Three-year trajectory of adult antisocial behavioral syndromes in the general U.S. population: Results from the National Epidemiologic Survey on Alcohol and Related Conditions

DSM-IV antisocial personality disorder (ASPD) requires both syndromal levels of antisocial behavior since age 15 (AABS) and conduct disorder (CD) with onset before 15. Cross-sectional studies have identified more severe antisociality in respondents with ASPD than in those with AABS but not CD before age 15. No follow-up studies have examined the longitudinal trajectory of antisocial behavior among general population adults. We compared total ASPD symptoms, major violations of others' rights (MVOR), and violent symptoms over a 3-year follow-up in respondents to the National Epidemiologic Survey on Alcohol and Related Conditions who were diagnosed at Wave 1 with ASPD versus AABS. Predictions of antisocial symptomatology over follow-up by antisocial syndromes at Wave 1 were analyzed using logistic regression. In unadjusted analyses, respondents with ASPD reported significantly more total symptoms, MVOR, and violent symptoms from Wave 1 to Wave 2 than respondents with AABS. Adjustment for baseline demographics and psychiatric comorbidity attenuated but did not eliminate associations with antisocial syndromes; after further adjustment for antisocial symptom counts since age 15 at Wave 1, associations with antisocial syndromes disappeared. Factors independently predicting greater antisocial symptomatology over follow-up included male sex, not being married, low income, high school or less education, and comorbid lifetime drug use, tobacco dependence, and additional personality disorders diagnosed at Wave 1. We conclude that the diagnostic distinction between ASPD and AABS may hold modest value in predicting near- to medium-term future antisocial behavior among adults with histories of either syndrome.