once persons are released from prisons or forensic insti-
tutions. In addition to criminal behavior, risk-taking
behavior is common. This can take a variety of forms,
such as problematic substance use that is associated
with adverse outcomes, such as crime, injury, personal
neglect, or financial difficulties. It also may include irre-
sponsible behaviors, such as reckless driving, failing to
care for children adequately, sexual behavior that puts
others’ safety at risk, or gambling problems.
In terms of more general life functioning, the
effects of ASPD are notable as well. For instance,
ASPD is associated with low socioeconomic attain-
ment, poor employment records and performance,
low educational attainment and success, and unsta-
ble interpersonal relationships. The latter may
include broken ties with one’s family, abuse
and other mistreatment within romantic relation-
ships, and having only friends of convenience.
Furthermore, ASPD predicts increased morbidity
and mortality associated with accidental death and
injury, as well as suicide.AAssssoocciiaattiioonn WWiitthh OOtthheerr DDiissoorrddeerrss
Most PDs are associated with other PDs, and
ASPD is no exception. It is common for people with
ASPD to show symptoms of other PDs involving dys-
regulation of affect and impulsive behavior, such as
borderline, narcissistic, or histrionic PDs. In addition,
perhaps stemming from the high degree of negative
emotionality commonly present in ASPD, some
depressive and anxiety disorders are overrepresented
in ASPD. Substance-related disorders also are dispro-
portionately present in persons with ASPD relative to
those without.Assessment
Both self-report and interview-based measures are
available to assess ASPD. Although conducting an
interview is regarded as meeting a higher standard of
clinical care when assessing personality (or other)
pathology, self-report tools may be desirable additions
to an assessment because they tend to be relatively
brief, may be appropriate for group administration, and
do not require an examiner with advanced credentials.
On the other hand, self-reports require cooperation
from the examinee and a minimum level of literacy.
Several (semi)structured interviews exist for assess-
ing ASPD, including the Diagnostic Interview for DSM-
IVPersonality Disorders, the Structured Interview forDSM-IVPersonality Disorders, the Personality Disorder
Examination, the Diagnostic Interview Schedule, and
the Composite International Diagnostic Interview.
Perhaps the most widely used and researched semi-
structured interview schedule for use by trained clinicians
in assessing ASPD (and other PDs) is the Structured
Clinical Interview for DSM-IV Axis II Personality
Disorders (SCID–II). Each symptom criterion is
assessed by an item that the interviewer rates using a 3-
point scale (1 =absent or false; 2 =subthreshold; and
3 =threshold or true). Research indicates acceptable
levels of internal consistency, test-retest reliability, and
interrater reliability for the SCID–II ASPD module.
Several self-report measures that include modules
for assessing ASPD also have been developed, such as
the Personality Diagnostic Questionnaire–4 (PDQ–4),
the Assessment of DSM-IV Personality Disorders
Questionnaire, and the Wisconsin Personality Disor-
ders Inventory. Self-reports whose items closely track
the diagnostic criteria, such as the PDQ–4, have
greater clinical relevance to the assessment of ASPD
than those that do not. Although many self-report per-
sonality measures and diagnostic inventories include
scales for assessing features of ASPD (e.g., the
California Psychological Inventory, the Minnesota
Multiphasic Personality Inventory–2, the Millon
Clinical Multiaxial Inventory–III, and the Personality
Assessment Inventory), they often emphasize concep-
tualizations of delinquent personality other than ASPD
(e.g., psychopathy). These scales typically demon-
strate low concordance with SCID–II diagnoses of
ASPD, which likely is related to their lack of represen-
tation of the DSMcriteria for ASPD. Compared with
interview-based measures, self-reports tend to yield
elevated prevalence rates of ASPD. Furthermore, an
actual diagnosis of ASPD must be made by a qualified
mental health professional, who interprets whatever
tests and measures are used, rather than simply relying
on scores on a test or measure.
Research studies comparing the utility of self-report
and interview measures for ASPD generally conclude
that whereas agreement for dichotomous diagnostic clas-
sification tends to be poor, concordance is much higher
when a dimensional perspective is considered. Although
knowing the rates of categorical classification is attrac-
tive from a clinical perspective, there nevertheless is sub-
stantial empirical support for the use of dimensional
representations of PDs. In terms of relevance to applied
practice, information regarding the severity of symptoms
(i.e., a dimensional perspective) can be useful for treat-
ment planning and case management.30 ———Antisocial Personality DisorderA-Cutler (Encyc)-45463.qxd 11/18/2007 12:41 PM Page 30