Antisocial personality disorder (ASPD) is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition (DSM-IV-TR), as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."[1]
The World Health Organization's International Statistical Classification of Diseases and Related Health Problems', tenth edition (ICD-10), defines a conceptually similar disorder to antisocial personality disorder called (F60.2) Dissocial personality disorder.[2]
Though the diagnostic criteria for ASPD were based in part on Hervey Cleckley's pioneering work on psychopathy, ASPD is not synonymous with psychopathy and the diagnostic criteria are different.[3]
Diagnosis
ICD-10
The World Health Organization's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), defines a conceptually similar disorder to antisocial personality disorder called (F60.2) Dissocial personality disorder.[4]
It is characterized by at least 3 of the following:
Callous unconcern for the feelings of others;
Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
Incapacity to experience guilt or to profit from experience, particularly punishment;
Markedly prone to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.
There may be persistent irritability as an associated feature.
The diagnosis includes what may be referred to as amoral, antisocial, psychopathic, or sociopathic personality (disorder.)
The criteria specifically rule out conduct disorders.[5] Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.[6]
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
DSM-IV-TR
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV-TR), defines antisocial personality disorder (in Axis II Cluster B) as:[1]
A) There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following:
failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
impulsiveness or failure to plan ahead;
irritability and aggressiveness, as indicated by repeated physical fights or assaults;
reckless disregard for safety of self or others;
consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another;
B) The individual is at least age 18 years.
C) There is evidence of conduct disorder with onset before age 15 years.
D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.
The individual must be at least 18 years of age to be diagnosed with this disorder (Criterion B), but those diagnosed with ASPD as adults were commonly diagnosed with conduct disorder as children. The prevalence of this disorder is 3% in males and 1% in females, as stated in the DSM IV-TR.
Further diagnostic considerations
Psychopathy
Although there are behavioral similarities, ASPD and psychopathy are not synonymous. A diagnosis of ASPD using the DSM criteria is based on behavioral patterns, whereas psychopathy measurements also include more indirect personality characteristics. The diagnosis of antisocial personality disorder covers two to three times as many prisoners as are rated as psychopaths. Most offenders scoring high on the PCL-R also pass the ASPD criteria but most of those with ASPD do not score high on the PCL-R.[3]
Theodore Millon's subtypes
Theodore Millon identified five subtypes of antisocial personality disorder.[7][8] exhibiting all of the following:
covetous antisocial variant of the pure pattern where individuals feel that life has not given them their due.
reputation-defending antisocial including narcissistic features
risk-taking antisocial including histrionic features
nomadic antisocial including schizoid, avoidant features
malevolent antisocial including sadistic, paranoid features.
Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) - covetous, risk-taking, malevolent, tyrannical, malignant, unprincipled, disingenuous, spineless, explosive, and abrasive - but specifically stresses that "the number 10 is by no means special...Taxonomies may be put forward at levels that are more coarse or more fine-grained".[9]
Comorbidity
The following conditions commonly coexist with antisocial personality disorder:[10]
Anxiety disorders
Depressive disorder
Impulse control disorders
Substance-related disorders
Somatization disorder
Attention deficit hyperactivity disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Sadistic personality disorder
When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[11]
