Cognitive Distortions in Male Patients With Antisocial Personality Disorder

Objective: Cognitive distortions related to the neutralization of antisocial conduct have been linked to aggressive behaviors in patients with antisocial personality disorder (ASPD). However, there is ongoing debate regarding whether these neutralizations are related to aggression and whether this association differs between patients with ASPD and nonpatients. Method: In the present study, it was investigated to what extent primary and secondary cognitive distortions were associated with reactive (frustration-driven) and proactive (goal-driven) forms of aggression. Additionally, these constructs and their interrelations were compared between male patients with ASPD (N = 88, M-age = 33.4, SD = 14.6) and male nonpatients from the general population (N = 188, M-age = 40.3, SD = 10.5). Results: Findings suggest that patients with ASPD exhibited higher levels of primary cognitive distortions than nonpatients, whereas no significant differences were observed for several secondary cognitive distortions. Regression analyses revealed that the relationships between cognitive distortions and aggression were largely comparable across groups. However, in nonpatients, both primary and secondary cognitive distortions demonstrated stronger associations with proactive aggression relative to patients with ASPD. Conclusions: Theoretically different cognitive distortions showed considerable overlap in the present study, undermining their distinctiveness. Although cognitive distortions and aggression were generally more prevalent among patients with ASPD, cognitive distortions were as strongly associated with aggression compared to nonpatients. This may be due to reduced emotional responses in patients with ASPD, diminishing the need to justify aggressive behavior. In contrast, for nonpatients, cognitive distortions played a more significant role in neutralizing aggression.