✍ Scribed by Richard Harrington; Professor Sue Bailey
No coin nor oath required. For personal study only.
Personality disorder may only be diagnosed in adulthood but, in general, the pervasive and enduring patterns of behaviour necessary to such a diagnosis first emerge in childhood or adolescence. Does this offer an opportunity for prevention? There is a strong case for the desirability of preventing so-called antisocial personality disorder (ASPD) (DSM-IV; American Psychiatric Association, 1994) or dissocial personality disorder as the International Classification of Disorders would have it (ICD-10; WHO, 1992). ASPD is associated with much social handicap and, once established, is hard to treat. There is also an association with increased morbidity and mortality, especially through accidents, suicide, substance abuse and murder (Robins and Rutter, 1990). The prevalence in the general population is approximately 2% (Torgersen et al., 2001;Coid, 2003).
When should ASPD be prevented? There are good reasons for intervening as early as possible, because the available evidence suggests that the processes leading to ASPD start early in life (Loeber et al., 2003). Whilst desirable, however, this is not always possible, for several reasons. First, the strongest risk factor for ASPD (in adults) is conduct disorder, yet many cases of conduct disorder do not appear until adolescence and those that do account for a relatively high proportion of cases in adulthood (Moffitt, 1993). Second, prevention programmes that focus on infancy and childhood may be less effective than previously thought. Many small-scale studies have found benefits but effectiveness has been lower in the larger studies (Conduct Problems
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