Background and Aims: The DSM-IV personality disorders (PDs) are comorbid with alcohol use disorder (AUD) and with each other. It remains unclear which PD criteria are most likely to drive onset and recurrence of AUD and which are merely confounded with those criteria. We determine which individual PD criteria predict AUD and the degree of underlying genetic and/or environmental aetiology. Design: A prospective observational twin study. Setting: Norway 1999–2011. Participants: A total of 2528 and 2275 Norwegian adult twins in waves 1 and 2 variable-selection analyses, and 2785 in biometric analyses. Measurements: DSM-IV PDs and their 80 criteria were assessed using a structured personal interview, and AUD using the World Health Organization's Composite International Diagnostic Interview. Findings: In a variable-selection analysis, two PD criteria were associated with AUD even after taking all the other criteria into account: criterion 8 of antisocial PD (childhood conduct disorder) and criterion 4 of borderline PD (self-damaging impulsive behaviours). Adjusting for each other, their respective odds ratios were 3.4 [confidence interval (CI) = 2.1–5.4] and 5.0 (CI = 3.3–7.7). Endorsement strength of the criteria was associated with AUD in a dose–response manner and they explained 5.5% of variation in AUD risk—more than the full diagnoses of antisocial and borderline PDs together (0.5%). The association between borderline criterion 4 and AUD 10 years later derived mainly from their overlapping genetic factors, whereas the association between antisocial criterion 8 and AUD 10 years later was due to both genetic and non-genetic factors. Conclusions: Conduct disorder and self-harming impulsivity are the foremost risk traits for alcohol use disorder among the 80 personality disorder criteria of DSM-IV, predicting alcohol use disorder more effectively than personality disorder diagnoses. The twin-study analysis suggested that conduct disorder represents a joint genetic and developmental risk for alcohol use disorder and that impulsivity is a genetic risk.
Bibliographical noteFunding Information:
We acknowledge funding from the US National Institutes of Health and National Institute on Drug Abuse (1R01DA037558-01A1), the Research Council of Norway (226985), the Norwegian Foundation for Health and Rehabilitation, the Norwegian Council for Mental Health and the European Commission under the programme ‘Quality of Life and Management of the Living Resources’ of the Fifth Framework Program (QLG2-CT-2002-01254; Fifth Framework Programme, EkstraStiftelsen Helse og Rehabilitering, National Institute on Drug Abuse, Norwegian Council for Mental Health, Norges Forskningsråd). T.H.R. had full access to all the data in this study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The funding sources had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
- Antisocial personality disorder
- behavior genetics
- borderline personality disorder
- causal inference
- co-twin control
- conduct disorder
- data mining
- predictive model
- self-harming impulsivity