From the Research
Antisocial personality disorder (ASPD) should be diagnosed through a comprehensive clinical assessment by qualified mental health professionals using established diagnostic criteria from the DSM-5, prioritizing a thorough clinical interview and collateral information to ensure accurate diagnosis and treatment planning. The assessment typically begins with a thorough clinical interview exploring the patient's history of conduct problems before age 15, including behaviors like aggression toward people or animals, property destruction, deceitfulness, and serious rule violations. For diagnosis, the individual must be at least 18 years old and demonstrate a pervasive pattern of disregard for others' rights since age 15, including at least three of the following: law-breaking behaviors, deceitfulness, impulsivity, aggressiveness, reckless disregard for safety, consistent irresponsibility, and lack of remorse.
Key Considerations
- Collateral information from family members, legal records, and previous medical documentation is crucial as individuals with ASPD often minimize or deny problematic behaviors.
- Standardized assessment tools like the Psychopathy Checklist-Revised (PCL-R) or the Personality Assessment Inventory (PAI) can supplement clinical judgment.
- Differential diagnosis is important to rule out substance use disorders, other personality disorders, and conditions that may better explain the symptoms.
- There are no specific medications approved for ASPD itself, though pharmacotherapy may target specific symptoms like impulsivity, aggression, or co-occurring conditions.
Recent Evidence
The most recent study 1 suggests that the DSM-5 alternative model for personality disorders' (AMPD) operationalization of ASPD is a vast improvement over previous versions of the DSM, and its relationship to established measures of psychopathy is an area of ongoing research.
Clinical Implications
The diagnosis of ASPD requires careful consideration as it carries significant implications for treatment planning and prognosis, and clinicians should prioritize a comprehensive and multidisciplinary approach to diagnosis and treatment, as supported by the study 2.