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Aggressive antisocial behavior- clinical, cognitive, and behavioral covariates of its persistence Wallinius, Märta 2012 Link to publication Citation for published version (APA): Wallinius, M. (2012). Aggressive antisocial behavior- clinical, cognitive, and behavioral covariates of its persistence. Department of Clinical Sciences, Lund University. Total number of authors: 1 General rights Unless other specific re-use rights are stated the following general rights apply: Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal Read more about Creative commons licenses: https://creativecommons.org/licenses/ Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. LUND UNIVERSITY PO Box 117 221 00 Lund +46 46-222 00 00 Aggressive antisocial behavior Clinical, cognitive, and behavioral covariates of its persistence Märta Wallinius Copyright © Märta Wallinius Cover drawing by Anita Wallinius Department of Clinical Sciences, Malmö, Faculty of Medicine ISBN 978-91-87189-59-3 ISSN 1652-8220 Tryckt i Sverige av Media-Tryck, Lunds universitet Lund 2012 Gutta cavat lapidem non vi sed saepe cadendo Ovidius Contents Contents ....................................................................................................................5 Abstract .....................................................................................................................9 Svensk sammanfattning ...........................................................................................10 Acknowledgments ...................................................................................................11 List of papers ...........................................................................................................13 Abbreviations...........................................................................................................15 Introduction ............................................................................................................17 Violence throughout history 17 Definitions of aggressive antisocial behavior 18 Aggression 19 Violence 19 Antisocial behavior, criminality, and delinquency 20 Externalizing behaviors 20 Aggressive antisocial behavior 21 Distribution of aggressive antisocial behavior 21 Aggressive antisocial behavior in society 21 Aggressive antisocial behavior over the life course 21 Risk factors for aggressive antisocial behavior 24 Mental disorders 25 Personality disorders 27 Psychopathy 29 Cognitive distortions 31 Protective factors for aggressive antisocial behavior 32 Risk assessments of aggressive antisocial behavior 33 Unstructured clinical judgment 34 Actuarial assessment 34 Structured professional judgment 35 Using protective factors in risk assessment 35 Issues in assessing the risk of aggressive antisocial behavior 36 Comprehensive models of aggressive antisocial behavior 37 Aims ........................................................................................................................39 General aims 39 Specific aims 39 Methods ..................................................................................................................41 Subjects 41 Swedish general population (Paper I) 42 Violent offenders in emerging adulthood (Paper II) 42 Mentally disordered offenders (Papers III–IV) 43 HIT study group (Paper V) 44 Measures 45 Retrospective information 47 Clinical measures 49 Prospective follow-up data 53 Analytical methods 53 Analysis of between-group differences 53 Analysis of variance 54 Cronbach’s alpha 54 Correlation analysis 54 Regression models 55 Receiver operating characteristics analysis 55 Survival analysis 56 Factor analysis 57 Multiple testing 57 Power 58 Ethical aspects 58 Results .................................................................................................................... 61 Persistence of aggressive antisocial behavior 61 Swedish general population (Paper I) 61 Violent offenders in emerging adulthood (Paper II) 61 Mentally disordered offenders (Papers III–IV) 64 Risk factors for persistence 64 Previous aggressive antisocial and/or criminal behavior 64 Age at onset of aggressive antisocial behavior 64 Psychopathic traits (PCL-R scores) 65 Mental disorders and personality disorders 66 Sociodemographic factors 66 Psychopathic traits (PCL-R) among offenders 69 Distribution 69 Clinical covariates 70 Cognitive covariates of aggressive antisocial behavior 70 Summary of findings ............................................................................................... 73 Discussion .............................................................................................................. 75 Comments on the main findings 75 Persistence of aggressive antisocial behavior 75 Risk factors for persistence 76 Psychopathic traits (PCL-R) among offenders 78 Cognitive covariates of aggressive antisocial behavior 79 Limitations 80 General definitions 80 Sources of data 81 Composition of study groups 83 Clinical implications 84 Future research directions 86 References ...............................................................................................................87 Abstract Introduction Aggressive antisocial behavior is a major challenge to society, and studies on the determinants of its persistence are essential to the development of strategies to prevent violence. Aims & Methods The overall aim of the thesis was to establish covariates of persistent aggressive antisocial behavior in a population-based cohort and in clinically evaluated, prospectively followed, offender groups. Specific aims were: (1) to quantify the persistence of aggressive antisocial behavior, (2) to identify risk factors for such persistence, (3) to describe the distribution of psychopathic traits (according to the Psychopathy Checklist-Revised; PCL-R) in relation to clinical factors, and (4) to determine thinking styles related to aggressive antisocial behavior. Results One percent of the Swedish general population was responsible for 63% of all violent crimes between 1973 and 2004. Risk factors for persistence of aggressive antisocial behavior included its early onset, conduct disorder, antisocial personality disorder, and substance-related disorders. In the PCL-R, the Antisocial facet outperformed all other facets and the total score as a predictor of persistence. The Interpersonal facet showed unique clinical attributes. A distorted thinking style characterized by antisocial features was related to aggressive antisocial behavior. Conclusions Aggressive antisocial behaviors and clinical factors including externalizing mental health problems aggregate within individuals. The best predictor of future aggressive antisocial behavior is a history of similar behaviors, especially with an early onset. Scientific and clinical efforts aimed to prevent violence have therefore to focus both on early-onset and persistent aggressive antisocial behavior, and their associated clinical and cognitive characteristics. 9 Svensk sammanfattning Introduktion Aggressivt antisocialt beteende utgör en stor utmaning för dagens samhälle, och undersökningar av vad som ligger bakom ett återkommande sådant beteende behövs för utvecklingen av våldspreventiva insatser. Syften & Metod Syftet med avhandlingen var att identifiera faktorer som samvarierar med återkommande aggressivt antisocialt beteende. De specifika målsättningarna var: (1) att beskriva omfattningen av återkommande aggressivt antisocialt beteende, (2) att identifiera riskfaktorer för sådant beteende, (3) att beskriva fördelningen av, och kliniska samband till, psykopatiska personlighetsdrag studerade med Psychopathy Checklist-Revised (PCL-R), och (4) att beskriva samband mellan dysfunktionella tankemönster och aggressivt antisocialt beteende. Resultat En procent av den svenska befolkningen stod för 63 % av alla våldsbrottsdomar under åren 1973–2004. Riskfaktorer för återkommande aggressivt antisocialt beteende var tidig debut i sådant beteende, uppförandestörning, antisocial personlighetstörning och missbruksproblem. Bland de psykopatiska personlighetsdragen var tidigare kriminellt beteende den överlägset bästa prediktorn för återkommande aggressivt antisocialt beteende. De grandiosa och manipulativa personlighetsdragen i PCL-R uppvisade unika kliniska karaktäristika. Dysfunktionella tankemönster av en antisocial karaktär var relaterade till aggressivt antisocialt beteende. Slutsatser Aggressivt antisocialt beteende och psykisk problematik av en utagerande karaktär ansamlas inom individer. Tidigare aggressivt antisocialt beteende, särskilt med tidig debut, är den enskilt bästa prediktorn av framtida aggressivt antisocialt beteende. Våldspreventiva insatser bör därför fokusera på tidigt debuterande och återkommande aggressivt antisocialt beteende, samt psykisk och social problematik som är associerad med sådant beteende. 10 Acknowledgments This thesis was made
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