Relation between childhood maltreatment and severe intrafamilial male-perpetrated physical violence in Chinese community: the mediating role of borderline and antisocial personality disorder features

Childhood emotional abuse and motor impulsiveness among male violent inmates with antisocial personality disorder

This study aimed to explore the relationship among childhood maltreatment, impulsiveness and antisocial personality through a questionnaire survey of violent male inmates. We found that the scores of inmates with Antisocial Personality Disorder (ASPD) in Childhood Trauma Questionnaire-28 item Short Form (CTQ-SF) and Barratt Impulsive Scale-11 (BIS-11) were higher than those in the Non-Antisocial personality group, and there was a significant correlation between the scores of CTQ-SF and BIS-11. We found that the interaction between impulsivity and childhood abuse predicts ASPD levels. Moreover, motor and non-planning impulsiveness played important roles in the observed differences in antisocial personality scores among the inmates who had experienced childhood maltreatment; motor impulsiveness was mainly related to emotional abuse, physical abuse, and sexual abuse, while non-planning impulsiveness was mainly related to emotional neglect and physical neglect. These findings suggest that identifying and providing timely intervention for inmates with high impulsiveness who experienced maltreatment in childhood may also contribute to the prevention of violent behavior and to better prison management.

Associations Among Child Maltreatment, Mental Health, and Police Contact in Adulthood: Findings From a National Canadian Sample

The purpose of this study was to examine associations between three subtypes of childhood maltreatment (physical abuse, sexual abuse, and exposure to intimate partner violence) and two forms of adult police contact (criminality, victimization) using nationally representative Canadian data. Presence of a mental health disorder was also explored as a potential mediating variable in these associations. The weighted sample included 23,846 adult participants from the 2012 Canadian Community Health Survey-Mental Health. Logistic and multinomial regression analyses examined associations among individual and multiple exposures to subtypes of childhood maltreatment with police contact. The Sobel test was used to assess the mediating effect of mental health disorders. Adjusting for sociodemographic variables, results indicated that all maltreatment subtypes were significantly associated with increased odds of both forms of police contact (adjusted odds ratios ranged from 2.06 to 2.95). Presence of a mental health disorder was a partial mediator in the associations between child maltreatment and both forms of adult police contact (adjusted odds ratios ranged from 1.52 to 2.32). In addition, a dose-response relationship was observed for victimization; as the number of subtypes of maltreatment increased, there was an incremental increase in risk of victimization. Future efforts are needed to prioritize child maltreatment prevention, trauma-informed approaches, mental health awareness, and training in law enforcement.

Complex PTSD and borderline personality disorder

BACKGROUND

This article builds on a previous review (Ford and Courtois, Borderline Personal Disord Emot Dysregul 1:9, 2014) which concluded that complex posttraumatic stress disorder (cPTSD) could not be conceptualized as a sub-type of either PTSD or BPD. Recent research is reviewed that extends and clarifies the still nascent understanding of the relationship between cPTSD and BPD.

MAIN BODY

The circumscribed formulation of adult cPTSD that has been developed, validated, and included in the 11th Edition of the International Classification of Diseases has spurred research aimed at differentiating cPTSD and BPD both descriptively and empirically. A newly validated Developmental Trauma Disorder (DTD) syndrome for children and adolescents provides a basis for systematic research on the developmental course and origins of adult cPTSD and BPD. This review summarizes recent empirical findings regarding BPD, PTSD, and cPTSD in terms of: (1) prevalence and comorbidity; (2) clinical phenomenology; (3) traumatic antecedents; (4) psychobiology; (5) emotion dysregulation; (6) dissociation; and (7) empirically supported approaches to clinical assessment and psychotherapeutic treatment.

CONCLUSION

The evidence suggests that PTSD, cPTSD, and BPD are potentially comorbid but distinct syndromes. A hypothesis is advanced to stimulate scientific research and clinical innovation defining and differentiating the disorders, positing that they may represent a continuum paralleling the classic conceptualization of the stress response, with dissociation potentially involved in each disorder.

Traumatic Experiences and PTSD Symptoms in the Chinese Male Intrafamilial Physical Violence Perpetrators: A Comparative and Structural Equation Modeling Study

We aimed to compare traumatic experiences among the groups of perpetrators with or without violent pedigree, and establish a structural model of posttraumatic stress disorder (PTSD) symptoms as mediators of traumatic experiences and severe intrafamilial physical violence among Chinese male perpetrators. A cross-sectional survey and a face-to-face interview were conducted to examine intimate partner violence (IPV) perpetration and violent pedigree, childhood maltreatment, other traumatic events, PTSD symptoms, and severe intrafamilial physical violence in a community sample of 229 abusive men and 303 controlled men in China. Using structural equation modeling (SEM) techniques, the scores of the questionnaires were entered into the theoretical model and calculated. Findings demonstrated that the numbers of the traumatic events in four groups were significantly different with a declining trend, and the SEM data had an adequate fit. The loadings of pathways from childhood witness domestic violence (DV) to severe physical violence (SPV) were more salience than other pathways, and the indirect effect of every pathway, except for the childhood witness DV to PTSD symptoms, on severe intrafamilial physical violence in the model was significant. The results suggest that PTSD symptoms cluster as mediator of the intergenerational transmission of SPV perpetration in Chinese abusive men. Childhood witness IPV has effects on adulthood perpetration of IPV.

Differential MCMI-III psychopathological profiles between intimate partner violence perpetrators with and without childhood family violence

This study explored the differential prevalence of personality disorders (PD) and clinical syndromes between male perpetrators of intimate partner violence (IPV) with and without a history of childhood family violence (CFV). A sample of 981 perpetrators of IPV was assessed with the Millon Clinical Multiaxial Inventory-III (MCMI-III). Comparisons of sociodemographic characteristics and MCMI-III scales' scores between perpetrators with (n = 293) and without (n = 688) CFV were carried out. Results showed that IPV perpetrators with CFV had a lower level of education, were less frequently employed, and had higher rates of previous psychiatric history than perpetrators without CFV. Statistically significant differences between groups in almost all the MCMI-III scales were found. Perpetrators with CFV presented with higher scores on most of the evaluated scales and showed a more severe psychopathological profile than perpetrators without CFV. The multivariate analysis showed that the main MCMI-III domains related to CFV were higher scores on the disclosure and alcohol dependence scales and lower scores on the passive-aggressive scale. These findings reveal that CFV is associated with a more severe psychopathological profile in perpetrators of IPV. In order to develop tailored interventions, the presence of CFV and psychopathological symptoms should be assessed in IPV perpetrators.

Psychometric Properties of a Measure of Borderline Personality Organization in a Spanish Court-Referred Partner-Violent Male Sample

Borderline personality organization (BPO) is a key personality component of some but not all partner-violent men. The study described in this paper examines the psychometric properties of the borderline personality organization scale (BPO Scale; Oldham et al., 1985) in a Spanish sample of 643 men undergoing court-mandated psychological treatment after conviction for episodes of intimate-partner violence. Three confirmatory factor analyses were carried out first, and the three-factor structure of the BPO scale was then tested. Results for concurrent validity show positive and significant correlations between the subscales and the overall BPO scale, and with other instruments that measure borderline and antisocial personality disorders (ASPDs), and impulsivity. The BPO scale also presents evidence of known-groups validity, since BPO scores decrease with age, and of discriminant validity, as the scale discriminates between participants who do and do not exceed the cutoff point on a borderline personality scale. The BPO Scale is a suitable instrument for evaluating BPO in partner-violent men.

Multiple Forms of Early Violent Socialization and the Acceptance of Interpersonal Violence Among Chinese College Students

Early violent socialization has consistently been associated with individuals' attitudes toward interpersonal violence in adulthood. However, how particular types of violent socialization during childhood differently influence individuals' acceptance of interpersonal violence remains unclear. The current study examined the effect of multiple types of violent socialization on acceptance of interpersonal violence among Chinese college students in Hong Kong (N = 794). The findings of hierarchical multiple regression analyses indicated that verbal advice regarding and witnessed experience with violence during childhood predict the acceptance of violence. In contrast, childhood experience of being a violence victim was not significantly associated with the acceptance of violence. In addition, gender moderates the relationship between verbal advice toward violence and acceptance of violence. Therefore, educational interventions related to the impact of multiple forms of violent socialization on attitudes toward violence that create a safe and stable environment for children may be beneficial for parents, teachers, and practitioners who work closely with children. The results may be also useful in informing colleges, universities, and professional practitioners as they make decisions about social awareness programs for college students to help change their attitudes toward violence.

Psychophysiological Reactivity Profiles of Partner-Violent Men With Borderline or Psychopathic Personality Features: The Role of Empathy

Borderline and psychopathic features have been linked to unique psychophysiological reactivity profiles. Studies have suggested that levels of psychophysiological reactivity for partner-violent men cannot be attributed to personality features alone. This study tested cognitive and affective empathy as moderators of relations between borderline personality, Factor 1 psychopathy, and psychophysiological reactivity using a community sample of 135 male participants and their female partners. Cognitive empathy moderated the relation between borderline personality features and heart rate reactivity. Affective empathy moderated the relation between Factor 1 psychopathy features and heart rate reactivity. However, directions of these interactions were contrary to original predictions. Understanding unique empathy deficits may be beneficial for identifying ways to minimize relationship conflict, manage arousal, and decrease violence.

From Family Violence Exposure to Violent Offending: Examining Effects of Race and Mental Health in a Moderated Mediation Model Among Confined Male Juveniles

Depression, substance use, and impulsivity have been linked to family violence exposure and to the development of violent offending during adolescence. Additionally, the indirect effects associated with these factors may not generalize across different racial/ethnic adolescent populations. The present study tested whether race/ethnicity moderated the mediated relationship between family violence exposure and violent offending, with depression, substance use, and impulsivity as mediators. A sample of 1,359 male adolescents was obtained from a juvenile correctional program. Between-racial/ethnic group comparisons were generally consistent with previous findings. The overall moderated mediation model was significant in predicting violence for both racial/ethnic groups. Different factors influenced violent offending among African Americans and European Americans in the tested model. Furthermore, race/ethnicity moderated the relationship between family violence exposure and impulsivity and substance use. Implications and future directions resolving issues are discussed concerning whether race/ethnicity should be included as a moderator in models of violence.

Monoamine Oxidase-A Genetic Variants and Childhood Abuse Predict Impulsiveness in Borderline Personality Disorder

Objective

Impulsivity is a core feature of borderline personality disorder (BPD) and antisocial personality disorder (ASPD) that likely arises from combined genetic and environmental influences. The interaction of the low activity variant of the monoamine oxidase-A (MAOA-L) gene and early childhood adversity has been shown to predict aggression in clinical and non-clinical populations. Although impulsivity is a risk factor for aggression in BPD and ASPD, little research has investigated potential gene-environment (G×E) influences impacting its expression in these conditions. Moreover, G×E interactions may differ by diagnosis.

Methods

Full factorial analysis of variance was employed to investigate the influence of monoamine oxidase-A (MAO-A) genotype, childhood abuse, and diagnosis on Barratt Impulsiveness Scale-11 (BIS-11) scores in 61 individuals: 20 subjects with BPD, 18 subjects with ASPD, and 23 healthy controls.

Results

A group×genotype×abuse interaction was present (F(2,49)=4.4, p=0.018), such that the interaction of MAOA-L and childhood abuse predicted greater BIS-11 motor impulsiveness in BPD. Additionally, BPD subjects reported higher BIS-11 attentional impulsiveness versus ASPD participants (t(1,36)=2.3, p=0.025).

Conclusion

These preliminary results suggest that MAOA-L may modulate the impact of childhood abuse on impulsivity in BPD. Results additionally indicate that impulsiveness may be expressed differently in BPD and ASPD.

Borderline personality disorder in men: A literature review and illustrative case vignettes

The aim is to review the salient literature on borderline personality disorder (BPD) in men and link those findings with case vignettes. We provide a literature review and then report case examples of those who met DSM and clinical BPD criteria, and consider the extent to which the small male sub-set corresponded developmentally and phenomenologically with prototypic BPD in women. The review considered phenomenological, epidemiological, biological and developmental BPD factors, finding BPD men evidence elevated substance abuse, and 'externalising' patterns of behavior, antisocial personality traits, violent self-harm and interpersonal aggression, whereas women display more 'internalising' strategies. The five male vignettes enriched the literature review providing support for gender differences reported in our review. The literature and case vignette findings should assist clinicians in recognising that BPD in men may not be as rare as generally viewed, and which may reflect BPD being commonly viewed as weighted to women and being misdiagnosed as an antisocial personality disorder (ASPD) in men.

Exploring the Moderating Role of Problematic Substance Use in the Relations Between Borderline and Antisocial Personality Features and Intimate Partner Violence

Borderline and antisocial personality features relate to multiple externalizing behaviors, including intimate partner violence (IPV). However, not all individuals with borderline and antisocial traits perpetrate IPV. The strength of the personality-IPV link may be related to problematic substance use. We examined borderline and antisocial personality features, problematic substance use, and IPV in a community sample of couples. Positive relations between both borderline and antisocial features and IPV were stronger in conditions of high problematic alcohol use relative to low problematic alcohol use. Alcohol misuse may be an important factor to consider for IPV reduction in men with these personality features.

Borderline personality disorder and violence in the UK population: categorical and dimensional trait assessment

BACKGROUND

Borderline personality disorder (BPD) is characterised by difficulties with impulse control and affective dysregulation. It is unclear whether BPD contributes to the perpetration of violence or whether this is explained by comorbidity. We explored independent associations between categorical and dimensional representations of BPD and violence in the general population, and differential associations from individual BPD criteria.

METHODS

We used a representative combined sample of 14,753 men and women from two British national surveys of adults (≥16 years). BPD was assessed using the Structured Clinical Interview II- Questionnaire. We measured self-reported violent behaviour in the past 5 years, including severity, victims and locations of incidents. Associations for binary, dimensional and trait-level exposures were performed using weighted logistic regression, adjusted for demography and comorbid psychopathology.

RESULTS

Categorical diagnosis of BPD was associated only with intimate partner violence (IPV). Associations with serious violence leading to injuries and repetitive violence were better explained by comorbid substance misuse, anxiety and antisocial personality disorder (ASPD). However, anger and impulsivity BPD items were independently associated with most violent outcomes including severity, repetition and injury; suicidal behaviours and affective instability were not associated with violence. Both trait-level and severity-dimensional analyses showed that BPD symptoms might impact males and females differently in terms of violence.

CONCLUSIONS

For individuals diagnosed BPD, violence is better explained by comorbidity. However, BPD individual traits show different pathways to violence at the population level. Gender differences in BPD traits and their severity indicate distinct, underlying mechanisms towards violence. BPD and traits should be evaluated in perpetrators of IPV.

Effects of Exposure to Domestic Physical Violence on Children's Behavior: A Chinese Community-based Sample

Domestic physical violence (DPV) is common in China due to its long history of slavery and feudalism. This study aimed to examine the effects of exposure to DPV on children's behavior in a Chinese community. Ninety-three 12- to 16-year-old adolescents exposed to DPV were compared to 54 adolescents with no exposure to DPV. We found that DPV exposure was associated with adverse behaviors in children, especially among boys. Children witnessing DPV alone had similar behavioral scores as the abused children. We recommend that both abused and DPV witness-only adolescents in Chinese communities need treatment to mitigate the effects on maladjusted behaviors. The intervention programs for children who witness domestic violence are also important.

Childhood maltreatment and violence: mediation through psychiatric morbidity

Childhood maltreatment is associated with multiple adverse outcomes in adulthood including poor mental health and violence. We investigated direct and indirect pathways from childhood maltreatment to adult violence perpetration and the explanatory role of psychiatric morbidity. Analyses were based on a population survey of 2,928 young men 21-34 years in Great Britain in 2011, with boost surveys of black and minority ethnic groups and lower social grades. Respondents completed questionnaires measuring psychiatric diagnoses using standardized screening instruments, including antisocial personality disorder (ASPD), drug and alcohol dependence and psychosis. Maltreatment exposures included childhood physical abuse, neglect, witnessing domestic violence and being bullied. Adult violence outcomes included: any violence, violence toward strangers and intimate partners (IPV), victim injury and minor violence. Witnessing domestic violence showed the strongest risk for adult violence (AOR 2.70, 95% CI 2.00, 3.65) through a direct pathway, with psychotic symptoms and ASPD as partial mediators. Childhood physical abuse was associated with IPV (AOR 2.33, 95% CI 1.25, 4.35), mediated by ASPD and alcohol dependence. Neglect was associated with violence toward strangers (AOR 1.73, 95% CI 1.03, 2.91), mediated by ASPD. Prevention of violence in adulthood following childhood physical abuse and neglect requires treatment interventions for associated alcohol dependence, psychosis, and ASPD. However, witnessing family violence in childhood had strongest and direct effects on the pathway to adult violence, with important implications for primary prevention. In this context, prevention strategies should prioritize and focus on early childhood exposure to violence in the family home.

Empathy Impairments in Intimate Partner Violence Perpetrators With Antisocial and Borderline Traits: A Key Factor in the Risk of Recidivism

Antisocial, borderline, and narcissistic personality traits have been described as characteristics of intimate partner violence (IPV) perpetrators. Furthermore, deficits in cognitive empathy and impairments in emotional decoding processes may at least partially explain conduct disorders and social dysfunction in general. However, previous research has not explored potential associations between empathy deficits and the aforementioned traits or whether they are reflected in recidivism in IPV perpetrators. Accordingly, the main aim of this study was to explore associations between empathy deficits, antisocial, borderline, and narcissistic traits and the risk of recidivism in this population. The sample consisted of 144 IPV perpetrators (mean age = 41 years). High antisocial and borderline personality traits in this sample were associated with a high risk of recidivism, these relationships being moderated by poor empathy skills. Moreover, in IPV perpetrators with both antisocial and borderline personality traits, the risk of recidivism was higher than in those with only one of these traits. In contrast, narcissistic traits were unrelated to the risk of recidivism and impairments in empathy. The results of our study highlight the importance of empathy deficits and may help professionals to develop specific intervention programs focusing on improving empathy skills in antisocial and borderline IPV perpetrators.

Neighborhood informal social control and child maltreatment: A comparison of protective and punitive approaches

This paper introduces a new measure of informal social control of child maltreatment (henceforth ISC_CM) by neighbors. Research literature typically uses collective efficacy (Sampson, Raudenbush, & Earls, 1997) to examine neighborhood informal social control. We argue that double standards about the application of informal social control to family versus street crime requires a measure of informal social control specific to child maltreatment. We also argue that how neighbors intervene may matter as much as whether they intervene. Neighbors may engage in ISC_CM aimed at protecting the child and calming the parent, or more punitive ISC_CM aimed at deterring future abuse. We tested the relationship of both with very severe physical abuse and with abuse related child behavior problems. We used a random, 2-stage cluster design of Hanoi to collect the sample. Thirty Hanoi wards were randomly selected using probability proportional to size sampling. A simple random sample of families in each ward was then drawn using local government lists of ward residents. Based on power analysis, the target sample size was 300. Of 315 residents contacted, 293 participated, yielding a response rate of 93%. Random effects regression models (which estimate a random effect for each ward) were run in Stata11. We found that protective ISC_CM is associated with lower odds of very severe physical abuse and lower reported externalizing problems when abuse is present. Perceived collective efficacy and punitive ISC_CM is not associated with lower odds of very severe physical abuse. Implications for research, policy and practice are discussed. We conclude that further investigation of neighbor ISC_CM is needed to replicate the findings in other cultural contexts, ultimately followed by experimental manipulation of ISC_CM in a neighborhood context to examine the effects on child maltreatment. If further research corroborates the current findings, the development of neighborhood intervention programs to enhance protective ISC_CM may assist materially in reducing very severe child abuse and negative consequences stemming from such abuse.

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.

Antisocial personality disorder: a current review

The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classification of antisocial personality disorder (ASPD) describes individuals who engage in repetitive irresponsible, delinquent, and criminal behavior. The diagnosis is highly controversial, with many researchers and clinicians arguing that the category is too heterogeneous, overinclusive, and demonstrates considerable overlap with other disorders. This review focuses on recent studies that have improved our understanding of the characteristics of individuals who fit the ASPD definition by exploring how subtypes differ and how comorbid conditions influence the presentation of ASPD. In addition, we discuss research on the etiology of ASPD that has identified genetic and environmental factors that may contribute to the development and persistence of antisocial behavior, and brain imaging research that has improved our understanding of the relationships between ASPD and other psychopathology. Finally, we discuss promising preliminary research on treatment for this disorder.