How is personality disorder linked to dangerousness? A putative role for early-onset alcohol abuse

SummaryThis paper questions the assumption that personality disorder and dangerousness are causally linked, and suggests that insofar as a relationship between them exists, it is mediated by early-onset alcohol abuse. The latter, by impairing the function of prefrontal cortex during adolescence, a critical period of its development, putatively leads to deficits in goal-directed behaviour and emotional self-regulation that place the individual at high risk of becoming chronically antisocial in adulthood. Evidence is adduced in support of the hypothesis from the literature on: (i) the comorbidity of personality disorder and alcohol abuse; (ii) frontal lobe deficits in psychopaths; and (iii) life-course persistent offenders. Some testable predictions from the hypothesis are presented, together with its implications; most importantly, that measures to prevent serious antisocial behaviour in adulthood should target at-risk individuals prior to their commencing heavy drinking during adolescence.