The correlates of comorbid antisocial personality disorder in schizophrenia

More than 15 years ago, findings from the Epidemiological Catchment Area Study indicated that antisocial personality disorder (APD) is more prevalent among persons with schizophrenia than in the general population. The present study analyzed data from a multisite investigation to examine the correlates of APD among 232 men with schizophrenic disorders, three-quarters of whom had committed at least one crime. Comparisons of the men with and without APD revealed no differences in the course or symptomatology of schizophrenia. By contrast, multivariate models confirmed strong associations of comorbid APD with substance abuse, attention/concentration problems, and poor academic performance in childhood; and in adulthood with alcohol abuse or dependence and deficient affective experience (a personality style indexed by lack of remorse or guilt, shallow affect, lack of empathy, and failure to accept responsibility for one's own actions). At first admission, men with schizophrenia and APD presented a long history of antisocial behavior that included nonviolent offending and substance misuse, and an emotional dysfunction that is thought to increase the risk of violence toward others. Specific treatments and management strategies are indicated.