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Journal article : Review

Personality disorders, violence and antisocial behaviour: updated systematic review and meta-regression analysis

Abstract:
Background
Links between personality disorders and antisocial outcomes has not examined individual personality disorders, and the contribution of comorbidities remain uncertain. Previous systematic reviews are dated.

Aims
To synthesise evidence from observational studies on the risk of antisocial outcomes and recidivism associated with personality disorders.

Method
We searched six bibliographic databases (up to March 2024) for observational studies examining the risk of antisocial behaviour, interpersonal violence and recidivism in individuals diagnosed with personality disorders, compared to controls. We explored sources of heterogeneity using subgroup analyses and meta-regression.

Results
We identified 21 studies involving 83 418 individuals with personality disorders from 10 countries examining antisocial and violent outcomes (Aim 1), and 39 studies of 14 131 individuals from 13 countries with recidivism (or repeat offending) as the outcome (Aim 2). We found increased risks of violence among individuals with any personality disorder (odds ratio 4.5, 95% CI 3.0–6.7), particularly antisocial personality disorder (odds ratio 7.6, 95% CI 5.1–11.5) and borderline personality disorder (odds ratio 2.6, 95% CI 1.8–3.9). Individuals with any personality disorder (odds ratio 2.3, 95% CI 2.0–2.6) and antisocial personality disorder (odds ratio 2.8, 95% CI 1.6–4.9) also demonstrated an elevated risk of recidivism. Personality disorder types and comorbid substance use disorder were associated with between-study heterogeneity.

Conclusions
The assessment and management of personality disorders should be considered as part of violence prevention strategies. Improving identification and treatment of comorbid substance misuse may reduce adverse outcomes in individuals with personality disorders.
Publication status:
Published
Peer review status:
Peer reviewed

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Files:
Publisher copy:
10.1192/bjp.2024.226

Authors

More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Psychiatry
Oxford college:
Green Templeton College
Role:
Author
ORCID:
0000-0003-4361-4945
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Psychiatry
Role:
Author
ORCID:
0000-0001-7315-3348
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Psychiatry
Oxford college:
Merton College
Role:
Author
ORCID:
0000-0002-5281-5960
More by this author
Institution:
University of Oxford
Division:
MSD
Department:
Psychiatry
Role:
Author
ORCID:
0000-0002-5383-5365


More from this funder
Funder identifier:
https://ror.org/029chgv08
Grant:
202836/Z/16/Z


Publisher:
Cambridge University Press
Journal:
British Journal of Psychiatry More from this journal
Volume:
227
Issue:
1
Pages:
481-491
Place of publication:
England
Publication date:
2024-12-11
Acceptance date:
2024-09-30
DOI:
EISSN:
1472-1465
ISSN:
0007-1250
Pmid:
39659141


Language:
English
Keywords:
Subtype:
Review
Pubs id:
2070419
Local pid:
pubs:2070419
Deposit date:
2025-01-17
ARK identifier:

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