Social anxiety disorder (SAD) and antisocial personality disorder (ASPD) are not often thought of as being comorbid. However, recent research suggests the existence of a SAD subtype with characteristics atypical of SAD but common to ASPD. Thus, we explored two competing hypotheses: 1) SAD and ASPD represent opposite ends of a single dimension, or 2) SAD and ASPD exist on two separate dimensions that may be positively correlated. Data were obtained from the National Epidemiological Survey on Alcohol and Related Conditions. SAD-ASPD was related to greater impairment and psychiatric comorbidity than either disorder alone. The SAD-ASPD group was also more likely to seek treatment for their SAD symptoms and to drink before/during antisocial acts than the SAD only group. The presence of SAD for individuals with ASPD (and vice versa) does not appear to provide any “protective benefits.” SAD and ASPD appear to be two separate but correlated disorders.

Background Evidence suggests that impulsive aggression and explosive anger are common among individuals with anxiety disorders; yet, the influence of IED on the onset, course, consequences, and patterns of comorbidity among those with anxiety disorders is unknown. Methods Data were drawn from the National Comorbidity Survey Replication (N=9,282) and Adolescent Supplement (N=9,632), nationally representative surveys conducted between 2001–2004. Diagnoses were based on structured lay-administered interviews. Lifetime diagnoses assessed with structured instruments. Outcomes included comorbidity, functional and role impairment, and treatment utilization. Results Adolescents with a lifetime anxiety disorder had a higher prevalence of a lifetime anger attacks (68.5%) and IED (22.9%) than adolescents without a lifetime anxiety disorder (48.6% and 7.8%, respectively), especially social phobia and panic disorders. Similar elevation was found for adults. Age of onset and course of anxiety disorders did not differ by IED. Severe functional impairment associated with anxiety was higher among adolescents (39.3%) and adults (45.7%) with IED than those without IED (29.2% and 28.2%, respectively). Comorbidity for all other disorders was elevated. However, individuals with anxiety disorders and IED were no more likely to use treatment services than those with anxiety disorders without IED. Conclusions Individuals with IED concomitant to anxiety disorder, especially social phobia and panic, are at marked risk for worse functional impairment and a higher burden of comorbidity, but onset and course of anxiety disorder do not differ, and those with anxiety and IED are no more likely to utilize treatment services. Assessment, identification, and specialized treatment of anger in the context of anxiety disorders are critical to reducing burden.

We examined the lifetime prevalence of anxiety disorders (ADs) among adolescents with lifetime intermittent explosive disorder (IED), as well as the impact of co-occurring ADs on anger attack frequency and persistence, additional comorbidity, impairment, and treatment utilization among adolescents with IED. IED was defined by the occurrence of at least three anger attacks that were disproportionate to the provocation within a single year. Data were drawn from the National Comorbidity Survey-Adolescent Supplement (N = 6,140), and diagnoses were based on structured lay-administered interviews. Over half (51.89%) of adolescents with IED had an AD, compared to only 22.88% of adolescents without IED. Compared to adolescents with IED alone, adolescents with IED and comorbid ADs: (a) were more likely to be female; (b) reported greater impairment in work/school, social, and overall functioning; (c) were more likely to receive an additional psychiatric diagnosis, a depressive or drug abuse diagnosis, or diagnoses of three or more additional disorders; and (d) had higher odds of receiving any mental/behavioral health treatment as well as treatment specifically focused on aggression. Adolescents with IED alone and those with comorbid ADs did not differ in the number of years experiencing anger attacks or the highest number of anger attacks in a given year. ADs frequently co-occur with IED and are associated with elevated comorbidity and greater impairment compared to IED alone. Gaining a better understanding of this comorbidity is essential for developing specialized and effective methods to screen and treat comorbid anxiety in adolescents with aggressive behavior problems.

Substance use has been identified as a major problem on college campuses across the country, with excessive use often leading to unintended and unwanted negative health outcomes. Sensation seeking has been shown to be a consistent predictor of engagement in various health risk behaviors, including substance use. Religiosity has been shown to negatively predict substance use. However, there is mixed evidence on the relations among these risk and protective factors. This may be due to the operational definitions of religiosity in previous research. The current study investigated religiosity as a moderator of the relation between sensation seeking and substance use using robust measures of religiosity. The primary hypotheses were (a) sensation seeking would be positively associated with higher levels of heavy episodic drinking and marijuana use; (b) religiosity would be negatively associated with higher levels of substance use; and (c) religiosity would moderate the relation between sensation seeking and substance use such that, when religiosity was high, there would be no association between sensation seeking and substance use, but at low and moderate levels of religiosity, there would be a positive association between them. Religiosity was a significant moderator of the relation between risk seeking and marijuana use (p < .01), but it was less effective as a moderator between sensation seeking and heavy episodic drinking. Religiosity appears to have a stronger buffering effect for illegal drug use compared with alcohol use, perhaps in part because of the relative acceptance of alcohol consumption across major U.S. religious orientations.