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date: 17 May 2021

Abstract and Keywords

Dual diagnosis, the co-occurrence of substance abuse and another psychiatric disorder, is common. There is evidence to suggest that impulsivity may serve as a common substrate for these comorbidities, despite behavioral and biochemical differences between disorders. This chapter describes common neurobiological and behavioral findings between individuals with high impulsivity and those with dual diagnosis. Specifically, we focus on the co-occurrence of substance abuse with schizophrenia, eating disorders, attention-deficit/hyperactivity disorder, antisocial and borderline personality disorders, and bipolar disorder. For each type of dual diagnosis, we review literature that provides empirical evidence for the presence of impulsivity and treatment recommendations. In this context, we propose a “bottom-up” conceptualization, in which clusters of co-occurring phenotypes are used to formulate diagnostic and clinical plans; such an approach may produce more homogeneous diagnostic groups than exist in the current system. Further, a bottom-up approach may reveal that dual-diagnosis disorders represent distinct groups that share a common factor of impulsivity.

Keywords: anorexia, antisocial personality disorder, attention-deficit/hyperactivity disorder, bipolar disorder, borderline personality disorder, bulimia, comorbidity, dual diagnosis, eating disorders, impulsivity, schizophrenia, substance abuse, substance use

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