Undiagnosed Symptoms of Attention-Deficit Hyperactivity Disorder Underlie More Frequent Engagement in Interpersonal Violence

Undiagnosed Symptoms of Attention-Deficit Hyperactivity Disorder Underlie More Frequent Engagement in Interpersonal Violence

Compared to their counterparts who were not diagnosed with Attention-deficit Hyperactivity Disorder (ADHD), participants diagnosed with ADHD in this Dutch sample demonstrated more frequent psychological, minor physical and clinician rated interpersonal violence (IPV). In addition, the ADHD group had higher rates of various comorbid psychiatric disorders, including a mood disorder, substance use disorder, and personality disorder. This is the bottom line of a recently published article in The International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.

Featured Article | International Journal of Forensic Mental Health| 2020, Vol. 19, No. 2, 142-151

Type and Severity of Intimate Partner Violence in Offenders with and without ADHD

Authors

Nannet Buitelaar, Department De Waag, De Forensische Zorgspecialisten, De Waag Utrecht; Department Medical Centre, Radboud University
Jocelyne Posthumus, Expertise Center of Forensic Psychiatry
Denise Bijlenga, PsyQ Department Expertise Center Adult ADHD
Robert Ferdinand, GGZ Delfland
Jan Buitelaar, Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior; Karakter Child and Adolescent Psychiatry

Abstract

Intimate partner violence (IPV) offenders were clinically assessed for ADHD, other psychiatric diagnoses, and frequency of different types of IPV. Of the 347 participants (16.4% women), n = 210 (61%) were clinically diagnosed with ADHD. The ADHD group showed a higher frequency of psychological, minor physical and clinician rated IPV, and also higher rates of comorbid anxiety or mood disorder, substance use disorder, and borderline and antisocial personality disorders. Hierarchical multiple regression analyses revealed that ADHD accounted for significant change of variance in frequency of psychological and clinician rated IPV above the effects of age, gender, and comorbid disorders.

Keywords

ADHD, intimate partner violence, aggression, forensic psychiatry

Summary of the Research

“Intimate partner violence (IPV) involves physical, psychological or sexual aggression by a current or former intimate partner…and is a serious public health concern…One of the known intrapersonal risk factors associated with IPV is the presence of Attention-deficit Hyperactivity Disorder (ADHD)…Case control studies showed positive associations between adult ADHD and presence of IPV…Further, cohort studies showed positive associations between IPV and hyperactive symptoms…inattentive symptoms…and impulsivity…it is still unknown if, in IPV cases, ADHD influences the frequency of IPV in general, or of specific types of IPV…the first research question for the present study is if offenders of IPV with ADHD differ from offenders without ADHD with respect to frequency of physical, psychological, and sexual IPV.” p.142-143

“It is important to understand the role of comorbidity because ADHD is often associated with various comorbid disorders, such as anxiety and mood disorders, substance use disorders, and personality disorders…This leads to the second research question: is the association between ADHD and IPV offending solely due to ADHD symptoms or partly mediated by comorbid disorders…we hypothesize that an ADHD diagnosis is associated with more frequent IPV, even when controlling for comorbidities. The aims of the present study are therefore to (1) investigate whether and how offenders of IPV with ADHD differ from offenders without ADHD with respect to frequency of physical, psychological, and sexual IPV, and (2) study whether found differences were due to the ADHD diagnosis or to any comorbid conditions. To meet these aims, we examined frequency of minor and severe physical, psychological, and sexual IPV and injury of adult forensic outpatients who are referred for IPV offending, and compared the group with ADHD to the group without ADHD.”p.143

“…The ADHD group scored higher on minor physical aggression, minor and severe psychological aggression and clinician-rated IPV than the non-ADHD group. No group differences were found with respect to frequency of severe physical aggression, injury, and sexual coercion, which means that the association of ADHD with a higher frequency of IPV is probably restricted to the psychological types of IPV and minor physical aggression…Comparison of the two groups also showed that offenders with ADHD were younger and had more psychiatric comorbidity…Moreover, we found more forensic characteristics of general aggression (more police contacts, convictions for general aggression and more thefts) in the ADHD group…” p.148

“…analyses showed a significantly additional effect of presence of ADHD on increased frequency of minor and severe psychological aggression and clinician-rated IPV, controlled for age, gender, and psychiatric comorbidity. This confirms our hypothesis that ADHD symptoms such as emotional dysregulation and deficits in self-control may play an important role in the association of ADHD with IPV offending. There was also an effect of presence of BPD [Borderline Personality Disorder] on increased frequency of minor and severe psychological aggression and of SUD [Substance Use Disorder] on increased frequency of clinician-rated IPV…” p.148

Translating Research into Practice

“This study shows that IPV offenders with ADHD have more frequent minor and severe psychological and minor physical IPV than IPV offenders without ADHD. Since BPD and SUD were also related to more frequent IPV, and they are often comorbid with ADHD, those with ADHD and comorbid BPD or SUD will have even more frequent IPV. Our findings have clinical implications…in this study, 74% of the IPV offenders with ADHD were not diagnosed with ADHD before…This high percentage of undetected ADHD, together with the association with increased IPV, underscores the need for screening for ADHD in IPV offenders…” p.149

“…it is important to identify treatable factors that are associated with frequency of IPV, such as ADHD. ADHD symptoms can be reduced effectively by medication…Furthermore, crime rates among patients with ADHD were lower in periods when they were using ADHD medication…Treatment of ADHD symptoms in IPV offenders will probably have similar positive effects. The results of this study underscore the need of assessment and treatment of ADHD and comorbid psychiatric disorders in IPV offenders. Future studies should address whether detection and treatment of ADHD and associated disorders in IPV offenders may enhance treatment outcomes and decrease occurrence or frequency of IPV.” p.149

Other Interesting Tidbits for Researchers and Clinicians

“There was no additional effect of ADHD on more minor physical aggression above the effect of age and BPD, which may suggest that either BPD is [more strongly] related to a higher frequency of minor physical aggression than ADHD in this study or that ADHD only in combination with BPD is associated with more physical aggression. To investigate the presence of ADHD, in association with BPD, for predicting increased frequency of minor physical aggression, we conducted a post-hoc…analysis…[the results] support the hypothesis that ADHD especially in combination with BPD was associated with increased minor physical aggression…” p.148

“…It was unexpected that presence of ASPD [Antisocial Personality Disorder] was not significantly related to increased frequency of any of the IPV outcomes in this study. The findings suggest that age and BPD were [more strongly] related to increased minor physical aggression than ASPD and that age, ADHD, and BPD were [more strongly] related to increased severe psychological aggression than ASPD. It is possible that ASPD is related to more severe forms of IPV in IPV offenders, and that ASPD predicts IPV in a general population, however, these hypotheses ere not the subject of this study…” p.148

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Authored by Amber Lin

Amber Lin is a clinical psychology doctoral student at Fairleigh Dickinson University. Her research interests include forensic assessment, competency to stand trial, and the refinement of instruments used to assess the psychological states of criminal defendants.

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