Alcohol abuse, personality disorders, and aggression: The quest for a common underlying mechanism

Alcohol abuse and personality disorders are often comorbid, and their co-occurrence is associated with worse prognostic expectations, poor therapeutic outcomes, as well as deleterious behavioral and interpersonal consequences. The current review aims at untangling the association among alcohol abuse, personality disorders, and aggression. After reviewing the relevant literature on alcohol abuse, personality disorders, and related aggression, we propose that their association could be better understood by acknowledging common underlying mechanisms. Accordingly, we outline different potential avenues that can explain their association. In particular, we focus on impulsivity and emotion dysregulation as possible triggers of alcohol abuse and personality disorders, ultimately leading to self-harm and interpersonal violence. Also, the critical role of contextual influences in exacerbating both subjective and interpersonal dysfunctions is considered. Finally, we argue that emotion dysregulation and impulsivity could serve as useful intervention targets to treat clients with personality disorders and alcohol abuse who engage in aggressive behavior, by tackling these mechanisms underlying their complex pathology. Relevant implications for both clinical and research purposes are also highlighted.