Am J Psychiatry 1992; 149:482-487
Copyright © 1992 by American Psychiatric Association
Antisocial behavior of intravenous drug abusers: implications for diagnosis of antisocial personality disorder
RK Brooner, CW Schmidt, LJ Felch and GE Bigelow
Johns Hopkins University School of Medicine, Baltimore, MD.
OBJECTIVE: A pattern of chronic adult antisocial behavior is not sufficient
for the DSM-III-R diagnosis of antisocial personality disorder unless the
early-onset criteria are satisfied, even if the adult criteria are met. The
utility of the early-onset requirement for the diagnosis was examined in
intravenous drug abusers, a population known to have high rates of
irresponsible, aggressive, and criminal behavior. METHOD: The subjects were
237 drug abusers who had volunteered for an outpatient study of
psychopathology and HIV risk behavior and infection. They completed a
structured psychiatric interview as part of their participation in that
study. The adult antisocial behavior of the group that met both the
early-onset and the adult criteria for antisocial personality disorder, the
group that met only the adult criteria, and the group that met neither the
early-onset nor the adult criteria was then compared. RESULTS: Antisocial
personality disorder (meeting the early-onset and adult criteria) was
diagnosed in 44% of the sample; an additional 24% met only the adult
criteria. The group with the diagnosis of antisocial personality disorder
reported a more pervasive and more serious pattern of adult antisocial
behavior than did the other groups, although antisocial behavior was
commonplace in all three groups. CONCLUSIONS: Early onset of multiple
antisocial behaviors identified a subset of drug abusers with important
differences in the extent and severity of their adult antisocial behavior.
The antisocial behavior of the group that met only the adult criteria
suggests the possibility of a late-onset and less severe form of antisocial
personality disorder.
