Dimensions of personality and neuropsychological function in eating disorders, substance use disorders, and addictions

Substance abuse, eating disorders, and other addictive behavior problems tend to be comorbid with personality disorders and with dimensions of personality pathology. Substance abuse and pathological gambling tend to be highly comorbid with antisocial personality disorder, whereas eating disorders are often comorbid with both Cluster B and Cluster C personality disorders. These comorbidities can increase symptom severity and compromise treatment. Negative emotionality, negative urgency, and sensation seeking correlate with most forms of addictive behavior, although anorexia nervosa appears quite different and is associated with lower levels of novelty seeking and high levels of self-directedness and perfectionism. Well-developed neurobiological models of brain system functioning and neurotransmitter plasticity paint a picture of how the initially impulsive engagement in addictive behaviors can become compulsive over time. Behavioral and pharmacological treatment strategies emphasize renewed engagement in nondrug pleasurable activities, and new treatments are being developed that target the specific personality pathology of the patient.