Diagnosing the DSM-III antisocial personality disorder.

The criteria for diagnosing the DSM-III antisocial personality disorder have become so broad as to include the vast majority rather than a small minority of criminals. The psychiatric diagnosis attributes to criminals a fundamental antisocial trait, which ignores low levels of cross-situational consistency and predictability of dangerous and criminal behavior. The diagnosis ignores individual differences regarding chronicity, degree of violence, situational determinants, and rehabilitation potential. Since required use of the diagnosis may often lead to prejudicial dispositional and therapeutic results that violate the ethical standards of psychologists, several responses to this dilemma are explored. (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

DSM—IV antisocial personality disorder field trial.

The development of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994 ) included 12 field trials to assess proposed revisions. This article provides results from the antisocial personality disorder (APD) field trial that was conducted to obtain data of relevance to the proposals for simplification and for the inclusion of more traditional traits of psychopathy. Provided herein are the results from 4 sites that had sampled from populations of particular relevance to the diagnosis of APD (i.e., prison inmates, psychiatric inpatients, outpatients with substance use disorders, and homeless persons). The results indicated that some items from the 3rd revised Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) could be deleted without affecting the diagnosis. The field trial provided mixed support for the proposal to include more traditional traits of psychopathy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attribution of antisocial symptoms in coexistent antisocial personality disorder and substance abuse

Two methods for diagnosing antisocial personality disorder (ASPD) were compared based on whether antisocial symptoms that occurred when subjects also experienced alcohol- or other drug-related problems were counted toward the diagnosis of ASPD. From a family study of alcoholism and ASPD, 93 male subjects who met ASPD criteria in the absence of substance-related problems were contrasted with 312 subjects who were diagnosed with ASPD regardless of whether criterion symptoms occurred along with substance-related problems. Subjects did not differ in types of antisocial behaviors, age of onset of behaviors, or comorbid psychiatric disorders except for alcoholism and drug abuse. A subgroup was contrasted on family history of psychiatric illness, with no differences noted between groups. Counting antisocial symptoms toward the diagnosis of ASPD regardless of whether symptoms occur during periods of substance abuse increases the observed population prevalence of the disorder, but does not change the observed phenomenology of ASPD or affect commonly accepted indicators of validity of diagnosis.     

Correspondence between self-report and interview-based assessments of antisocial personality disorder.

Antisocial personality disorder (ASPD) is associated with suicide, violence, and risk-taking behavior and can slow response to first-line treatment for Axis I disorders. ASPD may be assessed infrequently because few efficient diagnostic tools are available. This study evaluated 2 promising self-report measures for assessing ASPD--the ASPD scale of the Personality Diagnostic Questionnaire-4 (PDQ-4; S. E. Hyler, 1994) and the Personality Assessment Inventory (PAI; L. Morey, 1991, 2007)--as well as the ASPD module of the Structured Clinical Interview for DSM-IV Axis II (SCID-II; M. B. First, R. L. Spitzer, M. Gibbon, J. B. W. Williams, & L. S. Benjamin, 1997). The measures were administered to 1,345 offenders in court-mandated residential substance abuse treatment programs and prisons. PDQ-4 and PAI scores related strongly to SCID-II symptom counts (rs = .67 and .51, respectively), indicating these measures convey useful clinical information about the severity of offenders' ASPD pathology. The dimensional association between the measures was relatively invariant across gender, race, and site, although differences in mean scores were observed. Levels of agreement of the SCID-II with the PDQ-4 (κ = .31) and PAI (κ = .32) in classifying participants as ASPD was limited. Alternative thresholds for both self-report measures were identified and cross-validated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Conduct disorder: Parsing the confounded relation to parental divorce and antisocial personality.

Previous research has shown an association between parental divorce and child conduct problems. This relation is confounded, however, because antisocial personality disorder (APD) is common among the parents of children with conduct disorder (CD) and divorce is very frequent for adults with this disorder. Twenty-eight clinic-referred boys who received a Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association, 1980) diagnosis of conduct disorder and 34 who received any other diagnosis served as subjects. A 2 (APD vs. not APD)?×? 2 (divorced vs. not divorced) log-linear analysis revealed a significant main effect for APD with the number of sons given the diagnosis of conduct disorder as the dependent variable, but the main effect for divorce and the interaction were not significant. Among boys with divorced parents, more than twice as many boys with a parent with APD received a diagnosis of CD than boys without a parent with APD, but there was no significant association between divorce and CD in the absence of parental APD. A similar 2?×?2 analysis of variance of the number of 13 specific DSM-III symptoms of conduct disorder resulted in essentially identical findings. These results suggest the hypothesis that parental APD is directly linked to both parental divorce and child CD, but the divorce and CD are not directly related. Methodological limitations of the present dataset are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychopathy and the DSM-IV criteria for antisocial personality disorder.

The Axis II Work Group of the Task Force on Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions of psychopathy and to international criteria. R. D. Hare et al describe an alternative to the approach taken in the DSM-III—Revised (DSM-III—R; American Psychiatric Association, 1987), namely, the revised Psychopathy Checklist. The authors also discuss the multisite APD field trials designed to evaluate and compare 4 criteria sets: the DSM-III—R criteria, a shortened list of these criteria, the criteria for dyssocial personality disorder from the 10th edition of the International Classification of Diseases (World Health Organization, 1990), and a 10-item criteria set for psychopathic personality disorder derived from the revised Psychopathy Checklist. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Gender differences in autonomic indicators of antisocial personality disorder features.

We investigated the autonomic indicators of antisocial personality disorder (APD) features in a mixed gender student sample. One hundred college students (50 men, 50 women) were administered an interview of APD and self-report measures of aggression and psychopathy. Participants completed a passive coping task and viewed emotionally valenced slideshows while their electrodermal activity (EDA), pre-ejection period (PEP), and respiratory sinus arrhythmia (RSA) were measured. Associations between APD features and autonomic reactivity were examined, controlling for aggression and psychopathy. APD features were associated with EDA hyporeactivity in men, but not women, during passive coping. While viewing threatening slides, APD features were associated with RSA hyperreactivity in women and with PEP hyperreactivity in men. APD features were associated with RSA hyperreactivity in women, but not men, while viewing slides of others in distress. These findings suggest that APD features are characterized by parasympathetic nervous system dysfunction in women but sympathetic nervous system dysfunction in men. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and psychopathology.

The author outlines a biometric model for analysis of behavior on 5 major levels of activity: physiological, sensory, perceptual, psychomotor, and conceptual. The tests and the technique are described and evaluated. 47 references. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria.

Early starting, lifetime criminal persistence has been called sociopathy, antisocial personality disorder, and psychopathy. There is, however, disagreement about its core features and which measure is best for identifying such individuals. In the 1st of 2 studies of male offenders (n = 74), we found a large association between scores on the Psychopathy Checklist-Revised (PCL-R; R. D. Hare, 1991) and the Diagnostic and Statistical Manual of Mental Disorders (4th ed. [DSM-IV; American Psychiatric Association, 1994) antisocial personality disorder criteria scored as a scale. The second study (n = 684) replicated this finding and found that, as previously shown for PCL-R scores, a discrete class (or taxon) also underlies scores on items reflecting antisocial personality disorder. The high association among these sets of items and their similarity in predicting violence suggested that the same natural class underlies each. Results indicated that life-course-persistent antisociality can be assessed well by measures of psychopathy and antisocial personality disorder. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Unique roles of antisocial personality disorder and psychopathic traits in distress tolerance.

Previous research indicates that individuals with antisocial personality disorder (ASPD) evidence low distress tolerance, which signifies impaired ability to persist in goal-directed behavior during an aversive situation, and is associated with a variety of poor interpersonal and drug use outcomes. Based on theory and research indicating that psychopathic traits are associated with hypo-reactivity in emotional responding, a unique hypothesis emerges where psychopathic traits should have the opposite effect of ASPD and be related to high levels of distress tolerance. In a sample of 107 substance-dependent patients in an inner-city substance use residential treatment facility, this hypothesis was supported. ASPD was related to lower distress tolerance, while psychopathic traits were related to higher distress tolerance, with each contributing unique variance. Findings are discussed in relation to different presentations of distress tolerance as a function of psychopathic traits among those with an ASPD diagnosis. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Personality and psychopathology: Genetic perspectives.

Genetic factors exert an important influence on adult personality traits, accounting for anywhere between 30–60% of the variance. Heredity is also important for most forms of psychopathology and plays a major role in several theories that relate personality to psychopathology. Despite this, there has been surprisingly little multivariate genetic research reported on joint analyses of personality and psychopathology. The small amount of available data suggests that genes may account for over 50% of the observed correlation between neuroticism and state symptoms of anxiety and depression. The mechanisms behind such strong genetic correlations are crucial for understanding the causal relationship between a personality trait and a disorder because genetically influenced biological systems may operate as exogenous "3rd-party" factors that are responsible for what appear to be phenotypic cause–effect relationships. How recent analytical advances in behavior genetics can use multivariate family data to address questions about the causal role of personality in psychopathology is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Social support and psychopathology: Interrelations with preexisting disorder, stress, and personality.

Contends that social support represents an integral component of theory on stress and psychopathology but that little attention has been directed toward understanding social support within the context of other predictors of disorder. Three alternative predictors are discussed: preexisting disorder, stress, and personality. It is suggested that research has been hindered by a lack of attention to the diverse associations between measures of social support and these related features of the individual's social environment and psychological functioning. This is due, in part, to (a) measurement redundancies, (b) method limitations, and (c) conceptual ambiguities involving support and these other constructs. Implications for related issues in the study of social support and psychopathology are presented. (56 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A twin study of the association between pathological gambling and antisocial personality disorder.

Many individuals with a history of pathological gambling (PG) also have a history of engaging in antisocial behaviors, and this has often been interpreted as a result of the former causing the latter. In a sample of 7,869 men in 4,497 twin pairs form the Vietnam Era Twin Registry, the authors examined (a) the association between PG and antisocial personality disorder (ASPD), (b) the extent to which PG might be differentially associated with childhood conduct disorder (CD) and adult antisocial behavior (AAB), and (c) the contribution of genetic and environmental factors to the association of PG with ASPD, CD, and AAB. PG was significantly associated with all 3 antisocial behavior disorders, and the association of PG with ASPD, CD, and AAB was predominantly explained by genetic factors. The results of this study suggest that the greater-than-chance co-occurrence of PG and antisocial behavior disorders is partially due to their sharing a common genetic vulnerability. The antisocial behavior observed among many individuals with PG probably cannot be interpreted as being simply a consequence of the PG. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effect of systematic variation in retrospective conduct disorder reports on antisocial personality disorder diagnoses.

A diagnosis of antisocial personality disorder (ASPD) requires a conduct disorder (CD) diagnosis. A CD diagnosis is often obtained retrospectively. This study tested the influence of current behavior on CD recall and the association between recent behavior change and inconsistencies in contemporaneous and retrospective CD reports. Five hundred young adults reported ASPD; retrospective CD; current problem behavior; and, at ages 12 to 15 years, contemporaneous CD. True-positive, true-negative, false-positive, and false-negative CD and ASPD groups were identified. The results supported the hypotheses. Participants whose current behavior agreed with past behavior provided reliable retrospective CD reports. Inaccurate diagnoses occurred among participants whose current behavior was inconsistent with past behavior, either becoming more problematic (CD and ASPD false positives) or less problematic (CD and ASPD false negatives) over time. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Personality and psychopathology: A historical perspective.

The possible links between personality psychology and psychopathology are examined with the goal of understanding the constraints that set boundaries to the possible contributions of one to the other. The reciprocal nature of these contributions is described. The historical survey looks at the early concepts of the humors and temperament; at the concept of a general vulnerability to psychosis and deviance, represented by the 19th-century concept of degeneracy; and at later typologies arising from the work of H. J. Eysenck, Freud, E. Kretschmer, Pavlov, and W. H. Sheldon. The impact of current developments in neuropsychology and in cognitive psychology is discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Alcoholism: A developmental disorder.

Alcoholism etiology is discussed from a developmental behavior genetic perspective. At the outset point, temperament characteristics, by means of ongoing and reciprocal interaction with the social environment, shape the course of behavioral development. The behavioral characteristics successively acquired during development are vectors that determine the ontogenetic trajectory that culminates ultimately in the clinical disorder of alcoholism. The temperament features that appear to be associated with a heightened risk for alcoholism are examined. Their interactions with the environment during the course of development are considered within an epigenetic framework and, as discussed, have important ramifications for improving the prevention and treatment of alcoholism. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Temporal stability of antisocial personality disorder: blind follow-up study at 8 years

We studied the relation between Helicobacter pylori and residual gastritis in 28 patients with gastric cancer on whom distal partial gastrectomy with Billroth I reconstruction was performed over a 13-month period. They were subjected to serologic testing along with endoscopic and histologic examinations before operation and at 3, 6, and 12 months after operation. Anti-H. pylori immunoglobulin G (IgG) and serum gastrin levels were measured by serologic tests. The presence or absence of gastritis was determined endoscopically, and gastric mucosal hexosamine levels were determined. Gastritis was measured quantitatively by histologic examination in specimens taken from the gastric mucosa using Rauws' score. After the initial histologic evaluation we divided the H. pylori-positive patients into two groups: those with a Rauws' score of 0 to 3 ("weak" gastritis group), and those with a Rauws' score of 4 to 10 ("strong" gastritis group), allowing us to compare the results of our three postoperative histologic examinations of the two groups for possible significant differences. Our endoscopic examinations showed gastric mucosal inflammatory changes in both H. pylori-positive and H. pylori-negative patients at 3, 6, and 12 months after operation, but there was no significant difference between these two groups at any point. During the histologic examinations, however, anti-H. pylori IgG assay had become negative in several patients in the "weak" gastritis group at 3 months after operation and was found to have become negative in 78% of all patients in that group 12 months after operation. In contrast, in the "strong" gastritis group H. pylori infection was still evident in the patients 12 months after operation, suggesting that "strong" histologic gastritis may have some connection to H. pylori infection, whereas "weak" histologic gastritis has no such connection. The gastric mucosal hexosamine level was higher in the "weak" gastritis group than in the "strong" gastritis group both before operation and at 6 and 12 months, indicating some relation between gastric inflammatory changes and hexosamine levels in gastric mucosa. It further suggested the possibility that H. pylori plays a role in destroying gastric mucosa by depleting mucin, thus acting as one (though not the only) cause of residual gastritis after distal partial gastrectomy. In conclusion, we found evidence that there is a relation between residual gastritis and H. pylori infection, but H. pylori is not the sole cause of residual gastritis after gastric surgery. A causal relation is difficult to detect by simple analysis of histologic findings or by endoscopic observation or clinical symptoms alone.     

Development of antisocial personality disorder in detained youths: The predictive value of mental disorders.

Antisocial personality disorder (APD) is a serious public and mental health concern. Understanding how well conduct disorder (CD) and other mental disorders predict the development of APD among youths involved in the juvenile justice system is critical for prevention. The authors used a stratified random sample of 1,112 detained youths to examine the development of APD at a 3-year follow-up interview. Nearly one fifth of male juvenile detainees later developed APD; approximately one quarter of male juvenile detainees with CD at baseline later developed APD. Significantly more males than females developed APD; no differences were found by race/ethnicity. Having 5 or more symptoms of CD, dysthymia, alcohol use disorder, or generalized anxiety disorder was significantly associated with developing modified APD (M-APD; APD without the CD requirement). Some disorders were strong predictors of APD; however, none were adequate screeners for identifying which detainees would later develop M-APD. The findings of this study have implications for interventions and further research in developmental psychopathology. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Genetics of personality disorders: Perspectives from personality and psychopathology research.

Although the field is young, studies pertinent to genetic hypotheses have accumulated for several personality disorders. Genetic links to personality disorders from the domains of normal personality and Axis I disorders are reviewed. Evidence of a link to schizophrenia is clearest for schizotypal and less conclusive for paranoid and schizoid personality disorders. A genetic association between borderline personality disorder and affective disorders has not been clearly supported, but there may be a subtype genetically linked to affective disorders. Evidence of genetic influence is mixed for obsessive-compulsive personality disorder. In general, greater attention to dimensional phenotypic measures and multivariate designs can yield more definitive answers regarding the correct subtyping and probable etiology of personality disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)