The Impact of Anti-Social Personality Disorder on Relationships

Introduction

Using a broad definition, Antisocial Disorders may be defined as pervasive, maladaptive behaviors that violate the norms and rules of a group or society, causing social impairment or distress to others. Currently, the classification and assessment of antisocial disorders may follow (a) the medical model or (b) the dimensional model:

The medical model uses a categorical approach in which the presence of a variety of diagnostic criteria, such as persistent violations of social norms (including lying, stealing, truancy, inconsistent work behaviour and traffic arrests), is evaluated by experts (clinicians). This model relies on diagnostic criteria as outlined in the DSM-IV (Diagnostic and Statistic Manual of Mental Disorders: APA, 1994) and ICD (International Classification of Diseases: WHO, 1993).

The dimensional model evaluates antisocial disorders along a continuum of development, from normal to pathological, focusing on behavioral and trait dimensions, and identifying clusters of highly interrelated behaviors and traits.

There is agreement among researchers about the development of antisocial behavior: it begins early in life (infancy) with aggressive and oppositional behaviors (e.g. conduct problems), gradually advances toward more significant expressions of antisocial acts (e.g. vandalism, stealing, truancy, lying, substance abuse) during adolescence, and lastly, progresses to extreme forms of delinquency in adult life. The most recent longitudinal and retrospective studies (Patterson, Reid & Dishion, 1992) suggest that the 'early starters' (childhood and preadolescence) are at greater risk for adult involvement in delinquent acts and are more likely to move toward more serious offences that lead to a 'criminal career' compared to the 'later starters' (adolescence).

Controversies

The ASPD diagnosis has generated controversy on several fronts. The debate that has received the most commentary pertains to whether the diagnostic criteria should emphasize objective behaviors or personality features. The introduction of ASPD into the DSM was intended to reflect the clinical disorder known as psychopathy, which includes features such as callousness, remorselessness, guiltlessness, superficiality, and shallow affect. The ASPD criteria were written with a behavioral focus in the service of the decreasing subjectivity involved in rating personality features, thereby increasing reliability. In the current diagnostic nomenclature, ASPD is presented as being largely the same as psychopathy—even though many of the descriptors traditionally associated with psychopathy are absent from the diagnostic criteria. That the two disorders are not in fact synonymous is highlighted by the results of contemporary prevalence studies demonstrating that about three quarters of prisoners meet the criteria for ASPD whereas only about one quarter, or less, meets the criteria for psychopathy.

Additionally, the criteria have been criticized for lacking specificity; for instance, meeting diagnostic criteria may arise from a boggling number of permutations of the 7 adult disorder and 15 CD symptoms. An important impact of the imprecision with which the outcome of ASPD is delineated is that it renders investigation into the disorder's causal factors much more challenging, as noted above. Moreover, the validity of ASPD has been challenged in light of the paucity of available longitudinal data. Critics of the ASPD criteria also argue that they are underinclusive (in that ...