Criteria For Antisocial Personality Disorder Research Articles

Antisocial Personality Disorder With and Without Antecedent Childhood Conduct Disorder: Does It Make a Difference?

The purpose of this study was to test whether prior conduct disorder increased deviance in persons diagnosed with antisocial personality disorder. One hundred and three male inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder achieved significantly higher scores on self-report measures of criminal thinking and antisocial attitudes than 137 male inmates satisfying only the adult criteria for antisocial personality disorder and 87 male nonantisocial inmates. Inmates satisfying adult antisocial and conduct disorder criteria for antisocial personality disorder were also more likely to receive disciplinary infractions for misconduct than inmates in the other two conditions. The theoretical, diagnostic, and practical implications of these results are discussed.

Antisocial Personality Disorder—Stable and Unstable Subtypes

There have been criticisms that the criteria for antisocial personality disorder (ASPD) are over-dependent on criminal behavior. This study aimed to identify unrelated criteria of social and behavioral problems and instability, and to investigate their associations in a representative household sample of adults in the UK. Approximately one third of adults with ASPD did not fulfill any of the criteria for instability. They were less aggressive and involved in illegal activities but expressed less remorse for their behaviors. Instability in ASPD was mediated primarily through comorbid anxiety disorders and borderline personality disorder. The concept of Secondary Psychopathy, which has not generally been applied to ASPD, demonstrated many similarities to the unstable subtype.

Diagnosis and Subtypes of Adolescent Antisocial Personality Disorder

The present study examined the application of the Antisocial Personality Disorder (APD) diagnosis to adolescents and investigated the possibility of subtypes of APD adolescents. As part of a broader study of adolescent personality in clinically-referred patients, experienced clinicians provided personality data on a randomly selected patient in their care using the SWAP-II-A personality pathology instrument. Three hundred thirteen adolescents met adult DSM-IV diagnostic criteria for APD. To characterize adolescents with the disorder, we aggregated the data to identify the items most descriptive and distinctive of APD adolescents relative to other teenagers in the sample (N = 950). Q-factor analysis identified five personality subtypes: psychopathic-like, socially withdrawn, impulsive-histrionic, emotionally dysregulated, and attentionally dysregulated. The five subtypes differed in predictable ways on a set of external criteria related to global adaptive functioning, childhood family environment, and family history of psychiatric illness. Both the APD diagnosis and the empirically derived APD subtypes provided incremental validity over and above the DSM-IV disruptive behavior disorders in predicting global adaptive functioning, number of arrests, early-onset severe externalizing pathology, and quality of peer relationships. Although preliminary, these results provide support for the use of both APD and personality-based subtyping systems in adolescents.

Antisocial personality disorder and anxiety disorder: A diagnostic variant?

Antisocial personality disorder (ASPD) with co-morbid anxiety disorder may be a variant of ASPD with different etiology and treatment requirements. We investigated diagnostic co-morbidity, ASPD criteria, and anxiety/affective symptoms of ASPD/anxiety disorder. Weighted analyses were carried out using survey data from a representative British household sample. ASPD/anxiety disorder demonstrated differing patterns of antisocial criteria, co-morbidity with clinical syndromes, psychotic symptoms, and other personality disorders compared to ASPD alone. ASPD criteria demonstrated specific associations with CIS-R scores of anxiety and affective symptoms. Findings suggest ASPD/anxiety disorder is a variant of ASPD, determined by symptoms of anxiety. Although co-morbid anxiety and affective symptoms are the same as in anxiety disorder alone, associations with psychotic symptoms require further investigation.

Inattention, hyperactivity/impulsivity and antisocial personality disorder. Which is the best predictor of false confessions?

The aim of the study was to investigate the relative importance of Antisocial Personality Disorder (APD) and Attention Deficit Hyperactivity Disorder (ADHD) in predicting a history of false confessions to police. The participants were 90 male prisoners who were interviewed within 10 days of admission to prison. They completed the Mini International Neuropsychiatric Interview and the Wender–Utah Rating Scale (WURS) and DSM-IV-TR Checklist for childhood and adult ADHD symptoms, respectively. Over half of the participants (58%) met criteria for APD, half (50%) had ADHD in childhood and of those 60% were either fully symptomatic or in partial remission of their symptoms. Twenty-two (24%) reported a history of giving false confessions during police interrogation. Adult inattention and hyperactivity symptoms were significantly more common among the false confessors than the other prisoners with high and moderate effect size (1.03 and 0.58), respectively. Binary logistic regression (‘forced entry method’) was used to determine the order of the predictor variables of false confession and the data were entered in three blocks (APD, hyperactivity/impulsivity, and inattention). Inattention was the only remaining significant predictor after controlling for APD and hyperactivity/impulsivity. The findings suggest that inattention is a more powerful predictor of false confession than hyperactivity/impulsivity and APD.

Psychopathy and APD in Non-forensic Patients: Improved Predictions or Disparities in Cut Scores?

Psychopathy has traditionally been viewed as a distinct syndrome that is superior to Antisocial Personality Disorder (APD) for the prediction of violent and aggressive behavior. However, direct comparisons of psychopathy and APD are infrequent and mostly occur in correctional populations. Moreover, any observed differences could simply reflect a disparity in cut scores. The constellation of Psychopathy Checklists (PCL-R, PCL:SV, and PCL:YV) set the minimum cut score at 75% (e.g., ≥30 of 40 for the PCL-R), which is far more stringent than what is required for the DSM-IV APD adult criteria (i.e., ≥ 3 of 7 or 42.9%). For use in a non-forensic setting, we re-examined the MacArthur Risk Assessment data set to evaluate the usefulness of the PCL:SV and APD for short-term predictions of violent and aggressive acts. Using the ≥75% cut score to predict violence produced low sensitivities for both the psychopathy (.18) and APD adult criteria (.14) but very high specificities (.94). Reducing the cut score to approximately 40% greatly improved sensitivity rates (.62 for psychopathy and .85 for Adult APD criteria) at the expense of specificity (.59 and .40 respectively). In making multiple comparisons, psychopathy did not appear superior to APD adult criteria in predicting violent or other aggressive behavior. Instead, both constructs had limited predictive power with patients in a non-forensic setting. On an item level, specific indicators of violent behavior were explored.

Subtypes of Alcohol and Intimate Partner Violence: A Latent Class Analysis

The investigation explored whether subtypes of relapse to violence exist for different levels of intimate partner violence and drinking behavior among men who relapse to both alcohol and violence after alcoholism treatment. Male clients entering an alcoholism treatment program who reported at least one incident of intimate partner violence and their female partners (N = 294) were recruited for participation. Data were analyzed using a latent class analysis of mixture model. Findings revealed that two classes of violence best described the sample of men that relapsed to violence. Class 1 contained males who had perpetrated more days of violence, relapsed to violence faster, more frequently relapsed to alcohol, and had a higher percentage of males identified as meeting diagnostic criteria for antisocial personality disorder compared to those in class 2.

Different Generations Review One Flew Over the Cuckoo's Nest Miloš Forman (Director)

Different Generations Review <i>One Flew Over the Cuckoo's Nest</i> Miloš Forman (Director)

To sum or not to sum: Taxometric analysis with ordered categorical assessment items.

Meehl's taxometric method has been shown to differentiate between categorical and dimensional data, but there are many ways to implement taxometric procedures. When analyzing the ordered categorical data typically provided by assessment instruments, summing items to form input indicators has been a popular practice for more than 20 years. A Monte Carlo study compared the accuracy of taxometric analyses implemented in the traditional way (without summing items) and taxometric analyses implemented with the summed-input method. These analyses generated no support for the summed-input method, which substantially reduced discriminating power for 2 of the 3 procedures studied. Accuracy was highest when 5 or more indicators and 4 or more ordered categories were used. Findings from the simulation study were then used to help interpret the results for taxometric analyses of antisocial personality disorder criteria with real research data. In this example, the traditional method yielded clearer results than the summed-input method. Implications for the use and further study of the taxometric method in assessment research are discussed. (PsycINFO Database Record (c) 2009 APA, all rights reserved).

Antisocial personality disorder and psychopathy in women: A literature review on the reliability and validity of assessment instruments

Crime rates are low in women compared to men. The two disorders most commonly associated with offending behaviour, antisocial personality disorder (ASPD) and psychopathy, are also less prevalent in female samples. However, developments in forensic psychiatry have often ignored gender, and the utility of constructs such as psychopathy and their assessment instruments in female samples remains unclear. This article presents a review of studies looking at rates of ASPD and psychopathy and on the reliability and validity of assessment instruments of these disorders in women. Gender differences in symptom patterns will be considered. The literature seems to suggest that DSM-IV criteria for ASPD may lead to an underestimation of the prevalence of the disorder in women due to the requirement of childhood conduct disorder symptoms. The Psychopathy Checklist-Revised (PCL-R) is a valid and reliable instrument to identify psychopathy in women but there are gender differences in the factor structure and item loadings on this measure. Research to date seems to suggest a three-factor model may be most strongly supported in females. Preliminary evidence suggests the PCL-R may have some value in predicting future offending while the PCL:SV may be useful in predicting institutional violence. Clinical implications are discussed.

Gender differences in comorbid disorders among offenders in prison substance abuse treatment programs

This study examined gender differences in a range of lifetime psychiatric disorders in a sample of 272 offenders newly admitted to a prison substance abuse program. Although these men and women did not differ in severity of substance use in the six months prior to incarceration, women were significantly more likely than men to report a lifetime psychiatric disorder and a lifetime severe disorder. Furthermore, gender differences emerged in the pattern of lifetime psychiatric comorbidity. Women reported greater lifetime major depression, posttraumatic stress disorder, eating disorder, and borderline personality disorder; men were more likely than women to meet criteria for antisocial personality disorder. Additionally, female offenders were found to have a higher degree of internalizing disorders than male offenders, but there were no gender differences in degree of externalizing disorders. The study concluded that women offenders newly admitted to a prison substance abuse program present with a greater psychiatric vulnerability and a different pattern of psychiatric comorbidity than their male counterparts.

Psychopathy in a Civil Psychiatric Outpatient Sample

In this primarily descriptive study, the authors describe a sample of patients referred or brought to a Brazilian civil psychiatric facility for evaluation and consultation because of a chronic pattern of social and behavioral problems. Their Psychopathy Checklist: Screening Version (PCL: SV) scores generally were very high, and half of the patients met the DSM-IV criteria for antisocial personality disorder. In addition, about half of the patients reportedly had been charged or convicted of a serious criminal offense. The correlates of the PCL: SV were consistent with the research literature on psychopathy in criminal and forensic psychiatric populations. The results add to the small but growing literature on psychopathy in the community and are consistent with the view that antisocial dispositions and behaviors are part of the psychopathy construct.

Antisocial Behavioral Syndromes and Past-Year Physical Health Among Adults in the United States

To describe associations of DSM-IV antisocial personality disorder (ASPD), DSM-IV conduct disorder without progression to ASPD (CD-only), and syndromal antisocial behavior in adulthood without conduct disorder before age 15 years (AABS, not a DSM-IV diagnosis) with past-year physical health status and hospital care utilization in the general U.S. adult population. This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (N = 43,093, response rate = 81%). Respondents were classified according to whether they met criteria for ASPD, AABS, CD-only, or no antisocial syndrome. Associations of antisocial syndromes with physical health status and care utilization were examined using normal theory and logistic regression. ASPD and AABS were significantly but modestly associated with total past-year medical conditions, coronary heart and gastrointestinal diseases, and numbers of inpatient hospitalizations, inpatient days, emergency department visits, and clinically significant injuries (all p < .05). ASPD was also associated with liver disease, arthritis, and lower scores on the Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 (SF-12v2) physical component summary, role physical, and bodily pain scales (all p < .05). AABS was associated with noncoronary heart disease, lower scores on the SF-12v2 general health and vitality scales, and, among men, arthritis (all p < .05). CD-only was associated with single but not multiple inpatient hospitalizations, emergency department visits, and clinically significant injuries (all p < .05). Estimates of burden related to antisocial behavioral syndromes need to consider associated physical health problems. Prevention and treatment guidelines for injuries and common chronic diseases may need to address comorbid antisociality, and interventions targeting antisociality may need to consider general health status, including prevention and management of injuries and chronic diseases.

Antisocial behavioral syndromes and body mass index among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Objective To describe associations of antisocial behavioral syndromes, including DSM-IV antisocial personality disorder (ASPD) and conduct disorder without progression to ASPD (“CD only”), and syndromal antisocial behavior in adulthood without CD before age 15 (AABS, not a codable DSM-IV disorder), with body mass index (BMI) status in the general US adult population. Methods This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43 093; response rate, 81%). Respondents were classified according to whether they met criteria for ASPD, AABS, “CD only,” or no antisocial syndrome, and on current BMI status based on self-reported height and weight. Associations of antisocial syndromes with BMI status were examined using multinomial logistic regression. Results Among men, antisociality was not associated with BMI. Among women, ASPD was significantly associated with overweight and extreme obesity; AABS was associated with obesity and extreme obesity; and “CD only” was significantly associated with overweight, obesity, and extreme obesity. Conclusions Assessment of antisocial features appears warranted in overweight, obese, and extremely obese women, and assessment of BMI status appears indicated in antisocial women. Prevention and treatment guidelines for overweight and obesity may need revision to address comorbid antisociality, and interventions targeting antisociality may need to include attention to weight concerns.

The interactive effects of antisocial personality disorder and court-mandated status on substance abuse treatment dropout

The present study sought to examine the interactive effects of court-mandated (CM) treatment and antisocial personality disorder (ASPD) on treatment dropout among 236 inner-city male substance users receiving residential substance abuse treatment. Of the 236 participants, 39.4% ( n = 93) met criteria for ASPD and 72.5% ( n = 171) were mandated to treatment through a pretrial release-to-treatment program. Results indicated a significant interaction between ASPD and CM status, such that patients with ASPD who were voluntarily receiving treatment were significantly more likely to drop out of treatment than each of the other groups. Subsequent discrete time survival analyses to predict days until dropout, using Cox proportional hazards regression, indicated similar findings, with patients with ASPD who were voluntarily receiving treatment completing fewer days of treatment than each of the other groups. These findings suggest the effectiveness of the court system in retaining patients with ASPD, as well as the role of ASPD in predicting treatment dropout for individuals who are in treatment voluntarily. Implications, including the potential value of the early implementation of specialized interventions aimed at improving adherence for patients with ASPD who are receiving treatment voluntarily, are discussed.

Gender Similarities and Differences in Antisocial Behavioral Syndromes among Injection Drug Users

Studies report that more female substance users meet the adult antisocial behavioral (AASB) criteria of antisocial personality disorder (ASPD) without having conduct disorder. We assessed gender and antisocial syndrome (ASPD vs. AASB) effects jointly on multiple outcomes in injection drug users. More males had ASPD (40%) and more females had AASB (67%). After adjusting for gender, the ASPD group was consistently more severe, indicating discriminative validity for the diagnosis. However, the AASB group reported substantial pathology, signifying AASB as an important sub-threshold antisocial syndrome. Antisocial behavior might be described as a distribution, with AASB and ASPD defined by increasingly extreme points.

A behavioral treatment for opioid-dependent patients with antisocial personality

Antisocial personality disorder (APD) is associated with increased problem severity in treatment-seeking opioid-dependent patients. Treatment studies have reported mixed results but generally show that patients with APD make progress that is often comparable to drug-dependent patients without the personality disorder. Much of this work is based on secondary analyses of studies evaluating responses to a variety of drug abuse treatment interventions. This study reports on a randomized prospective trial evaluating a behavioral approach for managing opioid-dependent patients with APD. Subjects ( N = 100) met Diagnostic and Statistical Manual of Mental Disorders criteria for opioid dependence and APD using a structured clinical interview and were randomly assigned to either an experimental condition ( n = 51), which used a highly structured contingency management intervention, or a control condition ( n = 49), which reflected standard methadone treatment. Subjects in the experimental group had significantly better counseling attendance and some indication of lower psychosocial impairment compared to the control group. The experimental intervention increased attendance in subjects with low and high levels of psychopathy and with and without other psychiatric comorbidity. These findings support the development of interventions more tailored to drug-dependent patients with APD.

Antisocial behavioral syndromes and DSM-IV drug use disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

Background Antisocial behavioral syndromes, including antisocial personality disorder (ASPD), syndromal adult antisocial behavior (AABS) without conduct disorder (CD) before age 15, and CD without progression to ASPD (“CD only”) are highly comorbid with drug use disorders (DUDs). Among patients in DUD treatment, antisocial syndromes are associated with greater severity and poorer outcomes. Comparative data concerning associations of antisocial syndromes with clinical characteristics of DUDs among general population adults have not previously been available. This study describes associations of antisocial syndromes with clinical characteristics of lifetime Diagnostic and Statistical Manual—Version IV DUDs in the general U.S. adult population. Methods This report is based on the 2001–2002 National Epidemiologic Survey on Alcohol and Related Conditions ( n = 43,093, response rate = 81%). Respondents ( n = 4068) with lifetime DUDs were classified according to whether they met criteria for ASPD, AABS, “CD only,” or no antisocial syndrome. Associations of antisocial syndromes with clinical characteristics of DUDs were examined using logistic regression. Results Antisocial syndromes were significantly associated with the phenomenology of DUDs, particularly ASPD with the most severe clinical presentations. Associations with AABS were similar to those with ASPD; those with “CD only” were weak, inconsistent, and not statistically significant. Patterns of associations differed little between men and women. Conclusions Both ASPD and AABS, but not “CD only,” appear to identify greater clinical severity of DUDs among adults in the general U.S. population.

Antisocial Behavioral Syndromes and DSM‐IV Alcohol Use Disorders: Results From the National Epidemiologic Survey on Alcohol and Related Conditions

Antisocial personality disorder (ASPD), syndromal adult antisocial behavior (AABS) without conduct disorder (CD) before age 15, and CD without progression to ASPD ("CD only") are highly prevalent among adults with alcohol use disorders (AUDs). Among patients in AUD treatment, antisocial behavioral syndromes are associated with more severe AUDs and poorer treatment outcomes. Comparative data concerning associations of antisocial syndromes with clinical characteristics of AUDs and the sociodemographic and clinical correlates of these syndromes among general population adults with AUDs have not previously been available. This study examines prevalences and correlates of antisocial syndromes among adults with lifetime Diagnostic and Statistical Manual--Version IV (DSM-IV) AUDs, and describes associations of these syndromes with clinical characteristics of AUDs, in the general U.S. population. This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n=43,093, response rate=81%). Respondents (n=11,843) with lifetime AUDs were classified according to whether they met criteria for ASPD, AABS, "CD only," or no antisocial syndrome. Correlates of antisocial syndromes were examined using contingency table approaches and normal theory analyses of variance. Associations of antisocial syndromes with clinical characteristics of AUDs, including number of lifetime episodes, duration of longest or only episode, and alcohol consumption during period of heaviest drinking were examined using normal theory and logistic regression. Sociodemographic and clinical correlates of antisocial syndromes among respondents with AUDs were consistent with results from prior studies. Antisocial syndromes were significantly associated with phenomenology of AUDs, particularly ASPD with the most severe clinical presentations. Associations with AABS were similar to but more modest than those with ASPD; those with "CD only" were weaker and less consistent. Patterns of associations between antisocial syndromes and clinical characteristics of AUDs were generally similar between men and women. Antisocial syndromes, particularly ASPD, appear to identify a more pernicious clinical profile of AUDs among adults in the general U.S. population.

Psychiatric Comorbidity in Long‐Term Abstinent Alcoholic Individuals

A high prevalence of comorbid psychiatric disorders has been demonstrated in individuals with an alcohol use disorder in both community and treatment samples, with higher comorbidity in treatment samples. In this study, we examined lifetime and current psychiatric diagnoses in long-term abstinent alcoholic individuals (LTAA; mean abstinence=6.3 years; n=52) compared with age and gender-comparable non-alcoholic controls (NC; n=48). We asked the following questions: (1) to achieve long-term abstinence, must an individual be relatively psychiatrically healthy (i.e., comparable with NC) and (2) can ongoing abstinence be maintained in the face of a current psychiatric disorder? Lifetime and current (prior 12 months) psychiatric diagnoses were assessed in the mood, anxiety, and externalizing disorder domains using the computerized Diagnostic Interview Schedule (c-DIS). Over 85% of LTAA had a lifetime psychiatric diagnosis, compared with 50% of NC. Long-term abstinent alcoholic individuals had a higher prevalence than NC of lifetime mood, anxiety, and externalizing disorder diagnoses. Long-term abstinent alcoholic individuals also had a greater prevalence than NC of current mood and anxiety diagnoses. Although LTAA had a greater lifetime prevalence of an antisocial personality disorder (ASPD) than NC, no LTAA or NC had a current ASPD diagnosis. Finally, there was no association of duration of abstinence with lifetime or current psychiatric diagnoses, consistent with psychiatric diagnoses having little effect on relapse. Our results suggest that: (1) the presence of a lifetime psychiatric diagnosis does not militate against achieving long-term abstinence, (2) abstinence can be maintained in the presence of a current mood or anxiety disorder, and (3) a current diagnosis of ASPD may not be compatible with long-term abstinence. The relatively low levels of antisocial behavior compared with preabstinence (as indicated by no LTAA meeting current criteria for ASPD) raises the question of whether the neurobiology underlying antisocial behavior is changed in abstinence, or brought under increased executive control, or both.