Holzer Katherine J, Vaughn Michael G
1 School of Social Work, College for Public Health and Social Justice, Saint Louis University, St Louis, MO, USA.
J Geriatr Psychiatry Neurol. 2017 Nov;30(6):291-302. doi: 10.1177/0891988717732155. Epub 2017 Sep 27.
Antisocial personality disorder (ASPD) has enormous negative impacts on the affected individuals, their loved ones, and society. This burden is intensified by the social and functional changes related to age. The lower prevalence of ASPD in older adults compared to younger adults is well-documented. This discrepancy, often attributed solely to antisocial "burnout," contributes to the lack of attention given to this disorder in older adults and may signify difficulty measuring ASPD in this population. These measurement issues likely stem from problems with the validity of the diagnostic criteria for older adults which may not effectively capture changes that occur with age. This review focuses on the current literature surrounding the validity of ASPD criteria with older adults and relevant concepts, including the connection between criminality and ASPD. Issues with screening tools and the measurement of ASPD caused by problems with the criteria are also discussed. Finally, recommendations for improvement, including use of dimensional models of personality disorders, a potential geriatric subclassification of criteria, and modification of the existing criteria are presented with clinical implications and suggestions for future research.
反社会人格障碍（ASPD）对受影响的个体、他们的亲人以及社会都有巨大的负面影响。与年龄相关的社会和功能变化加剧了这种负担。与年轻人相比，老年人中ASPD的患病率较低，这一点有充分的文献记载。这种差异通常仅归因于反社会“倦怠”，导致对老年人中这种障碍缺乏关注，并且可能意味着在这一人群中测量ASPD存在困难。这些测量问题可能源于针对老年人的诊断标准的有效性问题，这些标准可能无法有效捕捉随年龄发生的变化。本综述聚焦于围绕老年人ASPD标准有效性的当前文献以及相关概念，包括犯罪与ASPD之间的联系。还讨论了由标准问题导致的筛查工具和ASPD测量方面的问题。最后，提出了改进建议，包括使用人格障碍的维度模型、标准的潜在老年亚分类以及对现有标准的修改，并阐述了临床意义和对未来研究的建议。
