Personality Disorders 593
in the attic and writing the threatening notes prob-
ably resulted from uncontrollable emotions that
ended up hurting other people (and Reiland) rather
than from a disregard for others.
The diagnostic criteria for antisocial person-ality disorder are the most behaviorally specific
of the criteria for personality disorders and even
include overt criminal behaviors (Skodol, 2005).
Because of this specificity, antisocial personality
disorder is the most reliably diagnosed personality
disorder (Skodol, 2005). Clinicians may, however,
be biased in how they diagnosis this disorder: One
study found that clinicians in the United Kingdom
were more likely to rate a man described in a case
report as having antisocial personality disorder
when the man was identifi ed as White than when
he was identified as Black (Mikton & Grounds,
2007). And although the criteria are behaviorally
specific, it is not clear whether people with this
personality disorder who perpetrate a criminal act
have a unique constellation of personality traits
not shared by people with this disorder who do
not perpetrate a criminal act (Silverstein, 2007).
Like other personality disorders, antisocialpersonality disorder manifests itself in childhood
or adolescence, but DSM-IV-TR is again very spe-
cific about antisocial personality disorder: The
symptoms must have arisen by age 15 (although
the diagnosis cannot be made until the individual is at least 18 years old). The di-
agnosis for people who exhibit a similar pattern of symptoms but are younger than
18 is conduct disorder, which is characterized by consistently violating the rights of
others (through lying, threatening, destructive and aggressive behaviors) or violating
societal norms. (In Chapter 14 we discuss conduct disorder in detail.) Table 13.12
provides additional facts about antisocial personality disorder.
CASE 13.5 • FROM THE OUTSIDE:Antisocial Personality Disorder
John and his sister were adopted by the same family when they were respectively 1.5 and 3
years of age. From the very beginning, John was severely physically abused by his adoptive
father as a result of just minor misbehaviors. Furthermore, John felt that he and his sister were
neglected (lack of warmth and attention) by his adoptive parents and that he and his sister
were thought of much less highly by them than their only biological son. From age 10 John and
his sister were sexually abused on a regular basis by his adoptive father, and John was forced
to watch when his father raped his sister. He demonstrated more and more oppositional and
angry behavior, and he became a notorious thief. John left junior secondary technical school
prematurely and had many short-term jobs, but he was dismissed every time because of lack
of motivation, disobedience, and/or theft. As a consequence of his deviant behavior, John was
placed in a juvenile correctional and observation institute when he was 16 years of age. A psy-
chiatric report from this episode described him as a socially, emotionally, morally, and sexu-
ally underdeveloped person who was very suspicious and angry. He projected his discomfort
on the outside world. After his release from the juvenile correctional institute (when he was
18 years of age), John was arrested because of violent pedophilic rape, theft, and fraud. John
was sentenced to forensic psychiatric treatment. But soon after his release, when he was 24,
John was sentenced to life imprisonment because he committed an excessively violent sexual
homicide on a 9-year-old boy.
(Martens, 2005, pp. 117–118)Prevalence- Between 1% and 4% of Americans are diagnosed with antisocial disorder (American
Psychiatric Association, 2000; Grant, Hasin, et al., 2004). - Around 60% of male prisoners in a number of countries have antisocial personality
disorder (Moran, 1999).
Comorbidity - The most common comorbid Axis I disorders are anxiety disorders, mood disorders,
substance-related disorders, and somatization disorders (American Psychiatric Asso-
ciation, 2000; Compton et al., 2005; Sareen et al., 2004). - In a clinical setting, most patients who meet the criteria for antisocial personality
disorder also are diagnosed with at least one other personality disorder, typically
another dramatic/erratic personality disorder (Widiger & Corbitt, 1997).
Onset - As required by the DSM-IV-TR criteria, symptoms of conduct disorder emerge before
age 15, and specifi c symptoms of antisocial behavior occur since age 15. The specifi c
antisocial behaviors then continue into adulthood.
Course - Antisocial personality disorder has a chronic course, but symptoms may improve as
patients age, particularly in their 40s (Seivewright, Tyrer, & Johnson, 2002)
Gender Differences - Antisocial personality disorder is diagnosed three times more often in men than in
women.
Source: Unless otherwise noted, citations are to American Psychiatric Association, 2000.
Table 13.12 • Antisocial Personality Disorder
Facts at a GlanceAntisocial personality disorder
A personality disorder characterized by a
persistent disregard for the rights of others.Conduct disorder
A psychological disorder that typically arises
in childhood and is characterized by the
violation of the basic rights of others or of
societal norms that are appropriate to the
individual’s age.