; SUD substance use disorders; alcohol and/or drug abuse or dependence. Alcohol alcohol abuse or dependence; CannabisCannabis abuse or dependence; Anxiety anxiety disorders, simple phobias, generalized anxiety disorder, panic disorder, agoraphobia, social phobia and post-traumatic stress disorder; Mood mood disorders, dysthymia and major depressive episode; CD conduct disorder; ADHDattention deficit hyperactivity disorder. ** p < 0.05

Full article at:

Department for Child and Adolescent Mental Health (The Nic Waal Institute), Lovisenberg Diakonale Hospital, Oslo, Norway
Department of Psychology, University of Oslo, Oslo, Norway
Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway
Norwegian Centre for Violence and Traumatic Stress Studies, Oslo, Norway
Vestfold Hospital Trust, T√łnsberg, Norway
Institute of Clinical Medicine, University of Oslo, Oslo, Norway

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