This study focused on identifying the cause of dropping out from the integration process, evaluating whether the personality disorders or the psychosocial problems found in homeless people were more prominent.
According to the data, the typical profile of a homeless person would be one with more than one PD (X
= 2.84), who usually presents with psychosocial problems, mostly home and economic problems in the sample studied, but also with serious problems in axis IV. The axis II disorders from which the homeless people suffered belonged mainly to the group of interpersonal and ambivalent conflicting problems. The disorders most commonly found were: antisocial: 38.2%; compulsive: 32.6%; dependent: 28.1%; narcissistic and schizoid: 27.0%, very similar percentages to those found in previous studies [15
As expected, the most common disorders in the sample were related to interpersonal problems (dependent, narcissistic and antisocial), along with one belonging to the group of ambivalent personalities with conflicts (compulsive). This explains the correlation between these types of PD and the psychosocial problems as the main cause for dropping out. This, analyzed using Millon's typology [22
], shows a person looking for independence not by his own self-confidence but by the distrust of others, with frequent failures in their obligations and with irresponsible and transgressive behavior (ASPD), expressively arrogant and interpersonally exploitative, ignoring coexistence rules (NPD), with serious internal divisions from which he cannot escape (CPD), avoiding adult responsibilities and self-assertiveness, and with a lack of functional competence (DPD)
The disorder most prevalent in the study population (one in every three subjects) was the antisocial personality disorder (ASPD); in the normal population it appears in only 3%, which rises to 75% among prisoners [23
It is surprising that, along with ASPD, there was a high prevalence of the dependent personality (DPD). This was found in 29.9% of the subjects, three times the incidence obtained in previous studies. It is found in 3% of the clinical population and in 10% of the general population [14
]. The fact that all the subjects were male makes the implication of this result even more far reaching. Subjects with DPD adhered well to treatment, with a low dropout rate.
In this study it was shown that 28.6% (N = 22) of the subjects can be considered to have a narcissistic personality disorder (NPD), more than reported in previous studies. This can be explained because in pathological narcissism, self-esteem is disturbed [24
] and becomes fragile [25
], something that occurs in homeless people. The prevalence of the narcissistic personality disorder in a general population has been reported to be 1% [26
]. Other researchers have found a greater NPD rate [27
], for instance 22% of the adult clinical population, and both are far from the results of our study.
As a preliminary conclusion, a high prevalence of PD was observed in this study, well above the rate found from epidemiological data concerning the general population [28
Regarding the disorders in axis IV, every subject experienced home and economic difficulties, typical features of homeless people. Moreover, work problems, and difficulties with created family or the person's legal processes, have a marked impact on dropping-out, even greater than the personality disorders (axis II). This finding is consistent with studies concerning how the existence of a personality disorder influences the treatment dropout rate [29
]. It can be said that the subjects in the sample with more than one type of personality disorder have a worse prognosis, and comorbidity between axes II and IV is a complicating factor.
The outcomes of the study show that the homeless people examined present with greater psychopathological symptoms, both in axis II and in axis IV, than the general population. This determines the rate of dropping-out from treatment processes. Our findings indicate the need to take the comorbidity between the two types of disorders in homeless people into account, both in treatment and in the development of specific intervention programs.