Diagnosis Of Antisocial Personality Disorder Research Articles

Gender bias of antisocial and borderline personality disorders among psychiatrists.

Antisocial Personality Disorder (ASPD) and Borderline Personality Disorder (BPD) challenge mental health professionals with similar maladaptive behaviors. However, these two disorders differ regarding available evidence-based treatments. The Diagnostic and Statistical Manual of Mental Disorders (DSM) has been criticized as being gender-biased diagnostic construct. The present study aimed to determine the gender bias of ASPD and BPD among Turkish psychiatrists. Three case vignettes were randomly presented as male or female to the psychiatrists online. The first case was a patient with schizophrenia case to confirm the participant's ability to diagnose. The second case was a patient with ASPD, and the third one was a patient with BPD. Two hundred fifty participants diagnosed the first case correctly (n = 250). The results with statistical significance demonstrated that a female case with ASPD was 5.1 times more likely to get misdiagnosed than a male case with ASPD (p˂0.0001). Categorical classification of personality disorders in DSM leads to gender bias in in the diagnosis of ASPD and BPD. The present study shows that female cases with ASPD are misdiagnosed as BPD which may result in treatment attempts without evidence.

Do risk measure scores and diagnoses predict evaluator opinions in sexually violent predator cases? It depends on the evaluator.

Field research increasingly reveals that forensic evaluators are not interchangeable. Instead, they tend to differ in their patterns of forensic opinions, in ways that likely reflect something about themselves, not just the persons evaluated. This study used data from sexually violent predator (SVP) evaluations to examine whether evaluator differences in making intermediate decisions (e.g., instrument scoring, assigning diagnoses) might explain their different patterns of final opinions. Although this study was generally exploratory and not strongly hypothesis driven, we expected that there might be evidence for a simple form of bias in which some evaluators would be more likely than others to consistently "find" indications of SVP status (i.e., consistently assigning higher risk scores and more SVP-relevant diagnoses) and, therefore, be more likely to find behavioral abnormality, the legal construct qualifying someone for commitment as an SVP. The study used data from 745 SVP evaluations conducted by 10 different evaluators who were assigned cases from the same referral stream. Potential evaluator difference variables included behavioral abnormality opinions, paraphilia and antisocial personality disorder diagnoses, and Psychopathy Checklist-Revised and Static-99 scores. Evaluator differences explained a statistically significant (p < .001) amount of variance in behavioral abnormality opinions (17%), paraphilia diagnoses (7%), and Psychopathy Checklist-Revised scores (16%). Contrary to our expectation of a simple tendency for some evaluators to find all indicators of SVP status more often than others, evaluators differed in the ways that underlying diagnoses and scores corresponded with their conclusions. The overall pattern was one in which different evaluators appeared to base their final opinions on different factors. Findings reveal further evidence of substantial forensic evaluator differences in patterns of assigning instrument scores and reaching forensic conclusions. But these findings are the first to also reveal wide variability in their patterns of reaching forensic conclusions. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Person-Centered Combinations of Individual, Familial, Neighborhood, and Structural Risk Factors Differentially Relate to Antisocial Behavior and Psychopathology

Research highlights risk factors across systems, from person to community, for understanding antisocial behavior. However, limited research used person-centered analyses to investigate how individual, familial, neighborhood, and structural risk factors cluster and relate to antisocial behavior. We applied latent profile analysis to questionnaires and Census-derived data ( N = 478; Northeast sample). A five-profile solution fit best (1: Low Risk; 2: Elevated Personality Risk; 3: Elevated Family and Structural Risk; 4: Elevated Personality, Family, and Neighborhood Risk; 5: Elevated Neighborhood and Structural Risk). We compared profiles across questionnaire-based, interview-based, and criminal record outcomes. The Elevated Personality, Family, and Neighborhood Risk profile had the strongest relationship to risky behavior and an antisocial personality disorder diagnosis. The Elevated Neighborhood and Structural Risk profile showed the strongest relationship to number of crimes. These results elucidate patterns of co-occurring risk within-people, across systems, and reveal important commonalities and dissociations among forms of antisocial behavior.

Etiological Imaging, Diagnosis and Treatment of Antisocial Personality Disorder

This paper first summarizes the definition of antisocial personality disorder (APD), and then explains the influence of antisocial personality on the patients themselves and the society as well as the etiological diagnosis and treatment methods. Finally, some suggestions for future research and intervention are given. The etiology and influence of antisocial personality disorder are first introduced. The present study found that various factors such as childhood experiences and structural brain abnormalities, could contribute to symptoms of antisocial personality disorder (APD). Secondly, the diagnosis of antisocial personality disorder is introduced, which is based on the common scale test and the patient's actual symptoms and life experiences. Then it introduces the common treatment methods of antisocial personality disorder from the perspective of neurology and psychology. Finally, some suggestions are put forward to provide directions for future research. To sum up, through a systematic review of the previous literatures and analyzing, this paper aims to increase the understanding of APD and provide evidence-based recommendations for optimizing the treatment and intervention of APD.

Antisocial Personality Disorder: Labeling and Stigmatization from the Perspectives of Society, Judiciary, and Clinical Practices

This paper provides a comprehensive overview of recent research concerning the impact of antisocial personality disorder (ASPD) labeling and stigmatization within different environments. Mixed findings were found in all three environmental settings, revealing that an ASPD diagnosis (or a psychopathy label particularly in forensic settings) could result in either positive or negative outcomes. In social settings: inconsistent public responses to ASPD population were found which might suggest a situational effect in regard to ASPD symptoms, and further studies should be conducted on the subject matter. In addition, media portrayals of the ASPD population mistakenly confused ASPD individuals with psychopaths. It would then be important to study to what extent mass media contributed to ASPD stigmatization, in which fear as one contributing component was discussed. In forensic settings: findings supported the presence of ASPD stigmatization. However, considering the ambiguous boundary between ASPD and psychopath within the judicial system, more studies would be needed to investigate whether two labels triggered different levels of stigma and prejudice so as to ensure fairness and justice. In medical settings: there were mental health professionals advocating for replacing stigmatizing labels with less pejorative terms, yet other practitioners reinforced ASPD labeling and stigmatization through refusing treatment delivery that further led to discrimination and discouragement of the ASPD population. Future studies should focus more on finding better guidelines and modifications for the practical field in order to destigmatize or avoid labeling when treating ASPD populations.

A preliminary transcriptomic analysis of the orbitofrontal cortex of antisocial individuals.

Antisocial personality disorder (ASPD) and conduct disorder (CD) are characterized by a persistent pattern of violations of societal norms and others' rights. Ample evidence shows that the pathophysiology of these disorders is contributed by orbitofrontal cortex (OFC) alterations, yet the underlying molecular mechanisms remain elusive. To address this knowledge gap, we performed the first-ever RNA sequencing study of postmortem OFC samples from subjects with a lifetime diagnosis of ASPD and/or CD. The transcriptomic profiles of OFC samples from subjects with ASPD and/or CD were compared to those of unaffected age-matched controls (n = 9/group). The OFC of ASPD/CD-affected subjects displayed significant differences in the expression of 328 genes. Further gene-ontology analyses revealed an extensive downregulation of excitatory neuron transcripts and upregulation of astrocyte transcripts. These alterations were paralleled by significant modifications in synaptic regulation and glutamatergic neurotransmission pathways. These preliminary findings suggest that ASPD and CD feature a complex array of functional deficits in the pyramidal neurons and astrocytes of the OFC. In turn, these aberrances may contribute to the reduced OFC connectivity observed in antisocial subjects. Future analyses on larger cohorts are needed to validate these results.

Bir psikiyatri mahkum servisinde bulunan tutuklu ve hükümlülerin suçluluk, utanç ve affetme duyguları

Introduction: In the present study, the purpose was to examine whether there is a difference in the feelings of guilt, shame, and forgiveness in prisoners who committed one or more crimes. Also, the relationship between the number of crimes involved, the diagnosis of existing or past psychiatric diseases, and demographic data was examined. Methods: This cross-sectional study was conducted with 107 inpatients in the prisoner’s ward. The demographic data forms Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Guilt and Shame Scale (GSS), and Heartland Forgiveness Scale (HFS) were administered in the study. Results: A total of 107 people (51 people involved in one single crime and 56 people involved in more than one crime) were included in the study. The education level was lower in many crimes than in a single crime (p=0.032). Although the diagnosis of mood disorder was higher in the group that was involved in one single crime (36.6%), the diagnosis of antisocial personality disorder was higher in the group that was involved in multiple crimes (41.9%). No differences were detected between the groups in terms of BAI (p = 0.903) and BDI (p = 0.557) scores. No differences were detected between the groups in terms of GSS (guilt and shame) and HFS scores (p values of 0.745 and 0.676, respectively). A positive correlation was detected between the BDI and BAI of all prisoners and the HFS-forgiveness subscale. A positive correlation was detected between the GSS-guilt and shame subscales and all subscales and the total score of HFS. Conclusion: The study showed that anxiety and depression are more common in individuals who were exposed to violence in childhood. It was considered that identifying the prisoners who were involved in the crime for the first time and who felt remorseful and guilty could prevent further crimes. Finally, it is considered that the rate of crime can be reduced by preventing childhood violence and providing psychiatric support to individuals with psychiatric symptoms in order to raise individuals who are mentally healthy and have a low tendency to harm.

Primary and Secondary Capacities in the Context of Positive Psychotherapy in Individuals with Antisocial Personality Disorder: The Relationship with Criminal Behaviors and Anger.

The aim of this study was to evaluate the development of primary (PCs) and secondary capacities (SCs) in individuals diagnosed with antisocial personality disorder (ASPD) and the effects of these capacities on delinquent behaviors and anger levels. 101 male patients aged 18 years and over with a diagnosis of ASPD were divided into two groups as those with a criminal ASPD (cASPD) diagnosis (n=37) and those with a non-criminal ASPD (ncASPD) diagnosis (n=64). Participants were evaluated using a sociodemographic form, Wiesbaden's Inventory of Positive Psychotherapy and Family Therapy (WIPPF-2) and State-Trait Anger Expression Inventory (STAXI). Statistical analyses were performed using the SPSS 22.0 program; significance level was taken as p0.05. PCs, SCs and anger control levels of people with ASPD were lower while trait anger, anger expression and anger import were higher than the control group. In cASPD, among the PCs, belief (β=0.796, p=0.032), hope (β=-1.069, p=0.011), relationship (β=-0.980, p=0.007) and sexuality (β=0.937, p=0.021) predicted anger-out, and among the SAs politeness (β=-1.020, p=0.002) and reliability (β=1.140, p=0.001) predicted trait anger level. In ncASPD, patience predicted anger-out (β=-1.752, p=0.001) and anger control (β=1.468, p=0.002); belief (β=1.468, p=0.005) and trust (β=-0.845, p=0.002) predicted anger control. Positive psychotherapy can be effective in improving PCs and SCs of individuals with ASPD, improving interpersonal relationships, reducing criminal behaviors, anger management and psychotherapeutic treatment of ASPD.

Cocaine Effect Expectancies among Patients with Cocaine Use Disorder with and without Adult Attention Deficit Hyperactivity Disorder: Are There Any Relevant Differences?

ABSTRACT Cocaine use could be modulated by drug expectancies based on previously experienced subjective effects. Some patients perceive a paradoxical calming effect after cocaine use. This study was performed to explore cocaine effect expectancies in patients diagnosed with cocaine use disorder, with and without co-occurring adult attention deficit hyperactivity disorder (ADHD). Secondly, we sought to empirically determine the presence of this paradoxical calming effect after cocaine use in patients with co-occurring adult ADHD to identify the individuals most at risk of cocaine use and relapse. Cross-sectional study using a consecutive sampling method of patients diagnosed with cocaine use disorder (n = 221) treated at public therapeutic communities in Andalusia (Spain). Participants completed a battery of instruments to assess the following variables: cocaine effect expectancies, paradoxical calming effect, adult ADHD, and other co-occurring psychiatric disorders. A multivariate binary logistic regression analysis showed that two variables, the paradoxical calming effect and antisocial personality disorder (ASPD), were independently associated with the probability of being diagnosed with adult ADHD (OR = 3.43, 95% CI = 1.88–6.26 and OR = 3.42, 95% CI = 1.30–8.95, respectively). The presence of a paradoxical calming reaction to cocaine and/or a diagnosis of ASPD in patients with cocaine use disorder increases the diagnostic suspicion of co-occurring adult ADHD.

Exploring the Effects of Early Trauma in a Forensic High Secure Population: Evaluating Associations Between Adverse Childhood Experiences (ACEs) and Diagnosis of Antisocial Personality Disorder (ASPD)

AimsTo examine links between Adverse Childhood Experiences (ACE) categories and diagnosis of antisocial personality disorder (ASPD) in this population; it is predicted that there will be a positive association between number of ACEs and ASPD. The effectiveness of high secure hospital admission and treatment in reducing number of risk incidents was also examined. ACEs are known to impact significantly on the development of the personality and future psychiatric risk. Currently, research into links between distinct ACE categories and the diagnosis of ASPD in the high-secure inpatient population is limited.MethodsData were collected from a sample (n = 221) including all patients in the Mental Health, Personality Disorder and Women's Services at a high-secure hospital. Records were examined for evidence of abuse/neglect during childhood, and a number of markers of household dysfunction. The statistical relationship between each ACE category and subsequent diagnosis of ASPD was examined through paired t-tests. Frequency of incident reports (IR1s) involving violence was compared in the first, third and fifth years post-admission.ResultsSignificant associations with adult diagnosis of ASPD were seen in categories of childhood physical abuse, sexual abuse, divorced/separated parents, Looked After Child (LAC) status and parental substance misuse, and total number of ACE categories present overall. Significant reductions in frequency of IR1s were seen in all services between first- and fifth- year post admission.ConclusionA significant association between ACEs in specific domains and ASPD in adulthood was found. The importance of detailed exploration of childhood circumstances in this group is highlighted, as well as the need for further investigation of the psychological and social mechanisms underlying.

Deconstructing childhood conduct and adult antisocial criteria for the diagnosis of antisocial personality disorder

Antisocial personality disorder (ASPD) is a serious psychiatric disorder that can be incapacitating and costly to individuals and society. The ASPD diagnosis has 2 main components, childhood conduct problems and adult antisocial behaviors, with specific age requirements. The nosological effects of these criteria on population subgroups defined by these aspects of the criteria have not been fully explored. Data for ASPD were analyzed for 3,498 individuals in the St Louis, Missouri, site of the Epidemiologic Catchment Area study of general population psychiatric disorders collected in the early 1980s using structured diagnostic interviews for DSM-III criteria. Effects of the criteria on population subgroups defined by various combinations of the criteria were examined. Earlier-onset conduct disorder was more severe than later-onset childhood conduct disorder, with more total childhood and adult symptoms and negative psychosocial adult outcomes (substance use disorders, criminality, and homelessness). Three subgroups with adult antisocial behaviors (differentiated by no conduct disorder, later-onset conduct disorder, and earlier-onset conduct disorder meeting ASPD criteria) were similar in numbers of adult antisocial symptoms, but the ASPD subgroup had more negative psychosocial adult outcomes. These findings provide evidence for and against reconsideration of the 15-year age-of-onset requirement for conduct symptoms in ASPD criteria.

Arrest history and psychopathology among veterans at risk for suicide.

While preliminary evidence suggests an association between legal involvement and suicide risk among veterans, no research to date has explored the prevalence and/or correlates of legal involvement among veterans at high risk for suicide. The current study examined the relation of suicide attempt, suicidal ideation, and psychopathology to history of criminal arrest in a sample of 286 veterans at risk for suicide. Results indicated approximately half (47%) of at-risk veterans had a history of arrest. Inconsistent with hypotheses, arrest history was not associated with history of suicide attempt, current suicidal ideation, or severity of psychopathological symptoms. Arrest history was, however, associated with diagnoses of substance use disorder and antisocial personality disorder in this high-suicide risk sample. Further, likelihood of an antisocial personality disorder diagnosis was associated with higher frequency of past arrests. Taken together, results indicate that many veterans at risk for suicide have a history of arrest, and at-risk veterans with such history likely have a specific pattern of psychopathology, including antisocial personality traits and substance use. As such, legal status and history of justice involvement may be important considerations when assessing suicide risk and management of this high-risk population. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Understanding mechanisms underlying the relationship between antisocial personality disorder and substance-impaired driving among young adults involved with the justice system as minors

Introduction: Antisocial personality disorder is a risk factor associated with increased risk for substance-impaired driving. While past research has focused on identifying prevalence rates for the disorder among substance-impaired drivers, there is a dearth of research focused on identifying the mechanisms by which the disorder actually functions to increase risk for the behavior among young adults who were formerly adjudicated for a serious offense. There are cognitive, affective, and social mechanisms that may help to explain this relationship. Method: Impulse control, hostility, and deviant peer association are examined as mechanisms that explain the relationship in each of these domains, respectively. The Pathways to Desistance data were utilized in analyses, comprising the responses of 1,354 youth who were adjudicated for a serious offense just prior to baseline measurements. Generalized structural equation modeling was used to examine the direct effects of antisocial personality disorder on substance-impaired driving risk and the hypothesized mechanism variables were then included in the model to determine which of them provided significant pathways through which the main relationship operated. Results: Results indicated that meeting criteria for a diagnosis of antisocial personality disorder was associated with increased risk of substance-impaired driving at follow-up. This relationship was attenuated to non-significance upon inclusion of the mechanism variables and reduced in magnitude by 20%. This attenuation was due almost entirely to impulse control. Practical Applications: This provides indication that intervention for substance-impaired driving offenders with antisocial personality disorder may be most effective when structured around improving impulse control for young adults who were previously involved with the juvenile/criminal justice system.

Incremental validity of the Psychopathy Checklist-Revised above and beyond the diagnosis of antisocial personality disorder regarding recidivism in sexual offenders

PurposeThe diagnostic criteria of the Antisocial Personality Disorder (ASPD) overlaps greatly with the Lifestyle and Antisocial facets of the Hare Psychopathy Checklist-Revised (PCL-R), whereas the Interpersonal and Affective facets seem to differentiate between antisocial and psychopathic offenders. Previous studies investigated either the ASPD diagnosis or psychopathy measured with the PCL-R, but not the combination of both in sexual offenders. The present study tested three hypotheses that PCL-R scores are incrementally predictive above and beyond the ASPD diagnosis regarding general recidivism, non-sexual violent recidivism, and sexual recidivism. MethodsWe performed Cox regression modeling with two-fold cross validation, using a training sample (n = 755) and a testing sample (n = 368) of adult male sexual offenders from Austria. Average time-at-risk was 10.13 years. ResultsThe PCL-R scores predicted general and violent recidivism after the diagnosis of the ASPD was controlled for. The Lifestyle and Antisocial facets, in particular, were incremental. Sexual recidivism could not be predicted. ConclusionsThe current results support the use of the PCL-R in applied sexual offender assessment in addition to general clinical diagnostic procedures due to its incremental validity, despite a large overlap between the diagnostic criteria of ASPD and the PCL-R concept of psychopathy.

Antisocial Personality Disorder as a Risk Factor for Opioid Use: The Dual Mediating Roles of Antisocial Attitudes and Self-Control

Antisocial personality disorder is a risk factor for opioid use. There is a dearth of research which examines self-control and moral disengagement as potential mediators of this relationship. This study utilized data from the Pathways to Desistance study in analyses. Generalized structural equation modeling was utilized to test for mediation of the relationship between antisocial personality disorder and opioid use. Bootstrapped standard errors were computed so that a Clogg Z test could be estimated to determine if identified mediation effects significantly differed. Results indicated that a likely diagnosis of antisocial personality disorder increased risk for opioid use. Inclusion of moral disengagement and self-control into the model resulted in attenuation of this effect to non-significance and reduced the magnitude of the effect by around 45%. The contribution of both constructs to the total indirect effect did not significantly differ and only the total indirect effect was significant.

The Relevance of Hostility and Self-Control as Mediators of the Relationship Between Antisocial Personality Disorder and Offending

Hostility and low self-control are two hallmark characteristics of antisocial personality disorder and are also risk factors for offending. This study tested for mediating effects of these concepts for explaining the antisocial personality disorder-offending relationship. The Pathways to Desistance data were used in analyses. Generalized structural equation modeling was used to estimate these relationships. A Clogg Z test was used to test the equivalence of the mediation effects. Results indicated that antisocial personality disorder diagnosis was associated with offending. Inclusion of hostility and self-control in the model accounted for 65% of the antisocial personality disorder-offending relationship and attenuated it to non-significance. Only self-control was a significant mediator of this relationship and the magnitude of this effect was significantly greater hostility.

Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder.

Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield’s “harmful dysfunction” model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the “evil” is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others. For ASPD, we conclude that the arguments for eliminating it from the diagnostic manuals overweigh the arguments for keeping it.

Psychological interventions for antisocial personality disorder.

Psychological interventions for antisocial personality disorder.

Pharmacological interventions for antisocial personality disorder.

Pharmacological interventions for antisocial personality disorder.

What are the factors that contribute to aggression in patients with co-occurring antisocial personality disorder and substance abuse?

Background A significant number of individuals with high levels of aggression have substance use disorder problems. Objective This study aimed to evaluate the effect of substance use disorder on aggression in young men with Antisocial personality disorder (ASPD). Methods This cross-sectional study included 328 patients and were diagnosed with ASPD with a comorbidity of substance use disorder, along with 111 healthy young male subjects. Results The total aggression scores of the patients with a diagnosis of ASPD were significantly higher than those of the healthy group (p < 0.001). Mean scores of aggression subscale, except for indirect aggression, were higher in patients diagnosed with ASPD (p < 0.05). There was a positive correlation between aggression scores and total API scores in patients diagnosed with ASPD (p < 0.001). Aggression scores were higher when subjects were using volatile substances compared to other substances (p < 0.05). Aggression scores increased with duration of substance use disorder (p < 0.001). Discussion Substance use disorder should be treated first to mitigate aggression in individuals with ASPD. Patients with severe addiction to volatile substances should be given treatment priority. Further studies are necessary to determine the cause of aggression in individuals who abuse substances.