title: A comparison of alternate systems for diagnosing antisocial personality disorder in cocaine abusers.
abstract: We evaluated rates, reliability, internal consistency, factor structure, and clinical and predictive validity of antisocial personality disorder (ASP) across three diagnostic systems which varied in emphasis on a) core sociopathic traits and b) independence of antisocial behaviors from substance use in 399 cocaine abusers. Rates of ASP ranged from 7% (Research Diagnostic Criteria) to 53% (DSM-III-R). The DSM-III-R diagnosis of ASP was more reliable at 1 month and 1 year than the Research Diagnostic Criteria. Items assessing core traits of sociopathy had very low reliability and were poorly correlated with other criteria. Across all systems, cocaine abusers with ASP had earlier onset of drug dependence, more psychosocial dysfunction, and higher rates of other psychiatric disorders. Finally, only the DSM-III-R diagnosis of ASP was associated with treatment retention and short-term prognosis. These findings suggest that current diagnostic systems which require core sociopathic traits and independence of criminal behaviors from substance use may be more unreliable and of weaker prognostic significance than less restrictive systems.
authors.affiliation: Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06519.
authors.forename: K M
authors.initials: KM
authors.lastname: Carroll
authors.forename: S A
authors.initials: SA
authors.lastname: Ball
authors.forename: B J
authors.initials: BJ
authors.lastname: Rounsaville
mesh_terms: D000328:Adult; D000367:Age Factors; D000987:Antisocial Personality Disorder / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D003042:Cocaine; D005163:Factor Analysis, Statistical; D005260:Female; D006801:Humans; D008297:Male; D011379:Prognosis; D011569:Psychiatric Status Rating Scales / Q000592:standards / Q000706:statistics & numerical data*; D011594:Psychometrics; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D019966:Substance-Related Disorders / Q000150:complications* / Q000175:diagnosis / Q000523:psychology; D009626:Terminology as Topic
chemical_list: D003042:Cocaine