Cumulative trauma and early maladaptive schemas in a dual diagnosis of substance use disorders and cluster B personality disorders – Findings from a tertiary care center in India

Background: A dual diagnosis of substance use disorders and cluster B personality disorders (SUD-cluster B PDs) is associated with greater substance use severity, impulsivity, emotional dysregulation, and relational disruptions. Though Early Maladaptive Schemas (EMS) and traumatic events have been extensively studied independently in SUDs and cluster B PDs, few studies have examined these variables in this co-morbid condition. Aim: To examine Cumulative Trauma (CT) and EMS in individuals with a dual diagnosis of SUD-cluster B PDs in a tertiary care mental health center in South India. Material and Methods: An exploratory, cross-sectional design was employed. The sample comprised 20 participants, both men and women, aged 18–45 years (M age = 27.05 years). Results: High rates of CT related to physical and sexual experiences ( r = 0.56, P < 0.01) were found in individuals with SUD-Cluster B PDs. Participants also reported high rates of trauma symptoms such as depression, anxiety, and somatization ( r = 0.56, P < 0.001), and high rates of suicidality ( r = 0.44, P < 0.02). It was found that EMS related to Impaired Limits were associated with SUD-Cluster B PDs ( r = 0.58, P < 0.01). EMS of Entitlement ( r = 0.45, P < 0.05) and Insufficient Control ( r = 0.50, P < 0.03) were endorsed by the participants. The profiles indicated that participants experienced difficulties in exercising self-regulation, fulfilling responsibilities to others, and persisting in long-term goal orientation. Conclusion: The study adds to the extant literature examining CT and EMS in SUD-Cluster B PDs. Implications of the study are discussed.