Antisocial Personality Disorder: Wittgenstein’s Beetle
When I am in situations where there is lack of semantic clarity, where two or more speakers have a different set of “pictures” that describe one or a set of propositions, I am reminded of Wittgenstein. Science has specific operational definitions whose purpose it to get rid of lack of semantic clarity and achieve congruity in the perceived meaning of language signs between two or more individuals. That is why when there is a misunderstanding, the speaker or the listener should provide “clues” that would clarify what is meant by a language sign.
In the previous post, I was reminded by two readers that the four criminal profiles that I presented fit into the narrower criteria for psychopathy and not ASPD. It was a fair notice on their part. Although many characteristics between psychopathy and ASPD overlap, there are marked differences between the two. Moreover, the four profiles do not give a fair description of what a psychopath is like, since not all psychopaths engage in criminal behavior. The confusion stemmed from the fact that I used the criteria found in DSM-IV, and not the one found in PCL-R. Now that the source of misconstruction has been clarified, let’s look what is the distinction between the clinical and scholarly views on psychopathy.
The current edition of DSM does not have a criteria that specifically addresses psychopathy, although before the publication of DSM-III such a criteria did exist. Currently DSM includes a broader checklist for antisocial personality disorder that addresses specific behavioral patterns. According to Hare, Hard, & Harpur (1991) the change in clinical diagnosis and the exclusion of psychopathy from DSM is attributed to the following reasons: a)the desire to increase the congruence and compatibility between the DSM and ICD-10 (International Classification of Diseases and Related Health Problems), which does not include psychopathy and b) the desire to simplify the criteria for psychopathy. Even though proponents for retaining the criteria for psychopathy, such as Robert Hare, have tried to persuade the DSM committee to revert back to the previous criteria for psychopathy (with a few changes), they have been unsuccessful. The publication of a new DSM edition has largely been done because there was something lacking or wrong in the previous edition. One of those things that was lacking in previous edition is lack of specificity. When a diagnosis is based largely on observing character traits and making clinical inferences, there could be disagreements among clinicians when deciding if a person is a psychopath or not. Hence, the DSM-III committee saw the need to come up with a criteria that would increase reliability in diagnosing psychopathy. They changed the criteria and renamed it into antisocial personality disorder. This decision caused some controversy, which continues to the present day. Hare et. al(1991) points out that the addition of long lists of symptoms does not add any clarification and only makes the diagnosis process long and cumbersome, and the focus on behavioral indicators would likely lead to letting clinicians come up with their own idiosyncratic prototypical criteria (e.g., how many acts of deceit is enough to lead us to characterize an individual as deceitful?). In addition, Hare points out that behavioral indicators in diagnosis are not trustworthy especially in the case where there is reliance on self-reports of autobiographical memories.
Now, it is important to point out again that even though ASPD and psychopathy have some characteristics in common, but they are not the same. Psychopathy is usually defined as a disorder of personality, that is, diagnosis is not based only on behavioral patterns, while DSM-IV criteria for ASPD is largely behaviorally based (Ogloff, 2006). If you look at the wording of DSM and PLC-R, you can probably see what I mean.
|DSM-IV-TR (APA, 2000)||Hare Psychopathy Checklist Revised (Hare, 2003)|
|Evidence of conduct disorder before age 15 years pervasive pattern of disregard for, and violation of, the rights of others since the age of 15 years, as indicated by three or more of the following:
1. Failure to conform to social norms with respect
to lawful behaviors, as indicated by repeatedly
performing acts that are grounds for arrest;
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit
3. Impulsivity or failure to plan ahead;
4. Irritability and aggressiveness, as indicated by
repeated physical fights or assaults;
5. Reckless disregard for safety of self or others;
6. Consistent irresponsibility, as indicated by
repeated failure to sustain consistent work behavior or honor financial obligations; and
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
(Note: For DSM I selected only the criteria that relates to behavioral and personality indicators).
|Factor 1; Interpersonal/Affective
-Lack of remorse or guilt
-Callous/Lack of Empathy
-Failure to accept responsibility for actions
Factor 2; Social Deviance
-Need for stimulation/ prone to boredom
-Lack of realistic long-term goals
-Poor Behavioral controls
-Early behavioral problems
-Revocation of condition
As you can notice, in the Hare Psychopathy Checklist most traits are treated as open concepts. In the DSM, on the other hand, clinicians are expected to look at behavioral patterns. Of course, the former looks specifically for psychopathy while the latter for ASPD. In the next edition of DSM there will likely be some changes that would reconcile this divisive issue (Hesse, 2010).
American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 4th edn, text revision. Washington, DC: American Psychiatric Press, 2000.
Hare, R.D. (2003).Manual for the hare psychopathy checklist, 2nd edn, revised. Toronto, ON: Multi-Health Systems.
Hare, R., Hart, S., & Harpur, T. (1991). Psychopathy and the DSM-IV criteria for antisocial personality disorder. Journal of Abnormal Psychology, 100 (3), 391-398 DOI: 10.1037/0021-843X.100.3.391
Ogloff, J. (2006). Psychopathy/antisocial personality disorder conundrum Australian and New Zealand Journal of Psychiatry, 40 (6-7), 519-528 DOI: 10.1111/j.1440-1614.2006.01834.x
Morten Hesse (2010). What should be done with antisocial
personality disorder in the new edition of the diagnostic and statistical
manual of mental disorders (DSM-V)? BMC Medicine : 10.1186/1741-7015-8-66
- 56,149 since August 2010