REVMEDUAS
REVMEDUAS; Vol. 16 No. 2 Abril-Junio 2026
ISSN 3122-4342

Patología dual en trastornos de la personalidad y consumo de sustancias: revisión narrativa

Dual pathology in personality disorders and substance use: a narrative review

Juan Daniel Medina-Torres1*

  1. Instituto Mexicano del Seguro Social, Hospital general de zona número 20, Servicio de psiquiatría, Heroi-ca Puebla de Zaragoza, Puebla, México

*Autor de correspondencia: Dr. Juan Daniel Medina Torres.
Instituto Mexicano del Seguro Social, Hospital General de Zona No. 20, Servicio de Psiquiatría,
Avenida Fidel Velázquez 4211 Heroica Puebla De Zaragoza Col. Infonavit La Margarita, Puebla, C.P. 72560, Puebla, México.
Correo electrónico: mtjuandaniel96@gmail.com Teléfono: +52 44 3536 0843

DOI http://dx.doi.org/10.28960/revmeduas.3122-4342.v16.n2.009

Texto Completo PDF

Recibido 17 de octubre 2025, aceptado 25 de febrero 2026

RESUMEN
La comorbilidad entre los trastornos de la personalidad (TP) y los trastornos por consumo de sustancias (TCS) representa un desafío clínico mayor debido a su alta prevalencia, complejidad diagnóstica y peor pronóstico. Las investigaciones internacionales muestran que entre 34% y 73% de los pacientes con TCS presentan al menos un TP, especialmente trastorno límite de la personalidad (TLP) y trastorno de la personalidad antisocial (TPA). Los principales modelos explicativos incluyen la automedicación, la impulsividad, la desregulación emocional, el trauma infantil y factores sociales. Esta asociación incrementa las recaídas, el riesgo suicida, la violencia y los costos sanitarios. Las intervenciones con mayor evidencia son la Terapia Dialéctico-Conductual (TDC o por su siglas en inglés DBT ) y el Tratamiento Basado en la Mentalización (TBM o por sus siglas en inglés MBT), dentro de programas integrados que abordan de manera simultánea ambas condiciones. Esta revisión sintetiza la evidencia disponible y propone recomendaciones clínicas para el manejo integral de pacientes con TP–TCS. Palabras clave: Trastornos de la Personalidad, Trastornos Relacionados con Sustancias, Comorbilidad, Mentalización.
Palabras claves: Trastornos de la Personalidad, Trastornos Relacionados con Sustancias, Comorbilidad, Mentalización.

ABSTRACT
The comorbidity between personality disorders (PD) and substance use disorders (SUD) poses a major clinical challenge due to its high prevalence, diagnostic complexity, and poorer outcomes. International studies show that 34–73% of individuals with SUD meet criteria for at least one PD, particularly borderline personality disorder (BPD) and antisocial personality disorder (ASPD). Explanatory models include self-medication, impulsivity, emotional dysregulation, childhood trauma, and social determinants. This comorbidity increases relapse rates, suicide risk, violence, and healthcare costs. The most evidence-based psychotherapeutic interventions are Dialectical Behavior Therapy (DBT) and Mentalization-Based Treatment (MBT), implemented within integrated programs that address both conditions simultaneously. This narrative review synthesizes current evidence and provides clinical recommendations for the comprehensive management of PD–SUD comorbidity. Keywords: Personality Disorders; Substance-Related Disorders; Comorbidity; Mentalization.
Keywords: Personality Disorders; Substance-Related Disorders; Comorbidity; Mentalization.

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