Trastornos de la personalidad y trastorno por consumo de sustanciasanálisis desde la perspectiva dimensional de la Sección III del DSM-5 y su utilidad en el ámbito clínico

Abstract

The assesment of comorbid personality disorders in substance-consuming patients is of special relevance in the clinical setting. Section III of the DSM-5 includes a new model for the evaluation and diagnosis of personality disorders that proposes the organization of personality in 25 personality facets grouped into five domains. The assessment instrument developed simultaneously with the model, the DSM-5 Personality Inventory (PID-5) has shown good psychometric properties, but there is still the possibility of certain improvements. In this doctoral thesis, the psychometric properties of the PID-5 short version (PID-5SF), which consists of 100 items, are studied. The discriminative capacity of the PID-5 SF Personality Inventory to detect functional impairment in this type of patients is also analyzed, carrying out a study of the application of functional cutoff points for identifying pathological facets, instead of the normative criteria used to date. Finally the personality profiles of the patients are compared according to the consumption profile. A sample of 282 substance-consuming patients who completed the PID-5SF, the World Health Organization Disability Assessment (WHODAS 2.0) and the SDSS is used. The average value of Cronbach's alpha coefficients reached values of α = .73 in the facets and .84 for the domains. The item-scale correlation values ranged between .57 - .83 for the facets and .70 - .87 for the domains. The confirmatory factor analisys performed showed a good fit in both models tested: the structure of five correlated factors and the hierarchical structure of personality traits, with two second order factors (internalizing and externalizing). WHODAS 2.0 domains of understanding and communication, and participation in society, seem to show the strongest relationship with personality facets. The ROC analysis using as a criterion moderate to severe disability in the WHODAS, shows AUC values between .50 and .78 on all facets. Six facets showed no discriminative capacity for functional disability: attention seeking, grandiosity, intimacy avoidance, manipulation, restricted affectivity and rigid perfectionism. The cut-off points obtained using the functional criterion are superior in all facets that are discriminative of the functional impairment, compared to those proposed using normative criteria. The PID-5SF has a good discriminative capacity for dysfunctionality evaluated by WHODAS 2.0 in most facets, especially in the facets linked to the domain of negative affectivity. Considered globally, the use of normative criteria is possibly more suitable for population epidemiological studies, while functional criteria may be more useful in clinical samples. Four patient profiles were identified based on the consumption pattern: POLI (multiple drug use), COC-HER (cocaine-heroin), ALC (alcohol) and CAN (cannabis). When comparing the groups with the normative population, the POLI group presented higher scores in all domains, COC-HER and ALC groups in all domains, except antagonism, and the CAN group showed higher scores in detachment and psychoticism. The CAN group had lower scores than the other three groups in all domains. No statistically significant differences were observed in any domain between the POLI and COC-HER groups, while differences were found between the POLI and ALC classes for the detachment domain. Poly-consumer patients have a greater tendency towards pathological personality. In general, the spanish PID-5SF shows psychometric properties suitable for use in patients with dual diagnosis. The results of this thesis provide empirical evidence of the convenience of using the PID-5SF in its Spanish version in consuming patients. Also the results provided help identify the personality profiles associated with several TUS profiles. The consideration of these personality profiles associated with the consumption profiles, allow to plan a more individualized attention.