Should Behavior Harmful to Others Be a Sufficient Criterion of Mental Disorders? Conceptual Problems of the Diagnoses of Antisocial Personality Disorder and Pedophilic Disorder

Abstract

Generally, diseases are primarily harmful to the individual herself; harm to others may or may not be a secondary effect of diseases (e.g., in case of infectious diseases). This is also true for mental disorders. However, both ICD-10 and DSM-5 contain two diagnoses which are primarily defined by behavior harmful to others, namely Pedophilic Disorder and Antisocial (or Dissocial) Personality Disorder (ASPD or DPD). Both diagnoses have severe conceptual problems in the light of general definitions of mental disorder, like the definition in DSM-5 or Wakefield's "harmful dysfunction" model. We argue that in the diagnoses of Pedophilic Disorder and ASPD the criterion of harm to the individual is substituted by the criterion of harm to others. Furthermore, the application of the criterion of dysfunction to these two diagnoses is problematic because both heavily depend on cultural and social norms. Therefore, these two diagnoses fall outside the general disease concept and even outside the general concept of mental disorders. We discuss whether diagnoses which primarily or exclusively ground on morally wrong, socially inacceptable, or criminal behavior should be eliminated from ICD and DSM. On the one side, if harming others is a sufficient criterion of a mental disorder, the "evil" is pathologized. On the other side, there are practical reasons for keeping these diagnoses: first for having an official research frame, second for organizing and financing treatment and prevention. We argue that the criteria set of Pedophilic Disorder should be reformulated in order to make it consistent with the general definition of mental disorder in DSM-5. This diagnosis should only be applicable to individuals that are distressed or impaired by it, but not solely based on behavior harmful to others. For ASPD, we conclude that the arguments for eliminating it from the diagnostic manuals overweigh the arguments for keeping it.

Comparing the DSM-5 categorical model of personality disorders and the alternative model of personality disorders regarding clinician judgments of risk and outcome.

“…However, our findings might provide some indication that the AMPD does not reflect the potential diagnostic utility of antisocial behavior as well as the ASPD diagnoses in Section II. Along with highlighting a potential limitation of the AMPD, this pattern could also be interpreted as support for the notion that ASPD should not be conceptualized as a personality disorder in the traditional sense, as some have argued (e.g., Coid & Ullrich, 2010; Münch et al, 2020). Nevertheless, this pattern was ultimately the only concrete evidence of the Section II model predicting clinical judgments over and above the AMPD.…”

The Effect of Undesirable Internet Information on the Formation of Antisocial Personality among Adolescents

“…The concept of personality disorders inherits well-known difficulties from psychiatric and antisocial concepts, which were once used as waste paper classifications for patients who could not be diagnosed in any other way [3]. In the context of psychopathology, a personality disorder is a behavioural trait that falls between mental illness and normal behaviour [4], follow-up studies describes personality disorders as "significant deviations from the norm that begin in childhood or adolescence and continue throughout life". Furthermore, personality disorders are divided into several different categories.…”

The Societal Response to Psychopathy in the Community

“…Moreover, on the one hand, psychopathy is associated with characteristic emotional deficits and maladaptive behaviors that might be construed as signs of a mental disorder. On the other hand, psychopathic individuals tend not to perceive their personality traits as harmful and do not suffer from overt cognitive deficits, psychotic breakdowns, or delusions that characterize other typical mental disorders (Münch et al, 2020). Moreover, although psychopathy tends to be construed as a personality disorder, it is not an established category in prominent diagnostic manuals, such as the Diagnostic and Statistical Manual for Mental Disorders (American Psychiatric Association, 2013) or the International Classification of Diseases (World Health Organization, 2020).…”