Antisocial Personality Symptoms Research Articles

The prevalence of subthreshold psychiatric symptoms and associations with alcohol and substance use disorders: from a nationally representative survey of 36,309 adults

BackgroundOur aim was to describe a broad number of subthreshold psychiatric symptoms (SPS) in a nationally representative population and evaluate associations with substance use. SPS describe groups of symptoms with significant pathology, but that do not quite meet full psychiatric diagnostic criteria. They have been associated with significant impairment and cost.MethodsThe National Epidemiologic Survey on Alcohol and Related Conditions-III was a multistage, weighted, cross-sectional survey completed in the United States in 2013 comprising 36,309 noninstitutionalized adults. We report lifetime prevalence rates of 14 SPS related to mood, anxiety, trauma, eating, and personality disorders. We then evaluate associations with lifetime alcohol use disorders (AUD) and all substance use disorders (SUD) using logistic regression and adjusted odds ratios. SPS and psychiatric diagnoses were mutually exclusive (could not co-occur).ResultsLifetime prevalence of having at least one of 14 SPS was 57% compared with 37% for the related psychiatric disorders. This was similar for males and females, in contrast to psychiatric disorders in which prevalence was 42% in females and 31% in males. Otherwise, overall SPS and disorders had similar prevalence patterns across sociodemographic characteristics. Subthreshold personality symptoms had the highest prevalence rates (schizotypal 21.3%, antisocial 18.3%, and borderline 17.6%), followed by posttraumatic stress (13.1%). Subthreshold bipolar and depression had lifetime prevalence rates of 2.7 and 8.5%, respectively. Prevalence rates of subthreshold anxiety symptoms ranged from 2.2% (agoraphobia) to 9.8% (specific phobia). Subthreshold eating disorder related symptoms had the lowest prevalence rates (anorexia 1.5% and bulimia 1.7%). Half (seven) of the SPS had significantly increased odds of lifetime AUD. This number increased to 12 for all SUD. Subthreshold antisocial personality symptoms had the highest odds of AUD (2.2; 95% CI 2.00–2.37) and SUD (3.5; 95% CI 3.22–3.81).ConclusionsWe found high lifetime SPS prevalence rates and significant associations with AUD and SUD. To our knowledge, this is the first published study evaluating a broad number of SPS. This indicates possible opportunities for early intervention and prevention but requires additional research and development of infrastructure and guidelines to better understand and manage patients who experience SPS.

Sex Moderates Reward- and Loss-Related Neural Correlates of Triarchic-Model Traits and Antisocial Behavior.

Abnormalities in responses to reward and loss are implicated in the etiology of antisocial behavior and psychopathic traits. While there is evidence for sex differences in neural response to reward and loss, it remains unclear how sex differences may moderate links between these neural responses and the phenotypic expression of antisocial behavior and psychopathic traits. This study examined sex differences in associations of neural response to reward and loss with antisocial personality symptoms and psychopathic traits. Functional neuroimaging data were collected during a monetary incentive delay task from 158 participants. Among males, during loss anticipation, activation in the left nucleus accumbens was negatively associated with antisocial behavior. Among females, during loss feedback, activation in the left nucleus accumbens and left amygdala was negatively associated with antisocial behavior. These results suggest that phenotypic sex differences in psychopathic traits and antisocial behavior may in part be attributable to different etiological pathways.

Recollections of Maternal and Paternal Punitive Discipline in Childhood and Violent Attitudes and Behaviors in Adulthood: A Mediation Model.

This cross-sectional retrospective study on a convenience sample of 973 Greek undergraduate students examined whether the violent socialization in childhood and the criminal history in adolescence would be mediators between parents' harsh discipline and young adults' violent attitudes and behaviors (VA/B). Structural Equation Modelling indicated that both the mothers' and fathers' punitive discipline at age 10 have an indirect impact, through the mediators, on young adults' VA/B. A direct effect was also found from mothers' and fathers' punitive discipline to violence approval and from fathers' punitive discipline to antisocial personality symptoms, and corporal punishment law attitude. The findings suggest that early experiences of harsh discipline may increase the risk of adult's violence and call for multilevel prevention and intervention programs targeting both parents and children.

The Relationship Between Paternal Characteristics and Child Psychosocial Functioning in a Sample of Men Arrested for Domestic Violence

It is estimated that upward of 15.5 million children live in homes where they are exposed to physical and psychological intimate partner violence (IPV). Research indicates that IPV can have deleterious effects on children, including a variety of psychosocial problems, although there is much variability in outcomes of children exposed to IPV. Individual characteristics of the parents involved in IPV may be an important predictor of negative psychosocial outcomes for children. The current study expanded upon prior research and examined the simultaneous associations of paternal characteristics, including paternal IPV perpetration, and child psychosocial functioning (i.e., externalizing, internalizing, and attentional problems) among 153 men arrested for domestic violence and court ordered to attend batterer intervention programs. Analyses examined the relations between paternal alcohol and drug use, antisocial personality traits, hostility, posttraumatic stress symptoms, distress tolerance, IPV perpetration, and men's ratings of their child's psychosocial functioning. Results indicated that poor overall child psychosocial functioning was positively related to paternal antisocial personality symptoms and hostility. Subscale analyses revealed that child attentional problems were positively related to paternal hostility. Child externalizing problems were positively associated with paternal antisocial personality symptoms. The implications of these findings for future research and intervention are discussed.

Risk factors for parental psychopathology: a study in families with children or adolescents with psychopathology

The parents of children with psychopathology are at increased risk for psychiatric symptoms. To investigate which parents are mostly at risk, we assessed in a clinical sample of families with children with psychopathology, whether parental symptom scores can be predicted by offspring psychiatric diagnoses and other child, parent and family characteristics. Parental depressive, anxiety, avoidant personality, attention-deficit/hyperactivity (ADHD), and antisocial personality symptoms were measured with the Adult Self Report in 1805 mothers and 1361 fathers of 1866 children with a psychiatric diagnosis as assessed in a child and adolescent psychiatric outpatient clinic. In a multivariate model, including all parental symptom scores as outcome variables, all offspring psychiatric diagnoses, offspring comorbidity and age, parental age, parental educational attainment, employment, and relationship status were simultaneously tested as predictors. Both 35.7% of mothers and 32.8% of fathers scored (sub)clinical for at least one symptom domain, mainly depressive symptoms, ADHD symptoms or, only in fathers, avoidant personality symptoms. Parental psychiatric symptoms were predicted by unemployment. Parental depressive and ADHD symptoms were further predicted by offspring depression and offspring ADHD, respectively, as well as by not living together with the other parent. Finally, parental avoidant personality symptoms were also predicted by offspring autism spectrum disorders. In families with children referred to child and adolescent psychiatric outpatient clinics, parental symptom scores are associated with adverse circumstances and with similar psychopathology in their offspring. This signifies, without implying causality, that some families are particularly vulnerable, with multiple family members affected and living in adverse circumstances.

Marijuana use is associated with intimate partner violence perpetration among men arrested for domestic violence.

Intimate partner violence (IPV) is a serious public health problem. Substance use, particularly alcohol, is a robust risk factor for IPV. There is a small but growing body of research demonstrating that marijuana use is positively associated with IPV perpetration. However, research on marijuana use and IPV has failed to control for other known predictors of IPV that may account for the positive association between marijuana use and IPV perpetration. Therefore, the current study examined whether marijuana use was associated with IPV perpetration after controlling for alcohol use and problems, antisocial personality symptoms, and relationship satisfaction, all known risk factors for IPV. Participants were men arrested for domestic violence and court-referred to batterer intervention programs (N = 269). Findings demonstrated that marijuana use was positively and significantly associated with psychological, physical, and sexual IPV perpetration, even after controlling for alcohol use and problems, antisocial personality symptoms, and relationship satisfaction. Moreover, marijuana use and alcohol use and problems interacted to predict sexual IPV, such that marijuana use was associated with sexual IPV at high, but not low, levels of alcohol use and problems. These findings lend additional support to the body of research demonstrating that marijuana use is positively associated with IPV perpetration in a variety of samples. Results suggest that additional, rigorous research is needed to further explore why and under what conditions marijuana is associated with IPV perpetration.

Spousal resemblance in psychopathology: A comparison of parents of children with and without psychopathology

BackgroundSpouses resemble each other for psychopathology, but data regarding spousal resemblance in externalizing psychopathology, and data regarding spousal resemblance across different syndromes (e.g. anxiety in wives and attention deficit/hyperactivity disorder [ADHD] in husbands) are limited. Moreover, knowledge is lacking regarding spousal resemblance in parents of children with psychiatric disorders. We investigated and compared spousal resemblance within and across internalizing and externalizing symptom domains in parents of children with and without psychopathology. MethodsSymptoms of depression, anxiety, avoidant personality, ADHD, and antisocial personality were assessed with the Adult Self Report in 728 mothers and 544 fathers of 778 children seen in child and adolescent psychiatric outpatient clinics and in 2075 mothers and 1623 fathers of 2784 children from a population-based sample. Differences in symptom scores and spousal correlations between the samples were tested. ResultsParents in the clinical sample had higher symptom scores than in the population-based sample. In both samples, correlations within and across internalizing and externalizing domains of psychopathology were significant. Importantly, correlations were significantly higher in the clinical sample (P=0.03). Correlations, within and across symptoms, ranged from 0.14 to 0.30 in the clinical sample and from 0.05 to 0.23 in the population-based sample. ConclusionsThis large study shows that spousal resemblance is not only present within but also across symptom domains. Especially in the clinical sample, ADHD symptoms in fathers and antisocial personality symptoms in mothers were correlated with a range of psychiatric symptoms in their spouses. Clinicians need to be alert of these multiple affected families.

Effects of the MAOA gene and levels of exposure to violence on antisocial outcomes.

The monoamine oxidase A (MAOA) gene has been shown to moderate the impact of maltreatment on antisocial behaviour. Replication efforts have, however, yielded inconsistent results. To investigate whether the interaction between the MAOA gene and violence is present across the full distribution of violence or emerges at higher levels of exposure. Participants were 327 male members of the Québec Longitudinal Study of Kindergarten Children. Exposure to violence comprised retrospective reports of mother's and father's maltreatment, sexual and physical abuse. Conduct disorder and antisocial personality symptoms were assessed in semi-structured interviews and partner violence, property-violent crimes and arrest were self-reported. Non-linear interactions between the MAOA gene and violence were detected, suggesting that the genetic moderation may come about once a certain level of violence is experienced. Future studies should investigate the mechanisms translating substantial violence exposure, which could, subsequently, trigger the expression of genetically based differences in antisocial behaviour.

Substance use in young adults with ADHD: Comorbidity and symptoms of inattention and hyperactivity/impulsivity

Young adults with attention deficit hyperactivity disorder (ADHD) are at high risk of substance use (SU). The aims of the current study were: 1) to examine the use of alcohol, tobacco, marijuana and other illegal drugs by adults with and without ADHD; 2) to compare the oppositional, conduct, anxiety, depression, sleep and antisocial personality symptoms of ADHD adults with SU and ADHD adults without SU; 3) to examine the ability of ADHD symptoms and conduct problems to predict SU. A total of 93 young adults, 43 without ADHD and 50 with a childhood diagnosis of ADHD, who were part of the Spanish sample of the Multicenter ADHD Genetics (IMAGE) study, collaborated in a follow-up evaluation 10.1 years later. ADHD participants were divided into two groups based on the presence or absence of SU. Statistically significant differences were found between young adults with and without ADHD in their use of tobacco, marijuana and alcohol. A statistically significant association was also shown between externalization problems and a greater risk of SU. Conduct problems, to a greater degree than ADHD symptoms, affect SU in ADHD adults.

Early Prevention of Antisocial Personality: Long-Term Follow-Up of Two Randomized Controlled Trials Comparing Indicated and Selective Approaches

Antisocial personality is a common adult problem that imposes a major public health burden, but for which there is no effective treatment. Affected individuals exhibit persistent antisocial behavior and pervasive antisocial character traits, such as irritability, manipulativeness, and lack of remorse. Prevention of antisocial personality in childhood has been advocated, but evidence for effective interventions is lacking. The authors conducted two follow-up studies of randomized trials of group parent training. One involved 120 clinic-referred 3- to 7-year-olds with severe antisocial behavior for whom treatment was indicated, 93 of whom were reassessed between ages 10 and 17. The other involved 109 high-risk 4- to 6-year-olds with elevated antisocial behavior who were selectively screened from the community, 90 of whom were reassessed between ages 9 and 13. The primary psychiatric outcome measures were the two elements of antisocial personality, namely, antisocial behavior (assessed by a diagnostic interview) and antisocial character traits (assessed by a questionnaire). Also assessed were reading achievement (an important domain of youth functioning at work) and parent-adolescent relationship quality. In the indicated sample, both elements of antisocial personality were improved in the early intervention group at long-term follow-up compared with the control group (antisocial behavior: odds ratio of oppositional defiant disorder=0.20, 95% CI=0.06, 0.69; antisocial character traits: B=-4.41, 95% CI=-1.12, -8.64). Additionally, reading ability improved (B=9.18, 95% CI=0.58, 18.0). Parental expressed emotion was warmer (B=0.86, 95% CI=0.20, 1.41) and supervision was closer (B=-0.43, 95% CI=-0.11, -0.75), but direct observation of parenting showed no differences. Teacher-rated and self-rated antisocial behavior were unchanged. In contrast, in the selective high-risk sample, early intervention was not associated with improved long-term outcomes. Early intervention with severely antisocial children for whom treatment is indicated may prevent the development of antisocial personality in adolescence and may improve academic performance. In contrast, early intervention with selective high-risk samples may be ineffective.

Pathways and processes of risk in associations among maternal antisocial personality symptoms, interparental aggression, and preschooler's psychopathology

Two studies examined the nature and processes underlying the joint role of interparental aggression and maternal antisocial personality as predictors of children's disruptive behavior problems. Participants for both studies included a high-risk sample of 201 mothers and their 2-year-old children in a longitudinal, multimethod design. Addressing the form of the interplay between interparental aggression and maternal antisocial personality as risk factors for concurrent and prospective levels of child disruptive problems, the Study 1 findings indicated that maternal antisocial personality was a predictor of the initial levels of preschooler's disruptive problems independent of the effects of interparental violence, comorbid forms of maternal psychopathology, and socioeconomic factors. In attesting to the salience of interparental aggression in the lives of young children, latent difference score analyses further revealed that interparental aggression mediated the link between maternal antisocial personality and subsequent changes in child disruptive problems over a 1-year period. To identify the family mechanisms that account for the two forms of intergenerational transmission of disruptive problems identified in Study 1, Study 2 explored the role of children's difficult temperament, emotional reactivity to interparental conflict, adrenocortical reactivity in a challenging parent-child task, and experiences with maternal parenting as mediating processes. Analyses identified child emotional reactivity to conflict and maternal unresponsiveness as mediators in pathways between interparental aggression and preschooler's disruptive problems. The findings further supported the role of blunted adrenocortical reactivity as an allostatic mediator of the associations between parental unresponsiveness and child disruptive problems.

Multiple Factors at Root of Antisocial Behavior

Multiple Factors at Root of Antisocial Behavior

Individual, family, and neighborhood factors distinguish resilient from non-resilient maltreated children: A cumulative stressors model

Objective Children who are physically maltreated are at risk of a range of adverse outcomes in childhood and adulthood, but some children who are maltreated manage to function well despite their history of adversity. Which individual, family, and neighborhood characteristics distinguish resilient from non-resilient maltreated children? Do children's individual strengths promote resilience even when children are exposed to multiple family and neighborhood stressors (cumulative stressors model)? Methods Data were from the Environmental Risk Longitudinal Study which describes a nationally representative sample of 1,116 twin pairs and their families. Families were home-visited when the twins were 5 and 7 years old, and teachers provided information about children's behavior at school. Interviewers rated the likelihood that children had been maltreated based on mothers’ reports of harm to the child and child welfare involvement with the family. Results Resilient children were those who engaged in normative levels of antisocial behavior despite having been maltreated. Boys (but not girls) who had above-average intelligence and whose parents had relatively few symptoms of antisocial personality were more likely to be resilient versus non-resilient to maltreatment. Children whose parents had substance use problems and who lived in relatively high crime neighborhoods that were low on social cohesion and informal social control were less likely to be resilient versus non-resilient to maltreatment. Consistent with a cumulative stressors model of children's adaptation, individual strengths distinguished resilient from non-resilient children under conditions of low, but not high, family and neighborhood stress. Conclusion These findings suggest that for children residing in multi-problem families, personal resources may not be sufficient to promote their adaptive functioning.

The TaqI A1 allele of the dopamine D2 receptor gene and alcoholism in Brazil: association and interaction with stress and harm avoidance on severity prediction.

Allele and genotype frequencies of the TaqI A polymorphism of dopamine D2 receptor (DRD2) gene were compared in 115 alcohol-dependent Brazilian males and 114 ethnically matched controls. Regression analyses were performed to test for an interactive effect between the DRD2 TaqI A1 allele and measures of stress and harm avoidance on severity of alcoholism and number of antisocial personality symptoms. A slightly positive association of DRD2 TaqI A1 genotypes with alcoholism was observed, by standard and molecular heterosis approaches. The DRD2 TaqI A1 allele showed significant interaction with stress and harm avoidance in predicting the severity of physiologic dependence, and with harm avoidance for the number of antisocial personality symptoms. Separate partial correlation analyses showed that stress-related variables were significantly correlated with severity scores in alcoholics with the allele, but not in those without it. This is the first demonstration of an interaction between a genetic polymorphism and stress-related measures on the severity of psychiatric disorders.

Hormonal and behavioral homeostasis in boys at risk for substance abuse

This study modeled the influences of cortisol reactivity, androgens, age-corrected pubertal status, parental personality, family and peer dysfunction on behavioral self-regulation (BSR), in boys at high (HAR) and low average risk (LAR) for substance abuse. Differences between risk groups in cortisol and androgen concentrations, and cortisol reactivity were also examined. Subjects were 10- through 12-year-old sons of substance abusing fathers (HAR; n=150) and normal controls (LAR; n=147). A multidimensional construct of BSR was developed which utilized multiple measures and multiple informants. Boys reported on family dysfunction and deviant behavior among their peers. Parents reported on their propensity to physically abuse their sons, and their own number of DSM-III-R Antisocial Personality Disorder symptoms. Endocrine measures included plasma testosterone, dihydrotestosterone, and salivary cortisol. HAR boys, compared to LAR boys, had lower mean concentrations for testosterone, dihydrotestosterone, salivary cortisol prior to evoked related potential testing, and lower cortisol reactivity. The number of maternal Antisocial Personality Disorder symptoms, parental potential for physical abuse, degree of family dysfunction, and peer delinquency were significantly associated with BSR. Parental aggression antisocial personality symptoms and parental physical abuse potential are likely to influence sons’ behavioral dysregulation and homeostatic stress reactivity. These key components of liability are posited to increase the likelihood of developing suprathreshold Psychoactive Substance Use Disorder (PSUD).

The association of antisocial personality symptoms with marijuana abuse/dependence. A monozygotic co-twin control study.

This study examines the association of symptoms of lifetime antisocial personality disorder (ASP) with marijuana abuse/dependence in Vietnam-era veteran male monozygotic twin pairs. In 1992, 1,874 monozygotic twin pairs responded to a structured psychiatric interview that obtained data on lifetime history of drug use and ASP. Among randomly selected individuals from each twin pair, 8 of 10 ASP symptoms were significantly more prevalent in persons with a lifetime history of marijuana abuse/dependence compared with those who had never abused any drug (p < .001). Among 99 marijuana discordant twin pairs, however, only two ASP symptoms, "failure to conform to social norms" (odds ratio, 2.8; 95% confidence interval, 1.5 to 5.5) and "reckless regard of own or other's personal safety" (odds ratio, 2.4; 95% confidence interval, 1.0 to 5.4) were significantly increased in marijuana abusing/dependent twins compared with their non-abusing/nondependent twin brother. After adjustment for conduct disorder, alcohol abuse/dependence, and exposure to combat in Vietnam, only "failure to conform to social norms of lawful behavior" (odds ratio, 2.42; 95% confidence interval, 1.12 to 5.21) remained significantly increased in twins with marijuana abuse/dependence.

Hysteria and antisocial personality. A single disorder?

Antisocial personality and hysteria have been thought to represent a single condition. Different clinical presentations for the disorders have been attributed to cultural stereotyping and diagnostic bias. The present study carefully examines detailed psychiatric histories taken from 560 nonpatient university students. Diagnoses of antisocial personality and hysteria are based on the diagnostic criteria for psychiatric research of Feighner et al. Interviewer bias is avoided. Both disorders were present in both sexes. Hysteria was more common for women, whereas antisocial personality occurred more frequently in men. The two disorders presented with nearly equal frequency in men. Hysteria was more frequent and antisocial personality was less frequent in women than in men. The two disorders were associated for women but not for men. Specific symptoms of antisocial personality were associated with hysteria and were identified. Specific symptoms of hysteria were associated with antisocial personality, differed in some respects between men and women, and demonstrated more symptoms of depressive illness for female sociopaths. Antisocial personality, hysteria, and their combinations considered together as a possible single entity occurred with equal frequency for both sexes.