Approximately 10% of the adult population has some sort of personality disorder (PD) or personality pathology (PP). As a result, these individuals can have impaired functioning and decreased physical health. They also have a high risk of substance misuse. In fact, nearly one third of adults with PP or PD can meet the requirements for a clinical diagnosis of lifetime prevalence of alcohol use (AD). This is high when compared to the only 11% of adults with AD who have no history of PD or PP. Because drinking behaviors fluctuate over time, and because some types of PP like borderline personality or antisocial personality are less common in older individuals, it is important to understand how these variances affect the risk for AD in later life. Midlife presents a time of challenges and transitions. Factors including added stress, social support, family obligations, intimate relationships, and work demands all influence drinking behaviors and could affect how much PD and PP interact to increase AD risk.
Arpana Argawal of the Department of Psychiatry at Washington University in Saint Louis, Missouri recently led a study to determine just how stressors and events of middle age affect PP and PD and if those external influences weaken or strengthen the link between PP/PD and AD. Argawal evaluated 1,630 adults between the ages of 54 and 65 years old for AD, PD and PP. Friends or family members of the participants (informants) were also interviewed to assess drinking behaviors and psychological history.
Argawal found that individuals with a lifetime history of AD were more likely to demonstrate PP, including antisocial, schizotypal, paranoid, narcissistic, and borderline PP. Those with obsessive compulsive behaviors had lower rates of AD. The individuals most at risk for AD in the previous year were those with histrionic, antisocial, narcissistic and borderline PP. But those with OCD and schizotypal were least likely to have AD in the previous year. Argawal believes that these findings clearly show that AD is uniquely affected by PP and that even as people age, PD and PP should be examined in that context. The results of this research answered the primary question posed by this researcher, “Does the link between PP and AD persist into later middle age?” Argawal said, “Our results suggest that the answer is yes.”
Agrawal, A., Narayanan, G., and Oltmanns, T. F. (2012). Personality pathology and alcohol dependence at midlife in a community sample. Personality Disorders: Theory, Research, and Treatment. Advance online publication. doi: 10.1037/a0030224
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