Psychopathy and antisocial personality disorder among alcoholic inpatients

Objective: The purpose of this study was to compare the adequacy of two mea surement systems-the Revised Psychopathy Checklist (PCL-R) and DSM-III diag nosed antisocial personality disorder (APD)-to distinguish alcoholic inpati ents with regard to alcoholism; characteristics, criminal activities and ps ychiatric disorders. Method: The 740 patients, who included 440 men, 387 bl acks and 199 Hispanics, were admitted to one of five New York State alcohol treatment inpatient centers. Each patient was interviewed, and DSM-III dia gnoses and other characteristics were recorded, and trained interviewers co mpleted the PCL-R. Results: There was a statistically nonsignificant associ ation between DSM-LII-based APD diagnosis and PCL-based psychopathy diagnos is. APD (relative to non-APD) alcoholics had an earlier onset of problem dr inking, higher levels of pathological drinking and social impairment, and a higher prevalence of familial alcoholism; a similar pattern was not indica ted for PCL-R diagnosed psychopaths relative to nonpsychopaths. APD alcohol ics also engaged in higher levels of criminal activities and violent acts. APD alcoholics had a higher prevalence of substance abuse disorders, and ps ychopaths had a higher prevalence of generalized anxiety disorder, panic di sorder and schizophrenia. Conclusions: Distinct subpopulation of alcoholic inpatients are identified via the APD criteria of DSM-III and the psychopat hy criterion of the PCL-R. The majority of the identified psychopathic alco holics in this sample were likely to be secondary psychopaths, characterize d by features of psychopathy (e.g., callousness, manipulativeness) and emot ional dysregulation and/or thought disturbance.