What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)?

Abstract

Antisocial personality disorder, psychopathy, dissocial personality disorder and sociopathy are constructs that have generally been used to predict recidivism and dangerousness, alongside being used to exclude patients from treatment services. However, 'antisocial personality disorder' has recently begun to emerge as a treatment diagnosis, a development reflected within cognitive behaviour therapy and mentalisation-based psychotherapy. Many of the behaviour characteristics of antisocial personality disorder are, at the same time, being targeted by interventions at criminal justice settings. A significantly higher proportion of published articles focusing on antisocial personality concern treatment when compared to articles on psychopathy. Currently, the proposal for antisocial personality disorder for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, suggests a major change in the criteria for this disorder. While the present definition focuses mainly on observable behaviours, the proposed revision stresses interpersonal and emotional aspects of the disorder drawing on the concept of psychopathy. The present commentary suggests that developments leading to improvement in the diagnosis of this type of disorder should, rather than focusing exclusively on elements such as dangerousness and risk assessment, point us to ways in which patients can be treated for their problems.

Psycho-education for substance use and antisocial personality disorder: a randomized trial

“…As in several previous studies, we found evidence that individuals with ASPD reduced substance use during standard substance abuse treatment [ 1 , 39 ]; in the entire sample, alcohol and drugs composite scores were significantly reduced at the 9-month follow-up. These findings add further support to the view that individuals with ASPD should not be excluded from substance abuse treatment [ 28 , 34 , 39 ]. On the other hand, reductions in substance use generally represented small effect sizes.…”

Association of COL25A1 with Comorbid Antisocial Personality Disorder and Substance Dependence

“…Many of the behaviors characteristic of ASPD result in interventions by the criminal justice system(2). A longitudinal study of a cohort of abusers of several classes of drugs identified ASPD as a predictor of criminal behavior(3).…”

Working towards a new psychiatry - neuroscience, technology and the DSM-5

“…James Phillips and colleagues review what they suggest to be six essential questions in psychiatric diagnosis, and discuss how definitional issues in diagnostic schemas and concepts affect the scope and conduct of psychiatric care, and the social relevance of the field [ 3 ]. In response to proposed changes in the DSM-5, Morten Hesse discusses how revisions in the diagnostic criteria for antisocial personality disorder might lead to more accurate understanding, and improved therapeutics [ 4 ].…”