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Although criminal activity is not a necessary requirement for the diagnosis, these individuals often encounter legal difficulties due to their disregard for societal standards and the rights of others. Therefore, many of these individuals can be found in prisons. However, it should be noted that criminal activity does not automatically warrant a diagnosis of APD, nor does a diagnosis of APD imply that a person is a criminal. It is hypothesized that many high achievers exhibit APD characteristics.
Research has shown that individuals with APD are indifferent to the threat of physical pain, and show no indications of fear when so threatened; this may explain their apparent disregard for the consequences of their actions, and their lack of empathy for the suffering of others.
The recent, controversial science of sociobiology attempts to explain animal and human behavior and social structures, largely in terms of evolutionarily stable strategies. For example, in one well-known 1995 paper by Linda Mealey, chronic antisocial/criminal behavior is explained as a combination of two such strategies.
The DSM-IV-TR, a widely used manual for diagnosing mental disorders (see also: DSM cautionary statement), defines anti-social personality disorder as a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
The manual lists the following additional necessary criteria:
In contemporary research and clinical practice, APD is most commonly assessed with the Hare Psychopathy Checklist- Revised (PCL-R), which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point scale according to specific criteria through file information and a semi-structured interview. The items are as follows:
Interpersonal dimension
Affective dimension
Behavioral dimension
Score 0 if the trait is absent, 1 if it is possibly or partially present and 2 if it is present. The item scores are summed to yield a total score ranging from 0 to 40 which is then considered to reflect the degree to which they resemble the prototypical psychopath. A score > 30 supports a diagnosis of psychopathy. Interesting, forensic studies of prison populations have reported average scores of around 22 on PCL-R; control "normal" populations show an average score of around 5.
A note of caution: the test must be administered by a trained mental health practitioner under controlled conditions for it to have any validity.
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