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Question

You are asked to evaluate a 23yo male prisoner for underlying psychiatric illness prior to standing trial for his third aggravated assault arrest in 12 months. During your discussion, he discloses that he doesn’t hold jobs down very well because “his bosses are idiots”, does not speak with his family, and prefers to not have friends because “everybody is stupid”. He was expelled from 3 different high schools and finally dropped out at 16. In reviewing his criminal record with his attorney, it is revealed he has been arrested 9 times starting at age 14 for theft, burglary, assault, and intoxication infractions.

1. What condition is high on your differential?
2. What are the DSM-V criteria for this condition?

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Answer

1. This patient is exhibiting the signs and symptoms of Antisocial Personality Disorder
2. To make this diagnosis, the patient must have shown examples of conduct disorder before the age of 15, be olde than 18 years, and have a pervasive pattern of disregard for and violation of the rights of others as evidenced by at least three (3) of the following DSM-V criteria:
   1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
   2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
   3. Impulsivity or failure to plan ahead
   4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
   5. Reckless disregard for safety of self or others.
   6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
   7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.