Psychopathy/Antisocial Personality Disorder Conundrum

Abstract

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.

Antisocial personality disorder: new directions

“…Studies in the UK report a prevalence of between 2% and 3% in the general population (Moran 1999;Coid 2006). Prevalence rates are consistently higher in men compared Yakeley & Williams with women (Dolan 2009) and the disorder becomes increasingly common in mental health services, the judicial system and prison settings, representing up to 80% of the prison population (Singleton 1998;Moran 1999;Ogloff 2006).…”

Psychopathy: Assessment and Forensic Implications

“…The association between ASPD and psychopathy is generally asymmetric: most people with ASPD are not psychopathic, whereas most of those who are psychopathic meet the diagnostic criteria for ASPD. 2,89,96,97 The reason for this asymmetry is hardly surprising: ASPD is much more strongly associated with the lifestyle-antisocial, than with the interpersonal-affective, features measured by the PCL-R, a differential association that holds both when ASPD and psychopathy are treated as categorical variables and when they are treated as continuous variables. 20 These issues were well known before the publication of DSM-IV, and the supposition that personality traits could not be measured reliably was invalidated by the results of the ASPD Field Trial for DSM-IV.…”

Antisocial personalities: Measuring prevalence among offenders in South Africa

“…In contrast with ASPD, the diagnostic criteria for DPD focus more on the traditional concept of psychopathy, but emphasise the lack of affect or expressed emotion rather than the presence of specific personality traits or behaviours. 16 Unlike psychopathy, which has been the most researched of the antisocial personalities by far, very few studies have focused exclusively on DPD.…”