emotional, and behavioral features), assessment
approaches, treatment issues, etiological factors,
and current controversies.Description
There are a number of definitional elements to person-
ality disorder (PD) generally that apply to ASPD. A PD
is a pattern of inflexible interpersonal relations, behav-
ior, and internal experiences (emotional, cognitive, or
attitudinal tendencies) that is stable across the life span
and starts in adolescence (or early adulthood). It is
inconsistent with cultural norms or expectations and
involves distress or impairment to the individual. The
core of ASPD involves consistently disregarding social
norms or rules and violating other people’s rights.
The official diagnostic criteria for ASPD, as with
all PDs, are provided by the Diagnostic and Statistical
Manual of Mental Disorders, currently in its fourth
edition, which includes a textual revision (DSM-IV-
TR), published by the American Psychiatric Associa-
tion. To receive a diagnosis of ASPD, an individual
must be at least 18 years old; there must be evidence
of conduct disorder (CD) with an onset before the age
of 15; antisocial behavior must not be limited in its
occurrence solely within the course of schizophrenia
or a manic episode; and there must be a pattern of vio-
lating or disregarding others’ rights since the individ-
ual was 15 years old.
More specifically, an individual must meet three of
seven diagnostic criteria—as specified in the DSM-IV-
TR—since the age of 15. Paraphrasing, these include (1)
repeated criminal behavior; (2) frequent lying or manip-
ulation; (3) impulsive behavior; (4) aggression, including
physical violence; (5) jeopardizing other people’s safety
(e.g., driving while intoxicated); (6) being irresponsible
(i.e., refusing to pay one’s bills or debts); and (7) not
experiencing remorse for one’s harmful behaviors.
In addition to meeting at least three of these seven cri-
teria since age 15, an individual must also have shown
evidence of CD prior to the age of 15. Although the DSM-
IV-TRdoes not specify the number of CD symptoms
required to satisfy this diagnostic criterion, some experts,
and common assessment instruments (see below), have
suggested that as few as 2 (of 15) CD symptoms would
suffice. The 15 symptoms of CD include, among others,
aggressive behaviors (e.g., stealing, fighting, using
weapons, robbery, sexual assault), destroying property,
lying, and other rule-breaking behavior (e.g., skipping
school, running away from home).Phenomenology, Associated Features,
and CorrelatesAttitudinally,individuals with ASPD may hold dis-
paraging views of others and consider them to be
avenues to fulfill their own needs (e.g., for money,
sex, pleasure). They tend to have a hostile and dis-
trustful view of the world, believing that others may
be out to harm or deceive them and hence their own
harmful or deceptive behavior is justified. ASPD is
associated with negative views of societal institutions
such as law enforcement, the judiciary, or the govern-
ment. Procriminal attitudes that support, condone, or
justify criminal behavior are common.
Cognitively, ASPD is associated with impulsive
decision making involving little forethought, even
if negative consequences are serious and probable.
People with ASPD also may show poor concentration
abilities and an impaired ability to devote sustained
attention to routine activities. On the other hand, they
may indeed be able to devote attention to activities that
they consider pleasurable or exciting (e.g., gambling).
Emotionally, some, though not all or even the major-
ity of, people with ASPD show serious deficits in the
depth and breadth of emotional experience. That is, they
tend not to experience extremes (positive or negative) of
emotion, such as despair or love, to the same degree as
people without ASPD. This type of emotional poverty
would be most likely to occur in individuals with ASPD
who also meet definitions of the more classic form of
antisocial personality pathology—namely, psychopathy,
a hallmark of which is emotional detachment.
People with ASPD commonly are prone to negative
emotionality, or the tendency to have feelings of anger,
irritability, hostility, dissatisfaction, unhappiness, dis-
pleasure, and anxiety. Such an emotional disposition
may account, in part, for the tendency of people with
ASPD to have problems initiating or sustaining posi-
tive interpersonal relationships. Furthermore, such
emotional tendencies could explain the increased risk
of suicide-related behavior in ASPD.
Behaviorally, there are numerous correlates of ASPD
that span all domains of life functioning. Perhaps most
notably, ASPD is commonly associated with crimi-
nal and violent behavior. This observation is compli-
cated by the fact that crime and violence form part of
its diagnostic criteria, and hence, not surprisingly, indi-
viduals with ASPD have more crime and violence in
their histories than those without ASPD. However,
ASPD also is predictive of future criminal behaviorAntisocial Personality Disorder——— 29A-Cutler (Encyc)-45463.qxd 11/18/2007 12:41 PM Page 29