Three-Year Follow-Up of Syndromal Antisocial Behavior in Adults

Abstract

Objective-To present nationally representative findings on total antisocial personality disorder (ASPD) symptoms, major violations of others' rights (MVOR), and violent symptoms over a 3-year follow-up in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions among adults diagnosed at Wave 1 with ASPD versus syndromal adult antisocial behavior without conduct disorder before age 15 (AABS, not a codable DSM-IV disorder).Method-Face-to-face interviews were conducted with 34,653 respondents 18 years and older. Antisocial syndromes and comorbid lifetime substance use, mood, and 6 additional personality disorders were diagnosed at Wave 1 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule -DSM-IV Version. The Wave 2 Alcohol Use Disorder and Associated Disabilities Interview Schedule -DSM-IV Version assessed antisocial symptoms over follow-up, lifetime attention-deficit/hyperactivity (ADHD) and posttraumatic stress disorders, and borderline, narcissistic, and schizotypal personality disorders.Results-In unadjusted analyses, respondents with ASPD reported significantly more total, MVOR, and violent symptoms over follow-up than respondents with AABS. Adjustment for baseline sociodemographics and psychiatric comorbidity attenuated these associations; after further adjustment for parallel antisocial symptom counts from age 15 to Wave 1, associations with antisocial syndromes disappeared. Independent Wave 1 predictors of persistent antisociality over follow-up included male sex, not being married or cohabiting, low income, high school or less education, and lifetime drug use disorders, additional personality disorders, and ADHD.Conclusions-The distinction between ASPD and AABS holds limited value in predicting shortterm course of antisocial symptomatology among adults. However, the prediction of persistent antisociality by psychiatric comorbidity argues for comprehensive diagnostic assessments, treatment of all identified disorders, and investigation of whether treatment of comorbidity might hasten remission of antisociality.Antisocial personality disorder (ASPD) affects 3% to 5% of U.S. adults [1][2][3] and is associated with substantial burden on affected individuals, their families, and society, both in its own right and because of its high comorbidity with medical illnesses and injuries 4-15 as well as mood, 1,3,16,17 anxiety, 1,3,16,17 substance use, 1,3,18 and other personality disorders. 19 Individuals with ASPD are high utilizers of medical care 7,20 and are at elevated risk of premature death NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript from both natural and unnatural causes. 10,21 Despite the clinical, public health, and economic significance of ASPD, however, data concerning its course and outcomes remain limited. This paucity of data reflects ASPD's association with increased mortality, as well as the tendencies of affected individuals to be difficult to locate and uncooperative toward researchers, 22 especially if they are a...

Prevalence and correlates of anger in the community: results from a national survey

“…Fourth, participants may have underreported anger, due to concerns of social desirability. However, previous studies with the NESARC have reported even higher rates of other socially undesirable attributes such as shoplifting 60 or firesetting, 61 domestic violence, and commission of illegal acts 62-64 suggesting that underreporting of anger, if present, is unlikely to be substantial. Despite these limitations, the NESARC provides detailed nationally representative survey data on anger and its correlates.…”

Patterns of use of other drugs among those with alcohol dependence: Associations with drinking behavior and psychopathology

“…Those assessed at Wave 1 included avoidant, dependent, obsessive-compulsive, paranoid, schizoid, and histrionic PDs (Grant et al, 2004c). Antisocial PD was assessed at Wave 1 with a follow-up at Wave 2 to capture individuals who may not have met full diagnostic criteria at Wave 1 but went on subsequently to do so (Goldstein and Grant, 2009). Borderline, narcissistic, and schizotypal PDs were assessed at Wave 2 (Grant et al, 2008).…”

The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 and 2: review and summary of findings

“…In older adults, persistent mood and anxiety disorders were predicted by physical and mental comorbidity [224]. Persistent antisocial symptoms were predicted by being unmarried, low SES, and comorbidity [285]. Relapse.…”