"Therapeutic windows" in personality disorders

Abstract

Sixty-six years ago, psychiatrist H.M. Cleckley published the most influential description of psychopathy, which stood at the basis of “Psychopathy Checklist”, considered for a long time the gold standard in the assessment of psychopathies. In DSM-5, psychopathy is no longer included as a distinctive diagnostic, being replaced by the antisocial personality disorder with psychopatic mood traits. Because in the every day practice is not so easy to differentiate between antisocial behaviours and psychopatic mood traits, it’s no wander that the term “psychopathy” still exists. But the too wide coverage of this term can lay at the basis of some significant disadvantages. The concept of psychopathy is not clearly perceived by many specialists from areas that have wide interactions with antisocial behaviours, for example those dealing with prison rehabilitation. This article underlines that psychopathy is far from being a unitary concept, clearly delimited, a careful assessment of the individual cases being necessary in order to benefit from the “therapeutic windows” that can make wrong right. The “traditional” perception that psychopathy is something inborn or that cannot be changed is increasingly challenged. But, unfortunately, as Wong and Olver stated in 2015, “the therapeutic nihilism regarding the treatment of psychopathy is widespread and is mainly based on outdated and poorely designed studies”. There is already a considerable variety of solid studies which offer evidences on the progresses obtained in the rehabilitation of criminal psychopaths and in the reduction of the recidivism risk for antisocial behaviours. Today we invest many resources to diminsh the prison overcrowding, but there are no psychotherapeutic programs aimed at trying to reduce the recidivism, which is the reason for 6 out of 10 imprisonments. Cognitive restructuring programs and of the psychopats’ behaviour proved that is possible to modify their perceptive insensitivity to other people’s emotions, and reduced the violent recidivism, thus leading to significant social benefits. Maybe it’s time to take more into account the existence of the “therapetic windows” in psychopathies.