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)

Abstract

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.

The impact of childhood maltreatment on aggression, criminal risk factors, and treatment trajectories in forensic psychiatric patients

“…After this period, the progress was less obvious. These findings are consistent with previous research [e.g., (44,47)].…”

“…As previously stated, ACEs are intricately interwoven into a person's personality, leaving a lasting impact on physical and neurological functioning. This can eventually lead to psychopathy and cluster B personality disorder in adulthood (32,(42)(43)(44)(45)(46), contributing to more criminal behavior and recidivism (47-49). Thus, it is not surprising that many risk assessment tools, such as the Historical-Clinical Risk Management 20, version 3 (HCR-20 v3 ) (50) or the Historical Clinical and Future-Revised [Historische, Klinische en Toekomstige-Revisie (HKT-R)] (30), consider ACEs as a risk factor for recidivism.…”