Rutherford M J, Cacciola J S, Alterman A I
Alcohol and Drug Abuse Institute, University of Washington, Seattle 98105-6696, USA.
Am J Psychiatry. 1999 Jun;156(6):849-56. doi: 10.1176/ajp.156.6.849.
The goal of this study was to examine the lifetime prevalence of antisocial personality disorder according to five diagnostic systems and the prevalence of psychopathy in a study group of women. The relationship between antisocial personality disorder and psychopathy was also examined. Finally, differences in treatment admission variables based on the presence or absence of antisocial personality disorder and/or psychopathy were evaluated.
Antisocial personality disorder was diagnosed in 137 treatment-seeking, cocaine-dependent women according to the Feighner criteria, Research Diagnostic Criteria (RDC), and DSM-III, DSM-III-R, and DSM-IV criteria. Psychopathy was assessed by the Revised Psychopathy Checklist.
Rates of antisocial personality disorder varied from 76% according to the Feighner criteria to 11% for the RDC. Nineteen percent (N = 26) of the women scored in the moderate to high range on the Revised Psychopathy Checklist. All of these women were diagnosed with antisocial personality disorder according to DSM-III and Feighner criteria, but only 15 of the 26 were diagnosed according to DSM-III-R, 12 according to DSM-IV, and six with the RDC. Moderate levels of psychopathy were associated with a history of illegal activity at treatment admission, whereas antisocial personality disorder was not.
There was relatively little diagnostic agreement between classification systems. This study indicates that antisocial personality disorder and psychopathy are not synonymous terms for the same disorder. Findings support a need to redefine antisocial personality disorder diagnostic criteria to make them gender neutral by including behaviors associated specifically with antisociality in women.
本研究的目的是根据五种诊断系统检查反社会型人格障碍的终生患病率以及一组女性研究对象中精神病态的患病率。同时还研究了反社会型人格障碍与精神病态之间的关系。最后，评估了基于是否存在反社会型人格障碍和/或精神病态的治疗入院变量差异。
根据费格纳标准、研究诊断标准（RDC）、DSM-III、DSM-III-R和DSM-IV标准，对137名寻求治疗的可卡因依赖女性进行反社会型人格障碍诊断。通过修订的精神病态检查表评估精神病态。
反社会型人格障碍的患病率根据费格纳标准为76%，而RDC标准为11%。19%（N = 26）的女性在修订的精神病态检查表上得分处于中度至高度范围。所有这些女性根据DSM-III和费格纳标准被诊断为反社会型人格障碍，但26名中只有15名根据DSM-III-R被诊断，12名根据DSM-IV被诊断，6名根据RDC被诊断。中度精神病态水平与治疗入院时的非法活动史相关，而反社会型人格障碍则不然。
分类系统之间的诊断一致性相对较低。本研究表明，反社会型人格障碍和精神病态并非同一障碍的同义词。研究结果支持重新定义反社会型人格障碍诊断标准，通过纳入与女性反社会性具体相关的行为使其具有性别中立性。
