Personality trait differences in boys and girls with clinical or sub-clinical diagnoses of conduct disorder versus antisocial personality disorder

This study tested differences in personality traits measured by the Multidimensional Personality Questionnaire (MPQ) in a community sample of adolescents with definite or probable conduct disorder (CD) diagnoses that did not progress to a diagnosis of antisocial personality disorder (ASPD) by early adulthood (n=43), those with definite or probable ASPD that persisted into early adulthood (n=68), or controls with neither a CD nor an ASPD diagnosis (n=716) to examine whether antisocial behaviour disorders that differed in course were associated with differences in personality traits. As expected, boys and girls with ASPD were significantly different from controls on constraint, and those with ASPD were significantly lower on constraint than those with only CD. The results suggest that individual differences in certain personality traits may contribute to differences in the type of antisocial behaviour disorder that emerges and thereby to the course of antisocial behaviour.     

Relationship of cognitive ability to the developmental course of antisocial behavior in substance-dependent patients

1. The present study examined cognitive differences among three groups of abstinent substance-dependent patients and a control group of non-drug users. The patient groups were defined according to their DSM III-R substance dependence diagnosis(es): heroin, cocaine, or dual alcohol and cocaine dependence.

2. In the initial analysis, which compared the four subject groups on scores from the Shipley Institute of Living Scale, no significant differences were found. However, the groups did vary on the number of Antisocial Personality Disorder (ASPD) behaviors.

3. Another set of analyses was conducted to examine the relationship between ASPD and SILS scores. Analyses of the effects of ASPD (+/−) across all of the patients revealed lower SILS scores in the ASPD-positive group. Additional analyses examined the developmental course of the ASPD effect by contrasting 1) patient groups characterized by childhood Conduct Disorder (CD) combined with adult ASPD vs. 2) childhood CD which did not continue into adulthood as ASPD vs. 3) adults who did not report childhood CD but who met other ASPD behavioral criteria as adults, vs. 4) subjects who had neither childhood CD nor adult ASPD.

4. In this analysis, it was found that patients who met diagnostic criteria for childhood Conduct Disorder, but whose antisocial behaviors resolved after age 15, had equivalent SILS scores to those patients with no childhood CD or adult ASPD. A decrement in SILS scores was only found in those patients whose antisocial behaviors persisted into adulthood.

5. ASPD adults who did not report childhood CD behaviors had normal SILS scores compared to Controls.

DSM-IV conduct disorder criteria as predictors of antisocial personality disorder

Conduct disorder (CD) is a disorder of childhood and adolescence defined by rule-breaking, aggressive, and destructive behaviors. For some individuals, CD signals the beginning of a lifelong persistent pattern of antisocial behavior (antisocial personality disorder [ASPD]), whereas for other people, these behaviors either desist or persist at a subclinical level. It has generally been accepted that about 40% of individuals with CD persist. This study examined the rate of persistence of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) CD into ASPD and the utility of individual DSM-IV CD symptom criteria for predicting this progression. We used the nationally representative sample from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Approximately 75% of those with CD also met criteria for ASPD. Individual CD criteria differentially predicted severity and persistence of antisocial behavior with victim-oriented, aggressive behaviors generally being more predictive of persistence. Contrary to previous estimates, progression from CD to ASPD was the norm and not the exception in this sample. Relationships between individual DSM-IV CD symptom criteria and persistent antisocial outcomes are discussed. These findings may be relevant to the development of DSM-V.     

The adult antisocial syndrome with and without antecedent conduct disorder: comparisons from an adoption study.

DSM antisocial personality disorder (ASPD) requires a retrospective diagnosis of conduct disorder-historical behavior not present in everyone with adult ASPD criteria. Using adoption study data, we examined the impact of this requirement on biological and environmental risk associations. We also compared clinical correlates of adult antisocial behavior with and without prior conduct disorder. We defined three subgroups: DSM-III ASPD (n = 30), adult antisocials without conduct disorder (n = 25), and controls (n = 142). By design, the sample had a high incidence of biological parent ASPD, which was partially confounded with fetal alcohol exposure. We compared the associations of both of these putative risk factors with subgroup membership after controlling for gender and adverse adoptive environment. We also examined differences in two sociopathy scales and the incidence of co-occurring affective, alcohol, and other substance use disorders. Finally, we explored differences in individual antisocial symptoms. Having an antisocial biological parent was a specific risk factor for ASPD. In contrast, fetal alcohol exposure, male gender, and adverse environment were associated with the adult antisocial syndrome, regardless of conduct disorder history. The two antisocial groups were similar with respect to sociopathy scales, co-occurring diagnoses, and the incidence of most individual symptoms. However, several adult and conduct disorder symptoms had significant specific associations with biological or environmental background or their interaction. Phenotypic expression of the biological-possibly genetic-risk for ASPD appears to be manifest before adulthood. The influence of other risk factors may not depend on antecedent conduct disorder. Despite this, we could not detect clinically important differences between the two sociopathic groups. The conduct disorder requirement therefore may be more relevant to etiological than clinical understanding of adult antisocial behavior.     

Antisocial behavioral syndromes and body mass index among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE: To describe associations of antisocial behavioral syndromes, including DSM-IV antisocial personality disorder (ASPD) and conduct disorder without progression to ASPD ("CD only"), and syndromal antisocial behavior in adulthood without CD before age 15 (AABS, not a codable DSM-IV disorder), with body mass index (BMI) status in the general US adult population. METHODS: This report is based on the 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (n = 43093; response rate, 81%). Respondents were classified according to whether they met criteria for ASPD, AABS, "CD only," or no antisocial syndrome, and on current BMI status based on self-reported height and weight. Associations of antisocial syndromes with BMI status were examined using multinomial logistic regression. RESULTS: Among men, antisociality was not associated with BMI. Among women, ASPD was significantly associated with overweight and extreme obesity; AABS was associated with obesity and extreme obesity; and "CD only" was significantly associated with overweight, obesity, and extreme obesity. CONCLUSIONS: Assessment of antisocial features appears warranted in overweight, obese, and extremely obese women, and assessment of BMI status appears indicated in antisocial women. Prevention and treatment guidelines for overweight and obesity may need revision to address comorbid antisociality, and interventions targeting antisociality may need to include attention to weight concerns.     

Antisocial Patients: A Comparison of Those with and Those Without Childhood Conduct Disorder

The purpose of this study was to compare persons with antisocial personality disorder (ASP) with those who meet the adult criteria for ASP but fail to meet the criteria for childhood conduct disorder. Sociodemographic data, medical history, and psychiatric symptoms exhibited during a recent hospital admission were compared in the two groups by chart review. The two groups were virtually indistinguishable, except that patients without childhood conduct disorder were less likely to smoke or consume alcohol, were less likely to have spent time in a training school/boot camp as a child or adolescent, were less likely to have been admitted for a recent suicide attempt, and were less likely to have conned others. We conclude that persons meeting the adult criteria for ASP but not the childhood conduct disorder criteria essentially suffer the same disorder as those who meet full ASP criteria but are less severely affected.     

Antisocial personality disorder in Turkish substance dependent patients and its relationship with anxiety, depression and a history of childhood abuse

The prevalence of antisocial personality disorder (ASPD) in treatment-seeking Turkish substance dependent patients and the relationship of ASPD with clinical characteristics were studied. Participants were 132 inpatients with substance dependence according to the Structured Clinical Interview for DSM-IV (SCID-I), Turkish version. The clinician applied a semi-structured socio-demographic form, SCID-I, SCID-II, Childhood Abuse and Neglect Questionnaire (CANQ), Michigan Alcoholism Screening Test (MAST), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI). Among the 132 substance dependent patients, 31 (23.5%) had ASPD diagnosis and 56 (42.4%) had no personality disorder or personality traits. Rate of childhood physical abuse, childhood verbal abuse, childhood neglect, suicide attempt history, self-destructive behavior and lifetime major depression were higher among patients with ASPD. Also mean scores of BDI, BAI and MAST were higher among patients with ASPD. The high rate of ASPD found among Turkish substance dependent patients suggests that special attention must be paid to identify ASPD in this group. Findings in this study showed that there is an association between ASPD and childhood abuse, lifetime major depression and severity of substance use.     

Child and adolescent psychiatric disorders predicting adult personality disorder: a follow-up study

The objective of this study was to examine associations between childhood and adolescent psychiatric disorders and adult personality disorders in a group of former child psychiatric inpatients. One hundred and fifty-eight former inpatients with a mean age of 30.5 +/- 7.1 years at investigation had their childhood and adolescent Axis I disorders, obtained from their medical records, coded into DSM-IV diagnoses. Personality disorders in adulthood were assessed by means of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). The predictive effects of child and adolescent Axis I disorders on adult personality disorders were examined with logistic regression analyses. The odds of adult schizoid, avoidant, dependent,borderline and schizotypal personality disorders increased by almost 10, five, four, three and three times, respectively, given a prior major depressive disorder. Those effects were independent of age, sex and other Axis I disorders. In addition, the odds of adult narcissistic and antisocial personality disorders increased by more than six and five times, respectively, given a prior disruptive disorder, and the odds of adult borderline, schizotypal, avoidant and paranoid personality disorders increased between two and three times given a prior sub-stance-related disorder. The results illustrate an association between mental disorders in childhood and adolescence and adult personality disorders. Identification and successful treatment of childhood psychiatric disorders may help to reduce the risk for subsequent development of an adult personality disorder.     

Frontal P300 decrements, alcohol dependence, and antisocial personality disorder.

BACKGROUND: The purpose of this study was to examine the independent and interactive effects of alcohol dependence, antisocial personality disorder (ASPD), and age on brain function. METHODS: P300 event-related potentials (ERPs) were recorded from 393 alcohol-dependent and 170 non-alcohol-dependent adults while they performed a visual oddball task. The two subject groups were further subdivided based upon age and the presence/absence of ASPD. RESULTS: Alcohol dependence was associated with a significant P300 amplitude decrement at anterior electrode sites only. Antisocial personality disorder was also associated with reduced P300 amplitudes at anterior electrode sites; however, the effects were only significant among subjects 30 years of age or younger. To validate this association between ASPD and P300 amplitude a correlational analysis was performed; the correlation between anterior P300 amplitude and the total number of childhood conduct disorder and adult ASPD symptoms was significant. CONCLUSIONS: The P300 amplitude decrement found at anterior electrode sites among subjects with ASPD is consistent with the results of numerous ERP, neuroimaging, or neuropsychologic studies of anterior brain function. Our study is unique in suggesting that the effects of ASPD on anterior brain function are best detected during early adulthood. The study also suggests that the detrimental neurophysiologic effects of alcohol dependence predominantly involve the anterior brain.     

Adult antisocial behaviour without conduct disorder: demographic characteristics and risk for cooccurring psychopathology.

OBJECTIVE: Several studies note people who demonstrate adult antisocial behaviour (AAB) in the absence of conduct disorder (CD) before age 15 years. Perhaps because they do not meet diagnostic criteria for antisocial personality disorder (ASPD), this group of people exhibiting late-onset AAB has been underrecognized and understudied. Thus the goal of this study was to examine the demographic features and patterns of cooccurring psychopathology of people exhibiting late-onset antisocial behaviour (AB; AAB but not CD), compared with people suffering from ASPD (CD and AAB), people suffering from CD but not AAB, and members of a nonantisocial control group. METHOD: This study used the population-based sample of the National Comorbidity Survey (NCS). The demographic features examined were sex, percentage living in poverty, annual income, and years of formal education. The possibly cooccurring diagnoses examined were alcohol abuse and dependence, drug abuse and dependence, major depressive disorder, dysthymia, generalized anxiety disorder, social phobia, simple phobia, panic disorder, agoraphobia, and posttraumatic stress disorder. RESULTS: About 2.3% of participants exhibited AAB but not CD. These individuals had patterns of demographic characteristics and cooccurring psychiatric disorders quite similar to those of people diagnosed with full ASPD. CONCLUSION: Individuals who demonstrate this pattern of late-onset AB are at levels of risk comparable to those of individuals suffering from ASPD; therefore, they are equally in need of research and clinical attention.     

Antisocial personality disorder with childhood- vs. adolescence-onset conduct disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions

This study, based on a nationally representative, epidemiologic sample (N = 43,093, response rate 81%), compared sociodemographic and family history correlates, antisocial personality disorder (ASPD) symptom patterns, and Axis I and Axis II comorbidity, among adults with DSM-IV ASPD who reported onset of conduct disorder (CD) in childhood ( or =age 10). Prevalence of each ASPD diagnostic criterion and comorbid lifetime disorder was estimated. Logistic regression was used to examine associations of childhood-onset CD with ASPD symptom patterns and comorbid disorders. Among the 1422 respondents with ASPD, 447 reported childhood-onset CD. Childhood-onset respondents were more likely than adolescence-onset respondents to endorse CD criteria involving aggression against persons, animals, and property before age 15, and to endorse more childhood criteria and lifetime violent behaviors. Childhood-onset respondents displayed significantly elevated odds of lifetime social phobia, generalized anxiety disorder, drug dependence, and paranoid, schizoid, and avoidant personality disorders, but significantly decreased odds for lifetime tobacco dependence. Childhood-onset CD appears to identify a more polysymptomatic and violent form of ASPD, associated with greater lifetime comorbidity for selected Axis I and Axis II disorders, in nonclinical populations.     

Offenders with antisocial personality disorder show attentional bias for violence-related stimuli

Offenders with antisocial personality disorder (ASPD) may be characterized by a lack in emotional functioning that manifests in irritability and a lack of remorse. The proposed link between ASPD and negative emotionality led to the question of emotional processing anomalies in ASPD. Furthermore, the effect of childhood maltreatment/abuse on emotional processing was tested in the present study. Violent and sexual offenders with ASPD (n=35), without ASPD (n=34), and healthy non-criminal controls (n=24) were compared in an Emotional Stroop Task (EST) using neutral, negative, and violence-related words. Secondary analyses focused on the effect of psychopathic traits and childhood maltreatment. Offenders with ASPD showed a stronger attentional bias to violence-related and negative words as compared to controls. Comparable results were obtained when grouping offenders to high, medium, and low psychopathic subgroups. Offenders with childhood maltreatment specifically showed stronger violence-related attentional bias than non-maltreated offenders. The data suggest that enhanced attention to violence-related stimuli in adult criminal offenders is associated with adverse developmental experiences and delinquency but to a lesser extent with antisocial or psychopathic traits.     

Lack of remorse in antisocial personality disorder: sociodemographic correlates, symptomatic presentation, and comorbidity with Axis I and Axis II disorders in the National Epidemiologic Survey on Alcohol and Related Conditions

OBJECTIVE: The purpose of this study was to compare sociodemographic and family history correlates, symptomatic presentation, and comorbidity with Axis I and Axis II disorders, in an epidemiologic sample of adults with DSM-IV antisocial personality disorder (ASPD) who lacked, vs those who did not lack, remorse. METHODS: This study is based on a nationally representative sample of adults. Lifetime prevalences of each ASPD diagnostic criterion and each comorbid mood, anxiety, substance use, and personality disorder were estimated. Logistic regression was used to examine associations of lack of remorse with ASPD symptom patterns and comorbid disorders. Diagnoses were made using the National Institute on Alcohol Abuse and Alcoholism Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version. RESULTS: Among the 1422 respondents with ASPD, 728 (51%) lacked remorse. Respondents who lacked remorse were younger and more often reported a family history of drug problems than those who did not. More often than remorse-positive respondents, those who were remorse-negative met diagnostic criteria involving violence against persons and less often met criteria involving offenses against property. Remorse was not associated with cruelty to animals, nor with most nonviolent antisocial behaviors. Remorse-negative respondents endorsed more total lifetime violent behaviors than those who were remorse-positive. Lack of remorse was not associated with any lifetime comorbid Axis I or Axis II disorder. Patterns of findings were generally similar between men and women. CONCLUSIONS: Lack of remorse appears to identify at best a modestly more symptomatically severe and violent form of ASPD in nonclinical populations.     

Adverse outcomes associated with personality disorder not otherwise specified in a community sample

OBJECTIVE: The authors investigated 1) whether adolescents and adults in the community diagnosed with personality disorder not otherwise specified are at elevated risk for adverse outcomes, and 2) whether this elevation in risk is comparable with that associated with the DSM-IV cluster A, B, and C personality disorders. METHOD: A community-based sample of 693 mothers and their offspring were interviewed during the offspring's childhood, adolescence, and early adulthood. Offspring psychopathology, aggressive behavior, educational and interpersonal difficulties, and suicidal behavior were assessed. RESULTS: Individuals who met DSM-IV criteria for personality disorder not otherwise specified were significantly more likely than those without personality disorders to have concurrent axis I disorders and behavioral, educational, or interpersonal problems during adolescence and early adulthood. In addition, adolescents with personality disorder not otherwise specified were at significantly elevated risk for subsequent educational failure, numerous interpersonal difficulties, psychiatric disorders, and serious acts of physical aggression by early adulthood. Adolescents with personality disorder not otherwise specified were as likely to have these adverse outcomes as those with cluster A, B, or C personality disorders or those with axis I disorders. CONCLUSIONS: Adolescents and young adults in the general population diagnosed with personality disorder not otherwise specified may be as likely as those with DSM-IV cluster A, B, or C personality disorders to have axis I psychopathology and to have behavioral, educational, or interpersonal problems that are not attributable to co-occurring psychiatric disorders. Individuals with personality disorder not otherwise specified and individuals with DSM-IV cluster A, B, or C personality disorders are likely to be at substantially elevated risk for a wide range of adverse outcomes.     

Monoamine oxidase A regulates antisocial personality in whites with no history of physical abuse

Objective

Preclinical and human family studies clearly link monoamine oxidase A (MAOA) to aggression and antisocial personality (ASP). The 30–base pair variable number tandem repeat in the MAOA promoter regulates MAOA levels, but its effects on ASP in humans are unclear.

Methods

We evaluated the association of the variable number tandem repeat of the MAOA promoter with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, ASP disorder (ASPD) traits in a community sample of 435 participants from the Hopkins Epidemiology of Personality Disorders Study.

Results

We did not find an association between the activity of the MAOA allele and ASPD traits; however, among whites, when subjects with a history of childhood physical abuse were excluded, the remaining subjects with low-activity alleles had ASPD trait counts that were 41% greater than those with high-activity alleles (P < .05).

Conclusion

The high-activity MAOA allele is protective against ASP among whites with no history of physical abuse, lending support to a link between MAOA expression and antisocial behavior.     

Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection

OBJECTIVE: To investigate the role of parenting in the development of adult antisocial personality traits. METHOD: A total of 742 community-based subjects were assessed for adult DSM-IV antisocial personality disorder traits and for measures of parental behavior experienced as children, including by the Parental Bonding Instrument (PBI). RESULTS: Three fundamental dimensions of parental behavior - care, behavioral restrictiveness and denial of psychological autonomy - were derived by factor analysis from the PBI. These dimensions significantly correlated with measures of parental behavior considered influential in later antisocial behavior. Adult antisocial traits in males were associated with low maternal care and high maternal behavioral restrictiveness, and in females, antisocial traits were associated with low paternal care and high maternal denial of psychological autonomy. These dimensions did not, however, explain all variance parental behavior has on adult antisocial personality traits. CONCLUSION: Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection.     

Predictors of 2-year outcome for patients with borderline personality disorder

OBJECTIVE: The primary purpose of this report was to investigate whether characteristics of subjects with borderline personality disorder observed at baseline can predict variations in outcome at the 2-year follow-up. METHOD: Hypothesized predictor variables were selected from prior studies. The patients (N=160) were recruited from the four clinical sites of the Collaborative Longitudinal Personality Disorders Study. Patients were assessed at baseline and at 6, 12, and 24 months with the Structured Clinical Interview for DSM-IV Axis I Disorders; the Diagnostic Interview for DSM-IV Personality Disorders, a modified version of that instrument; the Longitudinal Interval Follow-Up Evaluation; and the Childhood Experiences Questionnaire-Revised. Univariate Pearson's correlation coefficients were calculated on the primary predictor variables, and with two forward stepwise regression models, outcome was assessed with global functioning and number of borderline personality disorder criteria. RESULTS: The authors' most significant results confirm prior findings that more severe baseline psychopathology (i.e., higher levels of borderline personality disorder criteria and functional disability) and a history of childhood trauma predict a poor outcome. A new finding suggests that the quality of current relationships of patients with borderline personality disorder have prognostic significance. CONCLUSIONS: Clinicians can estimate 2-year prognosis for patients with borderline personality disorder by evaluating level of severity of psychopathology, childhood trauma, and current relationships.     

Antisocial behavior of intravenous drug abusers: implications for diagnosis of antisocial personality disorder.

OBJECTIVE: A pattern of chronic adult antisocial behavior is not sufficient for the DSM-III-R diagnosis of antisocial personality disorder unless the early-onset criteria are satisfied, even if the adult criteria are met. The utility of the early-onset requirement for the diagnosis was examined in intravenous drug abusers, a population known to have high rates of irresponsible, aggressive, and criminal behavior. METHOD: The subjects were 237 drug abusers who had volunteered for an outpatient study of psychopathology and HIV risk behavior and infection. They completed a structured psychiatric interview as part of their participation in that study. The adult antisocial behavior of the group that met both the early-onset and the adult criteria for antisocial personality disorder, the group that met only the adult criteria, and the group that met neither the early-onset nor the adult criteria was then compared. RESULTS: Antisocial personality disorder (meeting the early-onset and adult criteria) was diagnosed in 44% of the sample; an additional 24% met only the adult criteria. The group with the diagnosis of antisocial personality disorder reported a more pervasive and more serious pattern of adult antisocial behavior than did the other groups, although antisocial behavior was commonplace in all three groups. CONCLUSIONS: Early onset of multiple antisocial behaviors identified a subset of drug abusers with important differences in the extent and severity of their adult antisocial behavior. The antisocial behavior of the group that met only the adult criteria suggests the possibility of a late-onset and less severe form of antisocial personality disorder.     

Co-morbidity of adult attention-deficit/hyperactivity disorder with focus on personality traits and related disorders in a tertiary referral center

Objective The prevalence and consequences of co-morbid axis-I and axis-II disorders as well as personality traits were examined in a large cohort of adult attention-deficit/hyperactivity disorder (AADHD) at a tertiary referral center. Methods In- and outpatients referred for diagnostic assessment of AADHD were screened. 372 affected probands were examined by means of the Structured Clinical Interview of DSM-IV axis-I/II disorders, the Revised NEO Personality Inventory (NEO-PI-R), and the Tridimensional Personality Questionnaire (TPQ). Results Lifetime co-morbidity with mood disorders was 57.3%, with anxiety disorders 27.2%, and with substance use disorders 45.0%. The histrionic personality disorder (35.2%) was the most frequent personality disorder. AADHD patients exhibited significantly altered scores on most of the NEO-PI-R and TPQ personality dimensions. The extent of substance abuse and dependence, as well as the presence of antisocial personality disorder alone or the cumulative number of other specific personality disorders was associated with lower psychosocial status (p < .0001). Discussion In a cohort of patients with AADHD referred to a single tertiary center co-morbidity with axis-I/II disorders was remarkably prevalent. In AADHD co-morbid mood, anxiety, and personality disorders as well as substance abuse/dependence is likely to be predictive of poor outcome.     

Discriminant efficiency of antisocial and borderline personality disorder criteria in Hispanic men with substance use disorders

The authors examined the discriminant efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV ) criteria for borderline personality disorder (BPD) and antisocial personality disorder (APD). Subjects were 74 men admitted to an outpatient substance abuse program for monolingual Hispanic adults. All were reliably assessed with the Spanish-language version of the Diagnostic Interview for DSM-IV Personality Disorders. Conditional probabilities were calculated to determine the diagnostic efficiency and discriminant efficiency of BPD and APD symptoms. Twenty-five (34%) subjects met diagnostic criteria for BPD, and 16 (22%) met criteria for APD. The diagnostic co-occurrence of these disorders was statistically significant. Whereas the diagnostic efficiency of the BPD criterion set was comparable to that reported in other clinical studies, these criteria were not significantly more efficient in diagnosing BPD than APD. By contrast, the APD criteria were more efficient in diagnosing APD than BPD; this was true for both the "adult" and the "conduct disorder" APD criterion subsets. In male Hispanic outpatients with substance use disorders, BPD and APD show significant diagnostic overlap. The APD criteria are useful in discriminating these 2 disorders, whereas the BPD criteria are not. These findings have implications for the discriminant validity of the BPD and APD criteria and support the value of the conduct disorder criteria in predicting APD in adulthood.