McGonigal Patrick, Kerr Sophie, Morgan Theresa, Dalrymple Kristy, Chelminski Iwona, Zimmerman Mark
University of Nebraska-Lincoln, Room 237, Burnett Hall. E-MAIL:
Ann Clin Psychiatry. 2019 Feb;31(1):36-44.
Antisocial personality disorder (ASPD) is the only DSM personality disorder that requires a diagnosis of conduct disorder (CD) during childhood. Previous research comparing adults diagnosed with ASPD with adults who meet all ASPD criteria except for a history of CD (referred to in this study as adult antisocial syndrome [AAS]) have reported mixed results. This study sought to clarify the differences among adults with ASPD, adults with AAS, and a large psychiatric outpatient control group.
A series of semi-structured interviews were conducted with 2,691 psychiatric outpatients. We compared groups on demographic variables, psychiatric comorbidity, symptom presentation, parental history, and psychosocial morbidity.
Significant differences were found among ASPD, AAS, and controls in regard to demographic variables, comorbidity, symptom presentation, and parental history. The ASPD and AAS groups were similarly impaired with respect to global functioning, occupational and social functioning, and suicidality.
Findings suggest that by including a history of CD in ASPD criteria, our diagnostic system excludes an important group of later-onset patients who also require attention and resources. Implications, limitations, and future directions are discussed.
反社会型人格障碍（ASPD）是《精神疾病诊断与统计手册》（DSM）中唯一一种在童年期需要诊断为品行障碍（CD）的人格障碍。以往的研究将被诊断为ASPD的成年人与除品行障碍病史外符合所有ASPD标准的成年人（本研究中称为成人反社会综合征[AAS]）进行比较，结果不一。本研究旨在阐明ASPD成年人、AAS成年人与大型精神科门诊对照组之间的差异。
对2691名精神科门诊患者进行了一系列半结构化访谈。我们比较了各组在人口统计学变量、精神科共病、症状表现、父母病史和社会心理发病率方面的情况。
在人口统计学变量、共病、症状表现和父母病史方面，ASPD组、AAS组和对照组之间存在显著差异。在整体功能、职业和社会功能以及自杀倾向方面，ASPD组和AAS组的受损程度相似。
研究结果表明，通过在ASPD标准中纳入品行障碍病史，我们的诊断系统排除了一组同样需要关注和资源的重要迟发性患者。文中讨论了研究的意义、局限性和未来方向。
