Criteria For Antisocial Personality Disorder Research Articles

The Effect of a Case Management Intervention on Drug Treatment Entry Among Treatment-Seeking Injection Drug Users With and Without Comorbid Antisocial Personality Disorder

We examined the effect of a case management intervention on drug treatment entry among injection drug users (IDUs) with and without comorbid antisocial personality disorder (ASPD). Injection drug users attending the Baltimore Needle Exchange Program who sought and were granted referrals to opioid agonist treatment were randomized to receive a strengths-based case management intervention or passive referral. Of 162 IDUs, 22.8% met the DSM-IV criteria for ASPD. Compared to those without ASPD, IDUs with comorbid ASPD who spent 25 or more minutes with their case manager prior to their treatment entry date were 3.51 times more likely to enter treatment than those receiving less than 5 min, adjusting for intervention status, race, and treatment site (95% confidence interval 1.04-11.89). Providing case management services to IDUs with comorbid ASPD may facilitate treatment entry and reduce the negative consequences of drug abuse.

Construct Validity of Adolescent Antisocial Personality Disorder

This study examined the construct validity of antisocial personality disorder (ASPD) diagnosed in adolescence. Boys and girls were grouped by history of DSM-III-R conduct disorder (CD) and ASPD: Controls (n=340) had neither diagnosis; CD Only (n=77) had CD by age 17 but no ASPD through age 20; Adolescent ASPD (n = 64) had ASPD by age 17. The Adolescent ASPD group was then compared to 20 young adult men who met criteria for ASPD (ASPD group). As expected, the Adolescent ASPD group had significantly more depression and substance use disorders, a greater performance>verbal IQ discrepancy, more deviant peers, and poorer academic functioning than the CD Only group and Controls. The Adolescent ASPD and ASPD groups did not differ on most variables. Results support the construct validity of Adolescent ASPD and suggest that such a diagnosis could help identify adolescents at risk for persistent antisocial behavior.

Neurofeedback, affect regulation and attachment: A case study and analysis of anti-social personality.

Abstract This case study examines the effects of neurofeedback (EEG biofeedback) training on affect regulation in a fifty-five year-old man with a history marked by fear, rage, alcoholism, chronic unemployment and multiple failed treatments. He had been diagnosed with ADHD and attachment disorder and met criteria for anti-social personality disorder. The case will demonstrate the effectiveness of neurofeedback in quieting this man's pervasive fear, his baseline affect, while increasing his ability to regulate affect and enhancing his capacity for adult attachment. His progress will be measured with the Symptom Checklist 90 (SCL-90 R). Keywords: Neurofeedback, EEG biofeedback, fear, rage, affect regulation, attachment disorder, anti-social personality disorder, empathy. Introduction I am running on pure This was one of the first statements Lyle made when he came for his initial assessment. He had sought out neurofeedback training after reading about it on the Internet. He stated that he was the end of his rope. He reported that he had tried psychotherapy, and that talking about his past only made him feel worse. He had tried many medications and they hadn't helped him either. He said, somewhat matter-of-factly, that if neurofeedback didn't help him he would end his life. Neurofeedback is biofeedback to the brain based on the operant conditioning of frequencies which the brain fires. The training process begins with an in-depth clinical assessment that includes a standard clinical and family history, as well as a medical history and a physical status report that covers physiological markers such as sleep, blood pressure, and bowel function. This intake is formulated to give the clinician an overview of the patient's arousal as it manifests emotionally, psychologically and physically. It provides a profile that indicates whether the patient is over or under aroused, has an instability of arousal or mixture of arousal symptoms. When the assessment is completed, sensors are attached to the patient's head to record the real time EEG (electroencephalogram) on a computer. The trainee looks on a second screen a video game that corresponds directly to this EEG and plays the game by shifting the amplitude of targeted frequencies in his brain. Brain frequencies relate to states of arousal. As an example, if someone is making a robust amount of 8-11 Hz (alpha waves) in the right hemisphere, they are likely to feel calm. If they are producing appropriate amplitudes of 15-18 Hz (beta) in the left hemisphere, they are likely to feel alert. The patient is rewarded for increasing appropriate frequencies in the appropriate hemisphere, as established with the assessment, while decreasing frequencies that might interfere with optimal functioning. It was clear from his assessment that Lyle was over aroused and having great difficulty regulating his emotions, particularly and rage. Affect regulation is the province of the right hemisphere (RH). More specifically, rage and are generated (primarily) by the amygdala in the right hemisphere. The right hemisphere is the non-verbal side of the brain,--in the vast majority of people the language centers are in the left hemisphere--and the amygdala is deep in the sub-cortical temporal lobe. This brain topography may provide a clue to why Lyle felt at the end of his rope, particularly with talk therapies. His history and his own report strongly suggested that his fight-flight-freeze RH amygdala was hyper reactive, and that it could not be reached with left hemisphere language. The outcome of this case suggests that neurofeedback training is an effective approach to disorders that are driven by fear. The author agrees with LeDoux (1996), that fear is a core emotion in psychopathology. The results of this case suggest the potential of neurofeedback in all based disorders, across DSM IV categories. Neurofeedback has been clinically demonstrated to be effective with many severe disorders and the mechanism in common may in fact be that neurofeedback enhances affect regulation, particularly the regulation of fear. …

Effects of comorbid psychopathy on criminal offending and emotion processing in male offenders with antisocial personality disorder.

Antisocial personality disorder (ASPD) and psychopathy are two syndromes with substantial construct validity. To clarify relations between these syndromes, the authors evaluated 3 possibilities: (a) that ASPD with psychopathy and ASPD without psychopathy reflect a common underlying pathophysiology; (b) that ASPD with psychopathy and ASPD without psychopathy identify 2 distinct syndromes, similar in some respects; and (c) that most correlates of ASPD reflect its comorbidity with psychopathy. Participants were 472 incarcerated European American men who met Diagnostic and Statistical Manual (4th ed., American Psychiatric Association, 1994) criteria for ASPD and Psychopathy Checklist criteria for psychopathy, who met the criteria for ASPD but not for psychopathy, or who did not meet diagnostic criteria for either ASPD or psychopathy (controls). Both individuals with ASPD only and those with ASPD and psychopathy were characterized by more criminal activity than were controls. In addition, ASPD with psychopathy was associated with more severe criminal behavior and weaker emotion facilitation than ASPD alone. Group differences in the association between emotion dysfunction and criminal behavior suggest tentatively that ASPD with and ASPD without prominent psychopathic features may be distinct syndromes.

Use of Outpatient Mental Health Services by Depressed and Anxious Children as They Grow Up

Use of Outpatient Mental Health Services by Depressed and Anxious Children as They Grow Up

Psychopathy/Antisocial Personality Disorder Conundrum

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.

Psychopathy/antisocial personality disorder conundrum

Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly affective deficits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder, and dissocial personality disorder are distinct. In this article, the relevant historical and contemporary literature concerning psychopathy is briefly reviewed. The diagnostic criteria for psychopathy, antisocial personality disorder, and dissocial personality disorder are compared. Consideration is given to the assessment, prevalence, and implications of psychopathy for violence risk and treatment efficacy. The DSM-IV-TR criteria for antisocial personality disorder, in particular, are largely behaviourally based. The ICD criteria for dissocial personality disorder, while paying more attention to affective deficits, also do not represent the broad personality and behavioural components of psychopathy. Since 1980, a great deal of research on these disorders has been conducted, using the Hare Psychopathy Checklist, Revised (PCL-R). The PCL-R assesses both personality (interpersonal and affective) and behavioural (lifestyle and antisocial) deficits. As such, the research and clinical implications of psychopathy, as operationalised by the PCL-R, cannot be readily extrapolated to the diagnoses of antisocial personality disorder and dissocial personality disorder. As currently construed, the diagnosis of antisocial personality disorder grossly over-identifies people, particularly those with offence histories, as meeting the criteria for the diagnosis. For example, research shows that between 50% and 80% of prisoners meet the criteria for a diagnosis of antisocial personality disorder, yet only approximately 15% of prisoners would be expected to be psychopathic, as assessed by the PCL-R. As such, the characteristics and research findings drawn from the psychopathy research may not be relevant for those with antisocial or dissocial personality disorder.

Association of Antisocial Personality Disorder with Psychiatric Morbidity Among Patients with Substance Use Disorder

Objectives: The aims were to determine among patients with Substance Use Disorder (SUD) whether patients with Antisocial Personality Disorder (ASPD) manifest less, the same, or more of the following: (1) psychiatric symptoms, (2) family history of psychiatric disorder, (3) psychiatric disorders and morbidity, and (4) psychiatric treatment, as compared to patients without ASPD. Design & Definition: Scheduled interview using DSM-III-R criteria for ASPD, with blinded interviewers making the ASPD classification vs. other assessments. Settings: Alcohol-drug treatment programs located in two university medical centers. Subjects: Six hundred and six voluntary patients aged 18 and older meeting diagnostic criteria for SUD. Results: SUD patients with ASPD reported more family history of non-SUD psychiatric diagnoses and endorsed more hostility symptoms. Demographic characteristics, psychiatric disorder, and past psychiatric treatment did not differ in association with ASPD.

Adult Antisocial Behaviour without Conduct Disorder: Demographic Characteristics and Risk for Cooccurring Psychopathology

Several studies note people who demonstrate adult antisocial behaviour (AAB) in the absence of conduct disorder (CD) before age 15 years. Perhaps because they do not meet diagnostic criteria for antisocial personality disorder (ASPD), this group of people exhibiting late-onset AAB has been underrecognized and understudied. Thus the goal of this study was to examine the demographic features and patterns of cooccurring psychopathology of people exhibiting late-onset antisocial behaviour (AB; AAB but not CD), compared with people suffering from ASPD (CD and AAB), people suffering from CD but not AAB, and members of a nonantisocial control group. This study used the population-based sample of the National Comorbidity Survey (NCS). The demographic features examined were sex, percentage living in poverty, annual income, and years of formal education. The possibly cooccurring diagnoses examined were alcohol abuse and dependence, drug abuse and dependence, major depressive disorder, dysthymia, generalized anxiety disorder, social phobia, simple phobia, panic disorder, agoraphobia, and posttraumatic stress disorder. About 2.3% of participants exhibited AAB but not CD. These individuals had patterns of demographic characteristics and cooccurring psychiatric disorders quite similar to those of people diagnosed with full ASPD. Individuals who demonstrate this pattern of late-onset AB are at levels of risk comparable to those of individuals suffering from ASPD; therefore, they are equally in need of research and clinical attention.

The characteristics of heroin users entering treatment: findings from the Australian Treatment Outcome Study (ATOS)

The current study aimed to describe the characteristics (demographics, drug use, mental and physical health) of entrants to treatment for heroin dependence in three treatment modalities; and to compare these characteristics with heroin users not in or seeking treatment. Participants were 825 current heroin users recruited from Sydney, Adelaide and Melbourne: 277 entering methadone/buprenorphine maintenance treatment (MT), 288 entering detoxification (DTX), 180 entering drug-free residential rehabilitation (RR) and 80 not in treatment (NT). Treatment entrants were generally long-term heroin users with previous treatment experience. The majority of the sample (55%) were criminally active in the month preceding interview. Injection-related health problems (74%) and a history of heroin overdose (58%) were commonly reported. There were high degrees of psychiatric co-morbidity, with 49% reporting severe psychological distress, 28% having current major depression, 37% having attempted suicide and 42% having a lifetime history of post-traumatic stress disorder. Personality disorders were also prevalent, with 72% meeting criteria for antisocial personality disorder and 47% screening positive for borderline personality disorder. Striking similarities were noted between the non-treatment and treatment groups in length of heroin use career, drug use and treatment histories.

The Natural History of Conduct Disorder Symptoms in Female Inmates: On the Predictive Utility of the Syndrome in Severely Antisocial Women.

This study examined the utility of the conduct disorder (CD) diagnosis in predicting antisocial personality disorder (ASPD) among incarcerated women. It was surprising that most female inmates did not meet standard criteria for ASPD. This was due to a low occurrence of CD symptoms reported before age 15. Cluster analysis of CD symptoms revealed 4 types that characterized women with criminal histories. One type, which was characterized by a history of CD with interpersonal and physical aggression, was more predictive of ASPD than the traditional CD diagnosis. Yet another type, characterized by destruction of property, also represented an improvement over the traditional CD diagnosis. Overall, the results suggest that the types of CD behaviors, rather than their number, may be a more important indicator for identifying women at risk for future antisocial personality pathology.

Antisocial personality disorder is associated with increased severity of gambling, medical, drug and psychiatric problems among treatment‐seeking pathological gamblers

To evaluate systematically whether pathological gamblers with antisocial personality disorder (ASPD) experience increased severity of gambling, medical, psychiatric, substance use and psychosocial problems compared to pathological gamblers without ASPD. PARTICIPANTS, DESIGN AND MEASUREMENTS: Pathological gamblers (n = 237) entering an out-patient treatment study for pathological gambling completed the ASPD section of the Structured Clinical Interview for Diagnostic and Statistical Manual version IV (DSM-IV) Personality Disorders, California Psychological Inventory-Socialization Scale, Addiction Severity Index (ASI), Brief Symptom Inventory (BSI) and gambling questionnaires. Pathological gambling research clinic. Thirty-nine (16.5%) pathological gamblers met DSM-IV diagnostic criteria for ASPD. Compared to pathological gamblers without ASPD, pathological gamblers with ASPD were younger, more likely to be male and divorced/separated, and had fewer years of education. They also began gambling earlier in life, reported increased severity of gambling, medical and drug problems, and scored higher on the paranoid ideation, somatization and phobic anxiety subscales of the BSI. Further, logistic regression identified male gender, history of illicit drug use and severity of gambling and medical problems as independent predictors of ASPD. These results underscore the importance of assessing a wide range of behaviors and personality indices, including ASPD, among treatment-seeking pathological gamblers.

The Role of Psychopathy and Sexuality in a Female Serial Killer

The case of Aileen Wuornos, executed in Florida for the serial killing of seven men, is studied to determine her degree of psychopathy and the presence or absence of sexuality or sexual sadism as a motivation or gratification for her crimes. The authors, one of whom evaluated the subject shortly before her death, determined that she evidenced a psychopathic personality (PCL-R score 32). She also met DSM-IV-TR criteria for Antisocial Personality Disorder and Borderline Personality Disorder. While her killings ostensibly were carried out during routine acts of prostitution, there was ambiguous evidence that her crimes were sexually motivated or gratifying. Her articulated motivation was robbery and elimination of the witness/victim. After carefully considering all available data, the authors concluded there was no convincing evidence of sexual sadism in either her personal history or her method of committing serial murder, and it remains unclear whether sexual gratification was to some degree a motivating factor in her commission of these offenses. The confluence of early childhood attachment disruptions, severe psychopathy, other personality disorder pathology, and a traumagenic abuse history likely contributed to her having serially murdered seven victims.

Discriminant efficiency of antisocial and borderline personality disorder criteria in Hispanic men with substance use disorders

The authors examined the discriminant efficiency of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition ( DSM-IV) criteria for borderline personality disorder (BPD) and antisocial personality disorder (APD). Subjects were 74 men admitted to an outpatient substance abuse program for monolingual Hispanic adults. All were reliably assessed with the Spanish-language version of the Diagnostic Interview for DSM-IV Personality Disorders. Conditional probabilities were calculated to determine the diagnostic efficiency and discriminant efficiency of BPD and APD symptoms. Twenty-five (34%) subjects met diagnostic criteria for BPD, and 16 (22%) met criteria for APD. The diagnostic co-occurrence of these disorders was statistically significant. Whereas the diagnostic efficiency of the BPD criterion set was comparable to that reported in other clinical studies, these criteria were not significantly more efficient in diagnosing BPD than APD. By contrast, the APD criteria were more efficient in diagnosing APD than BPD; this was true for both the “adult” and the “conduct disorder” APD criterion subsets. In male Hispanic outpatients with substance use disorders, BPD and APD show significant diagnostic overlap. The APD criteria are useful in discriminating these 2 disorders, whereas the BPD criteria are not. These findings have implications for the discriminant validity of the BPD and APD criteria and support the value of the conduct disorder criteria in predicting APD in adulthood.

Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom (ADHS) und Alkoholabhängigkeit: Eine Risikokonstellation

The estimated prevalence for attention-deficit hyperactivity disorder (ADHD) in adulthood is 2 - 6 %. Patients with a substance use disorder met the criteria for ADHD between 30 and 50 %. ADHD and conduct disorders are discussed to increase risk of developing substance abuse and increase severity of disorder. We compared epidemiological and clinical characteristics and comorbidity in subgroups of 314 adult alcoholics of German descent with or without persistent symptoms of attention-deficit hyperactivity disorder (ADHD). Aim of the study was to identify specific pathophysiological mechanisms that could contribute to vulnerability, severity or complication of alcohol dependence. 21.3 % of the alcoholics fulfilled DSM-IV-criteria of ADHD with ongoing symptoms in adulthood and had a Wender-Utah-Rating-Scale score > 90. Subgroup of alcoholics with ADHD were significantly younger at age of onset of alcoholism (24 years versus 30 years), had a significantly higher daily alcohol intake (253 g versus 196 g EtOH), had significantly more social stress, lifetime experiences in court proceedings against them (11 versus 2 %) and suicidal ideation (25 versus 11 %). In the subgroup of alcoholics with ADHD 51 % fulfilled criteria of antisocial personality disorder. The early onset of alcoholism was most pronounced in this subgroup. In our sample, persistence of ADHD symptoms from childhood into adulthood and antisocial personality disorder contributes to vulnerability and morbidity of alcohol dependence with early onset and greater severity of disorder.

Family transmission and heritability of externalizing disorders: a twin-family study.

Antisocial behavior and substance dependence disorders exact a heavy financial and human cost on society. A better understanding of the mechanisms of familial transmission for these "externalizing" disorders is necessary to better understand their etiology and to help develop intervention strategies. To determine the extent to which the family transmission of externalizing disorders is due to a general vs a disorder-specific vulnerability and, owing to the genetically informative nature of our data, to estimate the heritable vs environmental nature of these transmission effects. We used structural equation modeling to simultaneously estimate the general and specific transmission effects of 4 externalizing disorders: conduct disorder, adult antisocial behavior, alcohol dependence, and drug dependence. Participants were recruited from the community and were interviewed in a university laboratory. The sample consisted of 542 families participating in the Minnesota Twin Family Study. All families included 17-year-old twins and their biological mother and father. Symptom counts of conduct disorder, the adult criteria for antisocial personality disorder, alcohol dependence, and drug dependence. Transmission of a general vulnerability to all the externalizing disorders accounted for most familial resemblance. This general vulnerability was highly heritable (h2 = 0.80). Disorder-specific vulnerabilities were also detected for conduct disorder, alcohol dependence, and drug dependence. The mechanism underlying the familial transmission of externalizing disorders is primarily a highly heritable general vulnerability. This general vulnerability or common risk factor should be the focus of research regarding the etiology and treatment of externalizing disorders.

Effect of patient sex, clinician sex, and sex role on the diagnosis of Antisocial Personality Disorder: Models of underpathologizing and overpathologizing biases

This study examined the influence of patient sex and clinician sex and sex role for a case, meeting minimum diagnostic criteria for Antisocial Personality Disorder, in which patient sex was varied. The purpose was to provide an in-depth evaluation of the process by which patient sex and characteristics of clinicians may contribute to bias in personality disorder diagnoses. Psychologists (N = 167) read two cases, including the target case, and provided symptom ratings and diagnoses. A sex-unspecified condition served as a baseline to assess for over- and underpathologizing bias, and diagnoses based on the symptom ratings were compared to assigned diagnoses. Clinician sex role was assessed using the Bem Sex Role Inventory-Short Form. Results revealed that bias occurred when the patient's sex (female) was inconsistent with the gender weighting of the symptoms in the case (masculine), but the direction of the bias was consistent with sex roles (underdiagnosis of sex-role-inconsistent diagnoses, overdiagnosis of sex-role-consistent diagnoses). Path models of over- and underdiagnostic bias were developed using structural equation modeling. Patient sex had a direct effect on diagnostic ratings whereas clinician sex role had an indirect effect through symptom ratings.

Cortisol Levels and Conduct Disorder in Adolescent Mothers

To examine the association between cortisol levels and conduct disorder (CD) in adolescent mothers. Past research has shown that low levels of cortisol were associated with CD, particularly with its aggressive symptoms. The authors tested the hypothesis that adolescent mothers with CD would show lower levels of salivary cortisol compared to mothers without CD at 4 and 9 months postpartum. Midmorning salivary cortisol levels were measured in 228 adolescent mothers (age at delivery 16.9 +/- 1 years [mean +/- SD]) during a laboratory visit at 4 and 9 months postpartum. CD was diagnosed during pregnancy according to the CD subsection on the criteria for antisocial personality disorder (DSM-III-R). Results did not confirm the hypothesis. Lower cortisol levels were not significantly associated with a CD diagnosis, the number of CD symptoms, or aggressive symptoms. Despite valid measures and strong statistical power, this study failed to find an association between cortisol levels and CD in a sample of adolescent mothers. The results may have been influenced by the fact that participants were 4 and 9 months postpartum and by comparisons of mothers with CD to mothers living in stressful circumstances.

Wendy Wall: In the Wake of Childhood Trauma

The sequelae of childhood abuse can be ongoing, particularly when a child experiences abuse over an extended period and the perpetrator is a close family member. The Diagnostic and Statistical Manual (fourth edition, text revision) diagnoses frequently associated with adult survivors of such abuse are posttraumatic stress disorder and borderline personality disorder. The following extended case study explores the appropriateness of these diagnoses for a survivor of protracted physical abuse who met criteria for antisocial personality disorder as well as for posttraumatic stress disorder. The diagnostic category of complex posttraumatic stress disorder is explored for this woman. [Brief Treatment and Crisis Intervention 4:377–387 (2004)]

Neuroendocrine and behavioural responses to opioid receptor-antagonist during heroin detoxification: relationship with personality traits

The present study investigated clinical, cardiovascular and neuroendocrine consequences of rapid opioid detoxification (ROD) in heroin-dependent individuals, affected, or not, by comorbid antisocial personality disorder (ASPD). Thirty-two patients underwent ROD and subsequent treatment with daily naltrexone: 3 days detoxification procedures were performed utilizing clonidine, baclofen, oxazepam and ketoprofene, without anaesthesia. Withdrawal symptoms, mood changes, cardiovascular indexes (heart rate, blood pressure), norepinephrine (NE), epinephrine (EPI), adrenocorticotropic hormone (ACTH) and cortisol (CORT) were evaluated during naloxone–naltrexone administration on the second day of detoxification treatment. The patients were divided into two groups following DSM-IV criteria for ASPD. Group A comprised 14 ASPD patients and group B comprised 18 patients without ASPD. Slight and transient withdrawal symptoms and mood changes were demonstrated on the second day in the whole sample of patients, in association with a significant, but moderate, elevation of heart rate, blood pressure, NE (two-fold), EPI (five-fold), ACTH (two-fold) and CORT (two-fold) plasma levels, in response to opioid receptor-antagonist administration. When evaluated separately in ASPD (group A) and non-ASPD patients (group B), significantly higher withdrawal symptoms and mood changes, heart rate, blood pressure, NE, ACTH and cortisol levels were observed in ASPD subjects. By contrast, no differences were found in EPI responses to naloxone–naltrexone administration between group A and B patients. The significant differences demonstrated in clinical and neuroendocrine responses to opioid receptor-antagonist administration, in relation to personality traits, could be due to reduced alpha-adrenergic receptor sensitivity, which was previously reported in ASPD, with a possible impairment of clonidine action. Our study suggests that a detailed diagnostic assessment before detoxification procedure may help to predict treatment outcome.