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RESEARCH ARTICLE
Dysfunctional beliefs and antisocial personality disorder
Mary McMurrana* and Gary Christopherb
a
Division of Psychiatry, University of Nottingham, Nottingham, UK; bSchool of
Psychology, Cardi University, Cardi, UK
personality
disorder;
Personality
Belief
534
Beck and colleagues (1990) listed the dysfunctional beliefs associated with
DSM-III-R (American Psychiatric Association [APA], 1987) personality disorders, with the exception of schizotypal and borderline which were thought
not to be characterised by specic thought content. For example, a core belief
that people are malevolent leads to wariness, hostility, and a readiness to
counter-attack (paranoid personality disorder). These beliefs formed the basis
of the Personality Belief Questionnaire (PBQ; Beck & Beck, 1991), which has
been examined empirically in relation to personality disorders.
Beck et al. (2001) investigated the reliability and validity of the PBQ with
a sample of 756 outpatients receiving cognitive therapy. The personality
disorder scales of the PBQ showed good internal consistency (Cronbachs a
.81 to .93) and fair to good testretest reliability (Pearsons r .57 to .93). Of
the whole sample, 56% had Axis I disorders and 44% had Axis II disorders,
with avoidant, dependent, obsessive-compulsive, narcissistic, and paranoid
featuring in the latter group. These ve personality disorder types were the
focus of validation analyses. First, selecting those patients with only the
diagnosis in question and no others, it was hypothesised that they would
score signicantly higher on the pertinent personality disorder subscale over
the other personality disorder subscales. This hypothesis was supported.
Second, it was hypothesised that patients with a specic primary personality
disorder diagnosis (i.e., who may or may not have had an additional
personality disorder diagnosis) would score higher on the pertinent
personality disorder subscale than would those with another personality
disorder diagnosis and those with no personality disorder diagnosis (i.e.,
those with an Axis I diagnosis). This hypothesis was also supported.
Overall, the study by Beck et al. (2001) supported the association
between certain personality beliefs and corresponding personality disorders.
This conclusion applies only to the ve personality disorder types that
featured in their sample; they had insucient numbers of people with
histrionic, antisocial, and schizoid personality disorders to test the
associations between these beliefs and personality disorders. In this study,
we aimed to extend Beck et al.s (2001) ndings by examining the
associations between personality disorder beliefs, as measured by the
PBQ, and antisocial personality disorder (ASPD). Our hypotheses were that
the ASPD only group would score higher on the PBQ antisocial scale than
other scales; that the ASPD only group would score higher on the PBQ
antisocial scale than would those with no personality disorder; and that the
PBQ antisocial scale would best predict group membership.
Method
Participants
Participants were recruited from three prisons across south Wales. Adult
male prisoners convicted of any non-sexual oence were eligible for the
535
study unless they met one of the following exclusion criteria. First, those
with less than two months to discharge were excluded so that all recruits
would have enough time to complete the study. Second, those who had
taken part in intervention programmes within the six months prior to
recruitment were excluded, since selection for and completion of programmes requires the completion of a range of psychometric tests that may
have aected responses in this study.
Eligible prisoners were identied by a member of prison sta and invited
to volunteer. Of 138 oenders who showed an initial interest in the study, 18
(13%) were transferred or released before interview, and 26 (19%) declined
to take part in the study. Of the 94 who were recruited to the project, 23
(24%) did not complete both assessments. Therefore, participants in this
study were 71 convicted male oenders, whose mean age was 33 years
(SD 8.03). All were white and just over half (55%) were married or
cohabiting. Index oences were: violence (n 31; 44%), acquisitive
(n 18; 25%), drug-related (n 20; 28%), and dangerous driving (n 2;
3%).
Measures
International Personality Disorder Examination (IPDE; Loranger, 1999)
DSM-IV (APA, 1994) personality disorder diagnoses were obtained
using the IPDE, a semi-structured diagnostic interview. The IPDE consists
of 99 items, each scored as absent or normal (score 0), exaggerated or
accentuated (score 1), or at the criterion level (score 2). The item scores
contribute to the criteria used to diagnose personality disorders, with the
number of criteria that need to be denitely met (score 2) for a diagnosis
ranging from four to six.
Personality Belief Questionnaire (PBQ; Beck & Beck, 1991)
The PBQ is a 126-item self-report questionnaire that aims to identify
respondents key beliefs in nine of the DSM-III-R personality disorder
domains, with 14 items in each domain. Schizoid and schizotypal
personality disorder were run together in one set of beliefs. Originally, no
items were provided for borderline personality disorder, since this disorder
was seen as more variable in presentation and less specic in content than
other disorders (Beck et al., 1990). However, items that discriminate
borderline personality disorder have since been identied, and hence a score
for borderline beliefs may be calculated (Butler, Brown, Beck, & Grisham,
2002). Antisocial PBQ items include: I have to look out for myself; Lying
and cheating are OK as long as you dont get caught; and Other people are
weak and deserve to be taken.
536
Procedure
Ethical approval was obtained for the study from the relevant research
ethics committees. A prison liaison person, appointed by the governor to
facilitate the research, recruited potential participants by informing prisoners on normal prison wings about the study using posters, information
sheets, and personal contact. Volunteers were then seen by the researcher,
who gave further information about the study. Prisoners were informed that
participation was unpaid, and they were made aware that they could
withdraw from the study at any time. After providing informed, written
consent, two further appointments were made, one to conduct the IPDE and
the other to complete the PBQ. These assessments were conducted by a
trained interviewer (GC).
Statistical analysis
Participants were split into three groups. First, as a conservative grouping,
we selected those who met the criteria for a denite diagnosis of antisocial
personality disorder (ASPD) only. Then, because diagnoses often co-occur,
we grouped those not in Group 1 who met the criteria for ASPD and also
met probable or denite criteria for another personality disorder, including
personality disorder not otherwise specied (i.e., ASPD plus other PD). The
third group consisted of those who did not meet diagnostic criteria for any
personality disorder.
Data were analysed using SPSS 12.0.2 for Windows. The distribution
curves for most variables showed a positive skew; hence, square-root
transformations were conducted on all variables. Our hypothesis that the
ASPD group would score higher on the ASPD scale of the PBQ than on
other PBQ scales was tested by visual inspection of the mean scale scores.
Our hypothesis that the ASPD group would score higher on the ASPD scale
of the PBQ than would those with no personality disorder was tested by
comparing the means for each PBQ subscale for men with denite ASPD
only using ANOVA, followed by pairwise comparisons. Our hypothesis that
the antisocial scale of the PBQ would best predict group membership was
tested using a discriminant function analysis. The predictor variables
entered into the analysis were the 10 subscales of the PBQ.
Results
Of the 71 men, 31 had a denite diagnosis of ASPD (43.67%) and a further
12 (16.90%) had a probable diagnosis. Diagnoses are presented in Table 1.
The numbers of participants in each of the three groups to be analysed were:
17 with a denite IPDE diagnosis of ASPD only, 14 with denite ASPD plus
another personality disorder diagnosis, and 18 with no personality disorder
diagnoses.
537
Denite
Probable
Negative
3
2
0
2
3
0
66
66
71
31
2
0
0
12
13
0
0
28
56
71
71
0
1
2
9
2
0
3
2
69
70
66
60
Table 2. Mean PBQ scale scores for ASPD only (n 17), ASPD plus other PD
(n 14), and no PD (n 18).
PBQ scale
Paranoid
Schizoid
Antisocial
Borderline
Histrionic
Narcissistic
Avoidant
Dependent
Obsessivecompulsive
Passiveaggressive2
ASPD only
19.00
21.94
16.65
15.47
14.53
11.24
16.88
12.06
22.06
(13.80)1
(8.79)
(12.34)
(11.01)
(11.67)
(10.31)
(10.54)
(9.64)
(11.08)
24.53 (7.95)
ASPD other
26.71
28.43
22.50
20.00
18.21
13.21
21.79
13.64
26.07
(8.87)
(10.20)
(9.56)
(8.28)
(8.89)
(11.58)
(6.90)
(10.72)
(9.33)
26.43 (7.42)
No PD
10.44
17.17
10.33
7.89
7.39
4.83
9.72
8.89
23.00
(7.16)
(8.24)
(9.85)
(5.95)
(3.85)
(4.15)
(5.52)
(5.16)
(10.06)
15.89 (8.97)
F(2,46)
9.83
5.70
7.16
9.09
7.28
4.12
10.25
0.30
0.61
5.001
5.01
5.002
5.001
5.002
5.02
5.001
.74
.55
8.08
5.001
The mean scores on the PBQ subscales for the three groups are presented
in Table 2. Our hypothesis that the ASPD only group would score highest
on the PBQ antisocial scale, compared with all other PBQ scales, was not
supported. The antisocial scale score was ranked sixth of the 10 scales.
A multivariate ANOVA (using transformed data) showed signicant
dierences between PBQ means across groups for eight of the PBQ subscales
(i.e., all but the dependent and obsessive-compulsive subscales). Pairwise
comparisons between the ASPD only and no PD groups showed no
dierences on the schizoid, dependent, and obsessive-compulsive subscales.
The ASPD group scored signicantly higher on the other seven PBQ
scales: paranoid (mean dierence 1.01, SE 0.45, p 5 .03), antisocial
538
Figure 1.
539
.54
.41
.46
.53
.47
.35
.56
.10
.07
.49
1.06
70.46
70.18
70.74
0.47
0.20
1.36
70.99
70.75
0.37
540
541
and improving relationship skills could reduce both paranoid beliefs and
belligerence-hostility. That is, having the condence to relate well should
improve relationships and consequently reduce fear and suspicion. Social
problem-solving therapy addresses some of these issues and there is some
evidence of its success with people with personality disorders (Huband,
McMurran, Evans, & Duggan, 2007; McMurran, Fye, McCarthy,
Duggan, & Latham, 2001).
Finally, further investigation of personality disorder beliefs and
psychopathy is required. It may be that the PBQ antisocial scale actually
identies those with cold and callous traits, as measured by Factor 1 of the
PCL-R, rather than those characterised by impulsive and irresponsible
behaviours, as measured by Factor 2 of the PCL-R. These maladaptive
beliefs could be addressed as one part of therapy for primary psychopaths.
A scale identifying the maladaptive beliefs of people with ASPD or
secondary psychopathy needs to be constructed.
Acknowledgement
The research upon which this publication is based has been supported by funding
from the NHS National Programme on Forensic Mental Health R&D (Grant No.
MRD 12/59). However, the views expressed in this publication are those of the
authors and not necessarily those of the Programme or the Department of Health.
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