14 Reid 01-01.qxd

January 2001 55 n this column, I will discuss the diagnosis, assessment, forensic relevance, and treatment of antisocial personality disorder (APD) and its more severe subtype, psychopathy. In earlier work, I have generally equated the two terms. However, it is now more appropriate to separate them, referring to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)1 to define APD and reserving the term “psychopathy” to describe persons who meet more stringent criteria, often a high score on a version of Hare’s Psychopathy Checklist (e.g., on the revised checklist PCL-R2 or the screening version PCL-SV3). This is broad topic. For more information, there are at least two excellent references that readers should consult. Cleckley’s last edition of The Mask of Sanity4 is a brilliant clinical and practical description of psychopathy. Then, for an excellent modern discussion of diagnosis and forensic applications of both APD and psychopathy, read the review article by Cunningham and Reidy.5 Some of the key differences between the DSM-IV criteria for APD and the criteria for psychopathy, as defined by sources such as Hare and Cleckley, are outlined in Table 1. Although DSM-IV criteria for APD are more reliable than those of previous editions of the DSM, their validity rests largely on the fact that the DSM-IV simply creates its own definition. The criteria largely neglect important interpersonal and affective issues, do not allow weighting of symptoms, create a great many combinations which can result in an APD diagnosis, and have been found to lack reliability in several studies.5 DSM-IV’s behavioral focus comes at the expense of understanding personality dynamics, which are widely viewed as the foundation of true psychopathy.