TY - JOUR
T1 - Specific antisocial and borderline personality disorder criteria and general substance use
T2 - A twin study.
AU - Rosenström, Tom
AU - Torvik, Fartein Ask
AU - Ystrom, Eivind
AU - Aggen, Steven H.
AU - Gillespie, Nathan A.
AU - Krueger, Robert F.
AU - Czajkowski, Nikolai Olavi
AU - Kendler, Kenneth S.
AU - Reichborn-Kjennerud, Ted
N1 - Publisher Copyright:
© 2020 American Psychological Association
PY - 2021
Y1 - 2021
N2 - Antisocial (ASPD) and borderline (BPD) personality disorders (PDs) are associated with increased risk for substance use. They are “specific” risk factors among PDs in that they withstand adjusting for the other PDs, whereas the reverse does not hold. Specificity is a classic sign of causation. This empirical work addresses 3 further problems that can undermine causal inferences in personality and substance-use research: hierarchical nature of etiologic factors in psychiatry, imperfectly operationalized PD criteria, and possible genetic or environmental confounding, as seen in lack of “etiologic continuity.” We used exploratory structural equation bifactor modeling and biometric models to mitigate these problems. The participants were Norwegian adult twins of ages 19–36 years (N = 2,801). Criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), PDs were assessed using a structured interview. General substance-use risk was indicated by World Health Organization Composite International Diagnostic Interviewed alcohol use disorder and illicit drug use, and by self-reported regular smoking. A general risk factor for all criteria of both ASPD and BPD was the strongest individual correlate of general substance use and showed etiologic continuity, though just 3 specific PD criteria could predict substance use to the same extent. The findings indicate that a broad latent factor for both ASPD and BPD may be a specific and a genetically and environmentally unconfounded risk factor for substance use. Substance-use treatment research might benefit from attending to transdiagnostic models of ASPD, BPD, and related behavioral disinhibition.
AB - Antisocial (ASPD) and borderline (BPD) personality disorders (PDs) are associated with increased risk for substance use. They are “specific” risk factors among PDs in that they withstand adjusting for the other PDs, whereas the reverse does not hold. Specificity is a classic sign of causation. This empirical work addresses 3 further problems that can undermine causal inferences in personality and substance-use research: hierarchical nature of etiologic factors in psychiatry, imperfectly operationalized PD criteria, and possible genetic or environmental confounding, as seen in lack of “etiologic continuity.” We used exploratory structural equation bifactor modeling and biometric models to mitigate these problems. The participants were Norwegian adult twins of ages 19–36 years (N = 2,801). Criteria for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), PDs were assessed using a structured interview. General substance-use risk was indicated by World Health Organization Composite International Diagnostic Interviewed alcohol use disorder and illicit drug use, and by self-reported regular smoking. A general risk factor for all criteria of both ASPD and BPD was the strongest individual correlate of general substance use and showed etiologic continuity, though just 3 specific PD criteria could predict substance use to the same extent. The findings indicate that a broad latent factor for both ASPD and BPD may be a specific and a genetically and environmentally unconfounded risk factor for substance use. Substance-use treatment research might benefit from attending to transdiagnostic models of ASPD, BPD, and related behavioral disinhibition.
KW - bifactor model
KW - exploratory structural equation modeling
KW - hierarchical model
KW - population study
KW - substance use disorders
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U2 - 10.1037/per0000404
DO - 10.1037/per0000404
M3 - Article
C2 - 32584092
AN - SCOPUS:85087214499
SN - 1949-2715
VL - 12
SP - 228
EP - 240
JO - Personality Disorders: Theory, Research, and Treatment
JF - Personality Disorders: Theory, Research, and Treatment
IS - 3
ER -