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ASSESSMENT OF PERSONALITY DISORDERS IN DELINQUENT ADOLESCENTS USING SCID-II

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Juvenile delinquency represents all offenses against social norms, legally sanctioned, committed by minors under 18 years old. Objectives. Identifying personality disorders in delinquent adolescents examined for forensic psychiatric expertise, identifying the predictors for recurrent the childhood conduct disorder and the adolescent conduct disorder. Aims. This paper aimed to determine if juvenile delinquency is related to personality disorders and a set of risk factors. Method. Participants. A lot of 31  patients, aged 14-18 years, subjected to forensic examination at the Child Psychiatry Clinic of Cluj-Napoca during 2011. Instruments. To assess personality disorders we used SCIDII – structured interview to identify personality disorders on axis II-DSM and a set of questions related to the ​​origin area, socioeconomic status, education level, family environment, consumption of toxic, belonging to certain social groups, family history, were adressed to the adolescents and their parents. To assess intellectual coefficient were used Raven Progressive Matrices. Results. The most frequent personality disorders found among delinquent teens were abnormal personalities of cluster B (antisocial, borderline, narcissistic). Conclusions. Because juvenile delinquency represents a real social problem is important to identify underlying traits or personality disorders in order to establish specific treatment plans.

Introduction

Juvenile delinquency represents all offenses against social norms, legally sanctioned, committed by minors under 18 years old.

A number of studies in North America have reported the presence of one or more psychiatric disorders in 50% -60% in the incarcerated delinquent adolescents (Duclos et al., 1998; Eppright, Kashani, Robinson, & Reid, 1993; Teplin, Abram, McClelland, Dulcan, & Mericle, 2002; Wasserman, McReynolds, Lucas, Fisher, & Santos, 2002). The most common psychiatric disorders diagnosed were personality disorders, substance abuse and conduct disorders.

Similar results were reported in two studies made on German delinquent teens. Hinrichs (2001) using a sample composed of 101 adolescent offenders revealed that 92% of them met ICD 10 criteria for a psychiatric disorder: Personality disorders (33%), substance abuse (25%) and childhood conduct disorder. Jacobs & Reinhold (2004) using a sample composed of 40 delinquent adolescents reported a high prevalence of disorders due to substance abuse (80%) and personality disorders (53% antisocial personality disorders and 20% paranoid personality disorders).

Due to multiple social implications juvenile delinquency represents an important and current subject of research in child and adolescent psychiatry.

 

Objectives

We conducted a clinical trial design, analytical and observational, directed towards a well defined category of patients: adolescents with delinquent behavior.

The main objective was to identify the personality disorders occurring more frequently in delinquent teens.

The secondary objective was to identify the predictors for recurrent conduct disorders.

 

Method

Participants. We used a sample of 31 adolescents with ages between 14-18 undergoing forensic examination during 2011 in the Child and Adolescent Psychiatry Clinic from Cluj-Napoca.

Inclusion criteria: male or female with ages between 14-18 diagnosed with conduct disorder (CD), according to international criteria DSM IV-RT and ICD-10; the teenagers and caregivers agreed to participate in the clinical trial after they have been explained to and understood the purpose and clinical protocol.

Exclusion criteria: adolescent diagnosed with a mental retardation form, teenagers with insufficient knowledge of Romanian language, adolescent refusal to participate in the study.

Tools. The instrument used to assess personality disorders was the SCID II – structured interview to identify personality disorders on axis II DSM.

To establish other risk factors we used a set of questions regarding the area of origin, socioeconomic status, education level, family, consumption of toxic substances, belonging to certain social groups, family history. To assess intellectual coefficient we used The Raven Progressive Matrices.

Procedure. Adolescents underwent somatic, psychiatric and psychological evaluation. Were subsequently applied SCID-II-structured interview to identify personality disorders from axis II DSM. Both caregivers and adolescents were asked to respond honestly to questions related to environmental factors.

Data analysis. Data was entered into an SPSS database. For data analysis we used SPSS statistical package (version 17). Initially we performed a descriptive statistical data to define the general characteristics of the sample. To identify significant associations between variables we used bivariate statistical analysis (Chi-square, t test for independent samples) and to analyze the independent contribution of each PD to the appearance of the Childhood CD/Adolescent CD we used a linear multiple regression analysis.

 

Results and Discussion

31 subjects were included in the study, with ages between 14-18, with an average age of 15.35 years (SD=1.22) with a medium IQ=96.45 (SD =8.16).

 

Table I. General characteristics of the sample

CD incidence increases from childhood to adolescence. In the sample there was a net predominance of male subjects. According to literature data, the prevalence of CD is more common in boys. Usually children with antisocial behavior come from families with poor SES: low income, parents without a job, welfare dependence, state-subsidized housing (1). Pittsburgh Youth Study described a significant correlation between school performance and conduct disorders (2). There are meta-analyses that support the association between ADHD (3), impulsivity (4) and delinquency. The Developmental Trends Study, from U.S.A. has shown that ADHD predicts the appearance of ODD which in turn predicts the appearance of CD (5).

A number of 17 patients of the 31 taken in the study met simultaneously the DSM IV criteria for CD and PD, the most frequent personality disorders found among delinquent teens were abnormal personalities of cluster B (antisocial, borderline, narcissistic) (table III).

Kohler & al., 2009, on a sample composed of 149 male delinquent teens from Germany reported a prevalence of 81% CD, the cluster B personality disorder up to 62% and substance abuse up to 60% (6).

 

Table II. The relationship between PD and CD

According to DSM IV the diagnosis of personality disorder can be established under the age of 18 if the behavior pattern has lasted at least 1 year. An exception to this rule is the antisocial personality disorder, whose diagnosis can be established only after the age of 18. In the present study adolescents who met all criteria for APD except for age-related criterion were treated statistically as they had APD.

 

Table III. The personality disorders in delinquent teens

The comparison of personality disorders between the two subtypes of CD ( under 10, after 10 years) did not show statistically significant differences between the frequency of PD for the two age groups (Avoidant PD χ2 = 0.052, p = 0.82; Dependent PD χ2 = 0.01, p = 0.90; Obsessive-compulsive PD χ2 = 1.8, p = 0.40; Passive-aggressive PD χ2 = 2.1, p = 0.33; Depressive PD χ2 = 2.1, p = 0.33; Paranoid PD χ2 = 0.00, p = 1.00; Schizotypal PD χ2 = , p = ; Schizoid PD χ2 = 4.8, p = 0.08; Histrionic PD χ2 = 0.00, p = 1.00; Narcissistic PD χ2 = 4.12, p = 0.12; Borderline PD χ2 = 0.77, p = 0.67; Antisocial PD χ2 = 5.52, p = 0.62).

To analyze the independent contribution of each PD in explaining the appearance of CD we used a multiple linear regression analysis where PD were introduced as predictors for CD, who was treated as criterion variable. Data analysis revealed that personality disorders are not predictors of conduct disorder (beta = 0.04-0.37, p>0.05).

Statistical analysis of data revealed a higher prevalence of delinquency in teenagers who had CD (χ2 = 4.51, p = 0.03) and the association between APD with a higher rate of physical aggression (χ2 = 7.46, p = 0.02), with a higher rate of verbal aggression (χ2 = 6.09, p = 0.04), with a higher rate of consumption of toxic substance (χ2 = 14.58, p = 0.001), with multiple acts of delinquency (χ2 = 5.16, p = 0.05) and with early onset of the CD (χ2 = 5.19, p = 0.02).

 

Conclusions

 

  1. The delinquent teens had an average of 15 years and an average IQ of 96. They were usually boys, students with poor school performance, with an approximately equal distribution in the area of origin, organized in families with more children with a low SES status. Most of them had a co morbid disorder (most commonly ADHD) and had no family history of psychiatric disorder.
  2. The most frequent personality disorders found among delinquent teens were abnormal personalities of cluster B (antisocial, borderline, narcissistic).
  3. The personality disorders assesed with SCID-II were not considered predictors of conduct disorder based on the multiple linear regression analysis.
  4. A number of delinquent teens met simultaneously the DSM IV criteria for CD and PD.
  5. The APD was often associated with verbal and physical aggression, use of toxic substances and committing multiple acts of delinquency.
  6. Given that juvenile delinquency represents a real social issue it is important to identify the underlying personality traits or personality disorders in order to establish individualized specific treatment plans.

 

BIBLIOGRAPHY

  1. Murray J, Farrington DT. Risk Factors for Conduct Disorder and Delinquency: Key Findings From Longitudinal Studies. Can J Psychiatry 2010;55:633-643.
  2. Loeber R, Farrington DP, Stouthamer-Loeber M, et al. Antisocial behavior and mental health problems: explanatory factors in childhood and adolescence. Mahwah: Lawrence Erlbaum, 1998:341.
  3. Pratt TC, Cullen FT, Blevins KR et al. The relationship of attention deficit hyperactivity disorder to crime and delinquency: a meta-analysis. Int J Police 2002;4:344-360.
  4. Jolliffe D, Farrington DP. A systematic review of the relationship between childhood impulsiveness and later violence. In: McMurran M, Howard RC, eds. Personality, personality disorder, and risk of violence, London: John Wiley & Sons, 2008:41-61.
  5. Burke JD, Loeber R, Lahey BB, et al. Developmental transitions among affective and behavioral disorders in adolescent boys. J Child Psychol Psychiatry 2005;46:1200-1210.
  6. Köhler D, Heinzen H, Hinrichs G, Huchzermeier C. The Prevalence of Mental Disorders in a German Sample of Male Incarcerated Juvenile Offenders. Int J Offender Ther Comp Criminol 2009;3:211-227.
  7. American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).Washington, DC: Author.
  8. Kierkus CA, Hewitt JD. The contextual nature of the family structure/delinquency relationship. Journal of Criminal Justice 2009;37:123–132.

 

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