Aggressive antisocial behavior- clinical, cognitive, and behavioral covariates of its persistence

Sammanfattning: Introduction Aggressive antisocial behavior is a major challenge to society, and studies on the determinants of its persistence are essential to the development of strategies to prevent violence. Aims & Methods The overall aim of the thesis was to establish covariates of persistent aggressive antisocial behavior in a population-based cohort and in clinically evaluated, prospectively followed, offender groups. Specific aims were: (1) to quantify the persistence of aggressive antisocial behavior, (2) to identify risk factors for such persistence, (3) to describe the distribution of psychopathic traits (according to the Psychopathy Checklist-Revised; PCL-R) in relation to clinical factors, and (4) to determine thinking styles related to aggressive antisocial behavior. Results One percent of the Swedish general population was responsible for 63% of all violent crimes between 1973 and 2004. Risk factors for persistence of aggressive antisocial behavior included its early onset, conduct disorder, antisocial personality disorder, and substance-related disorders. In the PCL-R, the Antisocial facet outperformed all other facets and the total score as a predictor of persistence. The Interpersonal facet showed unique clinical attributes. A distorted thinking style characterized by antisocial features was related to aggressive antisocial behavior. Conclusions Aggressive antisocial behaviors and clinical factors including externalizing mental health problems aggregate within individuals. The best predictor of future aggressive antisocial behavior is a history of similar behaviors, especially with an early onset. Scientific and clinical efforts aimed to prevent violence have therefore to focus both on early-onset and persistent aggressive antisocial behavior, and their associated clinical and cognitive characteristics.