Impulsivity and negative emotionality associated with substance use problems and Cluster B personality in college students
Introduction
It has been well established that substance use disorders (SUDs) and personality disorders (PDs) frequently co-occur (Skodol, Oldham, & Gallaher, 1999). This relationship seems to be especially pertinent to Cluster B PDs, which are characterized by erratic behavior and emotions and include antisocial PD, borderline PD, histrionic PD, and narcissistic PD. A recent review of the literature suggested that SUDs are found in nearly 60% of individuals diagnosed with borderline PD (Trull, Sher, Minks-Bown, Durbin, & Burr, 2000) and similar rates of comorbidity are found between antisocial PD and SUDs (Koenigsberg, Kaplan, Gilmore, & Cooper, 1985). Both SUDs (Single, 2003) and PDs (Grant et al., 2004, Pilkonis et al., 1999) represent a significant cost to society, and their co-occurrence likely presents an even greater burden as PDs have a negative effect on treatment prognosis for many disorders including SUDs (Reich and Green, 1991, Reich and Vasile, 1993). Considerable research aimed at understanding SUDs and Cluster B PDs has focused on personality traits. The goal of the current study was to examine personality traits as potential mediators of the comorbidity between features of SUDs and Cluster B PDs.
Within the past decade, the role of personality traits in psychopathology has received increased attention in research. Proponents argue that underlying personality traits help explain the myriad intercorrelations among symptoms of psychological disorders and are therefore useful in understanding individual disorders as well as the comorbidity found among them (e.g., Krueger et al., 2001, Watson et al., 1994). If comorbidity among disorders reflects commonalities in underlying personality traits, then the descriptive clinical features of the disorders can reveal which traits are likely contributors (Watson et al.).
Substance use disorders have been conceptualized as disorders of impulse, undercontrol, or disinhibition (Fowles, 1980, Fowles, 1988, Gorenstein and Newman, 1980, Sher and Trull, 1994), and research on the association of SUDs to trait impulsivity (see Moeller & Dougherty, 2002, for review) and related personality traits like Constraint (e.g., McGue et al., 1999, McGue et al., 1997) and Conscientiousness (Trull, Waudby, & Sher, 1994) support this idea. However, a rich body of research on tension-reduction motives for substance use suggests that SUDs–perhaps at least in some cases – reflect a maladaptive coping response to high negative affect or high stress reactivity, and the positive relationship found between SUDs and personality traits like Neuroticism (see Ball, 2002 for a review; Brooner et al., 2002, Flory et al., 2002; Trull et al.) and Negative Emotionality (NEM; McGue et al., 1999, McGue et al., 1997) support this idea. Antisocial (Cloninger, 1987a, Gray, 1975, Gray, 1987) and borderline PD (Trull et al., 2000) have been similarly labeled as disorders of impulsivity or disinhibition, and that idea is supported by research showing that self-reported impulsivity was at least moderately related to all Cluster B PDs (Casillas & Clark, 2002). Like SUDs, Cluster B PDs are positively associated with Neuroticism (e.g., Ball, 2002, Flory et al., 2002, Morey and Zanarini, 2000) and antisocial PD has been linked to high NEM (Krueger et al., 2001, Verona et al., 2001). Thus, impulsivity and Neuroticism or NEM are traits that have a similar association to SUDs and Cluster B PDs and might serve to explain some of their comorbidity (Sher & Trull, 1994), and a few empirical tests provide some support for this idea.
Casillas and Clark (2002) demonstrated that trait impulsivity underlies part of the comorbidity among SUDs and Cluster B PDs. Similarly, Neuroticism (Ball et al., 1997, Brooner et al., 2002, Rounsaville et al., 1998) accounts for part of the relationship between SUDs and Cluster B PDs. Although a promising start, this literature does not paint a complete picture of how impulsivity and negative affectivity account for comorbidity between SUDs and Cluster B PDs. Krueger, McGue et al. (2001) pointed out that past research failed to deal effectively with the issue of comorbidity because of the tendency to focus on single disorders and single traits. Although more recent research has begun to examine comorbidity directly (i.e., focus on multiple disorders), the literature is still hampered in its available conclusions by a continued data analytic focus on single traits (even when multiple personality traits are examined within a study) and a lop-sided focus on comorbidity of SUDs with only some Cluster B PDs (antisocial and borderline PD, in particular).
The present study will further our understanding of the contribution of impulsivity and NEM to the comorbidity of SUDs and Cluster B PDs by examining the personality traits jointly, which will provide a means to test for an association of each trait to each disorder while controlling for the other trait to help clarify whether NEM and impulsivity are associated with unique variance in each disorder or whether their contributions largely overlap or interact. The present study will examine NEM and impulsivity as they relate separately to (a) alcohol use problems, controlling for symptoms of drug use disorders, (b) drug use problems, controlling for symptoms of alcohol use disorders, and (c) to all Cluster B PDs (not just the more commonly studied antisocial and borderline conditions), controlling for symptoms of other Cluster B PDs. The present study will improve upon the methodology of earlier investigations by controlling for symptoms of other Cluster B PD when analyzing each PD – an important control lacking in previous work given the high co-occurrence of PDs in the general population (Grant, Stinson, Dawson, Chou, & Ruan, 2005). Therefore, results of the present study will provide novel information about not only the comorbidity between alcohol and drug use problems to understudied Cluster B PDs (histrionic and narcissistic) but also about the association of NEM and impulsivity to histrionic and narcissistic PD that will help flesh out theories that attempt to explain the covariation of SUDs and Cluster B PDs. The current study is based on the premise that basic personality traits predispose individuals to the later development of PDs and SUDs; however, this is a cross-sectional study which prevents us from making causal attributions. Nonetheless, cross-sectional designs provide a useful first approach to novel research questions.
In line with previous research, we expected Cluster B PDs (particularly antisocial and borderline PD) to show independent positive associations with alcohol and drug problems. Notably, prior research showing a positive association between histrionic PD and SUDs (e.g. Oldham et al., 1995, Trull et al., 2004) failed to control for other Cluster B PDs and, therefore, our study will help clarify the relationship of histrionic PD to SUDs. Additionally, consistent with previous research, we expected both impulsivity and NEM to show independent positive associations with alcohol and drug problems and with symptoms of borderline and antisocial PD. Finally, we expected NEM and impulsivity to each mediate the association between substance use problems and Cluster B PD symptoms thereby demonstrating that each of those personality traits contributes to the comorbidity of SUDs and Cluster B PDs.
Section snippets
Participants
Participants were 617 (316 women) introductory psychology students who participated in a larger study at a southeastern university. Participants were aged 18 to 33 years (M = 19.18, S.D. = 1.36; our results did not change when the 10 individuals whose age was more than 3 standard deviations above the mean were excluded so these individuals were retained in the sample). Experiments were posted on a department website from which students could participate in studies of their choice for course credit
Results
Prior to data analysis, all variables were examined for outlier values and normality of score distributions. Univariate outlier values were adjusted after bringing the scores to within three times the standard deviation of the mean of each variable. With the exception of the SMAST, which had a bimodal configuration, distributions were normal. Means, standard deviations, and intercorrelations are presented in Table 1. Almost all correlations were significant and most were of medium size
Discussion
Negative affectivity and impulsivity are personality traits associated with SUDs and Cluster B PDs. In line with the idea that personality traits underlie psychopathology and the comorbidity among disorders (Krueger et al., 2001, Watson et al., 1994), we examined the independent and joint contributions of NEM and impulsivity to substance use problems, symptoms of Cluster B PDs, and their covariation. The multi-trait, multi-disorder approach for studying comorbidity as it relates to personality
References (49)
- et al.
Coping strategies in relation to personality disorders
Personality and Individual Differences
(1999) - et al.
Co-occurrence of DSM-IV personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
Comprehensive Psychiatry
(2005) Perspectives on anxiety and impulsivity: A commentary
Journal of Research in Personality
(1987)- et al.
The higher-order structure of common DSM mental disorders: Internalization, externalization, and their connections to personality
Personality and Individual Differences
(2001) The Drug Abuse Screening Test
Addictive Behaviors
(1982)- et al.
Borderline personality disorder and substance use disorders: A review and integration
Clinical Psychology Review
(2000) - et al.
Multiple regression: Testing and interpreting interactions
(1991) Diagnostic and statistical manual of mental disorders text revision
(2000)Big five, alternative five, and seven personality dimensions: Validity in substance-dependent patients
- et al.
Personality, temperament, and character dimensions and the DSM-IV personality disorders in substance abusers
Journal of Abnormal Psychology
(1997)
The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations
Journal of Personality and Social Psychology
Personality trait characteristics of opioid abusers with and without comorbid personality disorders
Dependency, impulsivity, and self-harm: Traits hypothesized to underlie the association between Cluster B personality and substance use disorders
Journal of Personality Disorders
Neurogenetic adaptive mechanisms in alcoholism
Science
A systematic method for clinical description and classification of personality variants
Archives of General Psychiatry
A practical way to diagnose personality disorder: A proposal
Journal of Personality Disorders
Statistical power analysis for the behavioral sciences
User's guide for the structured clinical interview for DSM-IV Axis II personality disorders (SCID-II)
The relations among personality, symptoms of alcohol and marijuana abuse, and symptoms of comorbid psychopathology: Results from a community sample
Experimental and Clinical Psychopharmacology
The three arousal model: Implications of Gray's two-factor learning theory for heart rate, electrodermal activity, and psychopathy
Psychophysiology
Psychophysiology and psychopathology: A motivational approach
Psychophysiology
Disinhibitory psychopathology: A new perspective and a model for research
Psychological Review
Prevalence, correlates, and disability of personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions
Journal of Clinical Psychiatry
Cited by (55)
Latent profile analysis of impulsivity and perfectionism dimensions and associations with psychiatric symptoms
2021, Journal of Affective DisordersA review of psychopathy and Cluster B personality traits and their neural correlates in female offenders
2019, Biological PsychologyImpulsivity and risk for prescription opioid misuse in a chronic pain patient sample
2016, Addictive BehaviorsCitation Excerpt :Impulsivity is one factor that may predispose some individuals to be at higher risk for problematic use of prescription opioids. There is an abundance of evidence to suggest that the personality trait of impulsivity is associated with substance use disorders, especially alcohol use disorders (Sher, Bartholow, & Wood, 2000; Littlefield & Sher, 2010; Sher, Trull, Bartholow, & Vieth, 1999; Lejuez et al., 2010; Hopwood et al., 2011, Sher & Trull, 2002; Bornovalova, Daughters, Hernandez, Richards, & Lejuez, 2005; Gunn, Finn, Endres, Gerst, & Spinola, 2013; Slutske et al., 2002; James & Taylor, 2007; Stautz & Cooper, 2013). For example, Littlefield, Sher, and Steinley (2010) found that individual differences in impulsivity were important to the development of problematic alcohol use over a 16-year period.
Romantic relationships and alcohol use: A long-term, developmental perspective
2016, Development and PsychopathologyPersonality Networks and Emotional and Behavioral Problems: Integrating Temperament and Character Using Latent Profile and Latent Class Analyses
2021, Child Psychiatry and Human Development