Having a current sexually transmitted infection (STI) and a history of STIs is significantly associated with having an antisocial personality disorder, according to study conducted in Baltimore and published in the January edition of Sexually Transmitted Diseases.
Individuals with antisocial personality disorder are defined as having impulsive and aggressive behaviour, a lack of remorse, and a disregard for the consequences of their behaviour and for the rights of others. The Baltimore investigators stress that individuals with antisocial personality disorder are unlikely to respond to current counselling strategies designed to encourage behavioural change, and that this could have important negative implications for HIV and STI prevention initiatives.
A high degree of psychological distress amongst individuals treating STI treatment had been noted by the investigators in an earlier study. The investigators wished to establish the prevalence of mood disorders such as depression and substance abuse, and personality disorders amongst sexual health patients.
Between summer 2000 and the end of 2001 a total of 671 adults aged between 18 and 65 were recruited to the study. Participation in the study involved a risk assessment interview, a screen for depressive symptoms, and STI and HIV testing. A subset of individuals was also assessed for personality disorders.
Overall, 45% of individuals met the diagnostic criteria for a mood disorder, and the prevalence of mood disorders amongst sexual health clinic attenders was significantly higher than the estimated prevalence of mood disorders in the community(28%). The investigators also found that the prevalence of personality disorders was significantly higher amongst sexual health patients than the community estimate (29.4% versus 9%). Antisocial personality disorder was the most commonly diagnosed personality disorder, occurring in 29.4% of men and 6.1% of women.
When the investigators further analysed these data, they found that of mood disorders only lifetime substance dependence was significantly associated with a history of a sexually transmitted infection (OR 2.61, 95% CI; 1.48 – 4.62, p=0.001). Neither depression nor substance dependence was strongly associated with a current STI or gonorrhoea.
However, the investigators found that an antisocial personality disorder was significantly associated with a history of STIs (p=0.001), a history of gonorrhoea (p=0.04), a current STI (p=0.002), and current gonorrhoea (p=0.01).
”We demonstrated that 29% of ST[I] clinic patients interviewed had a personality disorder”, state the investigators, adding, “a 29% prevalence of antisocial personality disorder among men was remarkably high and was associated with a diagnosis of an ST[I] on the day of the clinic visit, as well as with a history of prior ST[I]s…this finding suggests that this disorder could characterise the ‘core transmitters,’ those persons responsible for most ST[I] transmission. Effective prevention interventions for core transmitters is crucial to ST[I] control.”
However, the investigators note that individuals diagnosed with antisocial personality disorder are “defined by their impulsive and aggressive behaviours, their lack of remorse, and their lifelong pattern of disregard for the consequences of their behaviour and for the rights of others.” Therefore, “the success of any counselling strategy designed to motivate a person to avoid negative consequences, like HIV prevention counselling, could be limited in a person [with antisocial personality disorder], even when high standards for counselling are met.”
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Erbelding EJ et al. The prevalence of psychiatric disorders in sexually transmitted disease clinic patients and their association with sexually transmitted disease risk. Sexually Transmitted Diseases 31: 8 – 12, 2004.