TEMPORAL STABILITY OF ANTISOCIAL PERSONALITY-DISORDER - BLIND FOLLOW-UP-STUDY AT 8 YEARS

The study objective was to examine the temporal stability of the antis ocial personality disorder (ASPD) diagnosis based on whether specific antisocial symptoms were considered to be related to substance abuse. A total of 407 adults who were initially part of a family study of alc oholism and sociopathy were blindly reassessed an average of 8 years l ater, using the Home Environment and Lifetime Psychiatric Evaluation R ecord (HELPER) and basing diagnoses on the clinician's best final esti mate using all sources of data. ''Narrow'' and ''broad'' ASPD diagnose s were made at both times based on whether individual symptoms were co unted toward diagnosis if they occurred in the setting of significant substance abuse, kappa values varied from 0.31 to 0.68, with more rest rictive methods of diagnosis being less stable. After deriving estimat es of sensitivity and specificity of diagnosis, the probability of bei ng a ''case'' could be assigned based on the reported number of conduc t problems occurring before age 15 as a clinical covariate for diagnos is, We conclude that diagnosing ASPD without attempting to attribute t he cause of individual symptoms to substance abuse results in substant ially greater temporal stability. Using a broader definition, the diag nosis of ASPD is highly sensitive (P = .97) and specific (q = 0.93). T hese findings may allow more accurate diagnosis of ASPD in drug-abusin g individuals. Copyright (C) 1998 by W.B. Saunders Company.