9 - The Impulsive Cluster

Summary

Antisocial personality disorder

Phenomenology

Antisocial personality disorder (ASPD) has been an accepted category of mental illness for two centuries. The idea that there is a form of mental disorder characterized by callousness and criminality is probably universal in all cultures (Murphy, 1976). Many different terms – “moral insanity”, “psychopathy”, “sociopathy” – have been used in the past to describe its phenomenology. Although some writers (e.g., Blackburn, 1988) criticize the construct as a medicalization of “personal deviance”, there is a broad consensus in psychiatry as to its validity.

Since the definitions of antisocial personality disorder in DSM-IV, or of dissocial personality disorder in ICD-10 are similar, we will use them interchangeably. Both systems use primarily behavioral criteria for diagnosis. The criteria in DSM require that there be a pervasive pattern of disregard and violation of the rights of others, as indicated by at least three of the following: criminal actions, deceitfulness, impulsivity, aggressiveness, recklessness, irresponsibility, and lack of remorse. This pattern must have begun before age 15, and be associated with a prior diagnosis of conduct disorder. (The symptoms of conduct disorder are essentially childhood versions of the phenomena seen in adult ASPD.) However, as shown in studies in the United States (Robins et al., 1991), in the United Kingdom (Zoccolillo et al., 1992), and in Australia (Rey et al., 1995) only one third of cases of conduct disorder go on to antisocial personality disorder.