Neither mad nor bad? The classification of antisocial personality disorder among formerly incarcerated adults

Using the National Comorbidity Survey, this study explores the presence and symptoms of antisocial personality disorder (ASPD) among people with varying degrees of contact with the criminal justice system. The study finds an elevated prevalence of ASPD among formerly incarcerated persons, but also that ASPD is not a simple linear function of actual or potential contact with the criminal justice system. For example, among people who have been arrested the prevalence of ASPD is not much greater than among those who committed a crime but were never arrested. Furthermore, the difference in prevalence between those who were incarcerated and those who were arrested but not incarcerated is small. Moreover, the prevalence is highly sensitive to the elimination of one particular symptom among seven: failure to conform to social norms, as indicated by having been arrested. Eliminating this single symptom reduces the prevalence of ASPD by more than 50%, even among formerly incarcerated persons. Additional analyses reveal that, among formerly incarcerated persons who meet the diagnostic threshold for ASPD, their set of symptoms is perhaps driven more by their circumstance than their personality. For example, while formerly incarcerated persons frequently report failing to fulfill their promises, fewer than one in ten report a lack of remorse for having mistreated others. These findings suggest the need to further contextualize ASPD symptomatology, particularly among populations with frequent contact with the criminal justice system.