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Review of Crash Risk and Driving Performance for Drivers with Mental and Personality Disorders

Review of Crash Risk and Driving Performance for Drivers with Mental and Personality Disorders. Dr. Nicholas J. Ward HumanFIRST Program University of Minnesota. The Houston Study. Sociopath Alcoholic.

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Review of Crash Risk and Driving Performance for Drivers with Mental and Personality Disorders

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  1. Review of Crash Risk and Driving Performance for Drivers with Mental and Personality Disorders Dr. Nicholas J. Ward HumanFIRST Program University of Minnesota

  2. The Houston Study Sociopath Alcoholic Fatals were cases of drivers killed in a crash for which they were responsible. Controls taken from local voter lists from same precincts as fatalities. Assumed that this matched for income level and standard of housing . Matched on age and gender. Attempted to match on race. Fatals were significantly more likely to have personality disorders – notably alcoholism and sociopathology. (adapted from Finch, 1970)

  3. Interactions Alcoholism can interact with other factors. In this case, a birth cohort in Finland were examined in terms of history of violent crime and mental disorders in terms of convictions for drunk driving. The combination of violent tendencies with a mental disorders had the highest propensity for alcohol consumption with driving (DWI). (see Rasanen, Hakko, & Jarvelin, 1999)

  4. Sociopathology US crash involvement and arrest rates There is a compelling similarity in the shape of the age distribution of both traffic crash involvement and criminal arrests. Curiously, this may suggest that some forms of sociopathology that are related to criminal dispositions may also relate to driving behaviors and attitudes that can result in a crash. (Evans, 1991, p. 142)

  5. Personality Types (see Deery & Fildes, 1999) Some combinations of personality traits and disorders can combine into risky profiles. Notably (E), depression, and emotional maladjustment in combination with a risk taking (sensation seeking) can result in a risk driving style with a high crash involvement in which the driver is culpable.

  6. Aggressive Driving • Premise: two-thirds of all crashes result from “aggressive driving” • Aggressive drivers more likely than controls to have: • Antisocial Personality Disorder • Borderline Personality Disorder • Intermittent Explosive Disorder • Substance Abuse • (Anxiety Disorder) (see Galovski, Blanchard, & Veazey, 2002)

  7. “Road Rage” This table shows measures of psychological disorders and aggressive traits for a group of drivers that reported that they had perpetrated a road rage event, were victims of a road rage event, or were never involved in a road rage event (controls). “Lower levels of psychological/psychiatric distress may protect from involvement in road rage incidents as perpetrators or victims, while lower levels of aggression may protect people from being perpetrators.” (p. 285) (see Fong, Frost & Stansfeld, 2001)

  8. Summary • Personality disorders are related to crash risk and risky behaviors. • There are interactions amongst risk factors: • Impulsive anger, aggression • Indifference to social norms • Risk taking style • Substance abuse

  9. Medical Screening • Biased criteria • Gender, education • False positives • Restricted drivers no infractions/crashes • Misses • Crash involved drivers with disorders It remains to supply psychiatrists and general practitioners with new information, which is quantitatively as well as qualitatively valid, on the real nature and role of mental disorders in automobile crashes and traffic violations. (Niveau & Kelly-Puskas, 2001)

  10. Crash Etiology In order to identify risk factors and develop valid assessment tools, it is necessary to describe (and predict) the etiology of crashes related to personality disorders and intervening factors. Non-Behavioral Factors Crash Personality Disorder Pre-Crash State Stressful Events Alcohol (adapted from Finch, 1970)

  11. Crash Etiology Note that 44% of fatals had prior crash whereas only 16% of controls had prior crash. Similarly, 60% of fatals had four or more traffic convictions compared to 8% of controls. Crash (44% 16%) Pre-crash State Personality Disorder Fatal (76%) Control (8%) Fatal (92%) Control (12%) 80% 12% 72% Stressful Events Alcohol > 0 mg% (adapted from Finch, 1970)

  12. Crash Etiology (see Sumer, 2003)

  13. Treatments • Treat general disorder • Psychiatric counseling & medication • Drug side-effects • Treatment in driving context for specific impairments • Hazard-perception, decision-making, and attention-management skill training • Anger and aggression management • Motivating insurance programs • Need theory to justify screening (predict risk) and guide treatments

  14. Policy Issues • Screening or intervention based on “predicted” risk by group membership may not be cost-effective or ethical. • Better models of crash etiology • Validated treatments • Drunk-driving offenders need assessment and treatment for alcohol problems AND possibility of other psychiatric disorders. • Psychiatric examination of aggressive drivers may support treatment of this group AND co-morbid problems.

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