Holzer Katherine J, Vaughn Michael G, Fearn Noelle E, Loux Travis M, Mancini Michael A
Division of Clinical and Translational Research, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, 63110, United States; School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States.
School of Social Work, College for Public Health and Social Justice, Saint Louis University, St. Louis, Missouri, 63103, United States; Graduate School of Social Welfare, Yonsei University, Seoul, Republic of Korea.
J Psychiatr Res. 2021 May;137:444-451. doi: 10.1016/j.jpsychires.2021.03.025. Epub 2021 Mar 18.
The prevalence of antisocial personality disorder (ASPD) decreases with age. As such, research regarding ASPD typically focuses on children and younger adults. The apparent age-specific prevalence of ASPD may be due, in part, to diagnostic criteria informed by research excluding older adults. The present study sought to better understand the manifestation of ASPD in older adults and investigate potential age bias in the diagnostic criteria. Item response theory methods were used to the diagnostic criteria for ASPD with data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III. The measurement of three ASPD criteria showed uniform differential item functioning (DIF), suggesting that older adults were less likely to endorse the item than younger adults despite having the same level of underlying personality disorder. The items with DIF are related to the following criteria for ASPD: Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest (3 items with DIF); irritability and aggressiveness, as indicated by repeated physical fights or assaults (1 item with DIF); and consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations (1 item with DIF). Results of the present study can be used to inform the development of criteria that better capture the age-specific experience of this disorder. Improved criteria will result in increased diagnostic accuracy, systematic estimation of the prevalence, improved assessments, and more effective treatment options for this complex population.
反社会人格障碍（ASPD）的患病率随年龄增长而降低。因此，关于ASPD的研究通常集中在儿童和年轻人身上。ASPD明显的年龄特异性患病率可能部分归因于研究得出的诊断标准未涵盖老年人。本研究旨在更好地了解ASPD在老年人中的表现，并调查诊断标准中潜在的年龄偏差。运用项目反应理论方法，结合第三次全国酒精及相关状况流行病学调查的数据，对ASPD的诊断标准进行分析。对三项ASPD标准的测量显示出一致的差异项目功能（DIF），这表明尽管老年人与年轻人具有相同程度的潜在人格障碍，但老年人认可这些项目的可能性低于年轻人。存在DIF的项目与以下ASPD标准相关：反复实施应受逮捕处罚的行为，表明在合法行为方面未能遵守社会规范（3个存在DIF的项目）；反复发生肢体冲突或攻击行为，表明易怒和攻击性（1个存在DIF的项目）；反复未能维持持续的工作行为或履行财务义务，表明一贯不负责任（1个存在DIF的项目）。本研究结果可用于指导制定能更好地体现该障碍年龄特异性表现的标准。改进后的标准将提高诊断准确性、系统估计患病率、改善评估，并为这一复杂人群提供更有效的治疗选择。
