Axis I and axis II comorbidity in alcohol dependence and the two types of alcoholism.

BACKGROUND

Although high prevalence rates of psychiatric comorbidity were reported in alcoholism, there is a lack of studies covering the whole spectrum of DSM Axes I and II disorders. The relation of comorbid psychopathology and Cloninger's and Babor's types of alcoholism still remained unclear.

METHODS

Psychiatric comorbidity in 250 hospitalized alcohol-dependent patients without additional substance-related disorders was assessed by the Composite International Diagnostic Interview and the International Personality Disorder Examination. Information about the course and severity of alcoholism was obtained from several sources.

RESULTS

Additional Axis I disorders only were found in 24.0%, Axis II disorders only in 16.4%, and concurrent Axis I and Axis II disorders in 17.2% (total comorbidity rate: 57.6%). Two clusters of alcohol dependence were found that substantially overlap with Cloninger's and Babor's types of alcoholism. The majority of type A subjects were found to be either not comorbid at all, or to be Axis I comorbid only. Type B, on the other hand, was preferably associated with personality disorders (mainly Clusters A and B) and dimensional scores of personality pathology (schizoid, schizotypal, all Cluster B, and passive-aggressive).

CONCLUSIONS

The entire spectrum of personality pathology should be assessed in the comorbidity research of alcoholism. The two types of alcoholism differ on a variety of alcohol-related and comorbid personality characteristics, but further research is needed to clarify the underlying psychological and biological associations.