Personality disorder and sexual risk taking among homosexually active and heterosexually active men attending a genito-urinary medicine clinic

The role of personality disorders on drug dependence treatment outcomes following inpatient detoxification

Aims

The present 6 month follow-up study was conducted to investigate the possible influence of comorbid personality disorders on drug treatment, as well as associated psychopathology and HIV-related risk behaviors outcomes.

Subjects and methods

Data were collected initially from a consecutive sample of 74 patients with a diagnosis of opiate abuse or dependence, admitted for inpatient detoxification.

Result

During intake, 80.9% of patients reported at least one HIV-related risk behavior in the previous 6 months. Not using condoms during sexual intercourse was the most common and the only risk behavior that showed a statistically significant reduction over the follow-up period. A total of 58.1% of subjects had at least one personality disorder (PD). Borderline PD was the most prevalent. However, antisocial PD was the only PD that influenced substance use outcomes. The presence of this diagnosis increased the chance of worse opiate use outcomes, but decreased likelihood of not using condoms. Patients with low obsessive–compulsive PD dimensional scores showed a significant increase in the number of risk behaviors. However, these influences were only seen at the 3-month follow-up assessment.

Conclusions

These results suggest that personality disorders need to be considered when planning effective interventions for opiate dependent individuals and when preparing and evaluating HIV risk-reduction interventions, particularly for the more severe substance dependent patients.

Associations between blood lead level and substance use and sexually transmitted infection risk among adults in the United States

The effects of low-level lead exposure on neuropsychological status in the United States (US) general adult population have been reported, and the relationship between neuropsychiatric dysfunction and health risk behaviors including substance use and sexual risk taking is well established. However, the potential influence of lead exposure on risk-taking behavior has received little attention. Using the National Health and Nutrition Examination Survey (NHANES) 2005-2010, we estimated multivariable logistic regression models to measure odds ratios (ORs) and 95% confidence intervals (CIs) for the cross-sectional associations between blood lead level and risk behaviors including binge drinking, drug use, and indicator of sexually transmitted infection (STI) risk. STI indicators included past 12 month sexual risk behaviors (age mixing with partners who were at least five years younger or older and multiple partnerships), self-reported STI, and biologically-confirmed herpes simplex virus type 2 (HSV-2) infection. Dose-response like relationships were observed between blood lead and substance use, age mixing with younger and older partners, self-reported STI, and HSV-2. In addition, participants with lead levels in highest quartile versus those with levels in the lowest quartile had over three times the odds of binge drinking and over twice the odds of injection drug or cocaine use in the past 12 months, while being in one of the top two quartiles was significantly associated with 30-70% increased odds of multiple partnerships, sex with older partners, and self-reported and biologically confirmed STI. Results from this study suggested that lead exposure may contribute to substance use, sexual risk-taking, and STI. However, given limitations inherent in the cross-sectional nature of the study, additional studies that use longitudinal data and measure detailed temporal information are warranted.

Three-year follow-up of syndromal antisocial behavior in adults: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

To present nationally representative findings on total antisocial personality disorder (ASPD) symptoms, major violations of others' rights (MVOR), and violent symptoms over a 3-year follow-up in Wave 2 of the National Epidemiologic Survey on Alcohol and Related Conditions among adults diagnosed at Wave 1 with ASPD versus syndromal adult antisocial behavior without conduct disorder before age 15 years (AABS, not a codable DSM-IV disorder).

METHOD

Face-to-face interviews were conducted with 34,653 respondents aged 18 years and older. Antisocial syndromes and comorbid lifetime substance use, mood, and 6 additional personality disorders were diagnosed at Wave 1 using the Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV). The Wave 2 AUDADIS-IV assessed antisocial symptoms over follow-up, lifetime attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder, and borderline, narcissistic, and schizotypal personality disorders. Wave 1 was conducted in 2001-2002 and Wave 2 in 2004-2005 by the National Institute on Alcohol Abuse and Alcoholism.

RESULTS

In unadjusted analyses, respondents with ASPD reported significantly more total, MVOR, and violent symptoms over follow-up than did respondents with AABS. Adjustment for baseline sociodemographics and psychiatric comorbidity attenuated these associations; after further adjustment for parallel antisocial symptom counts from age 15 years to Wave 1, associations with antisocial syndromes disappeared. Independent Wave 1 predictors of persistent antisociality over follow-up included male sex, not being married or cohabiting, low income, high school or less education, lifetime drug use disorders, additional personality disorders, and ADHD.

CONCLUSIONS

The distinction between ASPD and AABS holds limited value in predicting short-term course of antisocial symptomatology among adults. However, the prediction of persistent antisociality by psychiatric comorbidity argues for comprehensive diagnostic assessments, treatment of all identified disorders, and investigation of whether treatment of comorbidity might hasten remission of antisociality.

Antisocial behavioral syndromes and body mass index among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE

To describe associations of antisocial behavioral syndromes, including DSM-IV antisocial personality disorder (ASPD) and conduct disorder without progression to ASPD ("CD only"), and syndromal antisocial behavior in adulthood without CD before age 15 (AABS, not a codable DSM-IV disorder), with body mass index (BMI) status in the general US adult population.

METHODS

This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43093; response rate, 81%). Respondents were classified according to whether they met criteria for ASPD, AABS, "CD only," or no antisocial syndrome, and on current BMI status based on self-reported height and weight. Associations of antisocial syndromes with BMI status were examined using multinomial logistic regression.

RESULTS

Among men, antisociality was not associated with BMI. Among women, ASPD was significantly associated with overweight and extreme obesity; AABS was associated with obesity and extreme obesity; and "CD only" was significantly associated with overweight, obesity, and extreme obesity.

CONCLUSIONS

Assessment of antisocial features appears warranted in overweight, obese, and extremely obese women, and assessment of BMI status appears indicated in antisocial women. Prevention and treatment guidelines for overweight and obesity may need revision to address comorbid antisociality, and interventions targeting antisociality may need to include attention to weight concerns.

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

This study, based on a nationally representative, epidemiologic sample (N = 43,093, response rate 81%), compared sociodemographic and family history correlates, antisocial personality disorder (ASPD) symptom patterns, and Axis I and Axis II comorbidity, among adults with DSM-IV ASPD who reported onset of conduct disorder (CD) in childhood (<age 10) versus adolescence (> or =age 10). Prevalence of each ASPD diagnostic criterion and comorbid lifetime disorder was estimated. Logistic regression was used to examine associations of childhood-onset CD with ASPD symptom patterns and comorbid disorders. Among the 1422 respondents with ASPD, 447 reported childhood-onset CD. Childhood-onset respondents were more likely than adolescence-onset respondents to endorse CD criteria involving aggression against persons, animals, and property before age 15, and to endorse more childhood criteria and lifetime violent behaviors. Childhood-onset respondents displayed significantly elevated odds of lifetime social phobia, generalized anxiety disorder, drug dependence, and paranoid, schizoid, and avoidant personality disorders, but significantly decreased odds for lifetime tobacco dependence. Childhood-onset CD appears to identify a more polysymptomatic and violent form of ASPD, associated with greater lifetime comorbidity for selected Axis I and Axis II disorders, in nonclinical populations.