There has been a renaissance in the study of the personality disorders this past decade. Promising new theories, significant advances in the defining criteria, in diagnosis and therapy, the existence of a special axis in DSM-III-(R) for these disorders, all point to the growing clinical importance of these syndromes. This development has a growing impact on clinical and research studies in general psychiatry but also in addictive disorders. While repeated attempts to capture the essence of the `alcoholic personality' have largely failed, more recent studies have examined the types of psychiatric disorders in alcoholics. In clinical populations of alcoholics there is a high comorbidity between alcoholism, additional psychiatric syndromes, co-existing other addiction problems and personality disorders. While the DSM-III-(R) is mainly a descriptive tool, the understanding of individual pathology and its etiology might be augmented by psychoanalytic approaches. Such an understanding is indispensable for treatment and prognosis of addictive disorders.

In this paper the authors examine especially the relationships between personality pathology and alcoholism from a psychoanalytic point of view. A substantial portion of inpatient treated polysyndromatic alcoholics experience the symptoms of moderate to severe personality disorders and is a particular focus for specialized treatment modalities. Multiple personality disorders may partly be diagnosed in the same patient just because of overlapping criteria.

It is stressed that treatment of alcoholics should be focused on both the alcohol dependence and the underlying personality disorder.