Is Psychopathy a Valid DSM-5 Diagnosis?
No, psychopathy is not a standalone diagnosis in DSM-5, but it can be captured through the DSM-5 Alternative Model for Personality Disorders (AMPD) Section III diagnosis of Antisocial Personality Disorder (ASPD) with a psychopathy specifier, or through dimensional trait assessment. 1, 2
Current Diagnostic Status
Psychopathy is not recognized as a distinct disorder in the main diagnostic section (Section II) of DSM-5. 3 Instead, the DSM-5 offers two pathways to capture psychopathic features:
Section II: Traditional ASPD (Main Diagnostic Codes)
- The traditional ASPD diagnosis in Section II emphasizes behavioral deviance symptoms but provides weak representation of the affective-interpersonal features central to psychopathy 4
- This approach shows limited convergence with psychopathy constructs, accounting for significantly less variance in psychopathy measures compared to the alternative model 5
Section III: Alternative Model (AMPD) - The Superior Approach
The AMPD approach in Section III provides substantially better capture of psychopathy, accounting for nearly twice the variance in psychopathy scores compared to Section II ASPD. 5
The AMPD operationalizes personality pathology through:
- Personality functioning impairments (self and interpersonal dysfunction) 1, 2
- Pathological personality traits across five domains: Negative Affectivity, Detachment, Antagonism, Disinhibition, and Psychoticism 1, 2
- A psychopathy specifier that can be added to ASPD diagnosis 1
How Psychopathy Is Captured Dimensionally
The AMPD traits effectively capture all three major facets of psychopathy when assessed through the Personality Inventory for DSM-5 (PID-5): 1, 4
- Impulsive externalization - captured through Disinhibition domain traits 4
- Callous aggression - captured through Antagonism domain traits 4
- Boldness - captured through additional PID-5 traits beyond the core ASPD criteria 4
In correctional samples, Section III ASPD demonstrates strong correlation with the Psychopathy Checklist-Revised (PCL-R) (r = .88) compared to Section II ASPD (r = .59), confirming its superior validity. 6
The Psychopathy Specifier: Limited Added Value
The psychopathy specifier included in Section III ASPD adds minimal incremental validity beyond the dimensional trait assessment itself. 5 The improvement in capturing psychopathy comes primarily from the trait-based dimensional approach rather than from the specific "psychopathy-related" traits in the specifier. 5 The specifier shows incremental validity mainly for fearless dominance features but contributes little beyond existing trait assessments for most psychopathy dimensions. 5
Parallel Classification in ICD-11
The WHO's ICD-11 provides a comparable dimensional framework that characterizes personality disorders by severity and allows specification of "dissociality" traits, which encompass psychopathic features. 1, 2 This approach parallels the DSM-5 AMPD dimensional model. 2
Clinical Implications
For clinical practice, use the DSM-5 Section III AMPD approach with dimensional trait assessment rather than relying on traditional Section II ASPD criteria when psychopathic features are clinically relevant. 7, 6 The dimensional trait model provides superior prediction of outcomes and better captures the heterogeneity within antisocial presentations. 7
The impairment criteria in Section III ASPD add incremental predictive value beyond traits alone for identifying clinically significant psychopathy. 6