Association between personality disorders and severity of alcohol dependence among patients followed in psychiatry at the Analankininina university hospital center of Toamasina, Madagascar

Introduction. Personality disorders are frequent comorbidities among patients with alcohol use disorder and may influence the clinical profile, illness trajectory, and therapeutic prospects [1,2]. Their frequency in the general population and in clinical settings varies according to diagnostic approaches and cultural contexts [3,4]. Among alcohol-dependent individuals, the literature reports a high co-occurrence with certain personality profiles, particularly antisocial and borderline personality disorders [5]. In low-resource countries, hospital-based data on this issue remain scarce. This study aimed to describe the sociodemographic and clinical profile of personality disorders among alcohol-dependent patients managed in psychiatry in Toamasina and to analyze correlates of alcohol dependence severity.

Methods. We conducted a monocentric, cross-sectional, descriptive, and analytical study in the Psychiatry Department of the Analankininina University Hospital Center (CHUAT), Toamasina, from January 1, 2024, to January 1, 2025. Patients aged 18 years or older, seen as outpatients or inpatients, with both a history of alcohol consumption and a diagnosis of personality disorder were included after consent, based on exhaustive recruitment of complete records. Personality disorders were identified according to ICD-10 [8], and alcohol use was assessed with the AUDIT [7], with severity graded according to DSM-5 criteria [6]. Bivariate analyses relied on the Chi-square test and, when necessary, Fisher’s exact test; the significance threshold was set at p<0.05.

Results. Among 1,797 patients managed during the study period, 30 met the inclusion criteria, corresponding to a prevalence of 1.67%. Men predominated (73.33%) with a sex ratio of 2.75. The mean age was 38 years, and the 40–49-year age group was the most represented (30.00%). The tertiary sector accounted for 56.67% of patients, and 43.33% were single. Antisocial personality disorder and emotionally unstable personality disorder, impulsive/borderline type, each represented 43.33% of cases. Alcohol dependence was moderate in 60.00% of cases and severe in 33.33%. Age was significantly associated with dependence severity (p=0.0027), whereas no statistically significant association was found for sex, occupation, marital status, or type of personality disorder.

Conclusion. In this hospital context, personality disorders observed among alcohol-dependent patients mainly involved antisocial and borderline/impulsive profiles. The severity of alcohol dependence appeared to be primarily related to age. Systematic screening for personality disorders among alcohol-dependent patients could improve therapeutic orientation and continuity of care [19,20].