Diagnosis and Subtypes of Adolescent Antisocial Personality Disorder

Abstract

The present study examined the application of the Antisocial Personality Disorder (APD) diagnosis to adolescents and investigated the possibility of subtypes of APD adolescents. As part of a broader study of adolescent personality in clinically-referred patients, experienced clinicians provided personality data on a randomly selected patient in their care using the SWAP-II-A personality pathology instrument. Three hundred thirteen adolescents met adult DSM-IV diagnostic criteria for APD. To characterize adolescents with the disorder, we aggregated the data to identify the items most descriptive and distinctive of APD adolescents relative to other teenagers in the sample (N = 950). Q-factor analysis identified five personality subtypes: psychopathic-like, socially withdrawn, impulsive-histrionic, emotionally dysregulated, and attentionally dysregulated. The five subtypes differed in predictable ways on a set of external criteria related to global adaptive functioning, childhood family environment, and family history of psychiatric illness. Both the APD diagnosis and the empirically derived APD subtypes provided incremental validity over and above the DSM-IV disruptive behavior disorders in predicting global adaptive functioning, number of arrests, early-onset severe externalizing pathology, and quality of peer relationships. Although preliminary, these results provide support for the use of both APD and personality-based subtyping systems in adolescents.

Personality Subtypes of Adolescents Who Attempt Suicide

“…Given the correlates, it is reasonable to hypothesize that this subtype may represent adolescents who are later diagnosed as having BPD. The relationships between this Q-factor and clinician-reported symptoms of BPD certainly support this hypothesis, but it should be cautioned that emotional dysregulation is an underlying feature of many psychiatric disorders (Jones and Westen, 2010;Powers and Westen, 2009;Thompson-Brenner et al, 2008).…”

“…DeFife et al (2010) demonstrated that clinician-report and self-report are significantly positively correlated and that clinicianreport data are highly correlated with data obtained via structured interview by an independent assessor. In addition, other studies have been published using data on which the current study is based and address separate topics, such as eating disorders and antisocial personality (Blagov and Westen, 2008;DiLallo et al, 2009;Jones and Westen, 2010;Thompson-Brenner et al, 2008).…”

Emotion Dysregulation and Negative Affect

“…Conversely, studies 65–68 focused on heterogeneity within psychiatric diagnoses suggest that subtypes of multiple psychiatric disorders (eg, eating disorders, personality disorders, anxiety disorders, and mood disorders) may be associated with varying degrees of emotion dysregulation. 65–68 Alternately, the relationship between emotion dysregulation and some psychological disorders may be an interactive cascade in which emotion dysregulation increases vulnerability for the development of psychiatric disorders that in turn exacerbate emotion dysregulation. In PTSD, the presence of trauma-related cues may lead to emotion dysregulation that in turn may lead to higher levels of PTSD symptoms such as avoidance and irritability.…”

Incarcerated youth with personality disorders: Prevalence, comorbidity and convergent validity

“…According to the DSM-IV-TR, persons younger than 18 years cannot be given a diagnosis of APD. Results of recent research suggest that there are no clinically significant differences between adolescents and adults who meet the criteria for APD (Jones & Westen, 2010;Taylor, Elkins, Legrand, Peuschold, & Iacono, 2007). Additionally, one study found that 54% of incarcerated juveniles met the criteria for APD, 53% of whom also met the criteria for borderline personality disorder (BPD; McManus, Alessi, Grapentine, & Brickman, 1984).…”