Age-Related Differences in Endorsement of Antisocial Personality Disorder Criteria

Background and Purpose: The prevalence of antisocial personality disorder (ASPD) is substantially lower in older adults compared to younger adults, with multiple studies reporting less than 1% among older adults. The age specific prevalence of ASPD suggests that the criteria are also highly age sensitive. Issues with the criteria create cyclical problems in which older adults are diagnosed with the disorder much less than younger adults, resulting in a lack of research into this phenomenon to create more applicable criteria. It is important, therefore, to examine the diagnostic criteria and measurement of ASPD in order to determine its validity for all ages, allowing practitioners to accurately diagnose and treat this disorder. The present study seeks to address the research gap and examine the applicability of ASPD criteria with older adults in a nationally representative sample.

Methods: This study employed data from the 2001-2002 wave of the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Diagnostic data were collected using the NIAAA Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (AUDADIS-IV) designed to measure alcohol use disorders and related psychiatric conditions, including PDs. The analytic sample included respondents without missing data for the ASPD criteria as well as the sociodemographic and psychosocial covariates. Individuals from the younger (age<50 years, n=5,392) and older (age>=50 years, n=1,483) age groups were matched on sex, race/ethnicity, marital status, education level, annual family income, drug use, and presence of a DSM-IV diagnosis. To determine whether age is associated with differential endorsement of ASPD criteria, logistic regression models were conducted with the matched data to predict each criterion measured by the AUDADIS-IV described above.

Results: Older adults were significantly less likely than younger adults to endorse 13 of the 28 items and more likely to endorse 5 items, after accounting for sociodemographic and psychosocial covariates. The majority of items older adults were less likely to endorse measured the criteria, “failure to conform to norms regarding legal behavior” and “deceitfulness.” Older adults were less likely to endorse vandalizing another’s property(OR = 0.374, p<.001), starting a fire intentionally(OR = 0.489, p<.001), shoplifting(OR = 0.638, p<.001), make money illegally(OR = 0.509, p<.001), ever do something they could have been arrested for(OR = 0.661, p<.001), and ever harass or threaten someone(OR = 0.443, p<.001).

Conclusions and Implications: Results of the current study suggest the presence of age bias in the 18 ASPD related items not equally endorsed by older and younger adults. These results can be used by practitioners and researchers to create new models of ASPD criteria specific for assessment of this population. Improved criteria will advance diagnostic accuracy and understanding of ASPD in older adults through increased research, leading to the development of treatment methods better suited for this population. More extensive research into these debilitating disorders will result in improvement of the quality of life for older adults and decrease the consequences associated with ASPD.