DSM-5 antisocial personality disorder: predictive validity in a prison sample

Symptoms of antisocial personality disorder (ASPD), particularly remorselessness, are frequently introduced in legal settings as a risk factor for future violence in prison, despite a paucity of research on the predictive validity of this disorder. We examined whether an ASPD diagnosis or symptom-criteria counts could prospectively predict any form of institutional misconduct, as well as aggressive and violent infractions among newly admitted prisoners. Adult male (n = 298) and female (n = 55) offenders were recruited from 4 prison systems across the United States. At the time of study enrollment, diagnostic information was collected using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV; APA, 1994) Axis II Personality Disorders (SCID-II; First, Gibbon, Spitzer, Williams, & Benjamin, 1997) supplemented by a detailed review of official records. Disciplinary records were obtained from inmates' respective prisons covering a 1-year period following study enrollment and misconduct was categorized hierarchically as any (general), aggressive (verbal/physical), or violent (physical). Dichotomous ASPD diagnoses and adult symptom-criteria counts did not significantly predict institutional misconduct across our 3 outcome variables, with effect sizes being close to 0 in magnitude. The symptom of remorselessness in particular showed no relation to future misconduct in prison. Childhood symptom counts of conduct disorder demonstrated modest predictive utility. Our results offer essentially no support for the claim that ASPD diagnoses can predict institutional misconduct in prison, regardless of the number of adult symptoms present. In forensic contexts, testimony that an ASPD diagnosis identifies defendants who will pose a serious threat while incarcerated in prison presently lacks any substantial scientific foundation.