Psychopathy and antisocial personality disorder among alcoholic inpatients

Objective: The purpose of this study was to compare the adequacy of two measurement systems-the Revised Psychopathy Checklist (PCL-R) and DSM-III diagnosed antisocial personality disorder (APD)-to distinguish alcoholic inpatients with regard to alcoholism; characteristics, criminal activities and psychiatric disorders. Method: The 740 patients, who included 440 men, 387 blacks and 199 Hispanics, were admitted to one of five New York State alcohol treatment inpatient centers. Each patient was interviewed, and DSM-III diagnoses and other characteristics were recorded, and trained interviewers completed the PCL-R. Results: There was a statistically nonsignificant association between DSM-LII-based APD diagnosis and PCL-based psychopathy diagnosis. APD (relative to non-APD) alcoholics had an earlier onset of problem drinking, higher levels of pathological drinking and social impairment, and a higher prevalence of familial alcoholism; a similar pattern was not indicated for PCL-R diagnosed psychopaths relative to nonpsychopaths. APD alcoholics also engaged in higher levels of criminal activities and violent acts. APD alcoholics had a higher prevalence of substance abuse disorders, and psychopaths had a higher prevalence of generalized anxiety disorder, panic disorder and schizophrenia. Conclusions: Distinct subpopulation of alcoholic inpatients are identified via the APD criteria of DSM-III and the psychopathy criterion of the PCL-R. The majority of the identified psychopathic alcoholics in this sample were likely to be secondary psychopaths, characterized by features of psychopathy (e.g., callousness, manipulativeness) and emotional dysregulation and/or thought disturbance.