Psychiatric Morbidity Differences in Male and Female Adolescent Inpatients With Alcohol Use Disorders

Gender Differences in Psychiatric and Behavioral Health Burden Among Adults With Alcohol and Other Substance Use Disorders in the United States

OBJECTIVES

Studies report that women with opioid use disorder experience more comorbid psychiatric disorders and behavioral health burdens than men. We broadened the study of this phenomenon to alcohol use disorder (AUD) and other substance use disorders (SUDs) using national epidemiologic data.

METHODS

Data from the National Epidemiological Survey on Alcohol and Related Conditions Wave-III identified 2491 women and 3317 men with DSM-5 AUD or SUDs, and 30,501 men and women without such disorders. Women and men with AUD and SUDs were compared to those without such disorders on 22 measures of DSM-5 psychiatric disorders and behavioral histories (eg, incarceration and suicide attempt). The interaction of female sex and AUD in relation to these measures was evaluated and we repeated analyses for SUDs.

RESULTS

Separate analyses of female and male adults with and without AUD or SUDs showed AUD and SUDs in both sexes were strongly associated with psychiatric disorders and behavioral histories. In pooled analyses, the interaction of female sex and AUD showed women with AUD had significantly greater likelihood than men of: borderline personality disorder, pain; parental history of incarceration; traumatic events; incarceration; and lifetime homelessness (P < 0.05 for all), but not for psychiatric diagnoses. Interaction of female sex with SUDs showed women had increased likelihood of all personality disorders, traumatic events, and past incarceration (P < 0.05 for all).

CONCLUSIONS

Certain personality disorders and behavioral histories, but not psychiatric diagnoses, may play a distinct role in leading to SUDs among women when compared to men.

Examining sex differences in DSM-IV-TR narcissistic personality disorder symptom expression using Item Response Theory (IRT)

The limited published literature on the subject suggests that there may be differences in how females and males experience narcissistic personality disorder (NPD) symptoms. The aim of this study was to use methods based on item response theory to examine whether, when equating for levels of NPD symptom severity, there are sex differences in the likelihood of reporting DSM-IV-TR NPD symptoms. We conducted these analyses using a large, nationally representative sample from the USA (n=34,653), the second wave of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). There were statistically and clinically significant sex differences for 2 out of the 9 DSM-IV-TR NPD symptoms. We found that males were more likely to endorse the item 'lack of empathy' at lower levels of narcissistic personality disorder severity than females. The item 'being envious' was a better indicator of NPD severity in males than in females. There were no clinically significant sex differences on the remaining NPD symptoms. Overall, our findings indicate substantial sex differences in narcissistic personality disorder symptom expression. Although our results may reflect sex-bias in diagnostic criteria, they are consistent with recent views suggesting that narcissistic personality disorder may be underpinned by shared and sex-specific mechanisms.

Validity aspects of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, narcissistic personality disorder construct

BACKGROUND

The Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, narcissistic personality disorder (NPD) construct has been criticized for being too narrowly defined, for example, by focusing on overt grandiosity at the expense of exhibitionism and narcissistic vulnerability and thus covering only parts of the domain of narcissism. The purpose of this study was to elucidate several validity aspects of the NPD construct.

METHODS

The material consisted of data from 2277 patients (80% of whom had a personality disorder [PD]) who were admitted to units connected to The Norwegian Network of Psychotherapeutic Day Hospitals. The Axis II diagnoses were assessed by Structured Clinical Interview for DSM, Fourth Edition, Axis II Personality Disorders.

RESULTS

The frequency of NPD was very low (0.8%). Male patients were overrepresented both on a diagnostic level and on criteria levels. The NPD category was positively associated with other cluster B disorders and negatively associated with avoidant PD. The criteria "demands excessive admiration" and "fantasies of unlimited success" correlated almost as highly with the histrionic PD category and loaded primarily on a histrionic factor. The dominant NPD factor also included the antisocial criterion of "showing no regret having injured others." The major part of the patients' personality pathology could be attributed to other PD criteria.

CONCLUSIONS

The results challenge the notion of NPD as a distinct diagnostic category. Rather, narcissism should be conceived as personality dimensions pertinent to the whole range of PDs. The results support the views put forward by Russ et al (Refining the construct of narcissistic personality disorder: diagnostic criteria and subtypes. Am J Psychiatry 2008;11:1473-1481) that what clinicians conceive as narcissism consists of several subtypes (dimensions). Our data support the existence of a grandiose/malignant type and an exhibitionistic type. Unfortunately, there was no measure of hypersensitivity. The proposal to delete NPD as a prototype category in the DSM, Fifth Edition, seems well justified. However, the proposed trait domain of antagonism in the DSM, Fifth Edition, seems to account better for the grandiose/malignant dimension than the exhibitionistic/histrionic dimension.

Gender differences in comorbid disorders among offenders in prison substance abuse treatment programs

This study examined gender differences in a range of lifetime psychiatric disorders in a sample of 272 offenders newly admitted to a prison substance abuse program. Although these men and women did not differ in severity of substance use in the six months prior to incarceration, women were significantly more likely than men to report a lifetime psychiatric disorder and a lifetime severe disorder. Furthermore, gender differences emerged in the pattern of lifetime psychiatric comorbidity. Women reported greater lifetime major depression, posttraumatic stress disorder, eating disorder, and borderline personality disorder; men were more likely than women to meet criteria for antisocial personality disorder. Additionally, female offenders were found to have a higher degree of internalizing disorders than male offenders, but there were no gender differences in degree of externalizing disorders. The study concluded that women offenders newly admitted to a prison substance abuse program present with a greater psychiatric vulnerability and a different pattern of psychiatric comorbidity than their male counterparts.

Adolescent alcohol misuse: methodological issues for enhancing treatment research

AIMS

The objective of this article is to present an overview of the current state of the field of adolescent alcohol treatment research and to discuss several priorities for future research directions.

METHOD

The authors identified trends in adolescent alcohol treatment research from multiple sources, including searches of the National Institutes of Health grantee listings, proceedings from annual meetings of the Research Society on Alcoholism and relevant English-language journal articles available in MEDLINE and PSYCHLIT databases over the past decade.

RESEARCH RECOMMENDATIONS

This field must build on its major strength, which has been its success in appreciating the unique developmental characteristics of adolescence and meaningfully incorporating them into adolescent alcohol treatment approaches. Priorities for future research include: empirically investigating the potential value of harm reduction approaches for promoting public health and reducing total harm for adolescents; developing efficacious interventions across a wide range of intensities and settings; increasing the reach and relevance of randomized treatment efficacy trials and their products, with a particular focus on enhancing the recruitment and retention of diverse treatment samples; increasing a focus on key individual difference variables such as co-occurring diagnoses, that may serve as the basis for treatment tailoring; and exploration of the potential benefits of transdisciplinary research.

Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships

Eating disorders are complex, multifactorially determined phenomena. When individuals with eating disorders present for treatment with comorbid conditions, case conceptualization is further complicated and, as a result, it may be difficult to determine optimal psychological or pharmacological treatment. This article reviews the evidence of the association between eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) and Axis I depression, obsessive-compulsive disorder (OCD), substance abuse, and Axis II personality disorders, for the purposes of increasing awareness about the different options for case conceptualization. Although other diagnoses comorbid with eating disorders are of interest to clinicians (e.g., posttraumatic stress disorder [PTSD] and social phobia), their comprehensive review is currently premature due to a lack of empirical scrutiny. Finally, future directions for research, including suggestions for the use of particular assessment tools and more sophisticated research designs, are discussed.

Understanding gender differences in adolescent drug abuse: issues of comorbidity and family functioning

Female adolescent drug use has increased dramatically in the last 30 years, and there is a growing consensus that the syndrome of female adolescent substance abuse is different from the well-recognized male pattern. Gender differences in patterns of comorbidity and family functioning were investigated in a sample of 95 youths (42 girls and 53 boys) referred for substance abuse treatment. The findings indicate that male and female adolescent substance users differ in several clinically meaningful ways. The results from a discriminant function analysis indicate that substance-using adolescents referred to treatment are distinguished especially by the greater degree to which girls have internalizing symptoms and family dysfunction. The clinical implications of these gender differences are articulated.