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Subgroups in alcohol use disorder based on externalising symptoms

Principal Investigator
Dr Bernadett Gál, University of Szeged, Hungary
ECNP 2020

Externalising personality and psychopathological features such as impulsivity, novelty seeking, and aggression have a group-forming effect when it comes to patients with alcohol use disorder (AUD). Based on the level of externalising symptoms, 3 groups with differing levels of externalisation symptoms can be identified, which can have implications for treatment decisions [1].

Researchers led by Dr Bernadett Gál (University of Szeged, Hungary) aimed to investigate whether externalising symptomatic traits have a clustering effect in a group of patients with chronic AUD. They also analysed demographic, addiction-related, and internalising symptoms in the subgroups. In a sample of 102 patients with AUD, subgroups were formed based on anger, physical and verbal aggression, hostility, novelty seeking, cognitive and behavioural impulsivity, and impatient restlessness.

Patients were eligible if they had an established DSM-5 diagnosis of AUD, finished at least primary education, and had an IQ >70. Exclusion criteria were a history of any psychosis spectrum disorder, progressive neurodegenerative disorders, neurological diseases, conditions that affect sight, and reported acute alcohol abuse. Mean age was 45.7 years, 71.2% were men, lifetime alcohol consumption was 18.37 years, and educational level was divided as follows: 7.8% primary education, 70.9% secondary education, and 21.4% higher education.

It emerged that the most reliable model was a model with 3 subgroups: 1) high value of externalising characteristics (12.8%), 2) medium value of externalising characteristics (49.0%), and 3) low value of externalising characteristics (38.2%) (see Figure).

Figure: Profiling of the 3 AUD subgroups [1]

Those with a high value of externalising characteristics had lower educational attainment, earlier alcohol use, and a higher family accumulation compared with the group with a low level of externalising characteristics. Those in the high-to-moderate level groups had significantly higher levels of stress, more severe substance use, and more severe depressive and anxiety symptoms than individuals with low externalising values [1].

There was no difference between the 3 subgroups regarding gender distribution, age, and relapses leading to hospitalisation. Externalising and internalising symptoms can co-occur. These findings underline the heterogeneity of AUD patients and may aid in identifying individuals who may benefit from different clinical decisions.


  1. Gál BI, et al. Chronic alcohol use disorder and externalising personality characteristics. P.014. ECNP Congress 2020.

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