Oktay SAHİN, Ahmet NALBANT, Kaasim Fatih YAVUZ

Predictors of social functioning in people with antisocial personality disorder

Objective: Although much research has been performed in defining and diagnosing the antisocial personality disorder (ASPD) and its etiology, very few data about the predictors of social functioning (SF) in ASPD are available. Acceptance and commitment therapy is a third-wave psychotherapy which puts the psychological inflexibility model at the heart of its psychopathology model. According to this model, experiential avoidance, cognitive fusion, and attachment to conceptualized self are three processes that are related to psychological inflexibility. Method: In this study, we included 220 people with ASPD. We investigated possible predictive effects of experiential avoidance (measured with Acceptance and Action Questionnaire-II), cognitive fusion (measured with Cognitive Fusion Questionnaire), attachment to conceptualized self (measured with Self-as-Context Scale), symptom severity (measured with Structured Clinical Interview for DSM-II), and perspective taking (measured with Interpersonal Reactivity Index) on SF (measured with Social Functioning Scale) in people with ASPD. We conducted regression analyses to determine possible predictive effects. Results: Our model explained 14% of the cases. ASPD severity, lower attachment to conceptualized self, and cognitive fusion were found to predict SF but perspective taking and experiential avoidance did not. Conclusion: Other than symptom severity, self-as-context and cognitive fusion were found to predict SF in people with ASPD. Results were compared with the literature data.

PDF

___

1. American Psychiatric Association Diagnostic and Statistical Manual of mental disorders. Fifth ed., Arlington, VA: American Psychiatric Publishing, 2013.
2. Gibbon S, Khalifa NR, Cheung NHY, Völlm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2020; 9:CD007668.
3. Weissman MM. The assessment of social adjustment: a review of techniques. Arch Gen Psychiatry 1975; 32:357-365.
4. Bosc M. Assessment of social functioning in depression. Compr Psychiatry 2000; 41:63-69.
5. Ellis PL. Empathy: A factor in antisocial behavior. J Abnorm Child Psychol 1982; 10:123-133.
6. Eisenberg N. Altruistic Cognition, Emotion, and Behavior. Hillsdale, NJ: Erlbaum, 1986.
7. Eisenberg N, Eggum ND, Di Giunta L. Empathy-related responding: Associations with prosocial behavior, aggression, and intergroup relations. Soc Issues Policy Rev 2010; 4:143-180.
8. Barnett G, Mann RE. Empathy deficits and sexual offending: A model of obstacles to empathy. Aggress Violent Behav 2013; 18:228-239.
9. Colman AM. Oxford dictionary psychology. Oxford, UK: Oxford University Press, 2009.
10. Cuff BMP, Brown SJ, Taylor L, Howat DJ. Empathy: A review of the concept. Emot Rev 2016; 8:144-153.
11. Davis MH. Measuring individual differences in empathy: Evidence for a multidimensional approach. J Pers Soc Psychol 1983; 44:113.
12. Yavuz KF, Şahin O, Ulusoy S, Ipek OU, Kurt E. Experiential avoidance, empathy, and anger-related attitudes in antisocial personality disorder. Turkish J Med Sci 2016; 46:1792-1800.
13. Vilardaga R, Hayes SC, Levin ME, Muto T. Creating a strategy for progress: A contextual behavioral science approach. Behav Anal 2009; 32:105-133.
14. Biglan A, Glasgow RE, Singer G. The need for a science of larger social units: A contextual approach. Behav Ther 1990; 21:195- 215.
15. Biglan A. The nurture effect: How the Science of Human Behavior Can Improve Our Lives and Our World. Oakland, California: New Harbinger Publications, 2015.
16. Levin ME, Luoma JB, Vilardaga R, Lillis J, Nobles R, Hayes SC. Examining the role of psychological inflexibility, perspective taking, and empathic concern in generalized prejudice. J Appl Soc Psychol 2016; 46:180-191.
17. Hayes SC. Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther 2004; 35:639-665.
18. Barnes-Holmes Y, McHugh L, Barnes-Holmes D. Perspective- taking and theory of mind: a relational frame account. Behav Anal Today 2004; 5:15.
19. Hayes SC, Strosahl KD, Wilson KG. Acceptance and Commitment Therapy: The Process and Practice of Mindful Change. New York: Guilford Press, 2011.
20. McHugh L. A contextual behavioural science approach to the self and perspective taking. Curr Opin Psychol 2015; 2:6-10.
21. McHugh L, Stewart I. The Self and Perspective Taking: Contributions and Applications from Modern Behavioral Science. Oakland, California: New Harbinger Publications, 2012
22. First MB, Gibbon M. The Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) and the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). In: Hilsenroth MJ, Segal DL (editors). Comprehensive Handbook of Psychological Assessment, Volume 2: Personality Assesment. Hoboken: John Wiley & Sons, 2004, 134-142.
23. Ozkurkcugil A, Aydemir O, Yildiz M, Esen Danaci A, Koroglu E. Turkish adaptation and reliability study of the structured clinical interview for DSM-IV axis I disorders. Ilac ve Tedavi Dergisi 1999; 12:233-236. [Turkish]
24. Coskunol H, Bagdiken I, Sorias S, Saygili R. The reliability of the SCID-II-Turkish Version in personality disorders. Turkish Journal of Psychology 1994; 9:26-29. [Turkish]
25. Engeler A, Yargic LI. Interpersonal reactivity index: Measurement of empathy multidimensionaly. New Symposium J 2007; 45:119- 127. [Turkish]
26. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire–II: A revised measure of psychological inflexibility and experiential avoidance. Behav Ther 2011; 42:676-688.
27. Yavuz F, Ulusoy S, Iskin M, Esen FB, Burhan HS, Karadere ME, et al. Turkish version of acceptance and action Questionnaire- II (AAQ-II): A reliability and validity analysis in clinical and non-clinical samples. Bullet Clin Psychopharmacol 2016; 26:397- 408.
28. Gird SR, Zettle RD. Developing a quantitative measure of self-as-context. GRASP: Graduate Research and Scholarly Projects 2013; 9:47-48.
29. Gillanders DT, Bolderston H, Bond FW, Dempster M, Flaxman PE, Campbell L, et al. The development and initial validation of the cognitive fusion questionnaire. Behav Ther 2014; 45:83-101.
30. Birchwood M, Smith JO, Cochrane R, Wetton S, Copestake S. The social functioning scale the development and validation of a new scale of social adjustment for use in family intervention programmes with schizophrenic patients. Br J Psychiatry 1990; 157:853-859.
31. Yaprak Erakay S, Gulseren S. Social Functioning Scale in patients with schizophrenia is to investigate the validity and reliability of the Turkish form. In Congress Abstract Book. Spring Symposium VI, 2002, 134-135.
32. Bosch S, Hixson MD. The final piece to a complete science of behavior: Behavior development and behavioral cusps. Behav Anal Today 2004; 5:244.
33. Raadal M, Milgrom P, Cauce AM, Mancl L. Behavior problems in 5− to 11-year-old children from low-income families. J Am Acad Child Adolesc Psychiatry 1994; 33:1017-1025.
34. Hoeve M, Dubas JS, Gerris JRM, van der Laan PH, Smeenk W. Maternal and paternal parenting styles: Unique and combined links to adolescent and early adult delinquency. J Adolesc 2011; 34:813-827.
35. Barker ED, Arseneault L, Brendgen M, Fontaine N, Maughan B. Joint development of bullying and victimization in adolescence: Relations to delinquency and self-harm. J Am Acad Child Adolesc Psychiatry 2008; 47:1030-1038.
36. Roberts AL, Gilman SE, Fitzmaurice G, Decker MR, Koenen KC. Witness of intimate partner violence in childhood and perpetration of intimate partner violence in adulthood. Epidemiology 2010; 2:809.
37. Liu N, Zhang Y, Brady HJ, Cao Y, He Y, Zhang Y. Relation between childhood maltreatment and severe intrafamilial male perpetrated physical violence in Chinese community: The mediating role of borderline and antisocial personality disorder features. Aggress Behav 2012; 38:64-76.
38. Blackledge JT. Disrupting verbal processes: Cognitive defusion in acceptance and commitment therapy and other mindfulness-based psychotherapies. Psychol Rec 2007; 57:555- 576.
39. Hayes SC, Brownstein AJ, Zettle RD, Rosenfarb I, Korn Z. Rule governed behavior and sensitivity to changing consequences of responding. J Exp Anal Behav 1986; 45:237-256.
40. Swann AC, Lijffijt M, Lane SD, Steinberg JL, Moeller FG. Trait impulsivity and response inhibition in antisocial personality disorder. J Psychiatr Res 2009; 43:1057-1063.
41. Paris J. Gender differences in personality traits and disorders. Curr Psychiatry Rep 2004; 6:71-74.