Antisocial personality disorder with childhood- vs. adolescence-onset conduct disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Identification of Transdiagnostic Childhood Externalizing Pathology Within an Electronic Medical Records Database and Application to the Analysis of Rare Copy Number Variation

Externalizing traits and behaviors are broadly defined by impairments in self-regulation and impulse control that typically begin in childhood and adolescence. Externalizing behaviors, traits, and symptoms span a range of traditional psychiatric diagnostic categories. In this study, we sought to generate an algorithm that could reliably identify transdiagnostic childhood-onset externalizing cases and controls within a university hospital electronic health record (EHR) database. Within the Vanderbilt University Medical Center (VUMC) EHR, our algorithm identified cases with a clinician-validated positive predictive value of 90% and controls with a negative predictive value of 88%. In individuals of genetically defined European ancestry (CEU-clustered; Ncase = 487, Ncontrol = 5638), case status was significantly associated with psychiatric comorbidity and with elevated externalizing polygenic scores (OR: 1.20; 95% CI: 1.09-1.33; p = 1.14 × 10-3; based on published genome-wide association data). To test whether our cohort definitions could be applied to generate novel genetic insights, we examined rare (allele frequency < 0.5%) copy number variation. An association (OR: 9.70; CI: 3.24-29.0) was identified in the CEU-clustered cohort on chromosome 2 (chr2: 45,408,678-45,551,530; duplication), although the statistical strength of this association was modest (p = 0.052). We also examined the role of an externalizing burden score based on the number of externalizing diagnoses present in cases and found similar results to our case-control analysis. This analysis identified several other statistically significant CNV region associations. This study provides a framework for identifying childhood externalizing case-control cohorts within an EHR. Future work should validate this framework within other health systems. A broadly applicable algorithm, like this one, may allow for detection of rare outcomes or outcomes in populations historically excluded from genomic research through meta-analysis of data across health care systems.

The Related Role of Anxiety and Parental Resilience on the Aggressive Tendencies of Preschool Children during the COVID-19 Pandemic

In this study, we aimed to determine the related role of anxiety and parental resilience on the aggressive tendencies of preschool children during the COVID-19 pandemic. The study sample comprised a total of 293 parents with children aged 4-6 years. Relationships between Preschool Anxiety Scale, Aggression Orientation Scale, and Brief Resilience Scale total and subscale scores were evaluated using Pearson and Spearman correlation analysis. The results of this study show that there is a positive relationship between children's aggression tendencies and anxiety levels. We observed weak to moderate correlations between parents' resilience scores and the children's aggression and anxiety scores. Although linear regression analysis indicated no significant effect of parental resilience on children's aggressive tendencies, anxiety levels may be related. In addition, study results showed that the physical aggression tendencies of children differed according to their age and the number of children in the family, albeit at a low level. Further studies are needed to identify factors associated with aggression in preschool children.

Incidence and comorbidities of disruptive behavior disorders diagnosed in Finnish specialist psychiatric services

PURPOSE

Disruptive behavior disorders (DBD), including oppositional defiant disorder (ODD) and conduct disorder (CD), are some of the most common psychiatric conditions in childhood. Despite this, there has been limited research on DBDs. We examined the incidence, comorbidity and gender differences of DBDs diagnosed by specialist services.

METHOD

This was a nationwide register study of 570,815 children and adolescents born in 1996-2005. The 7050 individuals diagnosed with DBD by specialist healthcare services were matched to 26,804 controls.

RESULTS

By the age of 15, the cumulative incidence of diagnosed DBDs was 3.5% for boys and 1.4% for girls. The yearly incidence rate increased for girls after 13 years of age, while the incidence for boys was relatively stable between 8 and 15 years of age. When we compared subjects born between 1996-1998 and 1999-2001, we found that by the age of 12, the cumulative incidence per 100 people had increased from 0.56 to 0.68 among girls and from 2.3 to 2.6 among boys. This indicated a minor increase in treated incidence. The parents of children diagnosed with DBDs had lower educational levels than the parents of controls. Children with DBD were also more likely to have been diagnosed with other psychiatric disorders.

CONCLUSION

Although DBDs were 3.5 times more common among boys during the whole follow-up period, the yearly incidence during adolescence was fairly similar between boys and girls. DBD existed alongside various psychiatric disorders at a relatively young age and only a minor increase in treated incidence was found during childhood.

Are Traumatic Brain Injuries Associated With Criminality After Taking Account of Childhood Family Social Status and Disruptive Behaviors?

OBJECTIVE

The authors aimed to elucidate the links between traumatic brain injuries (TBIs) and criminal convictions in a sample of 724 Canadian males with and without criminal records followed up to age 24.

METHODS

Prospectively collected data were analyzed to determine whether prior TBIs predicted subsequent criminal convictions after taking account of family social status (FSS) and childhood disruptive behaviors. At age 24, diagnoses of TBIs were extracted from health records and convictions from official criminal records. In childhood, teachers rated disruptive behaviors and parents reported FSS.

RESULTS

Proportionately more individuals with offender status than nonoffender status sustained a TBI from age 18 to age 24 but not before age 18. Individuals with offender status who had sustained a TBI before and after their first conviction were similar in numbers, were raised in families of low social status, and presented high levels of disruptive behaviors from age 6 to age 12. When FSS and childhood disruptive behaviors were included in multivariable regression models, sustaining a prior TBI was not associated with an increased risk of juvenile convictions for any type of crime, for violent crimes, for convictions for any crime or violent crime from age 18 to age 24, or for a first crime or a first violent crime from age 18 to age 24.

CONCLUSIONS

Among males, there was no evidence that prior TBIs were associated with an increased risk of subsequent criminal convictions from age 12 to age 24 when taking account of FSS and childhood disruptive behaviors, although these latter factors may be associated with an increased prevalence of TBIs among adult offenders.

A prospective, longitudinal, study of men with borderline personality disorder with and without comorbid antisocial personality disorder

BACKGROUND

Some evidence suggests that the prevalence of Borderline Personality Disorder (BPD) is elevated among male criminal offenders. It is not presently known whether offending, and violent offending, are limited to those presenting comorbid Antisocial Personality Disorder (ASPD) who have a childhood history of conduct problems and whether offending is linked to psychopathic traits.

METHODS

A community sample of 311 males followed from age 6 to 33 years, one third of whom had a criminal charge between ages 18 and 24, completed diagnostic interviews and the Psychopathy Checklist-Revised interview. Information on childhood included parent-reported family characteristics and teacher-rated of hurtful and uncaring behaviours, conduct problems, hyperactivity and inattention, and anxiety at age 6, 10, and 12 years. Health files were obtained as were records of criminal convictions from age 12 to 33.

RESULTS

At age 33, 4% of the men presented BPD and not ASPD, 16% ASPD and not BPD, 8% BPD + ASPD, and 72% neither disorder (ND). Comorbid disorders were common: BPD were distinguished by high levels of anxiety disorders, BPD and BPD + ASPD by depression disorders, and BPD, BPD + ASPD, and ASPD by substance dependence. Official files indicated use of health services by all participants. One-third of participants with BPD and BPD + ASPD acquired a diagnosis of a personality disorder. More than one-third of participants with BPD + ASPD obtained scores indicative of the syndrome of psychopathy. Convictions for violent crimes varied across groups: In adolescence, BPD none, BPD + ASPD 16%, ASPD 16%, and ND 3.6%; from age 18 to 33, BPD 18%, ASPD 19%, BPD + ASPD 52%, and ND 4.4%. Offenders with BPD + ASPD were convicted, on average, for four times more violent crimes than offenders with ASPD and seven times more than ND offenders. In childhood, men with BPD + ASPD and with ASPD had obtained similarly elevated ratings for disruptive behaviours as compared to ND.

CONCLUSION

BPD comorbid with ASPD was associated with violent criminal offending in adolescence and most strongly in adulthood, elevated levels of psychopathic traits, and childhood disruptive behaviour. BPD showed similar characteristics but to a much less degree.

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

PURPOSE

The NESARC, a "third-generation" psychiatric epidemiologic survey that integrated detailed measures of alcohol and drug use and problems has been the data source for over >850 publications. A comprehensive review of NESARC findings and their implications is lacking.

METHOD

NESARC was a survey of 43,093 participants that covered alcohol, drug and psychiatric disorders, risk factors, and consequences. Wave 1 of the NESARC was conducted in 2001-2002. Three years later, Wave 2 follow-up re-interviews were conducted with 34,653 of the original participants. Scopus and Pubmed were used to search for NESARC papers, which were sorted into topic areas and summarized.

RESULT

The most common disorders were alcohol and posttraumatic stress disorders, and major depression. Females had more internalizing disorders and males had more externalizing disorders, although the preponderance of males with alcohol disorders (the "gender gap") was less pronounced than it was in previous decades. A race/ethnic "paradox" (lower risk among disadvantaged minorities than whites) remains unexplained. Younger participants had higher risk for substance and personality disorders, but not unipolar depressive or anxiety disorders. Psychiatric comorbidity was extensive and often formed latent trans-diagnostic domains. Since 1991-1992, risk for marijuana and prescription drug disorders increased, while smoking decreased, although smoking decreases were less pronounced among those with comorbidity. A nexus of comorbidity, social support, and stress predicted transitions in diagnostic status between Waves 1 and 2. Childhood maltreatment predicted psychopathology. Alcohol and drug use disorders were seldom treated; attitudinal barriers (little perceived need, perceived alcoholism stigma, pessimism about efficacy) were more important in predicting non-treatment than financial barriers.

CONCLUSIONS

Understanding comorbidity and the effects of early stressors will require research incorporating biologic components, e.g., genetic variants and brain imaging. The lack of treatment for alcohol and drug disorders, predicted by attitudinal rather than financial variables, suggests an urgent need for public and professional education to reduce the stigma associated with these disorders and increase knowledge of treatment options.

Psychiatric Symptom Clusters as Risk Factors for Alcohol Use Disorders in Adolescence: A National Study

BACKGROUND

Few epidemiologic studies have examined a full range of adolescent psychiatric disorders in the general population. The association between psychiatric symptom clusters (PSCs) and DSM-IV alcohol use disorders (AUDs) among adolescents is not well understood.

METHODS

This study draws upon the public-use data from the 2000 National Household Survey on Drug Abuse, including a study sample of 19,430 respondents aged 12 to 17. Logistic regression and exploratory structural equation modeling assess the associations between PSCs and DSM-IV AUDs by gender. The PSCs are based on brief screening scales devised from the Diagnostic Interview Schedule for Children Predictive Scales.

RESULTS

Several PSCs were found to be significantly associated with DSM-IV AUDs, including separation anxiety, generalized anxiety, depression, oppositional defiant disorder, and conduct disorder among both genders, and panic disorder and obsessive/ compulsive disorder among females. Consistent with the literature, the analysis of PSCs yields 3 factors identical for both genders-2 internalizing factors (fear and anxiety-misery) and 1 externalizing factor. Adolescents who scored higher on the externalizing factor tended to have higher levels of the AUD factor. Female adolescents who scored higher on the internalizing misery factor and lower on the internalizing fear factor also tended to have higher levels of the AUD factor.

CONCLUSIONS

The associations that we found between PSCs and AUDs among adolescents in this study are consistent with those found among adults in other studies, although gender may moderate associations between internalizing PSCs and AUDs. Our findings lend support to previous findings on the developmentally stable associations between disruptive behaviors and AUDs among adolescents as well as adults in the general population.

The impact of childhood symptoms of conduct disorder on driver aggression in adulthood

BACKGROUND

Despite limited empirical investigation, existing scientific literature suggests that individuals with a history or current diagnosis of conduct disorder (CD) may be more likely to demonstrate reckless and aggressive driving. Much of the limited research in this field examines the impact of childhood CD on driver behaviour and collision risk in young adults. Few if any, studies assess the impact of this disorder on driver behaviour beyond age 21 years. The current research is a population-based study of the impact of CD symptoms during childhood on the risk of engaging in driver aggression during adulthood.

METHODS

Data are based on telephone interviews with 5230 respondents who reported having driven in the past year. Data are derived from the 2011-2013 cycles of the CAMH Monitor, an ongoing cross-sectional survey of adults in Ontario, Canada aged 18 years and older. A binary logistic regression analysis of self-reported driver aggression in the previous 12 months was conducted, consisting of measures of demographic characteristics, driving exposure, problem substance use, alcohol- and drug-impaired driving, symptoms of attention deficit hyperactivity disorder, and childhood (before age 15) symptoms of CD.

RESULTS

When entered with demographic characteristics, driving exposure, and other potential confounders, childhood symptoms of CD increased the odds of reporting driver aggression more than two-fold (adjusted OR=2.12). Exploratory analyses of the interaction between childhood symptoms of CD and age was not a significant predictor of driver aggression.

CONCLUSIONS

Results suggest that symptoms of CD during childhood are associated with significantly increased odds of self-reported driver aggression during adulthood. Limitations and future directions of the research are discussed.

Epidemiology, Comorbidity, and Behavioral Genetics of Antisocial Personality Disorder and Psychopathy

Psychopathy is theorized as a disorder of personality and affective deficits while antisocial personality disorder (ASPD) diagnosis is primarily behaviorally based. While ASPD and psychopathy are similar and are highly comorbid with each other, they are not synonymous. ASPD has been well studied in community samples with estimates of its lifetime prevalence ranging from 1-4% of the general population.^4,5 In contrast, psychopathy is almost exclusively investigated within criminal populations so that its prevalence in the general population has been inferred by psychopathic traits rather than disorder (1%). Differences in etiology and comorbidity with each other and other psychiatric disorders of these two disorders are also evident. The current article will briefly review the epidemiology, etiology, and comorbidity of ASPD and psychopathy, focusing predominately on research completed in community and clinical populations. This paper aims to highlight ASPD and psychopathy as related, but distinct disorders.

Monoamine oxidase A gene promoter methylation and transcriptional downregulation in an offender population with antisocial personality disorder

BACKGROUND

Antisocial personality disorder (ASPD) is characterised by elevated impulsive aggression and increased risk for criminal behaviour and incarceration. Deficient activity of the monoamine oxidase A (MAOA) gene is suggested to contribute to serotonergic system dysregulation strongly associated with impulsive aggression and antisocial criminality.

AIMS

To elucidate the role of epigenetic processes in altered MAOA expression and serotonin regulation in a population of incarcerated offenders with ASPD compared with a healthy non-incarcerated control population.

METHOD

Participants were 86 incarcerated participants with ASPD and 73 healthy controls. MAOA promoter methylation was compared between case and control groups. We explored the functional impact of MAOA promoter methylation on gene expression in vitro and blood 5-HT levels in a subset of the case group.

RESULTS

Results suggest that MAOA promoter hypermethylation is associated with ASPD and may contribute to downregulation of MAOA gene expression, as indicated by functional assays in vitro, and regression analysis with whole-blood serotonin levels in offenders with ASPD.

CONCLUSIONS

These results are consistent with prior literature suggesting MAOA and serotonergic dysregulation in antisocial populations. Our results offer the first evidence suggesting epigenetic mechanisms may contribute to MAOA dysregulation in antisocial offenders.

The health consequences of child mental health problems and parenting styles: unintentional injuries among European schoolchildren

OBJECTIVE

Unintentional injury is the leading cause of death for schoolchildren. We assessed the association between externalizing psychopathology, parenting style, and unintentional injury in European children in the community.

METHODS

Data were drawn from the School Children Mental Health in Europe project and included 4517 schoolchildren across seven diverse European regions. Past-year injuries serious enough to seek medical attention were reported by mothers. Child mental health problems were assessed using validated measures and reported by the mothers, teachers, and children. Parenting styles were based on The Parenting Scale and the Parent Behaviors and Attitudes Questionnaire.

RESULTS

Children with attention-deficit/hyperactivity symptoms and oppositional defiant symptoms had a higher risk of injury compared to other children whether based on parent report (OR=1.47, 95% C.I. 1.2-1.9), teacher report (OR=1.36, 95% C.I. 1.1-1.7), or parent and teacher report combined (OR=1.53, 95% C.I. 1.1-2.1). Children who self-reported oppositional symptoms also had higher risk of injury (OR=1.6, 95% C.I. 1.1-2.4). Low-caring behavior of parents increased the risk of injury (OR=1.4, 95% C.I. 1.1-1.9).

CONCLUSION

Unintentional injury is a potential adverse health consequence of child externalizing problems. Interventions to improve parent-child relationships and prevention as well as focused treatment for externalizing problems may reduce the burden of injury.

Associations Between Dysfunctional Personality Traits and Intimate Partner Violence in Perpetrators and Victims

In the current study, the role of borderline and antisocial personality traits and psychological and physical forms of intimate partner violence were examined. Using self- and partner-reports, 30 perpetrators (28 males) and 30 victims (29 females) of partner violence, including 23 (former) couples, were interviewed. Results showed that perpetrators (i.e., males) were higher on antisocial personality traits than victims (i.e., females), but the two groups did not differ on borderline traits and self-reported violence. Moreover, borderline traits were associated with partner violence in general, whereas antisocial personality traits were associated with physical, but not psychological, partner violence. Analyses on (former) couples suggest that there is little congruence between perpetrators' and victims' reports of partner violence. In conclusion, the findings of the current study not only emphasized the complex nature of intimate partner violence but also showed that dysfunctional personality traits and gender play a significant role in both the display and reporting of partner violence.

Adult antisocial syndrome co-morbid with borderline personality disorder is associated with severe conduct disorder, substance dependence and violent antisociality

This study tested the hypothesis that syndromal adult antisocial behaviour (AABS) co-morbid with borderline personality disorder (BPD) is a syndrome that emerges from severe conduct disorder (CD) in childhood and adolescence and is strongly associated, in adulthood, with both violence and substance dependence. In a sample of 8 580 community-resident adults screened for the presence of personality disorders, the following predictions arising from this hypothesis were tested: first, that those with AABS co-morbid with BPD would, in comparison with those showing AABS or BPD only, show a high level of antisocial outcomes, including violence; second, that adjusting for co-morbid alcohol dependence would attenuate group differences in many of the antisocial outcomes, and violence in particular; and third, that the AABS/BPD group would show both a high prevalence and a high severity of CD, and that adjusting for co-morbid CD would attenuate any association found between AABS/BPD co-morbidity and violence. Results confirmed these predictions, suggesting that AABS/BPD co-morbidity mediates the relationship between childhood CD and a predisposition to adult violence. The triad of AABS/BPD co-morbidity, alcohol dependence and severe CD is likely associated with the risk of criminal recidivism in offenders with personality disorder following release into the community.

Differential relationships of impulsivity or antisocial symptoms on P50, N100, or P200 auditory sensory gating in controls and antisocial personality disorder

Limited information is available on the relationship between antisocial personality disorder (ASPD) and early filtering, or gating, of information, even though this could contribute to the repeatedly reported impairment in ASPD of higher-order information processing. In order to investigate early filtering in ASPD, we compared electrophysiological measures of auditory sensory gating assessed by the paired-click paradigm in males with ASPD (n = 37) to healthy controls (n = 28). Stimulus encoding was measured by P50, N100, and P200 auditory evoked potentials; auditory sensory gating (ASG) was measured by a reduction in amplitude of evoked potentials following click repetition. Effects were studied of co-existing past alcohol or drug use disorders, ASPD symptom counts, and trait impulsivity. Controls and ASPD did not differ in P50, N100, or P200 amplitude or ASG. Past alcohol or drug use disorders had no effect. In controls, impulsivity related to improved P50 and P200 gating. In ASPD, P50 or N100 gating was impaired with more symptoms or increased impulsivity, respectively, suggesting impaired early filtering of irrelevant information. In controls the relationship between P50 and P200 gating and impulsivity was reversed, suggesting better gating with higher impulsivity scores. This could reflect different roles of ASG in behavioral regulation in controls versus ASPD.

Classes of conduct disorder symptoms and their life course correlates in a US national sample

BACKGROUND

Population data on conduct disorder (CD) symptoms can help determine whether hypothesized subtypes of CD are sufficiently disparate in their familial, psychiatric and life course correlates to distinguish separate diagnostic entities.

METHOD

Latent class analysis (LCA) of CD symptoms occurring before age 15 was conducted in a national sample of adults aged 18-44 years from the National Epidemiological Study of Alcohol and Related Conditions. Associations of latent class membership with parental behavior problems, onset of psychiatric disorders and anti-social behaviors after age 15, adolescent life events (e.g. high school drop-out), and past-year life events (e.g. divorce/separation, bankruptcy) were estimated.

RESULTS

LCA identified a no-CD class with low prevalence of all symptoms, three intermediate classes - deceit/theft, rule violations, aggression - and a severe class. The prevalence of CD, according to DSM-IV criteria, was 0% in the no-CD class, between 13.33% and 33.69% in the intermediate classes and 62.20% in the severe class. Latent class membership is associated with all the familial, psychiatric and life course outcomes examined. Among the intermediate classes, risk for subsequent mood/anxiety disorders and anti-social behavior was higher in the deceit/theft and aggressive classes than in the rule violations class. However, risk for adolescent life events is highest in the rule violations class.

CONCLUSIONS

CD symptoms tend to occur in a partially ordered set of classes in the general population. Prognostically meaningful distinctions can be drawn between classes, but only at low levels of symptoms.

Störungen des Sozialverhaltens

Dieser Beitrag diskutiert die prädiktive Validität der allgemeinen Diagnosekriterien von Störungen des Sozialverhaltens nach ICD-10 und DSM-IV-TR. Dabei wird Bezug genommen auf aktuelle Befunde, die eine Phänotypisierung früh beginnender Störungen des Sozialverhaltens auf der Basis neurobiologischer und persönlichkeitsspezifischer Faktoren nahelegen. Untersuchungsergebnisse, die auf defizitäre neurobiologische Mechanismen aggressiven Verhaltens in Bezug auf Prozesse der Emotionswahrnehmung und Emotionsregulation hinweisen, werden dargestellt, wobei auch die Bedeutung möglicher mediierender Einflüsse früher psychosozialer Erfahrungen auf neurobiologische Funktionen erörtert wird. Die klinischen Implikationen für die Klassifikation, den Verlauf und die Behandlung von Störungen des Sozialverhaltens werden abschließend diskutiert.

Psychiatric correlates of behavioral indicators of school disengagement in the United States

The current study examined relations between behavioral indicators of school disengagement and psychiatric disorders. Data was derived from a nationally representative sample of U.S. adults (N = 43,093). Indicators of school disengagement and diagnoses of personality, substance use, mood, and anxiety disorders were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV-version. Findings from multinomial logistic regression analyses revealed that cumulative school disengagement is associated with increased odds of reporting a lifetime psychiatric disorder and general antisociality. Behavioral indicators of school disengagement such as absenteeism and cutting class are potentially important signs of psychiatric distress and conduct problems. In addition to attending to academic achievement outcomes school disengagement prevention strategies should consider targeting these psychiatric conditions in order to reduce school dropout.

Contributors to traumatic exposure and posttraumatic stress disorder in juvenile justice youths

This study considers demographic, offense, and disorder contributors to exposure and posttraumatic stress disorder (PTSD) in a large (N = 9,611) dataset of standardized psychiatric assessments resulting from nationwide collaborations with justice agencies. Youths' antisocial history may elevate risk for traumatic exposure and PTSD; additionally, traumatic victimization increases risk for externalizing behavior. Rates of all types of traumatic exposure and PTSD were clearly elevated and expectably related to disorder and antisocial behavior. Males were significantly more likely than females to report assaultive violence, whereas females were significantly more likely than males to report forced sexual activity. Gender interactions with disorder and antisocial behavior were contributory only in predicting forced sexual activity: females' exposure was not conditional on features characterizing males' exposure. Findings highlight the high levels of trauma exposure at all levels of juvenile justice processing, and the particular vulnerability of males with internalizing psychopathology. Consistent with increased recent interest in the diagnosis of developmental trauma disorder, and given the likely interconnectedness between traumatic exposure and externalizing symptoms, treatment approaches for justice youths should address their co-occurrence.

Post-weaning social isolation induces abnormal forms of aggression in conjunction with increased glucocorticoid and autonomic stress responses

We showed earlier that social isolation from weaning (a paradigm frequently used to model social neglect in children) induces abnormal forms of attack in rats, and assumed that these are associated with hyperarousal. To investigate this hypothesis, we deprived rats of social contacts from weaning and studied their behavior, glucocorticoid and autonomic stress responses in the resident-intruder paradigm at the age of 82 days. Social isolation resulted in abnormal attack patterns characterized by attacks on vulnerable targets, deficient social communication and increased defensive behaviors (defensive upright, flight, freezing). During aggressive encounters, socially deprived rats rapidly switched from one behavior to another, i.e. showed an increased number of behavioral transitions as compared to controls. We tentatively term this behavioral feature "behavioral fragmentation" and considered it a form of behavioral arousal. Basal levels of plasma corticosterone regularly assessed by radioimmunoassay between 27 and 78 days of age were not affected. In contrast, aggression-induced glucocorticoid responses were approximately doubled by socially isolation. Diurnal oscillations in heart rate assessed by in vivo biotelemetry were not affected by social isolation. In contrast, the aggression-induced increase in heart rate was higher in socially isolated than in socially housed rats. Thus, post-weaning social isolation induced abnormal forms of aggression that developed on the background of increased behavioral, endocrine and autonomic arousal. We suggest that this paradigm may be used to model aggression-related psychopathologies associated with hyperarousal, particularly those that are triggered by adverse rearing conditions.

Sociodemographic, behavioral, and substance use correlates of reckless driving in the United States: findings from a national Sample

This study examined the sociodemographic, behavioral, psychiatric, and substance use correlates of three forms of reckless driving using a nationally representative sample of U.S. adults. Participants were 43,093 adults from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Interviewers administered the Alcohol Use Disorder and Associated Disabilities Interview Schedule--DSM-IV version (AUDADIS-IV). This measure provides extensive sociodemographic data as well as diagnoses for mood, anxiety, personality, and substance use disorders. Reckless driving was significantly associated with male gender, lower levels of income, being born in the U.S., and numerous forms of antisocial behaviors. Fully adjusted models revealed significant effects with respect to substance use disorders across categories of reckless drivers with those having their licenses revoked or suspended being particularly more likely to be diagnosed with antisocial (AOR = 3.35, 95% CI = 2.54, 4.42) and paranoid personality disorder (AOR = 1.56, 95% CI = 1.07, 2.29). All three reckless driving groups were more likely to have a family history of antisocial behavior than non-reckless drivers. Study findings provide information from which targeted behavioral interventions can be applied.

Conduct disorder and psychosocial outcomes at age 30: early adult psychopathology as a potential mediator

Conduct disorder (CD) is associated with a number of adverse psychosocial outcomes in adulthood. There is consistent evidence that CD is predictive of antisocial behavior, but mixed evidence that CD is predictive of other externalizing and internalizing disorders. Further, externalizing and internalizing disorders are often associated with similar psychosocial outcomes as CD. However, relatively little work has examined whether forms of psychopathology (e.g., externalizing and/or internalizing disorders) mediates the relationship between youth CD and adult psychosocial outcomes. The present study examined associations between youth CD and adult psychosocial outcomes and sought to identify forms of psychopathology that may potentially mediate this relationship. Participants completed self-report measures of psychosocial functioning and semi-structured diagnostic interviews during adolescence and young adulthood. Analyses found that most domains of adult psychosocial functioning were associated with youth CD. Adult antisocial behavior was the only form of psychopathology predicted by CD. Adult antisocial behavior appeared to mediate the relationship between CD and marital status, life satisfaction, and being in jail and partially mediated the relationship between CD and family support and global functioning. These data suggest that reducing the progression to adult antisocial behavior may improve multiple psychosocial outcomes among those with a history of CD.

The Severe 5%: A Latent Class Analysis of the Externalizing Behavior Spectrum in the United States

OBJECTIVE: Criminological research consistently demonstrates that approximately 5% of study populations are comprised of pathological offenders who account for a preponderance of antisocial behavior and violent crime. Unfortunately, there have been no nationally representative epidemiological studies characterizing the severe 5% group. MATERIALS AND METHODS: Data from the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a nationally representative sample of 43,093 non-institutionalized U.S. residents aged 18 years and older were analyzed using latent class analysis to assess sociodemographic, psychiatric, and behavioral characteristics. RESULTS: Four-classes of respondents were identified vis-à-vis lifetime externalizing behaviors. A normative class (66.1% of respondents) demonstrated little involvement in antisocial conduct. A low substance use/high antisocial behavior class (20.7% of respondents) and high substance use/moderate antisocial behavior (8.0% of respondents) class evinced diverse externalizing and psychiatric symptoms. Finally, a severe class (5.3% of respondents) was characterized by pathological involvement in more varied and intensive forms of antisocial and externalizing behaviors and extensive psychiatric disturbance. CONCLUSIONS: The current study is the first nationally representative epidemiological study of criminal careers/externalizing behavior spectrum in the United States and validates the existence of the 5% pathological group demonstrated by prior research.

Family conflict and childhood aggression: the role of child anxiety

Family conflict and childhood anxiety has been implicated in the development of aggressive behaviors, but the nature of these relationships has not been fully explored. Thus, the present study examined the role of anxiety in moderating the relationship between family conflict and childhood aggression in 50 children aged 7 to 13 years. Specifically, the study proposed that family conflict would be positively related to aggression in the context of higher levels of child anxiety. Parents completed self-report instruments examining family conflict and aggressive behavior exhibited by their children. Children completed a self-report measure of anxiety. The hypothesis was partially supported as family conflict was related to increased proactive but not reactive aggression in children with high levels of anxiety. Implications of these findings are discussed.

Psychiatric correlates of bullying in the United States: findings from a national sample

The aim of this study was to examine the psychiatric correlates of bullying behavior in the United States. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US adults. Structured psychiatric interviews (N = 43,093) were completed by trained lay interviewers between 2001 and 2002. Six percent of US adults reported a lifetime history of bullying others. Respondents who were men, 18 to 34, Asian/Native American, earned <or=$35,000 annually, were born in the US, and received no college education had significantly higher rates of bullying. Multivariate logistic regression analyses identified significant associations between bullying and bipolar disorder, lifetime alcohol and marijuana use disorders, nicotine dependence, conduct disorder, antisocial, paranoid, and histrionic personality disorders, and family history of antisocial behavior. Prevention and treatment targeting bullying behaviors, comorbid conditions, and their precursors could potentially reduce the prevalence and consequences of bullying.

Inhalant use, inhalant-use disorders, and antisocial behavior: findings from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC)

OBJECTIVE

Few studies have explored the topography of antisocial behavior in a nationally representative sample of inhalant users. We examined (a) the lifetime prevalence of 20 childhood and adult antisocial behaviors in inhalant users with inhalant-use disorders (IUD+) and without IUDs (IUD-); (b) the nature and strength of associations between inhalant use, IUDs, and specific antisocial behaviors in multivariate analyses; and (c) the relationships between inhalant use, IUDs, and antisocial behaviors in a national sample of adults with antisocial personality disorder.

METHOD

The National Epidemiologic Survey on Alcohol and Related Conditions was a multistage national survey of 43,093 U.S. residents. Respondents completed a structured psychiatric interview.

RESULTS

IUD+ and IUD- respondents were significantly younger and more likely to be unemployed, to be male, to have never married, and to report family and personal histories of alcohol and drug problems than inhalant nonusers. Family histories of alcohol problems and personal histories of drug problems were significantly more prevalent among IUD+ respondents, compared with IUD- respondents. In bivariate analyses, IUD+ and IUD- respondents evidenced significantly higher lifetime levels of all childhood and adult antisocial behaviors than inhalant nonusers. IUD+ respondents were significantly more likely than their IUD- counterparts to report bullying behavior, starting physical fights, using dangerous weapons, physical cruelty to people, staying out all night without permission, running away, and frequent truancy in childhood, as well as greater deceitfulness, impulsivity, irritability/aggressiveness, recklessness, and irresponsibility in adulthood. Multivariate analyses indicated that IUD+ respondents had a significantly elevated risk for childhood and adult antisocial behaviors, compared with inhalant nonusers, with the strongest effects for using dangerous weapons, physical cruelty to animals, and physical cruelty to people. Similarly, IUD+ respondents differed significantly from their IUD- counterparts primarily across measures of interpersonal violence. Among persons with antisocial personality disorder, inhalant use and IUDs were associated with greater antisocial behavior, albeit with fewer and weaker effects.

CONCLUSIONS

Respondents with IUDs had pervasively elevated levels of antisocial conduct, including diverse forms of early-onset and interpersonally violent behavior.

Prevalence and correlates of fire-setting in the United States: results from the National Epidemiological Survey on Alcohol and Related Conditions

Fire-setting is a serious and costly form of antisocial behavior. Our objective in this study was to examine the prevalence and correlates of intentional fire-setting behavior in the United States. Data were derived from a nationally representative sample of US residents 18 years and older. Structured psychiatric interviews (N = 43,093) were completed by trained lay interviewers between 2001 and 2002. Fire-setting as well as mood, anxiety, substance use, and personality disorders of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) version. The prevalence of lifetime fire-setting in the US population was 1.0%. Respondents who were men, white, 18 to 35 years old, born in the United States, and living in the western region of the United States had significantly higher rates of fire-setting than their counterparts. Fire-setting was significantly associated with a wide range of antisocial behaviors. Multivariate logistic regression analyses identified strong associations between lifetime alcohol and marijuana use disorders, conduct disorder, antisocial and obsessive-compulsive personality disorders, and family history of antisocial behavior. Intentional illicit fire-setting behavior is associated with a broad array of antisocial behaviors and psychiatric comorbidities. Given the substantial personal and social costs related to arson, prevention and treatment interventions targeting fire-setters potentially could save lives and property.

Heritability of MMPI-2 scales in the UCSF family alcoholism study

The current study evaluated the heritability of personality traits and psychopathology symptoms assessed by the Minnesota Multiphasic Personality Inventory 2nd Edition (MMPI-2) in a family-based sample selected for alcohol dependence. Participants included 950 probands and 1,204 first-degree relatives recruited for the University of California at San Francisco (UCSF) Family Alcoholism Study. Heritability estimates for MMPI-2 scales ranged from .25 to .49. When alcohol dependence was used as a covariate, heritability estimates remained significant but generally declined. However, when the MMPI-2 scales were used as covariates to estimate the heritability of alcohol dependence, the scales measuring antisocial behavior, depressive symptoms, and addictive behavior led to moderate increases in the heritability of alcohol dependence. This suggests that the scales may explain some of the non-genetic variance in the alcohol dependence diagnosis in this population when used as covariates, and thus may serve to produce a more homogeneous and heritable alcohol-dependence phenotype.

Social anxiety disorder: questions and answers for the DSM-V

BACKGROUND

This review evaluates the DSM-IV criteria of social anxiety disorder (SAD), with a focus on the generalized specifier and alternative specifiers, the considerable overlap between the DSM-IV diagnostic criteria for SAD and avoidant personality disorder, and developmental issues.

METHOD

A literature review was conducted, using the validators provided by the DSM-V Spectrum Study Group. This review presents a number of options and preliminary recommendations to be considered for DSM-V.

RESULTS/CONCLUSIONS

Little supporting evidence was found for the current specifier, generalized SAD. Rather, the symptoms of individuals with SAD appear to fall along a continuum of severity based on the number of fears. Available evidence suggested the utility of a specifier indicating a "predominantly performance" variety of SAD. A specifier based on "fear of showing anxiety symptoms" (e.g., blushing) was considered. However, a tendency to show anxiety symptoms is a core fear in SAD, similar to acting or appearing in a certain way. More research is needed before considering subtyping SAD based on core fears. SAD was found to be a valid diagnosis in children and adolescents. Selective mutism could be considered in part as a young child's avoidance response to social fears. Pervasive test anxiety may belong not only to SAD, but also to generalized anxiety disorder. The data are equivocal regarding whether to consider avoidant personality disorder simply a severe form of SAD. Secondary data analyses, field trials, and validity tests are needed to investigate the recommendations and options.

Criminal victimization and comorbid substance use and psychiatric disorders in the United States: results from the NESARC

PURPOSE

Criminal victimization produces enormous personal and societal costs, yet few investigations have systematically examined substance use and psychiatric disorders of crime victims. Our objectives were to (i) examine the prevalence and patterns of criminal victimization in the United States and (ii) their associations with specific substance use disorders, prevalent psychiatric conditions, and violent and nonviolent antisocial behaviors in controlled multivariate analyses.

METHODS

Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions, a nationally representative sample of US residents 18 years of age and older (N=43,093). Interviews conducted between 2001 and 2002 included measures of past-year criminal victimization and Diagnostic and Statistical Manual of Mental Disorders, IV mood, anxiety, substance use, and personality disorders.

RESULTS

More than 1-in-25 adults in the United States (4.1%) reported past-year criminal victimization. Respondents who reported lower levels of income, lived in urban areas, and were separated or divorced were at significantly heightened risk for criminal victimization. Persons reporting various forms of violent and nonviolent antisocial behavior also were more likely to be victims of crime. In controlled multivariate analyses, crime victims evidenced significantly increased rates of alcohol, cocaine, and opioid use disorders. Paranoid personality disorder, major depressive disorder, and a family history of antisocial behavior were also significantly associated with past-year criminal victimization.

CONCLUSIONS

Criminal victimization is prevalent in the United States and associated with significant psychiatric comorbidities and behavioral dysfunction. Poor, unmarried persons living in urban areas who have family histories of antisocial conduct and personal histories of specific substance use and psychiatric disorders are at substantially elevated risk for criminal victimization.

EEG spectral phenotypes: heritability and association with marijuana and alcohol dependence in an American Indian community study

Native Americans have some of the highest rates of marijuana and alcohol use and abuse, yet neurobiological measures associated with dependence on these substances in this population remain unknown. The present investigation evaluated the heritability of spectral characteristics of the electroencephalogram (EEG) and their correlation with marijuana and alcohol dependence in an American Indian community. Participants (n=626) were evaluated for marijuana (MJ) and alcohol (ALC) dependence, as well as other psychiatric disorders. EEGs were collected from six cortical sites and spectral power determined in five frequency bands (delta 1.0-4.0 Hz, theta 4.0-7.5 Hz, alpha 7.5-12.0 Hz, low beta 12.0-20.0 Hz and high beta/gamma 20-50 Hz). The estimated heritability (h(2)) of the EEG phenotypes was calculated using SOLAR, and ranged from 0.16 to 0.67. Stepwise linear regression was used to detect correlations between MJ and ALC dependence and the spectral characteristics of the EEG using a model that took into account: age, gender, Native American Heritage (NAH) and a lifetime diagnosis of antisocial personality and/or conduct disorder (ASPD/CD). Increases in spectral power in the delta frequency range, were significantly correlated with gender (p<0.001) and marijuana dependence (p<0.003). Gender, age, NAH and ASPD/CD were all significantly (p<0.001) correlated with theta, alpha and beta band power, whereas alcohol dependence (p<0.01), gender (p<0.001), and ASPD/CD (p<0.001) were all correlated with high beta/gamma band power. These data suggest that the traits of EEG delta and high beta/gamma activity are correlated with MJ dependence and alcohol dependence, respectively, in this community sample of Native Americans.

Correlates of cruelty to animals in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

To examine the sociodemographic, behavioral, and psychiatric correlates of cruelty to animals in the US.

MATERIALS AND METHODS

Data were derived from a nationally representative sample of adults residing in the US Structured psychiatric interviews (N=43,093) were completed by trained lay interviewers between 2001 and 2002. Personality, substance use, mood, and anxiety disorders and cruelty to animals were assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (DSM-IV) version.

RESULTS

The lifetime prevalence of animal cruelty in US adults was 1.8%. Men, African-Americans, Native-Americans/Asians, native-born Americans, persons with lower levels of income and education and adults living the western region of the US reported comparatively high levels of cruelty to animals, whereas Hispanics reported comparatively low levels of such behavior. Cruelty to animals was significantly associated with all assessed antisocial behaviors. Adjusted analyses revealed strong associations between lifetime alcohol use disorders, conduct disorder, antisocial, obsessive-compulsive, and histrionic personality disorders, pathological gambling, family history of antisocial behavior, and cruelty to animals.

CONCLUSIONS

Cruelty to animals is associated with elevated rates observed in young, poor, men with family histories of antisocial behavior and personal histories of conduct disorder in childhood, and antisocial, obsessive-compulsive and histrionic personality disorders, and pathological gambling in adulthood. Given these associations, and the widespread ownership of pets and animals, effective screening of children, adolescents and adults for animal cruelty and appropriate mental health interventions should be deployed.

[Prevalence and factors associated with behavioral disorders in adolescents: a population-based study]

This study proposed to estimate the prevalence of behavioral disorders and associated factors in adolescents (11-15 years), using a cross-sectional design (n = 1,145). Subjects answered a self-administered questionnaire. Behavioral disorder was assessed with the Mini International Neuropsychiatric Interview (MINI). The study analyzed disorders in relation to gender, age, socioeconomic status, schooling, failure in school, religion, smoking, sedentary lifestyle, alcohol consumption, drug use, depression, and bullying (as victim). Ordinal regression was used for the statistical analysis, with a hierarchical model for the outcome. An estimated 29.2% of the sample presented behavioral disorders. In the multivariate analysis, the odds ratio for a male adolescent to present one additional point on the behavioral disorder scale was 2.04 (95%CI: 1.53-2.71). Alcohol consumption, drug use, and suffering bullying were associated with higher scores on the behavioral disorder scale. The findings also showed that the factors associated with behavioral disorder showed a strong interrelationship between health behaviors in adolescence.

Predictors of illicit substance dependence among individuals with alcohol dependence

OBJECTIVE

Individuals with alcohol dependence (AD) are at increased risk for developing dependence on illicit and prescription drugs. The goal of this cross-sectional study was to identify factors associated with drug dependence among individuals with AD.

METHOD

The sample consisted of 855 adults from the Irish Affected Sib Pair Study of Alcohol Dependence who were treated in inpatient or outpatient alcohol treatment programs and met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for lifetime AD. We studied predictors of dependence on six classes of drugs: cannabis, sedatives, stimulants, cocaine, opioids, and hallucinogens. Potential predictors examined included gender, age, education, and socioeconomic status; the personality traits of extraversion, neuroticism, and novelty seeking; conduct disorder, major depressive disorder, nicotine dependence, age at onset of alcohol use, early illicit drug use, and parental AD.

RESULTS

Nicotine dependence, depression that began before substance use, and drug use before age 19 each increased the risk for dependence on several substance classes. Male gender, younger age, maternal AD, fewer years of education, higher neuroticism scores, conduct disorder, and early alcohol use each increased the risk of dependence on one or more substance classes.

CONCLUSIONS

Among individuals in treatment for AD, cigarette smoking, early onset of major depression, and early drug use were associated with increased risk for drug dependence. These results suggest individuals with these risk factors may benefit from more intensive screening to prevent the onset of or to identify and treat drug dependence.

Psychiatric comorbidity more common among adolescent females with CD/ODD than among males

Clinicians and researchers have been increasingly concerned on conduct problems among adolescent females. Yet, most research on the issue has been conducted among males. The aim of this study was to characterize conduct disorder (CD) among adolescent females in comparison with males. Family background, symptoms and severity of CD, and psychiatric comorbidity were assessed among Finnish 12-18-year-old females (n=40) with conduct disorder/oppositional defiant disorder (CD/ODD) compared with males (n=37). Data were collected via structured interviews with the subjects and interviews with parents. Lifetime and current Axis I diagnoses (DSM-IV) were assessed using the Structured Clinical Interview (SCID-I) interview. No gender differences were found in the number of CD symptoms or aggressive symptoms. Family adversities, comorbid major depression, anxiety disorders and substance use disorders as well as suicidality were more common, while reading disorder was less common among girls compared with boys. The varied problems and comorbid disorders among females with CD/ODD are important to recognize.

Externalizing disorders in American Indians: comorbidity and a genome wide linkage analysis

Alcohol dependence is one of the leading causes of morbidity and mortality in Native Americans. Externalizing disorders such as conduct disorder (CD) and antisocial personality disorder (ASPD) have been demonstrated to have significant comorbidity with alcohol dependence in the general population. This study's aims were to: assess the comorbidity of DSM-III-R ASPD and CD with alcohol dependence, to map susceptibility loci for ASPD and CD, and to see if there is overlap with loci previously mapped for alcohol dependence phenotypes in 587 American Indians. Alcohol dependence was found to be comorbid with DSM-III-R ASPD but not CD. However, the amount of alcohol dependence in the population attributable to ASPD and/or CD is low. ASPD and the combined phenotype of participants with ASPD or CD were both found to have significant heritability, whereas no significant evidence was found for CD alone. Genotypes were determined for a panel of 791 micro-satellite polymorphisms in 251 of the participants. Analyses of multipoint variance component LOD scores, for ASPD and ASPD/CD, revealed six locations that had a LOD score of 2.0 or above: on chromosome 13 for ASPD and on chromosomes 1, 3, 4, 14, 17, and 20 for ASPD/CD. These results corroborate the importance of several chromosomal regions highlighted in prior segregation studies for externalizing diagnoses. These results also further identify new regions of the genome, that do not overlap with alcohol dependence phenotypes previously identified in this population, that may be unique to either the phenotypes evaluated or this population of American Indians.

Antisocial behavioral syndromes in cocaine and cannabis dependence

Antisocial personality disorder (ASPD) is highly associated with substance use disorders (SUD). In addition to the full ASPD syndrome, which requires both childhood conduct disorder and the adult features, other antisocial behavioral syndromes, including conduct disorder (CD) alone without the adult syndrome, and the adult antisocial behavioral syndrome without childhood CD (AABS) are also frequently diagnosed in patients with SUD. The aim of this study was to compare the rates of these various ASPD syndromes between cocaine- and cannabis-dependent individuals seeking treatment. A structured interview for ASPD excluding symptoms that occurred solely in the context of substance use was conducted in 241 outpatients (cocaine dependence, n = 111; cannabis dependence, n = 130). Overall, the proportion of substance-dependent individuals in this study with AABS was significantly larger than the proportion with ASPD (30.9% vs. 17.3%). A diagnosis of CD-only, where CD did not progress to ASPD, was uncommon. No significant differences in the prevalence of antisocial behavioral syndrome diagnoses were found between cocaine- and cannabis-dependent patients. Antisocial behavioral syndrome diagnosis did not influence treatment retention. Antisocial behavioral syndromes are commonly diagnosed in patients with SUD and future research should evaluate prognostic implications of AABS compared to ASPD in a variety of clinical treatment settings.

Association of environmental toxicants and conduct disorder in U.S. children: NHANES 2001-2004

OBJECTIVE

The purpose of this study was to examine the association of tobacco smoke and environmental lead exposure with conduct disorder (CD).

METHODS

The National Health and Nutrition Examination Survey (NHANES) 2001-2004 is a nationally representative cross-sectional sample of the noninstitutionalized U.S. population. We examined the association of prenatal tobacco, postnatal tobacco, and environmental lead exposure with CD in children 8-15 years of age (n = 3,081). We measured prenatal tobacco exposure by parent report of cigarette use during pregnancy, and postnatal tobacco using serum cotinine levels. We assessed lead exposure using current blood lead concentration. Parents completed the Diagnostic Interview Schedule for Children to determine whether their children met criteria of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV ) for CD.

RESULTS

Overall, 2.06% of children met DSM-IV criteria for CD in the past year, equivalent to 560,000 U.S. children 8-15 years of age. After adjustment, prenatal tobacco exposure was associated with increased odds for CD [odds ratio (OR) = 3.00; 95% confidence interval (CI), 1.36-6.63]. Increased blood lead levels (fourth vs. first quartile) and serum cotinine levels (fifth vs. first quintile) were associated with an 8.64-fold (95% CI, 1.87-40.04) and 9.15-fold (95% CI, 1.47-6.90) increased odds of meeting DSM-IV CD criteria. Increasing serum cotinine levels and blood lead levels were also associated with increased prevalence of CD symptoms (symptom count ratio, lead: 1.73; 95% CI, 1.23-2.43; symptom count ratio, cotinine: 1.97; 95% CI, 1.15-3.40).

CONCLUSIONS

These results suggest that prenatal tobacco exposure and environmental lead exposure contribute substantially to CD in U.S. children.