Magazine article Clinical Psychiatry News

Antisocial Behavior: DSM-5 Revision Possible

Magazine article Clinical Psychiatry News

Antisocial Behavior: DSM-5 Revision Possible

Article excerpt

After years of reduced visibility, the psychopathic personality has returned to prominence in both the popular imagination and in the domain of clinical psychiatry.

In 2010, British television personality Jon Ronson published "The Psychopath Test," a somewhat cynical inquiry into the use, and purported misuse, of the Hare Psychopathology Checklist-Revised (PCL-R) in forensic, medical, and corporate settings. In recent years, research into the neurobiology of psychopathic traits has been cited in prominent articles and editorials in the American Journal of Psychiatry (2011;168:569-71). And now, as the DSM-5 work groups revise their proposals for diagnostic criteria, the psychopathic personality is poised to appear in the diagnostic manual, albeit in modified form.

Traditionally, the term "psychopathy" has referred to a cluster of affective and interpersonal features that predispose individuals to antisocial behavior. The classic psychopath is notable for an absence of remorse, a reduced ability to experience guilt, and a limited degree of emotionality. With little capacity for empathy, the classic psychopath is unencumbered by concerns about the dignity and humanity of others, and is therefore relatively free to exploit them at will.

Psychopathy's definition is distinguished from that of antisocial personality disorder (ASPD) by its emphasis on intrapsychic and interpersonal elements of personality style, rather than on the observable behaviors stipulated by most of the ASPD diagnostic criteria.

The construct and clinical utility of the concept of psychopathy is somewhat controversial, and has been the subject of extensive and thoughtful critiques (Psychol. Sci. Public Interest 2011;12:93-4). Neverttieless, evidence suggests that antisocial personality in the presence of psychopathy is associated with a more severe and intractable course of misconduct than in the absence of psychopathy Antisocial individuals with psychopathic features manifest more severe criminal behavior (J.Abnorm.Psvchol. 2006;115:798-more convictions for criminal violence (Compr, Psychiatry 2010;51:426-33), and greater involvement in illegal drug activity (Am. J. Psychiatry 1999;156:849-56) than do those without psychopathic features.

Psychopathy carries a highly pejorative connotation, and the labeling of individuals with this term has direct and measurable adverse consequences within the legal system.

For example, researchers at Sam Hous ton State University in Huntsville, Tex., showed that potential jurors believe that juveniles who are explicitly labeled as psychopaths deserved longer prison sen tences than did unlabeled juveniles who met criteria for psychopathy (Behav. Sci. Law 2008;26:487-510).

Over the years, several terms have been proposed as less pejorative stand-ins for the word itself. In the 1960s, "so-ciopathy" was offered more or less as a symptom for psychopathy, with an etymological emphasis on the purported societal roots of the disorder. Later, the DSM-III used the specifier "undersocialized" to describe a subtype of conduct disorder characterized by "a lack of concern for the feelings, well-being, and wishes of others" (Washington, D.C.: American Psychi-atric Association, 1980, p. …

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