Abstract
In official Norwegian government reports’ prison statistics, it is claimed that the prevalence of Dissocial Personality Disorder (DPD) or Antisocial Personality Disorder (APD) among inmates in preventive detention is approximately 50%. Furthermore, previous findings have described a practice in which forensic examiners use the DSM SCID axis II for APD to confirm an ICD 10 diagnosis of DPD. Clinical investigation supported by the use of SCID Axis II for quality assurance was performed on almost half the population of inmates (46.4%) in preventive detention at a high security prison. The inmates had all committed severe violent acts including murder. All the information obtained by applying the DSM IV-TR criteria was tested against the ICD-10 Research Criteria (ICD-10-RC) for Dissocial Personality Disorder (ICD-10, DPD). It was found that all inmates met the ICD-10-RC for (DPD) and the DSM-IV-TR definition for Adult Antisocial Behavior (AAB). On the other hand, none met the DSM-IV-TR criteria for (APD). The SCID Axis II failed to identify inmates with APD because the DSM-IV-TR C-criteria, referring to symptoms of childhood Conduct Disorder (CD), were not met. These findings raise important questions since the choice of diagnostic system may influence whether a person’s clinically described antisocial behaviour should be classified as a personality disorder or not. For the inmates, a diagnosis of APD or DPD may compromise their legal rights and affect decisions on prolongation of the preventive detention. Studies have shown that combining the DSM and the ICD diagnostic systems may have consequences for the reliability of the diagnosis.
Highlights
One of the problems in retrospective research in Norwegian forensic psychiatry is that few forensic examiners use psychometric tools for confirmation and quality assurance of their diagnosis—only 17% in a recent investigation [1]
A further problem is that the Diagnostic and Statistical Manual of Mental Disorders—4th Edition (DSM-IV), Structural Interview for Diagnosis Axis II (SCID II) [2] is used for the confirmation of International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) [3] diagnoses of personality disorders [1]
All inmates, had a history of violent crime, aggressive behavior, irresponsibility and a tendency to rationalize as adults, and met the ICD-10-RC for ICD-10, Dissocial Personality Disorder (DPD)
Summary
One of the problems in retrospective research in Norwegian forensic psychiatry is that few forensic examiners use psychometric tools for confirmation and quality assurance of their diagnosis—only 17% in a recent investigation [1]. A further problem is that the Diagnostic and Statistical Manual of Mental Disorders—4th Edition (DSM-IV), Structural Interview for Diagnosis Axis II (SCID II) [2] is used for the confirmation of International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) [3] diagnoses of personality disorders [1]. One study [4] found that when comparing the DSM-III-R to the ICD-10, 60% of the variance in personality disorder diagnosis was not attributable to the patients themselves. Starcevic et al [6] concluded that the sources of disagreement between the latest versions of the 2 systems could be traced to differences in the conceptualization of some of the personality disorders, differences between criteria, and the diagnostic threshold. Other authors have criticized the use of DSMand ICD-based clinical interviews for the assessment of personality disorders [7,8,9]
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