DOI: 10.22391/fppc.1899066 ISSN: 2458-8865

Aggression, impulsivity, ADHD symptoms, and 2D:4D digit ratio in individuals with alcohol use disorder: a case-control study with predictors of severity

Ayse Berra Aydin, Mahmut Selçuk
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Introduction: Alcohol Use Disorder (AUD) is a chronic condition influenced by neurodevelopmental and psychological vulnerabilities. While impulsivity is a well-established risk factor for AUD, aggression and related behavioral characteristics have also been frequently associated with the onset, persistence, and severity of the disorder. However, the roles of compulsive drinking, motivation to change, attention-deficit/hyperactivity disorder (ADHD) symptoms, and anthropometric markers such as the 2D:4D digit ratio remain less clearly defined. This study aimed to compare individuals with AUD and healthy controls across these domains and to identify predictors of severe AUD.Methods: Seventy-eight patients with AUD and 78 age- and sex-matched healthy controls were assessed using the Barratt Impulsiveness Scale (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ), Adult ADHD Self-Report Scale (ASRS), Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), and the Obsessive-Compulsive Drinking Scale (OCDS). Bilateral 2D:4D digit ratios were measured. Logistic regression analysis was conducted to determine independent predictors of severe AUD.Results: Compared with controls, patients with AUD demonstrated significantly lower 2D:4D ratios and higher impulsivity, aggression, and ADHD symptom scores (all p < 0.001). Within the AUD group, severe AUD was associated with higher impulsivity, stronger compulsive drinking patterns, and elevated motivation to change. Logistic regression analysis demonstrated that OCDS and BIS-11 total scores independently predicted severe AUD, whereas SOCRATES total score showed only marginal significance (p = 0.057) (Nagelkerke R² = 0.481; classification accuracy = 85.4%).Conclusion: Compulsive drinking and impulsivity emerged as robust predictors of AUD severity, whereas the 2D:4D ratio appeared to reflect a trait-related vulnerability rather than directly reflecting clinical severity. Incorporating assessments of compulsivity and motivation into clinical evaluation may facilitate more individualized treatment strategies for patients with AUD.

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