Self-Regulation in Inmates with and without Antisocial Personality Disorder: Investigating Emotion Regulation, Aggression and Cognitive Inhibitory Control

Abstract

In view of their high propensity for crime and their considerable recidivism rates, understanding the self-regulation of individuals with antisocial personality disorder (APDs) is of great social relevance. Particularly, deficits in emotion regulation (ER) and cognitive inhibitory control (IC) are assumed to contribute to aggressive behavior. However, to date, these aspects of self-regulation are still underexplored in APDs. Therefore, the current thesis aims to identify abnormalities in self-regulation that may underlie the behavioral phenotype of antisocial personality disorder (APD) and that distinguish between inmates with and without APD. (1) First, two preliminary analyses were conducted to examine the suitability of a newly developed anger induction (AI) and aggression paradigm to be used in the subsequent main study. This instrument assesses a mild form of resource aggression/theft (punishing behavior towards alleged other participants) prior to and during an AI (provocations by alleged other participants). The paradigm was tested among two different male community samples (N = 324 in an online survey, N = 35 in an experimental study). These studies yielded initial support for the effectiveness of the AI and the sensitivity of the aggression measure. (2) Part I of the main study comprehensively compared habitual as well as spontaneous ER and, for the first time, aggressive behavior prior to and during an experimental AI between APDs (n = 31), inmate control participants without APD (INCs; n = 33) and never-incarcerated, healthy controls (HCs; n = 39). APDs indicated severe deficits in habitual anger regulation, compared to both, HCs and INCs. However, during the actual regulation attempt in the lab (during the AI), no evidence for a reduced self-reported regulation success or a deviating strategy use was found. Yet, when considering the behavioral measure, resource aggression, abnormalities compared to HCs were revealed in both APDs and INCs – which where however different in nature: APDs showed an increased aggression proneness without the presence of instigating triggers (i.e. prior to the AI), while INCs showed reduced reactive aggression (i.e. during the AI). Regarding overall emotion dysregulation, APDs, but not INCs, reported deficits in comparison to HCs. Particularly APDs’ habitual ER strategy use was characterized by an increased use of (generally) maladaptive strategies compared to HCs. Within inmates, deficient ER predicted antisocial symptom severity above and beyond the effects of other variables. Overall, these findings highlight impairments in ER as a distinguishing feature between offenders with and without APD. (3) Part II of the main study aimed to examine whether APDs suffer from deficient IC performance. Second, potential associations between poor IC and antisocial symptoms were explored. No evidence was found for deficient IC efficiency, disturbed post-conflict adjustments or impairments in more broad cognitive control abilities – neither for APDs, nor INCs. Within inmates, poor IC was not associated with antisocial symptoms or overall symptom severity. These results challenge the assumption that particularly a poor IC might underlie APDs’ symptom domain. In sum, the current results indicate that impaired ER and elevated aggression proneness are more decisive for APDs’ behavioral phenotype than poor IC. The present findings clearly suggest that APD should be recognized as a disorder of ER. Furthermore, divergent mechanisms may underlie APDs’ as opposed to INCs’ increased aggression. Hence, different treatment options might be suitable for inmates with and without APD. Further implications as well as limitations of the present work – particularly with respect to the measures applied – are discussed.