Diagnostic validity of antisocial personality disorder

Competing models of antisocial personality disorder have important consequences for mentally disordered offenders and their management in the criminal justice system. In order to provide a fresh perspective on these enduring diagnostic problems, we conducted a prototypical analysis on 250 adult subjects' perceptions of psychopathy from a set of criteria, which included DSM-II, DSM-III, DSM-III-R, and Psychopathy Checklist (PCL) scores. Through principal components analysis we identified four factors: (a) impaired relationships and deception, (b) aggressive behavior, (c) nonviolent delinquency, and (d) frequent sexual relationships not attributable to mental illness/substance abuse. These factors appear to be more closely allied with PCL and two new proposals for DSM-IV than the current DSM-III-R model.We appreciate the efforts of David Di Giuseppe and Ireneusz Celejewski in data entry and management as well as the cooperation of the Ontario Science Centre in making this study possible.     

Diagnosis of antisocial personality disorder and criminal responsibility

The present study empirically investigates whether personality disorders and psychopathic traits in criminal suspects are reasons for diminished criminal responsibility or enforced treatment in high security hospitals. Recently, the tenability of the claim that individuals with personality disorders and psychopathy can be held fully responsible for crimes has been questioned on theoretical bases. According to some interpretations, these disorders are due to cognitive, biological and developmental deficits that diminish the individual's accountability.The current article presents two studies among suspects of serious crimes under forensic evaluation in a Dutch forensic psychiatric observation clinic. The first study examined how experts weigh personality disorders in their conclusions as far as the degree of criminal responsibility and the need for enforced forensic psychiatric treatment are concerned (n = 843). The second study investigated associations between PCL-R scores and experts' responsibility and treatment advisements (n = 108).The results suggest that in Dutch forensic practice, the presence of a personality disorder decreased responsibility and led to an advice for enforced forensic treatment. Experts also take characteristics of psychopathy concerning impulsivity and (ir)responsibility into consideration when judging criminal accountability. Furthermore, they deem affective deficiencies sufficiently important to indicate suspects' threat to society or dangerousness and warrant a need for forensic treatment.     

Childhood identification and prophylaxis of antisocial personality disorder

Physiological and psychological characteristics show considerable similarity between children with attention deficit disorder with hyperactivity (ADDH) and adults with antisocial personality disorder (ASPD). Prospective studies of ADDH children, with or without conduct disorder (CD), show a high outcome of ASPD. Recently, other forms of treatment have been added to the traditional psychopharmacological agents used for ADDH. If medication and new treatment modalities are administered for a period of three years, a recent controlled study indicates that the mean number of arrests for felony offenses and the mean number of institutionalizations are reduced at a p less than 0.0001 level (1.32 versus 0.19 and 0.49 versus 0.00, respectively).     

Rethinking the DSM III-R diagnosis of antisocial personality disorder

The diagnosis of antisocial personality disorder (APD) has undergone substantive revisions in the DSM III and DSM III-R criteria. Within the context of these modifications, the authors reviewed the current research and psychometric models of APD. They found considerable variability among these models which in turn appear to be only modestly correlated with DSM standards. Recommendations are offered to reduce symptom variations subsumed within APD and to explore a reformulation of APD for achieving greater congruence with research findings.     

Self-control strength in prison inmates with antisocial personality disorder

The present study aimed to examine the difference in self-control strength between individuals with and without antisocial personality disorder (ASPD) in a Chinese male prisoner sample. Thirty-seven male inmates who met the criteria for DSM-IV ASPD and 38 who did not were asked to watch a four-minute silent videotape of an interview, and ignore the words displayed on screen during the videotape to deplete their ego strength. A handgrip task was conducted both before and after watching the videotape, with participants’ time squeezing the handgrip being the dependent variable. Result showed a significant interaction between group (ASPD/no-ASPD group) and time (baseline/post-manipulation measure). The post-manipulation result was significantly worse than the baseline result for the ASPD group, but not for the no-ASPD group. These results indicate that tasks that contribute to ego depletion lead to a deficit of self-control strength in prisoners with ASPD.     

A Rorschach investigation of incarcerated female offenders with antisocial personality disorder

Although male psychopathy has been linked to histrionic, narcissistic, and antisocial personality disorders (ASPD), less is known about female psychopathy. The Psychopathy Checklist-Revised (PCL-R) and the Rorschach were used to explore the personality functioning of 45 incarcerated female offenders with ASPD delineated by their psychopathy level. Psychopaths (PCL-R > or = 30) and nonpsychopaths (PCL-R < 24) were compared on Rorschach measures of self-perception, interpersonal relatedness, and reality testing. Compared to female offenders with ASPD who were nonpsychopathic, female offenders with ASPD who were psychopathic exhibited marked disturbances in self-perception, interpersonal relatedness, and reality testing. Our findings highlight the heterogeneity of the ASPD diagnosis in women, support the utility of the psychopathy construct with female offenders, and implicate important differences between men and women with ASPD. These gender differences have relevance to the evaluation (PCL-R scoring) and treatment of female offenders. Our findings are discussed within the context of the female psychopath's hypothesized hysterical character style.     

Treating impulsivity, irritability, and aggression of antisocial personality disorder with quetiapine

There are few effective treatments of antisocial personality disorder (APD). Preliminary work suggests that the atypical antipsychotic quetiapine can decrease irritability, impulsivity, and aggressiveness. Data were collected from 4 patients with APD who were referred to a maximum-security inpatient psychiatric facility for pretrial evaluation and were treated with quetiapine. Quetiapine was effective in these patients as was indicated by a decrease in symptoms such as impulsivity, hostility, aggressiveness, irritability, and rage reactions. Typical dosage was 600 to 800 mg per day. Patients attributed their willingness to comply with quetiapine treatment to both the effectiveness of the drug and its favorable adverse-event profile. Quetiapine was successfully combined with mood stabilizers, particularly gabapentin, in patients with prominent affective instability. Quetiapine has demonstrated efficacy in aggression, impulsivity, and irritability and has proved to be an effective medication in these patients with APD. In addition, its favorable adverse-event profile makes patients willing to comply.     

Cluster analysis of a forensic population with antisocial personality disorder regarding PCL-R scores: differentiation of two patterns of criminal profiles

Fifty six cases of a forensic population were submitted to a cluster analysis to observe the aglomerative behavior in relation to the total scores of the items comprising the PCL-R Psychopathy Checklist Revised [R.D. Hare, Manual for the Hare Psychopathy Checklist-Revised, Multi-Health System, Toronto, 1991]. The analysis indicated two independent types of antisocial personality disorders, not identified in the PCL-R in its standardized form, one of them being strongly associated with criminal conduct and the other with psychopathic personality. Such clusters were stable when the analysis was replicated with other hierarchical algorithms, and also, they were independently extracted via the k-means method without having previously fixed the value for k. One of the clusters concentrated the PCL-R highest scores, indicating that it is the prototypical psychopathic character determinant.     

Biology, violence, and antisocial personality.

Previous reports have examined separately the role of perinatal biology in the etiology of violent criminal behavior and the etiology of antisocial personality disorder (ASP). This paper brings together those two studies to test the hypothesis that violent behavior and ASP may result from different etiological factors. The two studies are on Danish birth cohorts, examined both for perinatal health and for violent, aggressive, and antisocial behavior later in life. Results suggest that while perinatal factors may be important in the etiology of violent criminal behavior, they do not appear to be similarly influential in the formation of ASP. These two studies are examined and their results and findings discussed in light of the limited literature in this area.     

34例边缘型人格障碍患者临床资料分析

目的 了解边缘型人格障碍的临床特点.方法 通过临床资料回顾性分析,运用ICD-10诊断标准及SCL-90与<中国人性格特征量表>进行筛选,针对人格障碍进行Beck格式与Young图式的认知咨询与治疗.结果 针对人格障碍治疗的病例经过治疗后,在症状改变上及<中国人性格特征量表>中Borderline分值减分明显优于未明确诊断者.结论 分析得出病情确诊与针对性的治疗,对于边缘型人格障碍是有效的.     

Development of the Observation Scale for Aggressive Behavior (OSAB) for Dutch forensic psychiatric inpatients with an antisocial personality disorder

The Observation Scale for Aggressive Behavior (OSAB) has been developed to evaluate inpatient treatment programs designed to reduce aggressive behavior in Dutch forensic psychiatric patients with an antisocial personality disorder, who are "placed at the disposal of the government". The scale should have the sensitivity to measure changes in the possible determinants of aggressive behavior, such as limited control of displayed negative emotions (irritation, anger or rage) and a general deficiency of social skills. In developing the OSAB 40 items were selected from a pool of 82 and distributed among the following a priori scales: Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent (to aggressive behavior), Sanction (for aggressive behavior) and Social behavior. The internal consistency of these subscales was good, the inter-rater reliability was moderate to good, and the test-retest reliability over a two to three week period was moderate to good. The correlation between the subscales Irritation/anger, Anxiety/gloominess, Aggressive behavior, Antecedent, Sanction was substantial and significant, but the anticipated negative correlation between these subscales and the Social behavior subscale could not be shown. Relationships between the corresponding subscales of the OSAB and the FIOS, used to calculate concurrent validity, yielded relatively high correlations. The validity of the various OSAB subscales could be further supported by significant correlations with the PCL-R and by significant but weak correlations with corresponding subscales of the self-report questionnaires. The Observation Scale for Aggressive Behavior (OSAB) seems to measure aggressive behavior in Dutch forensic psychiatric inpatients with an antisocial personality disorder reliably and validly. Contrary to expectations, a negative relationship was not found between aggressive and social behavior in either the OSAB or FIOS, which were used for calculating concurrent validity.     

论人格障碍与犯罪--马加爵案件心理分析

马加爵故意杀人案件发生后,在全国上下引起极大的轰动和关注.这个案件所反映出来的犯罪手段的残忍、犯罪起因的琐碎以及犯罪后果的严重,使人们在唏嘘不已的同时,不禁思索:正当青春年华的马加爵为什么会以如此残忍的手段去杀害同样正处青春年华的他的同学?是一时冲动?是变态犯罪?他们之间究竟发生了什么?我们对青少年的教育和关心到底出了什么问题?如何去避免类似的悲剧重演?对这些问题的正确回答关系到整个社会的安宁和发展,关系到青少年的健康成长,关系到我们国家的未来.本文试从犯罪心理学的角度对这一案件进行心理分析,就上述几个问题谈一些自己粗浅的看法,以抛砖引玉,并期待有更多的人来研究这些问题,为防止类似犯罪案件的发生提供理论基础.     

Dimensions of antisocial behaviour in juvenile delinquency: A study of personality variables

The discrepancy among operational definitions of delinquency is one of the main causes of the fragmentation in this area of research. In this paper, we defend the need to analyse juvenile delinquency as a multidimensional construct rather than as a dichotomous variable. This approach allows one to identify homogeneous classes of behaviour, to take into account the frequency and seriousness of such behaviour, and to investigate the variables related to each separate class. In this work, the relationship of certain personality variables (sensation seeking, impulsivity, empathy and self-esteem) to various types of self-reported delinquent activity was investigated in two samples of male adolescents, one composed of institutionalized juvenile delinquents and the other drawn from the general population. Our results confirm the relevance of the personality variables considered and support their differential association with offence groups.     

Attitude to personality disorder among prison officers working in a dangerous and severe personality disorder unit

BACKGROUND: It is well established that staff attitudes to personality disordered patients are commonly negative, characterised by pessimism and rejection. A recent study in forensic psychiatric hospitals has described the psychological and social factors underlying positive attitudes, and suggested that staff with more positive attitudes perform better and are less stressed. AIM: To assess whether it is possible to predict which staff will adjust positively to working with personality disordered people. More specifically to confirm links between attitude to personality disorder and: job performance; perception of managers; personal well-being; burnout; and interaction rates with inmates. METHODS: The opening of a new Dangerous and Severe Personality Disorder unit within a UK prison allowed a longitudinal study of prison officers to be performed, in which a number of measures, including the Attitude to Personality Disorder Questionnaire (APDQ), were collected at three fixed points (at baseline, eight and sixteen months after the opening of the unit). RESULTS: Attitude to Personality Disorder varied over the course of the study, and changes in attitude were linked to events experienced by individual officers. More positive attitude to personality disorder was associated with improved general health and job performance, decreased burnout, and favourable perception of managers. CONCLUSIONS: Attitude to Personality Disorder has important outcomes, and is responsive to the psychosocial environment. Its measurement is not useful for staff selection, because of low stability over lengthy time periods. The APDQ has been demonstrated to be valid measure of attitude to PD, and potentially useful for outcome studies, or benchmarking between units.     

Offender characteristics in lethal violence with special reference to antisocial and autistic personality traits

The objective of the study is to assess the relationships between personality traits, lifetime psychosocial functioning, and crime scene behavior. Thirty-five male offenders referred for forensic psychiatric assessment in Sweden (1996-2001) and assigned a main diagnosis of either antisocial personality disorder (APD) or autism spectrum disorder (AUT) were retrospectively studied. APD were subcategorized into impulsive (APDi) and controlled (APDc). Those in the AUT group were less intoxicated at the time of the crime and did not often use knives or guns compared to the APD group. Males in the APDi group were older and had a higher proportion of abuse of alcohol and drugs in biological parents, physical abuse during childhood, psychiatric contacts, and suicide attempts compared to the APDc group. In the APDi group, knives were used in the homicide compared to the use of guns in the APDc group. The results suggest differences in psychosocial functioning and crime scene characteristics related to personality traits.     

Schizotypal personality disorder and the insanity defense

What constitutes a "mental disorder" for purposes of the insanity defense? Does mental disorder denote any diagnosable condition listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders? Is a mental disorder a disturbance wherein the functional criteria of the appropriate insanity law appear to be met? Or does insanity law define mental disorder apart from functional criteria of insanity? The answer to the last question is that some insanity laws attempt to define or qualify mental disorder, but many do not. Unclarities in the law leave room for unnecessary disagreements between expert witnesses even before the functional criteria for insanity are to be addressed. The potential for confusion is compounded when the defendant's disturbance is ambiguous, amphibious, or both. Schizotypal personality disorder is offered as an example of such a disturbance, and inferences are discussed.     

Matricide by person with bipolar disorder and dependent overcompliant personality

Matricide is an infrequent form of homicide. This paper is to present a case of matricide with typical characteristics of the act but interesting particularities as well. The perpetrator was a 43-year-old man, respected member of his community, with over compliant characteristics, eagerness in serving people and caring his parents, good social adaptation before and after the crime. He abandoned his family and work in order to better serve his old, disabled but over demanding mother who frequently insulted and humiliated him. Suddenly he came to a state of "mental confusion" and strangled her. After the crime, the perpetrator manifested the symptoms of a bipolar disorder and also received the diagnosis of dependant personality disorder. Years later, he presented again a crisis of escalating aggressive urge for which he was hospitalized. Many people and associations of his hometown actively demanded the minimal possible punishment for him. The case is discussed especially concerning: a) hypotheses about the aetiopathogeny of the act, b) the constant support provided to the perpetrator by his family and social environment.