Psychopathy, dissocial personality disorder, evil: forensic psychiatric aspects.

4 th international epilepsy symposium in Pula – how to start seizure treatment Psychopathy has traditionally been characterised as a disorder primarily of personality (particularly aff ective defi cits) and, to a lesser extent, behaviour. Although often used interchangeably, the diagnostic constructs of psychopathy, antisocial personality disorder , and dissocial personality disorder are distinct. Th ere are deff erences in diagnostic criteria for psy-chopathy, antisocial personality disorder, and dissocial personality. Also, consideration should be given to the assessment, prevalence, and implications of psychopa-thy for violence risk and treatment effi cacy. Patients with personality disorder are generally regarded as irritating, attention-seeking, diffi cult to menage and unlikely to comply with advice or treatment. Suicide attempts and other behaviours by patients previously diagnosed as having personality disorder were comonly regarded as manipulative and under voluntary control rather than the result of illness. Personality disorders are risk and complicating factor for a wide range of mental disorders with great forensic imlications. Forensic psychiatrists have more opportunities than most to contemplate the nature of evil and depravity. Th ey are asked to evaluate individuals accused of committing some of the most horrifi c acts imagin-able. People often assume that serial killers and geno-cidal leaders are " crazy. " If this were true, psychiatrists might have some expertise to off er in the evaluation of such evil. However, such individuals are rarely psychotic. Some perpetrators of the worst atrocities do not have a diagnosable psychiatric disorder. Part of our fascination with these individuals is their appearance of normality. Th e Gordian knot of evil cannot be untied by forensic psychiatry.