Dissocial personality disorder

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Conduct disorder
ICD-10 F60.2.
ICD-9 301.9

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Dissocial personality disorder is one of several psychopathic personality disorders, each of which has different operational definitions and terminology|terminologies depending on the system of classification of mental disorders used.[1] Psychopathy is a general construct that differs from the specific diagnoses of antisocial, psychopathic, dissocial, and sociopathic personality disorders, the various diagnostic classifications for psychopathy.[2] Dissocial personality disorder is the diagnostic category established for psychopathy in the ICD-10 diagnostic criteria developed by the World Health Organization (WHO). It is conceptually similar to the DSM-IV-TR diagnostic criteria for Antisocial personality disorder.[3]

ICD-10 Criteria for Dissocial Personality Disorder

Specifically, the dissocial personality disorder is described by the World Health Organization by the following criteria:

  1. Callous unconcern for the feelings of others and lack of the capacity for empathy.
  2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
  3. Incapacity to maintain enduring relationships.
  4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
  5. Incapacity to experience guilt and to profit from experience, particularly punishment.
  6. Marked proneness to blame others or to offer plausible rationalizations for the behavior bringing the subject into conflict.
  7. Persistent irritability.

The criteria specifically rule out Conduct disorders.[3] Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.[4]

Confusion in terminology

Although conceptually the antisocial, dissocial, and sociopathic personality disorders are synonymous with psychopathy, operationally the diagnostic criteria for these disorders are definitely distinct.[2] They are not equivalent disorders. The largest difference is the emphasis on delinquent and crime|criminal behaviors found in the DSM-IV-TR's version, the antisocial personality disorder. The dissocial personality disorder pays more attention to the affective, interpersonal and behavioral components not present in DSM-IV-R's criteria.[1]

The criteria for antisocial personality disorder are largely based on observable behaviors while the ICD criteria for dissocial personality disorder focus more on the affective and interpersonal deficits. However, the ICD criteria do not represent the broad personality and behavioral factors of psychopathy.[2]

The blurring of distinctions between these diagnostic categories and psychopathy have caused diagnosis confusion. For the mental health and criminal justice system the distinction between psychopathy and antisocial personality disorder is of considerable importance.[5] Further, the term "psychopathic" is no longer used in United Kingdom as it is seen as having pejorative connotations.[6]

Research findings

Much research into psychopathy, as operationalized by the Hare Psychopathy Checklist Revised (PCL-R), has been conducted. The checklist assesses both interpersonal and affective components as well as lifestyle and antisocial deficits. However, the research results cannot be easily extrapolated to the clinical diagnoses of dissocial personality disorder or antisocial personality disorder. A sample research finding is that between 50% and 80% of prisoners in England and Wales meet the diagnostic criteria of dissocial personality disorder, but only 15% would be predicted to be psychopathic as measured by the PCL-R. Therefore, the findings drawn from psychopathy research have not yet been shown to be relevant as an aid to the diagnosis and treatment of dissocial or antisocial personality disorders.[2]

Attempts to correlate dissocial personality disorder have had methodology|methodological problems. Although a high percentage of prisoners in England and Wales were shown in one survey to fulfill the criteria for a dissocial personality, since the diagnosis of dissocial personality includes a disregard for social rules and norms, it is not surprising that the same individuals commit crimes.[7]

Research has been done attempting to assess the co-morbidity of dissocial personality disorder with other conditions. However, the few studies that have been done use too many different methodology|methodologies to enable forming solid conclusions, although it seems that there is a low prevalence of antisocial personality disorder/dissocial personality disorder in psychiatric hospitals.[8]

Treatment

In practice, mental health professionals rarely treat dissocial personality disorders as they are considered untreatable and no interventions have proven to be effective. In England and Wales the diagnosis is grounds for Detention (imprisonment)|detention in secure psychiatric hospitals under the Mental Health Act if individuals with that diagnosis have committed serious crimes, but since such individuals are disruptive for other patients and not responsive to treatment this alternative to prison is not often used.[9]

See also

References

  1. 1.0 1.1 Irving B. Weiner & Donald K. Freedheim. Handbook of Psychology p. 88. John Wiley and Sons. Retrieved on 2008-01-12.
  2. 2.0 2.1 2.2 2.3 Ogloff, James R.P. (2006). Psychopathy/antisocial personality disorder conundrum. Blackwell Publishing. Retrieved on 2008-01-12.
  3. 3.0 3.1 602 F60.2 Dissocial personality disorder. World Health Organization. Retrieved on 2008-01-12.
  4. Early Prevention of Adult Antisocial Behavior. Cambridge University Press, p. 82. Retrieved on 2008-01-12. 
  5. Robert D. Hare, Ph.D. (1996). Psychopathy and Antisocial Disorder: A Case of Diagnostic Confusion. Psychiatric Times. Retrieved on 2008-01-12.
  6. The Disability Handbook on Personality Disorders. Retrieved on 2008-01-13.
  7. Dangerous Severe Personality Disorder. Advances in Psychiatric Treatment (2003). Retrieved on 2008-01-12.
  8. Moran, Paul (1999). Antisocial Personality Disorder: An Epidemiological Perspective. Amer Psychiatric Publishing, p. 25. 
  9. Paul Harrison & John Geddes. Lecture Notes: Psychiatry. Blackwell Publishing, p. 163–165. 

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