DSM‐III diagnosis in criminal psychopaths: a way forward

Abstract

Research diagnostic instruments were administered to 243 subjects, consisting of three subsamples. These included men detained under the English legal category of psychopathic disorder from one special hospital, female ‘psychopaths’ from three special hospitals, and male prisoners from three special units developed in prisons for the containment and control of highly dangerous and disruptive inmates. Using the DSM‐III classification, subjects were found to have multiple Axis‐II personality disorder categories and multiple Axis‐I clinical syndromes over their lifetime. Borderline and antisocial personality disorder were the most prevalent diagnoses, often in combination. The remaining subjects comprised subgroups with schizoid personality disorder and ‘pseudopsychopaths’, who were later recognised as suffering from slowly developing chronic schizophrenia or organic psychoses. Problems of treatability of these subjects relate to the ‘severity’ of their personality disorder. This in turn is reflected in the multiple Axis‐II diagnoses which are required to encompass the sheer range of their psychopathology. Multiple recurring Axis‐I conditions, which are amenable to conventional psychiatric treatment, indicate a need for specialist medical services for these patients, irrespective of arguments over the treatability of their Axis‐II conditions.

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