ANTISOCIAL PERSONALITY

DISORDER AND ITS ASSOCIATED

FACTORS AMONG
INCARCERATED OFFENDERS AT A
MAXIMUM-SECURITY PRISON IN
NIGERIA

OYEYEMI A. AFOLABI
AUTHORS
• ADETUNJI OBADEJI
• OLUYINKA EMMANUEL MAJEKODUNMI
• LATEEF OLUTOYIN OLUWOLE
• AYODELE FELA-THOMAS
OUTLINE
• Introduction
• Aim of the study
• Methods
• Results
• Discussion
• Conclusion
INTRODUCTION
• There is increased evidence to suggest a strong association between
personality disorders and significant risks for violence
• Of the various personality disorders associated with criminal behavior,
antisocial personality disorder (ASPD) has been described as one of
the best predictors of criminal behavior
• People with ASPD present with the pattern of socially irresponsible
behavior (such as violating or disregarding rights of others) alongside
repeated criminal behavior, impulsivity, aggressiveness, and
exploitative and guiltless behavior.
INTRODUCTION
• The prevalence of people with ASPD in the general population is quite
low, usually between 2% and 5%
• In prison population, however, ASPD is overrepresented, with the
prevalence of people with ASPD in the criminal justice population
increasing to about 50%
• Black et al. reported that over 35% of newly incarcerated offenders in
the USA met the criteria for ASPD, and approximately one in two male
prisoners and one in five female prisoners had ASPD, and relative to
other mentally ill offenders, this group of offenders is more likely to
re‑offend after discharge from the prison
INTRODUCTION
• In addition, majority of the people with ASPD also meet the criteria for
another psychiatric diagnosis, commonly depression, schizophrenia and
other psychotic disorders, substance misuse, borderline personality
disorder, domestic violence and increased risk of suicide
• Studies looking at psychiatric morbidity among incarcerated offenders in
Nigeria have reported high rates of psychiatric morbidity, with over half
of the population presenting with one mental disorder or the other,
most importantly substance use disorders.
• This is likely because ASPD is one of the most common co‑occurring
psychiatric diagnoses among people with a substance use disorder
INTRODUCTION
• According to Mueser et al., ASPD is strongly related to all measures of
substance use problems and disorders, as well as fathers’ history of
substance use disorder.
• Among drug abusers, it has been noted that the presence of
comorbid ASPD predicts criminal behavior following treatment
compared with substance abusers without such a diagnosis, however,
other studies had refuted this observation.
AIM OF THE STUDY
• This study aimed to determine the prevalence of ASPD and its
association with social and drug use variables among inmates at a
maximum‑security prison in Nigeria.
METHODS
• A cross‑sectional survey was adopted in this study
• The sample for the study was drawn from a prison population consisting of 489
awaiting trial (including 28 females) and 282 convicted inmates (including 5
females), who were serving various prison terms at the Federal Prison, Abeokuta
• Using Cochrane’s minimum sample size formula, the estimated sample size was 286
• Participants for this study population were selected using a simple random
sampling, using a table of random numbers, and the probability proportional to size
method was used to determine the number of participants based on their prison
status, i.e., either awaiting trial or convicted inmates
• An additional 10% was added to accommodate for those who may leave the prison
before they were evaluated or who may decline.
EXCLUSION
• Female inmates – due to limited number
• Those with severe physically illness
• Those with learning disability
• Those who understands neither Yoruba nor English languages
METHODS
• Each participant was interviewed with a pro forma containing
information on sociodemographic variables, forensic details, and
details of parental alcohol and substance use
• ASPD was assessed using the Mini‑International Neuropsychiatric
Interview English version 5.0 (MINI plus 5)
• Similarly, alcohol abuse/dependence and other psychoactive
substance use disorders were assessed using their respective modules
of the MINI plus 5
METHODS
• Data generated from the questionnaires were analyzed using
Statistical Package for the Social Sciences program version 18
• Presentations of data were done using frequency distribution tables
or chart
• Univariate analysis using t‑test was employed for continuous
variables, whereas Pearson’s Chi‑square test was used for qualitative
variables with Fisher’s exact or Yate’s correction applied, as
applicable.
• The level of significance was set at 5%
ETHICAL CONSIDERATION
• All procedures performed in study were in accordance with the ethical
standards of the institutional Ethics and Research Committee of the Federal
Neuropsychiatric Hospital, Aro, Abeokuta
• Official permission was granted by the Controller of Prisons, Ogun State
Command.
• A written informed consent was obtained from all the participants after
informing them about the research aims and objectives
• Confidentiality and privacy of information were ensured
• The participants were also assured of that their choice of participating or not
will not affect their trial, sentence, or treatment by the prison staff in anyway
RESULTS
• A total of 277 inmates finally participated in the interview.
• Of these, 169 (61.0%) were awaiting trial, whereas 108 (39.0%) were convicted of various
offenses.
• The mean age of the participants was 34.77 ± 10.28 years.
• Majority of the participants had some level of primary or high school education (75.45%)
and were employed (88.1%) prior to imprisonment.
• Those who were convicted were serving time‑specific imprisonment (27 [9.7%]), life
imprisonment (21 [7.6%]), or were sentenced to death (60 [21.7%]).
• Twelve (4.3%) of the 277 inmates had previous imprisonment, of which 3 (25.0%) had
ASPD.
• Seven (2.6%) of the inmates had a family history of imprisonment, with first‑degree
relatives in 3 (1.1%) and second‑degree relatives in 4 (1.5%) inmates
RESULTS – TYPES OF INMATE
OFFENCES
• Among these offenders, armed robbery was the most common
offense either charged with or convicted of, accounting for 153
(55.2%) of the inmates
• This was followed by murder, stealing, fraud, rape, and kidnapping,
representing 53 (19.1%), 28 (10.1%), 11 (4.0%), 7 (2.5%), and 6 (2.2%)
of the cases, respectively
• Other offenses were manslaughter in 4 (1.4%); illegal possession of
firearms, assault, and conspiracy, each representing 1.1%; fighting in 2
(0.7%); and drug trafficking, impersonation, bribery, and aiding and
abetment, each representing 0.4% of the inmates.
RESULTS – TYPES OF INMATE
OFFENCES
NATURE OF OFFENCE N N (%)
ARMED ROBBERY 153 55.2
MURDER 53 19.1
STEALING 28 10.1
FRAUD 11 4.0
RAPE 7 2.5
KIDNAPPING 6 2.2
OTHERS (manslaughter, illegal possession 19 6.9
of firearms, assault, conspiracy, fighting,
etc)
RESULTS - TYPES OF OFFENCE AND
ASPD
The rate of ASPD was highest among those charged with armed
robbery (19.5%), followed by rape and stealing accounting for 16.7%
and 11.1%, respectively.
OFFENCES ANTISOCIAL PD
PRESENT N(%) ABSENT N(%)
ROBBERY 30 (19.5) 124 (80.5)
MURDER 2 (3.8) 51 (96.2)
STEALING 3 (11.1) 24 (88.9)
FRAUD 0 (0.0) 7 (100.00)
RAPE 1 (16.7) 5 (83.3)
KIDNAPPING 0 (0.0) 11 (100.00)
OTHERS 1 (5.3) 18 (94.7)
ASPD AND INMATED
SOCIODEMOGRAPHIC
CHARACTERISTICS
• Higher proportions of those who were not employed prior to their
incarceration (8 [24.2%]) compared with those who were employed
(29 [11.9%]) had ASPD (P = 0.050)
• Twenty‑four (17.7%) of the inmates whose fathers were alive
compared with 12 (9.22%) of those whose fathers were dead had
ASPD (P = 0.039)
• Similarly, those whose fathers use/abuse alcohol or cannabis were
more likely to have ASPD (P = 0.033)
• There was no statistically significant relationship between ASPD and
other sociodemographic variables (P > 0.05).
ASPD AND ALCOHOL AND SUD
• A greater proportion of those who met the criteria for current AUDs
(37.5%) compared with those who did not (11.9%) had ASPD, and this
is statistically significant (P = 0.030).
• Similarly, those who met the criteria for a lifetime AUDs, lifetime and
current cannabis use disorders (CUDs) were more likely to have ASPD
(P < 0.05)
DISCUSSION
• The prevalence of ASPD in this population of offenders was 13.4%,
which was relatively lower than 18% and 19.2% earlier reported in
Nigeria and India, as well as 26.9% and 35.3% in Brazil and USA
respectively
• Although similar instrument was used in these studies, other
background characteristics such as nature of the prison, the presence
of other psychiatric disorders may possibly explain these variations
• Nevertheless, one common feature is that the prevalence of ASPD is
quite higher compared with that of the general population from
which the prisoners were drawn
DISCUSSION
• The relatively higher proportion of people with ASPD in the prison
relative to the general population may be due to the fact that people
with ASPD are likely to commit crime and consequently apprehended
and imprisoned.
• Besides, the higher prevalence can be explained based on the
disinhibition theory
• Exposure to inhumane condition of the prison and repeated exposure
to aggressive behavior from other prisoners lead to loss of normal
restraints and normalization of aggressive and antisocial behaviour
DISCUSSION
• With respect to the offenses committed, armed robbery was the most
common offense, accounting for over half of the total offenses
• Of these, a higher proportion had an ASPD compared with the
proportions of ASPD in other offenses
• Studies have shown that people with serious mental illness have
significantly higher rates of both violent and serious nonviolent
misconduct
• This may possibly explain why a relatively higher proportion of
offenders with ASPD were found among those charged with armed
robbery, rape, and murder.
DISCUSSION
• Most of the sociodemographic characteristics of the inmates do not predict
ASPD; however, when compared with those without ASPD, a majority of those
with ASPD were unmarried and were not employed prior to incarceration.
• Marriage has been described as a moderating variable. As noted in a review by
Black, being married aids the improvement of antisocial symptoms
• It has been shown that ASPD alongside other cluster B disorders was more
prevalent in men, separated or divorced, and those from lower social class
• Similarly, offenders whose parents abuse alcohol or other substances of abuse
were four times more likely to be diagnosed with ASPD than those whose
fathers did not
DISCUSSION
• As reported by earlier studies, there is an increased rate of mental
disorders or presence of psychopathology among children of parents
with substance use disorders
• As noted by Clark et al. parents with substance use disorders often
have other mental disorders similar to those found in their children.
• Oftentimes, those parents have childhood histories of conduct
disorder, ADHD, major depressive disorder, or anxiety disorders
• This may explain the association between parental substance use and
ASPD observed in this study
DISCUSSION
• In this study, significantly higher rates of offenders with ASPD met the criteria
for substance use disorders, notably AUDs and CUDs.
• As reported by Fridell et al., offenders with a diagnosis of ASPD, based on
clinical observation, were substantially more criminally active than substance
abusers without such a diagnosis
• This may account for the association between ASPD and substance use
disorders noted in this study and the elevation of both ASPD and substance
use disorders in the prison compared with the general population.
• Substance abusers diagnosed with ASPDs were twice more likely to be
charged with theft only and about two and half times more likely to be
charged committing multiple types of crime during an observational year
CONCLUSION
• The prevalence of ASPD among incarcerated offenders in this study
was higher than those reported for most general populations and
relatively lower compared with those reported in other prisoners’
population elsewhere
• Among this population, the diagnosis of ASPD is associated with
fathers’ substance use, fathers being alive, current or lifetime AUDs,
and current or lifetime CUDs
• There is therefore a need for adequate intervention and rehabilitation
programs that should address ASPD, AUDs, and substance use
disorders among offenders.
LIMITATIONS OF THE STUDY
• The sample was limited to offenders from a single prison, thus making
it difficult to extrapolate the findings to the general prison population
• The participants need to recall past drug usage, which may affect the
accuracy of the information given
• In addition, disclosing information about alcohol and other illicit drugs
in prison is considered an offense, and this may affect the extent to
which inmates reported their substance use.
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