Abstract
BackgroundThis review analyses and summarises the recent advances in understanding the neurobiology of violence and empathy, taxonomical issues on defining personality disorders characterised by disregard for social norms, evidence for efficacy of different treatment modalities and ethical implications in defining 'at-risk' individuals for preventive interventions.MethodsPubMed was searched with the keywords 'antisocial personality disorder', 'dissocial personality disorder' and 'psychopathy'. The search was limited to articles published in English over the last 10 years (1999 to 2009)ResultsBoth diagnostic manuals used in modern psychiatry, the Diagnostic and Statistical Manual published by the American Psychiatric Association and the International Classification of Diseases published by the World Health Organization, identify a personality disorder sharing similar traits. It is termed antisocial personality disorder in the diagnostic and statistical manual and dissocial personality disorder in the International Classification of Diseases. However, some authors query the ability of the existing manuals to identify a special category termed 'psychopathy', which in their opinion deserves special attention. On treatment-related issues, many psychological and behavioural therapies have shown success rates ranging from 25% to 62% in different cohorts. Multisystemic therapy and cognitive behaviour therapy have been proven efficacious in many trials. There is no substantial evidence for the efficacy of pharmacological therapy. Currently, the emphasis is on early identification and prevention of antisocial behaviour despite the ethical implications of defining at-risk children.ConclusionsFurther research is needed in the areas of neuroendocrinological associations of violent behaviour, taxonomic existence of psychopathy and efficacy of treatment modalities.
Highlights
The concept of a personality disorder with callousness and unemotionality plus disregard for social norms is well established in psychiatry [1]
Concepts of disorders or 'insanities' of each component would later develop along the lines of schizophrenia, manic depressive illness and antisocial behaviour [3]. Despite these theories being challenged with time, they helped to broaden the scope of classification of psychiatric illnesses to include the precursors of what is known as 'personality disorders' today. Both diagnostic manuals used in modern psychiatry, the Diagnostic and Statistical Manual, currently on it's 4th edition (DSM-IV) published by the American Psychiatric Association (APA) [4] and the International Classification of Diseases, on it's 10th edition (ICD-10) published by the World Health Organization (WHO) [5], identify a personality disorder sharing similar traits
The DSM-IV classifies it as antisocial personality disorder (Axis II, Cluster B) while the corresponding diagnosis in ICD-10 is dissocial personality disorder
Summary
The concept of a personality disorder with callousness and unemotionality plus disregard for social norms is well established in psychiatry [1]. The understanding of personality and its disorders were quite different in the early 19th century from their current context (which refers to a collection of traits that is expected to have a biological basis) Both diagnostic manuals used in modern psychiatry, the Diagnostic and Statistical Manual, currently on it's 4th edition (DSM-IV) published by the American Psychiatric Association (APA) [4] and the International Classification of Diseases, on it's 10th edition (ICD-10) published by the World Health Organization (WHO) [5], identify a personality disorder sharing similar traits (with certain disagreements). Some authors argue that these criteria do not go far enough to define a third entity termed 'psychopathy' [6] These blurred lines of classification, disagreement between mental health professionals, poor understanding of biological and non-biological factors (environmental) precipitating and maintaining such behaviour, add to the confusion. This review analyses and summarises the recent advances in understanding the neurobiology of violence and empathy, taxonomical issues on defining personality disorders characterised by disregard for social norms, evidence for efficacy of different treatment modalities and ethical implications in defining 'at-risk' individuals for preventive interventions
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