Mats Forsman

Genetic effects explain the stability of psychopathic personality from mid- to late adolescence.

This study examined the importance of genetic and environmental influence for the stability of psychopathic personality between mid- and late adolescence. The target sample consisted of all 1,480 male and female twin pairs born in Sweden between 1985 and 1986. Psychopathic personality was measured with the Youth Psychopathic Traits Inventory (YPI; H. Andershed, M. Kerr, M. Stattin, & S. Levander, 2002) when the participants were 16 and 19 years old. Results showed that the 3 psychopathic personality dimensions were stable at different levels of analysis and linked to a stable higher order general factor (i.e., psychopathic personality factor). Genetic factors contributed substantially to the stability of this general higher order factor, whereas environmental factors were of little importance. However, the authors also found specific genetic stability in the Callous/unemotional and Impulsive/irresponsible dimension. Thus, the model provides evidence for etiologic generality and etiologic specificity for the stability of psychopathic personality between mid- and late adolescence.

A longitudinal twin study of the direction of effects between psychopathic personality and antisocial behaviour

BACKGROUND Antisocial behaviour may partly develop as a consequence of psychopathic personality. However, neither the direction of effects nor the aetiology of the association has previously been clarified. The aim in this study was to investigate the direction of effects between psychopathic personality and antisocial behaviour, and to investigate the genetic and environmental contribution to this association. METHOD Twins (n = 2,255) in the Swedish Twin Study of Child and Adolescent Development were prospectively followed from adolescence to adulthood. We used a longitudinal cross-lagged twin model to study the associations between psychopathic personality and antisocial behaviour. RESULTS Psychopathic personality in mid-adolescence predicted antisocial behaviour in adulthood (p < .001), but not the other way around. However, bidirectional effects were found when a measure of persistent antisocial behaviour (from age 8-9 to age 16-17) was used. Psychopathic personality predicted both rule-breaking behaviour (p < .001) and aggressive behaviour (p < .01). Genetic factors were of importance in mediating the longitudinal associations between psychopathic personality and antisocial behaviour. CONCLUSIONS This study provides evidence that genetically influenced psychopathic personality is a robust predictor of adult antisocial behaviour, but also that persistent antisocial behaviour has an impact on adult psychopathic personality via genetic effects.

Childhood Neurodevelopmental Disorders and Violent Criminality: A Sibling Control Study

The longitudinal relationship between attention deficit hyperactivity disorder (ADHD) and violent criminality has been extensively documented, while long-term effects of autism spectrum disorders (ASDs), tic disorders (TDs), and obsessive compulsive disorder (OCD) on criminality have been scarcely studied. Using population-based registers of all child and adolescent mental health services in Stockholm, we identified 3,391 children, born 1984–1994, with neurodevelopmental disorders, and compared their risk for subsequent violent criminality with matched controls. Individuals with ADHD or TDs were at elevated risk of committing violent crimes, no such association could be seen for ASDs or OCD. ADHD and TDs are risk factors for subsequent violent criminality, while ASDs and OCD are not associated with violent criminality.

The Association between Persistent Disruptive Childhood Behaviour and the Psychopathic Personality Constellation in Adolescence: A Twin Study.

This study tested if persistent externalizing behaviour and symptoms of Attention Deficit Hyperactivity Disorder (ADHD) in childhood are associated with personality and behavioural aspects of the psychopathic personality constellation in adolescence. The target sample consisted of all 1,480 twin pairs born in Sweden between 1985 and 1986. Parent-reported externalizing behaviour and ADHD symptoms were obtained when the participants were 8-9 and 13-14 years old. Personality and behavioural aspects of the psychopathic personality constellation were measured with self-report questionnaires when the participants were 16-17 years old. Persistent externalizing behaviour in childhood was associated with both psychopathic personality and antisocial behaviour in adolescence. However, within twin-pair analyses showed that genetic factors explained the association between persistent externalizing behaviour and psychopathic personality, while shared environmental factors explained the association between persistent externalizing and antisocial behaviours. We conclude that persistent externalizing behaviour is a genetically influenced precursor of psychopathic personality among boys.

Outcomes of child psychiatric treatment

The aim of this study was to investigate outcomes of child psychiatric outpatient treatment as usual and to identify outcome predictors, with special regard to attention‐deficit/hyperactivity disorder (ADHD), mood disorder, obsessive‐compulsive disorder and conduct disorder.

Paraphilic sexual interests and sexually coercive behavior: a population-based twin study

AbstractPrior research with selected clinical and forensic samples suggests associations between paraphilic sexual interests (e.g., exhibitionism and sexual sadism) and sexually coercive behavior. However, no study to date used a large, representative and genetically informative population sample to address the potential causal nature of this association. We used self-report data on paraphilic and sexually coercive behavior from 5990 18- to 32-year-old male and female twins from a contemporary Finnish population cohort. Logistic regression and co-twin control models were employed to examine if paraphilic behaviors were causally related to coercive behavior or if suggested links were confounded by familial (genetic or common family environment) risk factors. Results indicated that associations between four out of five tested paraphilic behaviors (exhibitionism, masochism, sadism, and voyeurism, respectively) and sexually coercive behavior were moderate to strong. Transvestic fetishism was not independently associated with sexual coercion. Comparisons of twins reporting paraphilic behavior with their paraphilic behavior-discordant twin further suggested that associations were largely independent of shared genetic and environmental confounds, consistent with a causal association. In conclusion, similar to previously reported predictive effects of paraphilias on sexual crime recidivism, paraphilic behavior among young adults in the general population increases sexual offending risk. Further, early identification of paraphilic interest and preventive interventions with at-risk individuals might also reduce perpetration of first-time sexual violence.

Diabetes and obesity related risks for pelvic reconstructive surgery in a cohort of Swedish twins

OBJECTIVE—To determine the diabetes- and obesity-related risks for surgically managed stress urinary incontinence and pelvic organ prolapse. RESEARCH DESIGN AND METHODS—This twin cohort study used the Swedish Twin Register to identify 8,443 female twin pairs born from 1926 through 1958. The association between diabetes and pelvic floor surgery was estimated while taking into account the correlated (twin) structure of the data. RESULTS—For type 1 and type 2 diabetes, no significant associations were observed for stress urinary incontinence (odds ratio [OR] 1.0 [95% CI 0.1–9.2] and 2.0 [1.0–4.0], respectively). There were no cases of prolapse surgery in type 1 diabetic subjects, and for type 2 diabetes the risk estimate was nonsignificant (1.6 [1.0–2.7]). BMI >25 kg/m2, age ≥60 years, and childbirth were the strongest risk factors for having incontinence surgery. CONCLUSIONS—Our data suggest that diabetes is not associated with stress urinary incontinence or pelvic organ prolapse surgery.

Familial Factors, Victimization, and Psychological Health Among Sexual Minority Adolescents in Sweden

OBJECTIVES To determine the influences of victimization experience and familial factors on the association between sexual minority status and psychological health outcomes among adolescents. METHODS We used data from the Child and Adolescent Twin Study in Sweden, a prospective, population-based study of all twins born in Sweden since 1992. Cross-sectional analyses included individuals who completed assessments at age 18 years (n = 4898) from 2000 to 2013. We also compared psychological health among sexual minority adolescents and their nonminority co-twins. RESULTS Sexual minority adolescents were more likely than were unrelated nonminority adolescents to report victimization experiences, including emotional abuse, physical abuse or neglect, and sexual abuse. Sexual minority adolescents also reported significantly more symptoms of anxiety, depression, attention-deficit/hyperactivity disorder, disordered eating, and substance misuse in addition to increased parent-reported behavior problems. Victimization experience partially mediated these associations. However, when controlling for unmeasured familial confounding factors by comparing sexual minority adolescents to their same-sex, nonminority co-twins, the effect of sexual minority status on psychological health was almost entirely attenuated. CONCLUSIONS Familial factors-common genetic or environmental influences-may explain decreased psychological adjustment among sexual minority adolescents.

Response to Joyal’s (2016) “Linking Crime to Paraphilia: Be Careful with Label”

We thank Joyal (2016) for his reflections on our recent paper (Baur et al., 2016) in the Archives. We appreciate the possibility to comment on some of his points. First, as discussed in our article, a specified paraphilic behavior, albeit at the core of a DSM-5-defined paraphilic disorder, is obviously not a full definition of the corresponding paraphilic disorder. Equally important, a DSM-5 diagnostic criteria set for a paraphilic disorder or any other disorder could not possibly reflect all potential cognitions, emotions, and behaviors associated with that disorder. Assessment of all studied paraphilic behaviors in our study was based on the central part of criterion A, which specifiesthequalitativenatureofeachspecificparaphilia.According to theDSM-5(AmericanPsychiatricAssociation,2013,p.685), both sexual sadism andmasochismbelong to the group of algolagnic (algos=‘‘pain’’and lagneia=‘‘lust‘‘) disorders, marked by (active or passive) enjoyment of pain and suffering. The single questions used by us to tap masochistic and sadistic sexual behavior (‘‘Have you ever deliberately received physical pain andbecomesexuallyarousedbythis?’’formasochismand‘‘Have you ever deliberately used physical pain andbecome sexually aroused by this?’’ for sadism) bear on these core definitions and emphasize behavioral experience. Second, although likelyquiteuncommon, it cannotbe ruled out that someone who practiced autosadistic behavior might answer positively to the question used to tap sexually sadistic behavior against others. On the other hand, autosadistic study participants might occasionally answer positively to the questionmeant to assess sexuallymasochisticbehavior.Overall, this should not substantially influence the present findings. Third,JoyalandCarpentier (2017)foundaprevalenceof34% of any paraphilic interest in an adult internet-recruited panel. This rate is indeed higher than the prevalence rate of 18%of any paraphilic behaviorwe report.However, considerable selection bias in the Joyal and Carpentier report is likely (‘‘The Internet sample was drawn from a panel of volunteers’’and‘‘this sample cannot be considered representative of the Quebec population because it is not possible to reach a truly probabilistic sample through the Internet’’) and acknowledged by these authors:‘‘Our respondents might therefore show a higher rate of interest in paraphilia.’’Further, besides the broader, non-DSM-5 definition theyusedforsexualsadism(‘‘Haveyoueverbeensexuallyaroused bymaking someone suffer, or bydominatingor psychologically or physically humiliating another person?’’ instead of DSM-5’s ‘‘sexualarousalbyphysicalorpsychologicalsufferingofanother person’’), they also included categories that were not part of our study. First, they included fetishism (‘‘Have you ever been sexuallyarousedbyaninanimatenon-sexualobject?Pleasenotethat a vibrator does not enter into this category’’) the most common paraphilic interest and therefore likely to contribute substantially to differences in prevalence between studies. Second, they addressed ‘‘extended exhibitionism’’ in couples (‘‘Have you ever been aroused by engaging in sexual acts with a consenting partner knowing that someone was watching you or could bewatching you?’’) and, third,other paraphilic behavior (‘‘Have you ever been sexually aroused by an animal, fecal matter, enema, urine, cadavers, or other unusual things?’’). Unfortunately,however, the latterdefinitionoffetishism-relatedsexual interests does not clearly state that one has been sexually aroused by actually handling or using an animal/feces/enemas/ & Mats Forsman mats.forsman@ki.se