• Karen Yirmiya
    University College London
  • Matthew Constantinou
    University College London
  • Elizabeth Simes
    University College London
  • Anthony Bateman
    University College London
  • James Wason
    Newcastle University
  • Jessica Yakeley
    Portman Clinic
  • Mary McMurran
    University of Nottingham
  • Mike Crawford
    Imperial College London
  • Alison Frater
    University of London
  • Paul Moran
    University of Bristol
  • Barbara Barrett
    King's College London
  • Angus Cameron
    National Probation Service London Division
  • Zoe Hoare
    NWORTH Clinical Trials Unit
  • Elizabeth Allison
    University College London
  • Stephen Pilling
    University College London
  • Stephen Butler
    University College London
  • Peter Fonagy
    University College London

BACKGROUND: The nature of the pathway from conduct disorder (CD) in adolescence to antisocial behavior in adulthood has been debated and the role of certain mediators remains unclear. One perspective is that CD forms part of a general psychopathology dimension, playing a central role in the developmental trajectory. Impairment in reflective functioning (RF), i.e., the capacity to understand one's own and others' mental states, may relate to CD, psychopathology, and aggression. Here, we characterized the structure of psychopathology in adult male-offenders and its role, along with RF, in mediating the relationship between CD in their adolescence and current aggression.

METHODS: A secondary analysis of pre-treatment data from 313 probation-supervised offenders was conducted, and measures of CD symptoms, general and specific psychopathology factors, RF, and aggression were evaluated through clinical interviews and questionnaires.

RESULTS: Confirmatory factor analyses indicated that a bifactor model best fitted the sample's psychopathology structure, including a general psychopathology factor (p factor) and five specific factors: internalizing, disinhibition, detachment, antagonism, and psychoticism. The structure of RF was fitted to the data using a one-factor model. According to our mediation model, CD significantly predicted the p factor, which was positively linked to RF impairments, resulting in increased aggression.

CONCLUSIONS: These findings highlight the critical role of a transdiagnostic approach provided by RF and general psychopathology in explaining the link between CD and aggression. Furthermore, they underscore the potential utility of treatments focusing on RF, such as mentalization-based treatment, in mitigating aggression in offenders with diverse psychopathologies.

Original languageEnglish
Number of pages12
JournalPsychological medicine
Early online date2 Apr 2024
DOIs
Publication statusE-pub ahead of print - 2 Apr 2024
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