Understanding comorbidity of anxiety disorders with antisocial behavior: findings from two large community surveys

Although a positive association between antisocial behavior and anxiety disorders may seem clinically counterintuitive, some previous studies have in fact found a higher co-occurrence of anxiety disorders and antisocial behavior than in the general population. We investigated the relationship between anxiety disorders and antisocial behavior in two contemporaneous community surveys (National Comorbidity Survey, Ontario Health Survey). A significant association was found between any DSM-III-R anxiety disorder diagnosis and any DSM-III-R antisocial diagnosis (National Comorbidity Survey, odds ratio = 3.05, p <.01; Ontario Health Survey, odds ratio = 2.37, p <.01). This association remained significant after controlling for sociodemographics, depression, and alcohol and drug use disorders. Posttraumatic stress disorder and social phobia complex subtype (i.e., multiple social fears) produced the largest odds ratios. People with comorbid anxiety and antisocial diagnoses displayed high levels of distress, neuroticism, and disability, and poor quality of life. Clinicians and health policy makers need to be aware of the co-occurrence of anxiety disorders and antisocial behavior.