Ogloff James R P
Monash University, Thomas Embling Hospital, Fairfield, Victoria, Australia.
Aust N Z J Psychiatry. 2006 Jun-Jul;40(6-7):519-28. doi: 10.1080/j.1440-1614.2006.01834.x.
Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.
传统上，精神病态被视为一种主要涉及人格（尤其是情感缺陷）的障碍，行为方面的影响相对较小。虽然精神病态、反社会人格障碍和社交紊乱型人格障碍的诊断概念常常被互换使用，但它们是有区别的。本文简要回顾了有关精神病态的相关历史和当代文献。比较了精神病态、反社会人格障碍和社交紊乱型人格障碍的诊断标准。探讨了精神病态在暴力风险评估和治疗效果方面的评估、患病率及影响。特别是，《精神疾病诊断与统计手册》第四版修订版（DSM-IV-TR）中反社会人格障碍的标准主要基于行为。国际疾病分类（ICD）中社交紊乱型人格障碍的标准虽然更关注情感缺陷，但也未涵盖精神病态广泛的人格和行为成分。自1980年以来，使用《哈瑞精神病态量表修订版》（PCL-R）对这些障碍进行了大量研究。PCL-R评估人格（人际和情感方面）和行为（生活方式和反社会行为方面）的缺陷。因此，由PCL-R所界定的精神病态的研究和临床意义，不能轻易外推到反社会人格障碍和社交紊乱型人格障碍的诊断上。按照目前的解释，反社会人格障碍的诊断过度认定了许多人（尤其是有犯罪史的人）符合该诊断标准。例如，研究表明，50%至80% 的囚犯符合反社会人格障碍的诊断标准，但通过PCL-R评估，预计只有约15% 的囚犯会被判定为精神病态。因此，从精神病态研究中得出的特征和研究结果可能与反社会或社交紊乱型人格障碍患者无关。
