The Complex Associations Between Early Childhood Adversity, Heart Rate Variability, Cluster B Personality Disorders, and Aggression

• Author: Carlo Garofalo,Stefan Bogaerts,Wim Veling,Stéphanie Klein Tuente,Marija Jankovic,Geert van Boxtel
• Published date: 01 June 2021
• Date: 01 June 2021
• DOI: http://doi.org/10.1177/0306624X20986537
• Subject Matter: Articles

https://doi.org/10.1177/0306624X20986537

International Journal of

Offender Therapy and

Comparative Criminology

2021, Vol. 65(8) 899 –915

© The Author(s) 2021

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DOI: 10.1177/0306624X20986537

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Article

The Complex Associations

Between Early Childhood

Adversity, Heart Rate

Variability, Cluster B

Personality Disorders,

and Aggression

Marija Jankovic1,2 , Stefan Bogaerts1,2,

Stéphanie Klein Tuente3, Carlo Garofalo1,

Wim Veling3, and Geert van Boxtel1

Abstract

Early childhood adversity can cause an imbalance in the autonomic function, which

may in turn lead to the development of trauma-spectrum disorders and aggressive

behavior later in life. In the present study, we investigated the complex associations

between early adversity, heart rate variability (HRV), cluster B personality disorders,

and self-reported aggressive behavior in a group of 50 male forensic inpatients

(M age = 41.16; SD = 10.72). Structural Equation Modeling analysis revealed that patients

with cluster B personality disorders were more likely to have adverse early childhood

experiences and reduced sympathetic dominance in response to a threat than patients

without cluster B personality disorders. In addition, HRV and cluster B personality

disorders did not significantly mediate the association between early childhood

adversity and self-reported aggressive behavior. These findings are important for

clinical practice to facilitate specific treatment programs for those affected.

Keywords

forensic patients, aggression, early childhood adversity, cluster B personality disorders,

heart rate variability, structural equation modeling

1Tilburg University, The Netherlands

2Fivoor Science and Treatment Innovation (FARID), Rotterdam, The Netherlands

3University of Groningen, The Netherlands

Corresponding Author:

Marija Jankovic, Department of Developmental Psychology, Tilburg University, P.O. Box 90153, LE

Tilburg 5000, The Netherlands.

Email: M.Jankovic_1@uvt.nl

986537IJOXXX10.1177/0306624X20986537International Journal of Offender Therapy and Comparative CriminologyJankovic et al.

research-article2021

900 International Journal of Offender Therapy and Comparative Criminology 65(8)

Aggressive behavior represents one of the most important issues when dealing with

forensic psychiatric patients residing in high secure psychiatric centers. It is defined

as any act intended to cause harm, pain, or injury to another individual (Zirpoli,

2008). Aggressive behavior can cause serious psychological, emotional, and physical

consequences to the victim and may adversely affect the treatment progress and the

living environment (Tuente et al., 2018). Aggression in forensic psychiatric inpatient

units takes place regularly because many forensic psychiatric patients have an antiso-

cial personality disorder, high levels of impulsivity, and/or a lack of empathy, which

are all factors directly related to aggression (Jeandarme et al.,2019; Lobbestael et al.,

2015).

Generally, the explanatory factors underpinning aggressive behavior comprise an

interplay between biological (e.g., genetic, fetal, hormonal), psychological (e.g., per-

sonality), and social factors (e.g., upbringing; Citrome & Volavka, 2003). In associa-

tion with biological factors, it has been shown that the Autonomic Nervous System

(ANS) plays an important role in stress and aggression regulation (Stifter et al., 2011).

The ANS consists of two divisions that often have opposing effects on target organs:

the sympathetic division (Sympathetic Nervous System [SNS]) and the parasympa-

thetic division (Parasympathetic Nervous System [PNS]). The SNS is responsible for

activities related to the “fight-or-flight” response to a threat, while the PNS controls

the “rest-and-digest” response that calms the body down once the threat is over

(Andreassi, 2010). Research has shown that aggressive behavior is associated with

reduced Heart Rate Variability (HRV; Haller et al., 2014; Vögele et al., 2010), reflect-

ing reduced vagal system activity (Cherland, 2012), and impaired emotion regulation

capacity (Appelhans & Luecken, 2006). It is thought that in response to a threat the

“vagal brake” is released, which allows the SNS to dominate and prepare the human

body for the “fight-or-flight” response (Vögele et al., 2010). However, being exposed

to chronic stress can affect the functioning of the vagal system in the long run, dimin-

ishing capacity for adaptive reactions to distressing events (Thayer et al., 2012). A

higher resting HRV indicates the ability of the body to effectively respond to environ-

mental challenges (Vögele et al., 2010). Conversely, reduced resting HRV is thought

to index psychophysiological rigidity and maladaptive reaction to stress (Appelhans

et al., 2006). It has also been documented that different HRV variables are differently

associated with aggressive behavior. For example, Low Frequency (LF) was associ-

ated with physical aggression (Zohar et al., 2013), while decreased High Frequency

(HF) and increased LF/HF ratio were associated with increased trait aggression and in

vivo aggression (Puhalla et al., 2020). In the abovementioned studies, the association

between HRV and aggression was investigated in adolescents or healthy community

samples. However, no study to date has investigated the association between HRV and

aggression in a group of high-risk forensic inpatients.

Furthermore, a large number of studies on adults from colleges, prisons, and the

general population have also linked reduced HRV to different conditions such as early

childhood adversity (McLaughlin et al., 2015; Shaikh al arab et al., 2012), and a range

of mental disorders, particularly cluster B personality disorders (Carr et al., 2018;

Zhang et al., 2012). Cluster B includes antisocial, borderline, histrionic and