Personality Disorder Affects Alcohol Use in Middle-Aged Adults

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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The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • max

    December 25th, 2012 at 11:35 AM

    it can be dangerous to have sustained problems with alcohol.these people are putting their health at risk due to an already existing disorder.they need intervention or they will drown themselves in alcoholic problems.

    do the intervention programs for the general populace work well for those with personality disorder?if not do we have suggested methods specific to their needs?

  • Leighton

    December 26th, 2012 at 6:46 AM

    Why wouldn’t it continue to exist? Just because you get older never means that things like this will just go away on their own.

  • Nichols

    December 26th, 2012 at 9:13 AM

    As if personality disorders and personality pathology aren’t enough, these people also have to deal with alcohol dependence? I guess some people just can’t catch a break. I will keep these people in my thoughts and prayers and hope that the Lord will keep them strong.

  • Sarai

    December 26th, 2012 at 9:15 AM

    Stress in middle life can definitely lead to alcohol abuse in an otherwise mentally healthy adult. I can’t imagine what those stressors can do in someone who has a personality disorder. Very sad indeed.

  • Brenda

    December 26th, 2012 at 10:53 AM

    Not only can middle age issues add to stress and alcohol dependence in non-PD individuals but I suppose they can also exacerbate the symptoms of PD.So that would have a double whammy effect on alcohol dependence.If anything,the increase in alcohol dependence would be even greater than before.It is a good way to assess and monitor such individuals as they age and possible intervention programmes could be introduced to reduce and stop alcohol dependence.


    December 26th, 2012 at 6:44 PM

    Personality disorder by itself can cause reduced physical health. N then these people push themselves into alcohol dependence. That CANNOT b good. They are literally shooting themselves in the foot. I would suggest all those with PD be advised on maintaining their health with a stress laid upon avoiding alcohol. They r clearly more susceptible to issues with alcohol!


    December 26th, 2012 at 11:20 PM

    So basically these people instead of getting help for their personality disorder are actually heaping more problems for themselves!

    If the results are consistent across a wide demographic then they really should talk to PD clients about possible alcohol issues that could crop up. Even if they don’t have it already they can keep away from any such eventual possibility!

  • Molly

    December 27th, 2012 at 2:29 PM

    Joyce- While I Understand what you are stating, it really isn’t as if those with PD have much clear thought to the fact that they are causing more problems. Really, most of them probably think that with the use of alcohol and other drugs that they are solving their problems. This is the one way that many have found to cope that makes them feel a little better. if there is only occasional use and not abuse then I don’t see that there is a huge problem. I do hope for them that they will get some help for the personality disorder and that they find someone who will help them get through that, but drinking doesn’t have to be the bad guy.

  • sarai

    December 28th, 2012 at 4:01 AM

    It’s not addiction and abuse that affects just how much one uses?
    Not saying there is not a link there between those things and personality disorder, but once you get down to the basics, it is an addiction and that is ultimately what causes the behavior.

  • ANDY

    December 28th, 2012 at 3:45 PM

    Now this is interesting – suppose a person has a split personality and he is addicted to alcohol. Will both (or all) of his split personalities display the addiction with alcohol?Or is it possible that one part of him craves for alcohol while another stays away?!

  • kellen

    December 28th, 2012 at 11:13 PM

    is the mere presence of a personality disorder sufficient to make a person more vulnerable to alcohol related issues? or is it the manifestation of symptoms that push a person to it? if it i s the latter there should be techniques by which we can help all these people. because we have enough people with alcohol problems already,we could do with a few less in the department.

  • stressmom

    December 29th, 2012 at 4:17 AM

    I would have to think that in many alcoholics there would be a trait related to some sort of personality glitch, and I know that this sounds bad. But how is it that some people can have a drink and never have a problem with having another one in their lives, while others are hooked from the first sip? There just has to be something there that triggers this kind of need and dependency, so maybe this study is really onto that.

  • GREG

    December 29th, 2012 at 2:26 PM

    Do individuals with personality disorder have a distorted view of alcohol? it’s not for nothing that alcohol dependence is three times in these individuals compared to the general populace.

    what I want to know is whether personality disorder only makes a person more vulnerable to alcohol dependency or does it also make it harder for these people to quit?because that can be a huge problem to deal with you know!

  • scott

    December 30th, 2012 at 8:01 AM

    the most critical factors leading to alcohol problems are identified.but do the people most at risk aware of them?are they being advised to look for and discourage those factors?I don’t think so.alcohol is a problem not just for those with a personality disorder but for everyone in general and we need better efforts to reduce its can lead to so many negative things,the list would be too long here.

  • Zena

    December 31st, 2012 at 1:35 PM

    So they have to fight two things at once! Doesnt sound the least comforting. Do we at least have programmes that are suited to them, considering there are just so many people with personality disorder out there?!

  • Saul

    December 31st, 2012 at 10:38 PM

    “The individuals most at risk for AD in the previous year were those with histrionic, antisocial, narcissistic and borderline PP.”

    This has me thinking – does PD and PP bring in alcoholism or is it the other way around? because frankly, those with an alcohol problem generally tend to exhibit all of these – antisocial behavior and aggression included!

  • JuliaBrooke

    January 3rd, 2013 at 4:07 AM

    Funny how so many of these things always seem to go hand in hand

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