New findings on the diagnosis of antisocial personality disorder

New findings on the diagnosis of antisocial personality disorder

By Liz Lockhart

The diagnosis of antisocial personality disorder has been fraught with controversy and challenge.  There are no laboratory tests which can guide clinicians in their diagnosis of the disorder.

The Diagnostic and Statistical Manual of Mental Disorders (DMS IV) defines the condition as ‘a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood.’  DSM IV is used for the formal diagnostic criteria for every psychiatric disorder and has been the subject of much debate recently as it is due to change when DSM V is published.

The diagnosis process may include a rating scale which measures the traits associated with a personality disorder.  A recent research project has studied the dimensional structure associated with the DSM antisocial personality disorder criteria. 

The study was conducted by Dr. Kenneth Kendler of Virginia Commonwealth University and colleagues.  They examined questionnaire and genetic data from twin adults.  They discovered that the DSM IV criteria do not reflect a single dimension of liability.  It does, however, show that it is influenced by two dimensions of genetic risk reflecting aggressive disregard and dis-inhibition.   

Dr. Kendler said ‘When psychiatrists, as clinicians or researchers, think about our psychiatric disorders, we tend to think of them as one thing, one kind of disorder, a reflection of one underlying dimension of liability.  This is also true of genetics researchers.  We tend to want to identify and then detect ‘the’ risk genes underlying disorder X or Y.’

‘What is most interesting about the results of this paper is that they falsify this inherent and rather deeply held assumption.  Genetic risk factors for antisocial personality disorder are not one thing.  Rather, the disorder, as conceptualised by DSM IV, reflects two distinct genetic dimensions of risk,’ Kendler added.

‘The findings from this study make sense.  The distinction between the two sets of heritable traits contributing to antisocial personality disorder, aggressive disregard and dis-inhibition, highlights the complexity of unravelling the genes contributing to this personality style.  We now have some puzzle pieces, but we have a long way to go to fit these pieces together,’ concluded Dr. John Krystal.  Krystal is the editor of the publication Biological Psychiatry.