The comorbidity of alcoholism and personality disorders in a clinical population: Prevalence and relation to alcohol typology variables.

This study assessed prevalence rates and overlap among Diagnostic and Statistical Manual of Mental Disorders ( 3rd ed., revised; DSM-III—R; American Psychiatric Association, 1987) personality disorders in a multisite sample of 366 substance abusers in treatment. In addition, the relation of antisocial personality disorder (APD), borderline personality disorder (BPD), and paranoid personality disorder (PPD) to alcohol typology variables was examined. Structured diagnostic interviews and other measures were administered to participants at least 14 days after entry into treatment. Results indicated high prevalence rates for APD and non-APD disorders. There was extensive overlap between Axis I disorders and personality disorders, and among personality disorders themselves. APD, BPD, and PPD were linked to more severe symptomatology of alcoholism and other clinical problems. However, only APD and BPD satisfied subtyping criteria, after controlling for other comorbidity. Implications for classifying alcoholics by comorbid disorders are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy, antisocial personality, and suicide risk.

H. Cleckley (1976) maintained that psychopaths are relatively immune to suicide, but substantial evidence exists for a relationship between antisocial deviance and suicidal acts. This study was the first to explicitly examine suicidal history among psychopathic individuals as defined by R. D. Hare's (1991) Psychopathy Checklist—Revised (PCL—R). Male prison inmates (N?=?313) were assessed using the PCL—R and DSM-III R and DSM-IV criteria (American Psychiatric Association, 1987, 1994) for antisocial personality disorder (APD), and they completed A. Tellegen's (1982) Multidimensional Personality Questionnaire (MPQ). Presence or absence of prior suicide attempts was coded from structured interview and prison file records. Suicide history was significantly related to PCL—R Factor 2 (which reflects chronic antisocial deviance) and to APD diagnosis but was unrelated to PCL-R Factor 1, which encompasses affective and interpersonal features of psychopathy. Higher order MPQ dimensions of Negative Emotionality and low Constraint were found to account for the relationship between history of suicidal attempts and antisocial deviance, indicating that temperament traits may represent a common vulnerability for both. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Discriminant validity of the Psychopathy Checklist in a forensic psychiatric population.

The association between psychopathy and other mental disorders was investigated in 80 male forensic patients. Psychopathy was assessed with the Psychopathy Checklist (PCL; R. D. Hare [see PA, Vol 67:2477]). Diagnoses of other mental disorders were based on Axis I and Axis II criteria listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and on two standardized psychiatric rating scales. PCL diagnoses were significantly related only to antisocial and histrionic personality disorder (PD) and to nonalcohol substance abuse disorders. PCL ratings were also positively correlated with prototypicality ratings of antisocial, histrionic, and narcissistic PD and negatively correlated with ratings of avoidant PD. The results provide evidence for the convergent and discriminant validity of the PCL and are consistent with the view that psychopathy is a distinct clinical syndrome. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The long-term prediction of offender recidivism using diagnostic, personality, and risk/need approaches to offender assessment.

The present study examined the prediction of recidivism using diagnostic, personality, and risk/need approaches over a 10-year follow-up in a heterogeneous sample of 61 offenders (i.e., probationers and provincial and federal offenders). The Level of Service/Case Management Inventory (LS/CMI), Psychopathy Checklist-Revised (PCL-R), and DSM-III antisocial personality disorder (APD) were examined. The measures were highly correlated and demonstrated theoretically meaningful patterns of convergent validity. Although psychopathy was highly correlated with both LS/CMI and APD, the majority of the shared variance with LS/CMI and with APD was accounted for by Factor 2 and the criminality facet of the PCL-R. All three assessment measures predicted future violence, any future reincarceration upon release, and recidivism severity (as measured by aggregate sentence length). However, none of these measures made a significant incremental contribution to the prediction of recidivism beyond either of the other two measures. Differences between the predictive validities of the three measures were minimal. The results are discussed in terms of recent debates concerning the use of these instruments in the assessment of offender risk. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcohol and drug abuse-dependence disorders in psychopathic and nonpsychopathic criminal offenders.

Co-occurrence of psychopathy (assessed with the Revised Psychopathy Checklist [R. D. Hare, 1985]) and lifetime Diagnostic and Statistical Manual of Mental Disorders (DSM-III) alcohol and drug disorders (assessed with the Diagnostic Interview Schedule; National Institute of Mental Health) was examined in a sample of 360 male inmates. Consistent with previous research that used diagnoses of antisocial personality disorder, psychopaths were more likely than nonpsychopaths to have lifetime diagnoses of alcoholism, any drug disorder, and multiple drug disorder. The relation between substance abuse and the 2 factors of the Revised Psychopathy Checklist was also examined. Substance abuse was significantly related to general social deviance (Factor 2) but was unrelated to core personality features of psychopathy (Factor 1). Two possible models of psychopathy (unitary syndrome vs dual-diathesis model) are presented that may account for the association between psychopathy and substance abuse. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Differentiation of Axis I and Axis II disorders.

The revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III—R; American Psychiatric Association, 1987) distinguishes between Axis I and Axis II disorders: Axis II includes personality (and developmental) disorders, and all others are on Axis I. This distinction is often useful, but the reification of Axis I and II constructs through diagnostic criteria sets that demarcate categorically distinct entities is at times problematic. T. A. Widiger and T. Shea review the issues of differentiating personality from Axis I disorders, specifically illustrated by schizotypal and schizophrenic disorders, borderline and mood disorders, antisocial and substance use disorders, and avoidant personality from social phobia. The options for addressing their differentiation include adding exclusion criteria, shifting the placement of disorders, deleting overlapping criteria, adding differentiating criteria, and converting to a dimensional format. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria.

Early starting, lifetime criminal persistence has been called sociopathy, antisocial personality disorder, and psychopathy. There is, however, disagreement about its core features and which measure is best for identifying such individuals. In the 1st of 2 studies of male offenders (n = 74), we found a large association between scores on the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV; American Psychiatric Association, 1994) antisocial personality disorder criteria scored as a scale. The second study (n = 684) replicated this finding and found that, as previously shown for PCL-R scores, a discrete class (or taxon) also underlies scores on items reflecting antisocial personality disorder. The high association among these sets of items and their similarity in predicting violence suggested that the same natural class underlies each. Results indicated that life-course-persistent antisociality can be assessed well by measures of psychopathy and antisocial personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical diagnosis of borderline personality: Examination of professional differences.

We examined the influence of clinicians' professional affiliations on the assignment of DSM-III/DSM-III—R borderline personality disorder to clients. Practicing psychologists and psychiatrists provided data on patients who had been clinically diagnosed as manifesting personality disorder. Clinicians also were asked to indicate those features that best described their clients' symptomatology, using a checklist of the Axis II criteria that yielded a diagnosis based on DSM-III criteria. Results indicated that minimal differences existed between the two clinician groups in their diagnoses of borderline personality disorder and that both professional groups relied on the criteria specified in DSM-III. However, several differences in the professionals' weightings of specific features were found. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sex bias in the diagnosis of histrionic and antisocial personality disorders.

The differential prevalence of the histrionic and antisocial personality disorders among men and women has been attributed both to sex biases and to actual variation in disorder base rates. The present study assessed the bias and base rate explanations and examined whether sex biases are minimized by the relatively explicit diagnostic criteria in the DSM-III. Psychologists (N?=?354) either diagnosed 9 DSM-III disorders from case histories that varied in the ambiguity of the antisocial and histrionic personality disorder diagnoses or rated the degree to which specific features extracted from the case histories met 10 histrionic and antisocial diagnostic criteria. The sex of the patient was either male, female, or unspecified. Sex biases were evident for the diagnoses but not for the diagnostic criteria. The results are discussed with respect to base rate effects, sex biases, and the construction of diagnostic criteria. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clarifying the role of defensive reactivity deficits in psychopathy and antisocial personality using startle reflex methodology.

Prior research has demonstrated deficits in defensive reactivity (indexed by potentiation of the startle blink reflex) in psychopathic individuals. However, the basis of this association remains unclear, as diagnostic criteria for psychopathy encompass two distinct phenotypic components that may reflect differing neurobiological mechanisms—an affective–interpersonal component and an antisocial deviance component. Likewise, the role of defensive response deficits in antisocial personality disorder (APD), a related but distinct syndrome, remains to be clarified. In the current study, the authors examined affective priming deficits in relation to factors of psychopathy and symptoms of APD using startle reflex methods in 108 adult male prisoners. Deficits in blink reflex potentiation during aversive picture viewing were found in relation to the affective–interpersonal (Factor 1) component of psychopathy, and to a lesser extent in relation to the antisocial deviance (Factor 2) component of psychopathy and symptoms of APD—but only as a function of their overlap with affective–interpersonal features of psychopathy. These findings provide clear evidence that deficits in defensive reactivity are linked specifically to the affective–interpersonal features of psychopathy and not to the antisocial deviance features represented most strongly in APD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conduct disorder: Parsing the confounded relation to parental divorce and antisocial personality.

Previous research has shown an association between parental divorce and child conduct problems. This relation is confounded, however, because antisocial personality disorder (APD) is common among the parents of children with conduct disorder (CD) and divorce is very frequent for adults with this disorder. Twenty-eight clinic-referred boys who received a Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) diagnosis of conduct disorder and 34 who received any other diagnosis served as subjects. A 2 (APD vs. not APD)?×? 2 (divorced vs. not divorced) log-linear analysis revealed a significant main effect for APD with the number of sons given the diagnosis of conduct disorder as the dependent variable, but the main effect for divorce and the interaction were not significant. Among boys with divorced parents, more than twice as many boys with a parent with APD received a diagnosis of CD than boys without a parent with APD, but there was no significant association between divorce and CD in the absence of parental APD. A similar 2?×?2 analysis of variance of the number of 13 specific DSM-III symptoms of conduct disorder resulted in essentially identical findings. These results suggest the hypothesis that parental APD is directly linked to both parental divorce and child CD, but the divorce and CD are not directly related. Methodological limitations of the present dataset are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predicting Future Antisocial Personality Disorder in Males From a Clinical Assessment in Childhood.

It is essential to identify childhood predictors of adult antisocial personality disorder (APD) to target early prevention. It has variously been hypothesized that APD is predicted by childhood conduct disorder (CD), attention-deficit/hyperactivity disorder (ADHD), or both disorders. To test these competing hypotheses, the authors used data from a single childhood diagnostic assessment of 163 clinic-referred boys to predict future APD during early adulthood. Childhood Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) CD, but not ADHD, significantly predicted the boys' subsequent APD. An interaction between socioeconomic status (SES) and CD indicated that CD predicted APD only in lower SES families, however. Among children who met criteria for CD, their number of covert but not overt CD symptoms improved prediction of future APD, controlling for SES. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Refining the construct of psychopathy: Towards a hierarchical model.

Psychopathy is characterized by diverse indicators. Clinical accounts have emphasized 3 distinct facets: interpersonal, affective, and behavioral. Research using the Psychopathy Checklist–Revised (PCL–R), however, has emphasized a 2-factor model. A review of the literature on the PCL–R and related measures of psychopathy, together with confirmatory factor analysis of PCL–R data from North American participants, indicates that the 2-factor model cannot be sustained. A 3-factor hierarchical model was developed in which a coherent superordinate factor, Psychopathy, is underpinned by 3 factors: Arrogant and Deceitful Interpersonal Style, Deficient Affective Experience, and Impulsive and Irresponsible Behavioral Style. The model was cross-validated on North American and Scottish PCL–R data, Psychopathy Screening Version data, and data derived from the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) antisocial personality disorder field trial. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Changes in ion channel expression during in vitro differentiation of trout oligodendrocyte precursor cells

A prospective study of conduct disorder (CD) was conducted using 4 annual structured diagnostic interviews of 171 clinic-referred boys, their parents, and their teachers. Only about half of the 65 boys who met criteria for CD in Year 1 met criteria again during the next year, but 88% met criteria for CD again at least once during the next 3 years. For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high. Lower socioeconomic status, parental antisocial personality disorder (APD), and attention-deficit hyperactivity disorder were significant correlates of CD in Year 1, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time (i.e., only boys without a parent with APD and with above-average verbal intelligence clearly improved).     

Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia.

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial bebavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

An empirical study of the issue of sex bias in the diagnostic criteria of DSM-III Axis II Personality Disorders.

Responds to M. Kaplan's (see record 1984-06847-001) assertion that society encourages women to behave histrionically and dependently and then through the use of sex-biased diagnostic criteria, such as the DSM-III, labels these same women as mentally ill. To test Kaplan's hypothesis, the sex ratios of all of the DSM-III Axis II personality disorders were determined in 2 samples of 2,712 and 531 patients. Histrionic and dependent personality disorders were more commonly diagnosed in females, and antisocial personality disorder was more commonly diagnosed in males. The finding that there was no overall tendency for a female S to receive a personality disorder diagnosis more often than a male S provides no support for Kaplan's theory of sex bias in the DSM-III. (7 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Generalized social phobia versus avoidant personality disorder: A commentary on three studies.

The findings of J. D. Herbert et al (see record 1992-27377-001), C. S. Holt et al (see record 1992-27380-001), and S. M. Turner et al (see record 1992-27401-001) are largely consistent. Avoidant personality disorder and generalized social phobia appear to be overlapping constructs that have only minor differences with respect to severity of dysfunction. This commentary addresses the implications of the findings with respect to the validity of the categorical distinction in the Diagnostic and Statistical Manual of Mental Disorders-III—Revised (DSM-III—R) between avoidant personality and generalized social phobia, revisions of their respective diagnostic criteria, and their reclassification as either an anxiety or a personality disorder. Methodological and substantive suggestions for future research are also discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Familial risk factors to oppositional defiant disorder and conduct disorder: Parental psychopathology and maternal parenting.

In a sample of 177 clinic-referred children (aged 7–13 yrs), an association was found between a diagnosis of conduct disorder (CD) and several aspects of family functioning: maternal parenting (supervision and persistence in discipline) and parental adjustment (paternal antisocial personality disorder and paternal substance abuse). Children with oppositional defiant disorder were intermediate to families of children with CD and clinic control children on all variables, but differed from control children only in having a higher rate of paternal substance abuse and paternal antisocial personality disorder (APD). When both parental APD and deviant maternal parenting were entered into 2?×?2 logit-model analyses predicting CD, only parental APD was significantly associated with CD, and no interactions between parental adjustment and maternal parenting were found. The importance of these findings for understanding the etiology of CD and for disentangling correlated risk factors in future studies is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Depressive personality: Reliability, validity, and relation to dysthymia.

The reliability and validity of K. Schneider's (1958) construct of depressive personality was evaluated in a sample of 177 outpatients, who were administered structured diagnostic and family history interviews, an extensive battery of inventories, and a 6-mo follow-up assessment. The criteria for depressive personality had moderate to good interrater reliability, internal consistency, and test–retest stability, and the assessment of depressive personality traits was not influenced by patients' clinical states. In addition, preliminary support for the convergent and discriminant validity of the depressive personality construct was obtained. Although there were significant relations between the depressive personality and diagnoses of dysthymia from the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) and DSM-III—Revised (DSM-III—R), the depressive personality was not entirely subsumed by existing mood disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Four-year longitudinal study of conduct disorder in boys: Patterns and predictors of persistence.

A prospective study of conduct disorder (CD) was conducted using 4 annual structured diagnostic interviews of 171 clinic-referred boys, their parents, and their teachers. Only about half of the 65 boys who met criteria for CD in Year 1 met criteria again during the next year, but 88% met criteria for CD again at least once during the next 3 years. For most boys with CD, the number of symptoms fluctuated above and below the diagnostic threshold from year to year but remained relatively high. Lower socioeconomic status, parental antisocial personality disorder (APD), and attention-deficit hyperactivity disorder were significant correlates of CD in Year 1, but the interaction of parental APD and the boy's verbal intelligence predicted the persistence of CD symptoms over time (i.e., only boys without a parent with APD and with above-average verbal intelligence clearly improved). (PsycINFO Database Record (c) 2010 APA, all rights reserved)