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.

Psychopathy in Italian female murderers

“…The degree of expression of the psychopathic dimension was determined by dividing the sample into three different groups according to the total PCL‐R scores obtained: (1) PCL‐R ≥ 25; (2) PCL‐R between 20 and 24; and (3) PCL‐R ≤ 19. This tripartite stratification was used in two of our recent studies on psychopathy (Carabellese et al, in press a; Carabellese et al, in press b) and a similar stratification was used by Ogloff (). Finally, all the data obtained were statistically analyzed using the STATA MP 13.3 software.…”

Antisocial personality disorder and anxiety disorder: A diagnostic variant?

“…However, our findings demonstrate many similarities to those traditionally observed in the "primary" and "secondary" sub-division of psychopathy (Blackburn, 1998;Karpman, 1941Karpman, , 1948Skeem et al, 2007), with the non-anxious subgroup corresponding to primary psychopathy and ASPD/anxiety to secondary psychopathy. There are strong correlations between measures of psychopathy and ASPD and studies suggest that 15-20% of persons with ASPD are psychopaths (Ogloff, 2006). Although ASPD and psychopathy are considered different diagnostic constructs, a representative sample of prisoners in England and Wales found that symptoms of both ASPD and psychopathy demonstrated low diagnostic contrast when comparing subgroups of ASPD above and below the cut-off for psychopathy (Coid & Ullrich, in press).…”

Classification and Diagnosis in Psychiatry: The Emperor's Clothes Provide Illusory Court Comfort

“…A further cause of disquiet about personality disorder categories comes from the work of Ogloff. 28 He has demonstrated that for the most reliably diagnosed category on axis II of DSM-IV, antisocial personality disorder, it appears to over-identify by a factor of approximately five, people who are significantly disordered on the underlying psychopathy dimension. Similar concerns have been raised for other categories, where standardised instruments such as the Composite International Diagnostic Inventory (CIDI) are used to assign DSM-IV diagnoses.…”