FOCUS ON RESEARCH Exploring Links Between Child Abuse and Antisocial Personality Disorder

486
A CLASSIC CASE OF ANTISOCIAL
PERSONALITY DISORDER Alfred
Jack Oakley meets women through personal ads, claiming to be a millionaire
movie producer, pilot, and novelist. In reality, he is a penniless con artist who uses
his smooth-talking charm to gain the
women’s trust so he can steal from them.
In January 2000, after being convicted of
stealing a Florida woman’s Mercedes,
Oakley complimented the prosecutor’s
skills and the jury’s wisdom and claimed
remorse. The judge appeared to see
through this ploy (“I don’t believe there is
a sincere word that ever comes out of
your mouth”), but it was still effective
enough to get Oakley probation instead
of jail time!
Chapter 12 Psychological Disorders
paranoid, schizoid, and schizotypal personality disorders. People diagnosed as having
schizotypal personality disorder, for example, display some of the peculiarities seen in
schizophrenia but are not disturbed enough to be labeled as having schizophrenia. The
anxious-fearful cluster includes dependent, obsessive-compulsive, and avoidant personality disorders. The avoidant personality disorder, for example, is similar to social phobia in the sense that persons labeled with this disorder tend to be “loners” with a longstanding pattern of avoiding social situations and of being particularly sensitive to
criticism or rejection. Finally, the dramatic-erratic cluster includes the histrionic, narcissistic, borderline, and antisocial personality disorders. The main characteristics of
narcissistic personality disorder, for example, are an exaggerated sense of self-importance,
extreme sensitivity to criticism, a constant need for attention, and a tendency to arrogantly overestimate personal abilities and achievements.
The most serious, costly, and intensively studied personality disorder is antisocial personality disorder (e.g., Scott, 2001). It is marked by a long-term pattern of irresponsible, impulsive, unscrupulous, and sometimes criminal behavior, beginning in childhood
or early adolescence. In the nineteenth century, the pattern was called moral insanity
because the people displaying it appear to have no morals or common decency. Later,
people in this category were called psychopaths or sociopaths. The current “antisocial personality” label more accurately portrays them as troublesome but not “insane” by the legal
standards we discuss later. About 3 percent of men and about 1 percent of women in the
United States fall into this diagnostic category (American Psychiatric Association, 2000).
At their least troublesome, these people are a nuisance. They are often charming, intelligent “fast talkers” who borrow money and fail to return it; they are arrogant, selfish
manipulators who “con” people into doing things for them, usually by lying and taking
advantage of the decency and trust of others. A hallmark of those displaying antisocial
personality is a lack of anxiety, remorse, or guilt, whether they have wrecked a borrowed
car or killed an innocent person (Gray et al., 2003; Hare, 1993). No method has yet been
found for permanently altering the behavior of these people (Rice, 1997). Research suggests that the best hope for dealing with them is to identify their antisocial personalities
early, before the most treatment-resistant traits are fully developed (Compton et al., 2005;
Crawford, Cohen, & Brooks, 2001; Lynam, 1996; Stoff, Breiling, & Maser, 1997).
There are numerous theories about the causes of antisocial personality. Some research
suggests a genetic predisposition (Slutske et al., 2001), possibly in the form of abnormal
brain development, impaired neurological functioning, or chronic underarousal of both
the autonomic and central nervous systems (Dolan & Park, 2002; Fung et al., 2005; Kiehl
et al., 2006; Raine et al., 2000, 2005). This underarousal may render people less sensitive
to punishment, and more likely to seek excitement, than is normally the case (Birbaumer
et al., 2005; Verona et al., 2004). Broken homes, rejection by parents, poor discipline, lack
of good parental models, lack of attachment to early caregivers, impulsivity, conflict-filled
childhoods, and poverty have all been suggested as psychological and sociocultural factors
contributing to the development of antisocial personality disorder (Caspi et al., 2004;
Lahey et al., 1995; Raine, Brennan, & Mednick, 1994; Tremblay et al., 1994). The biopsychosocial model suggests that antisocial personality disorder results when these psychosocial and environmental conditions combine with genetic predispositions to low
arousal and the sensation seeking and impulsivity associated with it (Gray et al., 2003).
O
antisocial personality disorder
A
long-term, persistent pattern of impulsive, selfish, unscrupulous, even criminal
behavior.
FOCUS ON RESEARCH
ne of the most prominent environmental factors associated with the
Exploring Links Between
more violent forms of antisocial perChild Abuse and Antisocial
sonality disorder is the experience of abuse in
childhood (MacMillan et al., 2001). However,
Personality Disorder
most of the studies that have found a relationship between childhood abuse and antisocial
personality disorder were based on potentially biased reports (Monane, Leichter, & Lewis,
487
Personality Disorders
1984; Rosenbaum & Bennett, 1986). People with antisocial personalities—especially
those with criminal records—are likely to make up stories of abuse in order to shift the
blame for their behavior onto others. Even if their reports were accurate, however, most
of these studies didn’t compare the abuse histories of antisocial people with those of a
control group from similar backgrounds who did not become antisocial. This research
design flaw makes it almost impossible to separate the effects of reported child abuse
from the effects of poverty or other factors that might also have contributed to the development of antisocial personality disorder.
■ What was the researcher’s question?
Can childhood abuse cause antisocial personality disorder? To help answer this question and to correct some of the flaws in earlier studies, Cathy Widom (1989) used a
prospective research design, first finding cases of childhood abuse and then looking for
the effects of that abuse on adult behavior.
■ How did the researcher answer the question?
Widom began by identifying 416 adults whose backgrounds included official records
of their having been physically or sexually abused before the age of eleven. She then
explored the stories of these people’s lives, as told in police and school records, as well
as in a two-hour diagnostic interview. To reduce experimenter bias and distorted
reporting, Widom ensured that the interviewers remained “blind” to the purpose of the
study and that the respondents were told only that the study’s purpose was to talk to
people who had grown up in an urban area of the midwestern United States in the late
1960s and early 1970s. Widom also selected a comparison group of 283 people who
had no histories of abuse but who were similar to the abused sample in terms of age,
gender, ethnicity, hospital of birth, schools attended, and area of residence. Her goal
was to obtain a nonabused control group that had been exposed to approximately the
same environmental risk factors and socioeconomic conditions as the abused children.
■ What did the researcher find?
First, Widom (1989) tested the hypothesis that exposure to abuse in childhood is associated with criminality and/or violence in later life. She found that 26 percent of the
abused youngsters went on to commit juvenile crimes, 29 percent were arrested as
adults, and 11 percent committed violent crimes. These percentages were significantly
higher than the figures for the nonabused group. The correlations between criminality
and abuse were higher for males than for females and higher for African Americans
than for European Americans. And overall, victims of physical abuse were more likely
to commit violent crimes as adults than were victims of sexual abuse.
Next, Widom tested the hypothesis that childhood abuse is associated with the development of antisocial personality disorder (Luntz & Widom, 1994). She found that the
abused group did show a significantly higher rate of antisocial personality disorder
(13.5 percent) than did the comparison group (7.1 percent). The apparent role of abuse
in antisocial personality disorder was particularly pronounced in men, and it remained
strong even when other factors—such as age, ethnicity, and socioeconomic status—
were accounted for in the statistical analyses. One other factor—failure to graduate
from high school—was also strongly associated with the appearance of antisocial personality, whether or not childhood abuse had occurred.
■ What do the results mean?
Widom’s research supported earlier studies in finding an association between childhood
abuse and criminality, violence, and antisocial personality disorder. Further, although
her study did not permit a firm conclusion that abuse alone causes antisocial personality disorder, the data from its prospective design added strength to the argument that
abuse may be an important causal factor (Widom, 2000). This interpretation is supported by the results of research by other investigators (Jaffee et al., 2004). Finally,