Antisocial personality disorder

This chapter discusses the medical understanding of antisocial personality disorder (APSD), including research concerning its etiology, prevalence, pathology, differential diagnosis, and treatment. ASPD, and the closely related diagnosis of psychopathy, seem to be products of a strong genetic disposition interacting with a variety of environmental contributions. Epidemiological studies indicate that ASPD and psychopathy are much more prevalent in men than in women, a finding that is supported by general personality research. Theories of pathology are numerous, but generally point to several distinct deficits; psychopathy has been associated empirically with abnormal affective processing, neuroanatomical abnormalities, psychophysiological arousal system impairments, deficits in cognitive functioning, and maladaptive personality constellations. Although considered diagnostically reliable, ASPD and psychopathy are highly comorbid with substance dependence and narcissistic personality disorder because of similar criteria, making differential diagnosis difficult. Finally, treatment for psychopathy and ASPD is a very controversial subject; although meta-analytic findings demonstrate positive results, considerable evidence also indicates that these disorders are resistant to typical interventions.