The long-term outcome of antisocial personality disorder compared with depression, schizophrenia, and surgical conditions.

The objective of this study was to assess the long-term outcome of antisocial personality disorder (APD) compared with depression, schizophrenia, and surgical conditions. Seventy-one men meeting DSM-III criteria for APD and hospitalized at the University of Iowa Department of Psychiatry between 1945 and 1970 were followed up between 1986 and 1990, an average of 29 years after discharge. Comparison groups, collected during the Iowa 500 study, included depressed subjects (n = 225), schizophrenic subjects (n = 200), and surgical control subjects (n = 160). Patients were rated as having good, fair, or poor adjustment for marital, residential, occupational, and psychiatric status. The Global Assessment Scale was also used to rate subjects. At follow-up, antisocial subjects were doing significantly better than schizophrenic subjects for marital and residential, but not occupational or psychiatric, adjustment. Both depressed subjects and surgical controls had significantly better adjustment than antisocial subjects in all areas except residential status. Although these data apply to antisocial men who had been psychiatrically hospitalized, we conclude that APD causes significant long-term impairment in important domains of life.