Epidemiology of antisocial personality disorder, psychopathy and other related constructs in Arab countries: A scoping review

The current study aimed to examine the prevalence of certain personality disorders، including antisocial، borderline and narcissistic among parents of basic education students. Similarly، it aimed to examine the prevalence of oppositional defiant disorder among basic education students، and the differences in the prevalence of these disorders according to gender. The current study also aimed to investigate the contribution of parents’ personality disorders in the variance of children’s oppositional defiant disorder. The researchers prepared four measures to examine parent’s personality disorders، and oppositional defiant disorder according to DSM-5. Regarding the study sample، the data was collected throughout a multi-stages random sampling method. One thousand eight hundred parents (900 fathers and 900 mothers) of third، fourth and fifth grade children in Sulaymanyeah basic education schools participated in the current study. Along with the parents، sixty teachers also filled out the oppositional defiant disorder questionnaire.The results indicated that the prevalence of antisocial personality disorder was %1 for both parents، and the prevalence of borderline personality disorder among mother was %2 and was %3 for father respectively. The narcissistic personality reached %5 according to the mothers’ questionnaire and was %4 according to the fathers’ questionnaire. Concerning the prevalence of children’s oppositional defiant disorder، based on the parents report، it was found that %5 children suffer from this and %6 based on the teacher reports. The findings also showed no statistically significant difference in the prevalence of parent’s antisocial personality disorder. However، a significant difference was noticed in borderline personality disorder in favor of the fathers. In addition، the prevalence of narcissistic personality disorder was found to be higher among mother compared to fathers. Gender difference was also found in oppositional defiant disorder، suggesting that males manifested higher level of oppositional defiant disorder than females. Finally، the result of the study indicated a positive correlation between parents’ antisocial personality disorder and children’s oppositional defiant disorder.

Back to table of contents Previous article Next article LetterFull AccessLetterJifeng Cai Ph.D.Yan Gu Ph.D.Shuqiao Yao M.D., Ph.D.Jifeng Cai Ph.D.Search for more papers by this authorYan Gu Ph.D.Search for more papers by this authorShuqiao Yao M.D., Ph.D.Search for more papers by this authorPublished Online:1 Sep 2010https://doi.org/10.1176/ps.2010.61.9.947AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Screening for Personality Disorders Among Chinese Prison InmatesTo the Editor: Although only about one-third of the world's inmates live in Western countries, 99% of available data from prison surveys are derived from Western populations ( 1 ). Such disparity underscores the need for greater forensic psychiatric research in non-Western populations. We surveyed 2,961 inmates of five prisons in South China. Seventy-four percent (N=2,189) were men, and the mean±SD age was 30.0±9.9. We used the Personality Diagnostic Questionnaire–4+ (PDQ), the reliability and validity of which have been thoroughly confirmed in Chinese populations ( 1 ). Written informed consent was obtained. Data analyses were conducted with SPSS, version 13.0. Group differences were examined with t tests or Mann-Whitney U tests, depending on the nature of the data. Using a cutoff score of 4 or 5, depending on the personality disorder, we found rates of personality disorders ranging from 8% (N=240) to 67% (N=1,981). Borderline personality disorder and antisocial personality disorder were most common—52% (N=1,552) and 67% (N=1,981), respectively. Fazel and Danesh ( 2 ) systematically reviewed 62 studies on the prevalence of major psychiatric disorders among delinquents and found that approximately 65% (N=1,925) had a personality disorder, of which antisocial personality disorder was most common (47%, N=1,392) ( 1 ). One possible explanation for the higher prevalence of antisocial personality disorder in our study (67%) may be the poor economic status and low level of education of Chinese inmates. These factors have been linked to personality formation. Another explanation may be related to the large proportion of male inmates in our study. Rates of antisocial personality disorder were higher among male inmates than among female inmates in our sample (72% compared with 53%). The larger proportion of males resulted in a higher rate of antisocial personality disorder and higher average scores for the PDQ antisocial subtype. Among the 2,961 inmates, 42% (N=1,235) were violent offenders. We found that inmates with a history of violent behavior scored higher than nonviolent inmates on PDQ scales for antisocial, borderline, schizotypal, and depressive personality disorder. [A table comparing scores of inmate subgroups is available as an online supplement to this letter at ps.psychiatryonline.org .] These findings are consistent with those of a previous study, which found that antisocial and borderline personality disorders among men were correlated with violent conduct ( 3 ). Furthermore, the presence of antisocial personality traits among inmates with a history of violence has been consistently associated with an increased likelihood of violent reoffending ( 4 ). In a study of female offenders by Putkonen and colleagues ( 5 ), 81% of those who committed repeat offenses had a personality disorder diagnosis. In our sample, repeat offenders had significantly higher scores than first offenders on antisocial, depressive, and paranoid personality disorder scales (see online table). Thus personality disorder may have considerable predictive validity. A prison sentence should offer inmates an opportunity to receive psychiatric assessment and treatment that they may not have had access to outside prison. Furthermore, assessment and treatment may help prevent repeat offenses. Sadly, because of a lack of resources, this opportunity is often unavailable, and providing it remains a challenge for the Chinese government.Acknowledgments and disclosuresThis study was funded by grant 20060400892 from the Postdoctoral Science Foundation of China and grant 2007RS4032 from the Science Foundation of Hunan Province.The authors report no competing interests.Dr. Cai and Dr. Gu are affiliated with the Department of Forensic Science, School of Basic Medical Sciences, and Dr. Yao is with the Medical Psychological Research Center, all at Central South University, Changsha, Hunan, China.

Methamphetamine use is popular and rapidly increasing in China, and the co-occurrence of personality disorders has an impact on treatment outcomes and may increase vulnerability of developing dependence. The aim of the present study was to investigate the prevalence rates of personality disorders in methamphetamine users and further explore the association between personality disorders and methamphetamine use status. Five hundred and seventy-seven male methamphetamine users were recruited. The self-developed questionnaire was used for demographics, and a Structural Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (SCID-I/II) was performed covering psychiatric diagnosis. Our study found the prevalence of antisocial personality disorder in male methamphetamine users was 71.4%, followed by borderline (20.2%) and obsessive-compulsive (17.9%) personality disorder. Borderline and antisocial personality disorders were found to be risk factors of methamphetamine dependence (adjusted odds ratio = 2.891, p = 0.007 and adjusted odds ratio = 1.680, p = 0.042). These findings suggested personality disorders were highly prevalent in male methamphetamine users, and the comorbidity of antisocial and borderline personality disorders are especially associated with methamphetamine dependence.

To examine the relationships between antisocial personality disorder and executive abilities as well as antisocial personality disorder with other domains of cognitive functioning. Previous research has suggested that antisocial personality disorder is associated with impaired executive functioning. However, methodological limitations of past research have resulted in inconsistent findings. Executive functioning and other cognitive abilities were compared in four demographically matched groups of middle-aged community dwelling male veterans (N = 336). The groups were: (A). those with active antisocial personality disorder psychopathology; (B). those with a lifetime prevalence of antisocial personality disorder but inactive antisocial personality disorder psychopathology; (C). a nonantisocial personality disorder psychiatrically matched control group; and (D). a normal control group. Multivariate analysis of variance revealed that the four groups were not statistically significantly different on measures of executive functioning or other cognitive abilities. Those with antisocial personality disorder perform at comparable levels to psychiatric and normal controls with respect to executive functioning and other domains of cognitive ability (i.e., language, memory, visuospatial, and motor abilities). An incidental finding was that, over time, the antisocial personality disorder groups improved more than control groups on a measure of general intellectual aptitude.

BackgroundStudies from Western countries consistently report very high rates of comorbid Antisocial Personality Disorder (ASPD) among individuals with heroin addiction, but the reported proportion of Chinese individuals with heroin addiction who have co-morbid ASPD varies widely, possibly because Chinese clinicians do not consider personality issues when treating substance abuse problems. AimConduct a meta-analysis of studies that assessed the proportion of Chinese individuals with heroin dependence who have comorbid ASPD. MethodsWe searched for relevant studies in both Chinese databases (China National Knowledge Infrastructure, Wanfang Data Knowledge Service Platform, Taiwan Electronic Periodical Services) and western databases (PubMed, EMBASE, and PsycInfo). Two authors independently retrieved the literature, identified studies that met pre-defined inclusion and exclusion criteria, assessed the quality of included studies, and extracted the data used in the analysis. Statistical analysis was performed using StatsDirect 3.0 and R software.ResultsThe search yielded 15 eligible studies with a total of 3692 individuals with heroin dependence. Only 2 of the studies were rated as high-quality studies. All studies were conducted in rehabilitation centers or hospitals. The pooled lifetime prevalence of ASPD in these subjects was 30% (95%CI: 23%-38%), but the heterogeneity of results across studies was great (I2 =95%, p<0.001). Men had a higher prevalence than women (44% vs. 21%), and injection heroin users had higher prevalence than those who smoked heroin (44% vs. 27%). Studies that were methodologically stronger had higher reported prevalence of ASPD among heroin dependent individuals. ConclusionsThere are substantial methodological problems in the available literature about ASPD in Chinese individuals receiving treatment for heroin dependence, but we estimate that about one-third of them meet criteria for ASPD. Further work is needed to increase clinicians’ awareness of this issue; to compare the pathogenesis, treatment responsiveness and recidivism of those with and without ASPD; and to develop and test targeted interventions for this difficult-to-treat subgroup of individuals with heroin dependence.

Objective: This study sought to examine the association between unmet need and personality disorders in a sample of psychiatric inpatients. The authors tested the hypothesis that the presence of a personality disorder would be independently associated with a significantly greater number of unmet needs. Methods: A total of 153 psychiatric inpatients from four acute hospital wards serving an inner-city borough in London, United Kingdom, received standardized assessments of need and personality disorder by use of the Camberwell Assessment of Need Short Assessment Schedule and Structured Clinical Interview for DSM-IV Personality Disorders. Results: Fifty-four percent of the sample had a personality disorder. The presence of a personality disorder was associated with greater unmet need. In multiple regression analyses, after adjustment was made for the effects of all covariates, severity of personality disorder was significantly associated with unmet need. Personality disorder was significantly associated with greater need in eight of 22 domains of need: self-care, psychotic symptoms, psychological distress, risk to self, risk to others, alcohol use, sexual expression, and budgeting. Conclusions: Personality disorder was found to be independently associated with a greater level of unmet need among psychiatric inpatients. The study highlights for the first time the importance of a comprehensive assessment of need for patients with personality disorders

The goal of this study was to examine the lifetime prevalence of antisocial personality disorder according to five diagnostic systems and the prevalence of psychopathy in a study group of women. The relationship between antisocial personality disorder and psychopathy was also examined. Finally, differences in treatment admission variables based on the presence or absence of antisocial personality disorder and/or psychopathy were evaluated. Antisocial personality disorder was diagnosed in 137 treatment-seeking, cocaine-dependent women according to the Feighner criteria, Research Diagnostic Criteria (RDC), and DSM-III, DSM-III-R, and DSM-IV criteria. Psychopathy was assessed by the Revised Psychopathy Checklist. Rates of antisocial personality disorder varied from 76% according to the Feighner criteria to 11% for the RDC. Nineteen percent (N = 26) of the women scored in the moderate to high range on the Revised Psychopathy Checklist. All of these women were diagnosed with antisocial personality disorder according to DSM-III and Feighner criteria, but only 15 of the 26 were diagnosed according to DSM-III-R, 12 according to DSM-IV, and six with the RDC. Moderate levels of psychopathy were associated with a history of illegal activity at treatment admission, whereas antisocial personality disorder was not. There was relatively little diagnostic agreement between classification systems. This study indicates that antisocial personality disorder and psychopathy are not synonymous terms for the same disorder. Findings support a need to redefine antisocial personality disorder diagnostic criteria to make them gender neutral by including behaviors associated specifically with antisociality in women.

Age bias in the criteria for antisocial personality disorder

The identification of offenders who meet the criteria for psychopathy, antisocial personality disorder or dissocial personality disorder could be of significant value to help address the violent crime crisis in South Africa. A sample of 500 male maximum security offenders was selected to determine the prevalence of these disorders among South African offenders. Results for the incidence of psychopathy and dissocial personality disorder indicate a similar trend to that found in other countries; whereas the prevalence of antisocial personality disorder contradicts international findings.

There is a high prevalence of antisocial personality disorder (ASPD) in individuals affected by substance use disorders (SUD). However, there is limited information on the specific patterns of association of ASPD with SUD severity and specific SUD diagnostic criteria. We investigated the association of alcohol, cannabis, cocaine, opioid, and tobacco use disorders (AUD, CanUD, CocUD, OUD, and TUD, respectively) in 1660 individuals with ASPD and 6640 controls matched by sex (24% female), age, and racial/ethnic background in a sample ascertained for addiction-related traits. Generalized linear regressions were used to test ASPD with respect to the five DSM-5 SUD diagnoses, their severity (i.e., mild, moderate, severe), and their diagnostic criteria. We found that ASPD is associated with the diagnosis and severity of AUD (Odds Ratio, ORs = 1.89 and 1.25), CanUD (ORs = 2.13 and 1.32), and TUD (ORs = 1.50 and 1.21) (ps < 0.003). Of the specific diagnostic criteria, the “hazardous use” criterion showed the strongest association with ASPD across the five SUDs investigated (from ORTUD = 1.88 to ORCanUD = 1.37). However, when criteria of different SUDs were included in the same model, ASPD was independently associated only with TUD “hazardous use” and CocUD “attempts to quit”. Attempting to quit cocaine was inversely related to the presence of ASPD and remained significant (OR = 0.57, 95% confidence interval = 0.36–0.89) after controlling for interactive effects with sex. The current work provides novel insights into ASPD-SUD comorbidity, supporting the existence of different SUD patterns among individuals affected by ASPD.

Antisocial Behavioral Syndromes and Additional Psychiatric Comorbidity in Posttraumatic Stress Disorder Among U.S. Adults: Results From Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions

The purpose of this study was to determine the extent of comorbid substance use disorders in patients referred for treatment of personality disorders. Two hundred inpatients and outpatients were assessed by semistructured interviews for substance use and personality disorders. Univariate odds ratios were calculated for groups of substance use disorders and each DSM-III-R axis II disorder; comorbidity among axis II disorders was controlled in multivariate models predicting current or lifetime substance use disorder groups. The impact of personality disorder on chronicity and overall impairment associated with substance use disorders was evaluated. Close to 60% of subjects with substance use disorders had personality disorders. Borderline personality disorder was significantly associated with current substance use disorders, excluding alcohol and cannabis, and with lifetime alcohol, stimulant, and other substance use disorders, excluding cannabis. Antisocial personality disorder was associated with lifetime substance use disorders other than alcohol, cannabis, and stimulants. These relationships remained significant after controlling for the presence of all other personality disorders. There was no evidence that personality disorders increased the chronicity of substance use disorders, but comorbid personality disorders were associated with greater global impairment. Borderline personality disorder may be associated with a wide variety of substance use disorders, especially among patients seeking treatment for personality problems.