Chow Rachel T S, Yu Rongqin, Geddes John R, Fazel Seena
Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
NIHR Oxford Health Biomedical Research Centre, Warneford Hospital, Oxford, UK.
Br J Psychiatry. 2025 Jul;227(1):481-491. doi: 10.1192/bjp.2024.226.
Links between personality disorders and antisocial outcomes has not examined individual personality disorders, and the contribution of comorbidities remain uncertain. Previous systematic reviews are dated.
To synthesise evidence from observational studies on the risk of antisocial outcomes and recidivism associated with personality disorders.
We searched six bibliographic databases (up to March 2024) for observational studies examining the risk of antisocial behaviour, interpersonal violence and recidivism in individuals diagnosed with personality disorders, compared to controls. We explored sources of heterogeneity using subgroup analyses and meta-regression.
We identified 21 studies involving 83 418 individuals with personality disorders from 10 countries examining antisocial and violent outcomes (Aim 1), and 39 studies of 14 131 individuals from 13 countries with recidivism (or repeat offending) as the outcome (Aim 2). We found increased risks of violence among individuals with any personality disorder (odds ratio 4.5, 95% CI 3.0-6.7), particularly antisocial personality disorder (odds ratio 7.6, 95% CI 5.1-11.5) and borderline personality disorder (odds ratio 2.6, 95% CI 1.8-3.9). Individuals with any personality disorder (odds ratio 2.3, 95% CI 2.0-2.6) and antisocial personality disorder (odds ratio 2.8, 95% CI 1.6-4.9) also demonstrated an elevated risk of recidivism. Personality disorder types and comorbid substance use disorder were associated with between-study heterogeneity.
The assessment and management of personality disorders should be considered as part of violence prevention strategies. Improving identification and treatment of comorbid substance misuse may reduce adverse outcomes in individuals with personality disorders.
人格障碍与反社会后果之间的联系尚未针对个体人格障碍进行研究，且共病的影响仍不确定。以往的系统评价已过时。
综合观察性研究中关于人格障碍与反社会后果及再犯风险的证据。
我们检索了六个文献数据库（截至2024年3月），以查找观察性研究，这些研究将被诊断为人格障碍的个体与对照组进行比较，考察其反社会行为、人际暴力和再犯风险。我们通过亚组分析和meta回归探索异质性来源。
我们确定了21项研究，涉及来自10个国家的83418名患有人格障碍的个体，这些研究考察了反社会和暴力后果（目标1）；以及39项研究，涉及来自13个国家的14131名个体，这些研究以再犯（或重复犯罪）为结果（目标2）。我们发现，任何人格障碍患者的暴力风险均有所增加（优势比4.5，95%置信区间3.0 - 6.7），尤其是反社会型人格障碍（优势比7.6，95%置信区间5.1 - 11.5）和边缘型人格障碍（优势比2.6，95%置信区间1.8 - 3.9）。任何人格障碍患者（优势比2.3，95%置信区间2.0 - 2.6）和反社会型人格障碍患者（优势比2.8，95%置信区间1.6 - 4.9）的再犯风险也有所升高。人格障碍类型和共病物质使用障碍与研究间异质性相关。
人格障碍的评估和管理应被视为暴力预防策略的一部分。改善对共病物质滥用的识别和治疗可能会减少人格障碍患者的不良后果。
