Khalifa, Najat Rasool
(2012)
The link between conduct disorder and adult antisocial behaviour is partially mediated by early onset alcohol abuse.
DM thesis, University of Nottingham.
Abstract
This study sought to clarify the nature of the relationship between conduct disorder (CD), early-onset alcohol abuse (EOAA), some other externalizing-related constructs and adult violent antisociality (VA). It addressed two key questions: (i) whether EOAA mediated the link between CD and VA; and (ii) whether the effects of EOAA on VA were, in turn, mediated by impulsiveness, ventro-medial prefrontal cortex (vm-PFC) dysfunction and social deviance as measured by the Psychopathy Checklist-Revised (PCL-R). It tested the hypothesis that in the context of early disinhibitory psychopathology, e.g. CD, EOAA disrupts the neural substrates of self-regulation in vm-PFC during a critical neurodevelopmental period (i.e. before age 20). Consequently, on entry into adulthood the vm-PFC is functionally impaired and personality suffers maladaptive development which would then take the form of increased impulsiveness and social deviance, placing the individual at high risk of violent antisocial behaviour.
Using a cross sectional design, DSM-IV Axis I and II disorders, psychopathy, impulsiveness, vm-PFC functioning, history of drug and alcohol use, and both amount and severity of violence were assessed in 100 patients with personality disorders detained in secure hospital settings. Patients identified as having a history of EOAA, compared with those with no alcohol abuse history, were more impulsive, scored higher on the social deviance factor of psychopathy (PCL-R F2), were more conduct disordered, and showed a higher level of VA. Regression analysis showed that CD, EOAA, impulsiveness and PCL-R F2 significantly predicted VA, although PCL-R F2 rendered the effects of CD insignificant when used conjointly in regression analysis.
A multiple mediation model explaining about 20% of the variance in VA showed that EOAA partially mediated the effects of CD on VA, after controlling for age, cannabis misuse and ADHD. A separate multiple mediation model explaining 50% of the variance in VA showed that PCL-R F2 and impulsiveness partially mediated the effect of EOAA on VA. However, contrary to the prediction arising from the hypothesis, the effects of vm-PFC functioning on VA were insignificant. Although the study suffered from some limitations, results suggest that both impulsiveness and social deviance contribute importantly to a pathway leading from CD through adolescent alcohol abuse to maladaptive personality development and adult VA.
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