by Michael D. Anestis, Ph.D.
As they do so often, the crew over at the University of Maryland has put out a study that I believe is remarkably informative and interesting. In this case, I'm referring to a brief report published by Marsha Sargeant, Stacey Daughters, John Curtin (University of Wisconsin Madison), Randi Schuster (University of Illinois Chicago), and Carl Lejuez in the Journal of Abnormal Psychology. In this particular study, the authors examined how antisocial personality disorder (ASPD) and psychopathy - related but distinct constructs - might demonstrate differential relationships with distress tolerance. For those of you unfamiliar with psychopathy and how it differs from ASPD, click here to read Joye's fantastic description of the constructs. For those of you unfamiliar with distress tolerance, click here to read my description of the construct.
The basic idea underlying this study is that past research has demonstrated that individuals with ASPD tend to demonstrate low levels of distress tolerance (Daughters, Sargeant, Bornovalova, Gratz, & Lejuez, 2008), which in turn has been linked to a host of problematic outcomes (e.g., non-suicidal self-injury, binge eating, substance use, gambling; click on the distress tolerance category on the side bar to read summaries of many such studies). That being said, although up to 25% of with ASPD demonstrate elevated levels of psychopathy (e.g., Blair, Mitchell, & Blair, 2005) and ASPD is the DSM-IV-TR diagnosis that most closely resembles psychopathy, the emotional deficits (e.g., lack of empathy and fear) inherent in psychopathy makes it a contruct not only less likely to be associated with low distress tolerance, but in fact an candidate to demonstrate the very opposite relationship. This is actually very consistent with some research I have done demonstrating that although low distress tolerance is associated with greater levels of suicidal desire, high distress tolerance tends to be associated with greater acquired capability for suicide (Anestis, Bagge, Tull, & Joiner, 2011) and some research Joye and I are working on now examining psychopathy, antisocial traits, and those same outcomes.
In this particular study, the authors recruited 107 individuals (91 men) seeking treatment at a residential substance use treatment facility. Psychopathic traits were assessed using the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996), ASPD diagnosis was assessed using the Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV; Zanarini, Frankenburg, Sickel, & Yong, 1996), and distress tolerance was assessed using both the PASAT-C (Lejuez, Kahler, & Brown, 2003) and the Mirror Tracing Persistence Task (MTPT; Quinn, Brandon, & Copeland, 1996).
Consistent with their hypotheses, the authors found that individuals who met diagnostic criteria for ASPD persisted for less time (lower distress tolerance) on both distress tolerance tasks. Looking at it another way, they also found that individuals with ASPD persisted to the end of fewer distress tolerance tasks. On the other side of things, they found that individuals with higher levels of psychopathy persisted for greater amounts of time on both distress tolerance tasks and, similarly, persisted to the end of more distress tolerance tasks than did individuals with lower levels of psychopathic traits. The authors also published results regarding the subscales of the PPI and I encourage curious readers to consult the original paper for those results.
So what does this all mean? A few things, really. First of all -and this is rallying cry of much of my research these days - although low distress tolerance is clearly associated with a host of problematic outcomes, we should be careful not to overlook the degree to which, at least in certain contexts, high distress tolerance can be highly problematic. Secondly, the results further highlight the importance of looking beyond diagnostic status when attempting to understand a client, as a sizeable portion of individuals with ASPD demonstrate high levels of psychopathy and, as such, are likely to relate to their affective experiences differently (or have fewer of them in the first place), meaning that their antisocial behavior may be motivated by different functions (e.g., thrill-seeking versus attempt to reduce anger) and thus require different forms of intervention. Given that psychopathy is almost certain to emerge in DSM-V, these results should also help demonstrate why that development is such a vital and wonderful thing for this field. I would love to see these results replicated with a self-report measure of distress tolerance, as there is a tendency for behavioral and self-reported measures of distress tolerance not to relate to one another (click here for a summary of one such set of results).
Dr. Anestis is a post-doctoral fellow with the Military Suicide Research Consortium
Articles cited in this post:
Anestis, M.D., Bagge, C.L., Tull, M.T., & Joiner, T.E. (2011). Clarifying the role of emotion dysregulation in the interpersonal-psychological theory of suicidal behavior in an undergraduate sample. Journal of Psychiatric Research, 45, 603-611.
Blair, J., Mitchell, D., & Blair, K. (2005). The Psychopath: Emotion and the brain. Maldon, MA: Blackwell Publishing.
Daughthers, S.B., Sargeant, M.N., Gratz, K.L., Bornovalova, M.A., & Lejuez, C.W. (2008). The relationship between distress tolerance and antisocial personality disorder among male inner-city treatment seeking substance users. Journal of Personality Disorders, 22, 509-524.
Lejuez, C.W., Kahler, C.W., & Brown, R.A. (2003). A modified computer version of the Paced Auditory Serial Addition Task (PASAT) as a laboratory-based stressor. The Behavior Therapist, 25, 290-293.
Lilienfeld, S.O., & Andrews, B.P. (1996). Development and preliminary validation of a self-report measure of psyhopathic personlaity traits in noncriminal populations. Journal of Personality Assessment, 66, 488-524.
Quinn, E.P., Brandon, T.H., & Copeland, A.L. (1996). Is tak persistence related to smoking and substance abuse? The application of learned industriousness theory to addictive behaviors. Experimental and Clinical Psychopharmacology, 4, 186-190.
Sargeant, M.N., Daughters, S.B., Curtin, J.J., Schuster, R., & Lejuez, C.W. (2011). Unique roles of antisocial personality disorder and psychopathic traits in distress tolerance. Journal of Abnormal Psychology, 120, 987-992.
Zanarini, M.C., Frankenburg, F.R., Sickel, A.E., & Yong, L. (1996). The Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV). Belmont, Mass, Mclean Hospital.