اختلال شخصیت ضد اجتماعی و اختلالات فکری و روانی در زنان: بررسی ادبیات در قابلیت اطمینان و اعتبار ابزارهای ارزیابی

Crime rates are low in women compared to men. The two disorders most commonly associated with offending behaviour, antisocial personality disorder (ASPD) and psychopathy, are also less prevalent in female samples. However, developments in forensic psychiatry have often ignored gender, and the utility of constructs such as psychopathy and their assessment instruments in female samples remains unclear. This article presents a review of studies looking at rates of ASPD and psychopathy and on the reliability and validity of assessment instruments of these disorders in women. Gender differences in symptom patterns will be considered. The literature seems to suggest that DSM-IV criteria for ASPD may lead to an underestimation of the prevalence of the disorder in women due to the requirement of childhood conduct disorder symptoms. The Psychopathy Checklist-Revised (PCL-R) is a valid and reliable instrument to identify psychopathy in women but there are gender differences in the factor structure and item loadings on this measure. Research to date seems to suggest a three-factor model may be most strongly supported in females. Preliminary evidence suggests the PCL-R may have some value in predicting future offending while the PCL:SV may be useful in predicting institutional violence. Clinical implications are discussed.

High rates of personality pathology have been identified in offender populations (e.g. Singleton, Meltzer, Gatward, Coid & Deasy, 1998). The relationship between personality disorders, including psychopathy, and re-offending and violent crime is reflected in their inclusion in major risk assessment instruments such as the HCR-20 (Webster, Douglas, Eaves & Hart, 1997). A recent general increase in aversion to risk has been observed across different countries (Maden, 2007). In line with this trend, mental health policies have placed increasing emphasis on the protection of the public from those who may pose a risk to others. Acknowledging the link between violent offending and personality disorders, the assessment and management of personality disorders has become a policy priority in a number of countries, e.g. the UK (Dolan & Doyle, 2000) and Finland (Putkonen & Völlm, 2006). Given the likely implications of a diagnosis of personality disorder or psychopathy in the decision to detain and treat an individual, it is crucial to consider the validity and reliability of assessment instruments used to identify these conditions. To date, however, much of the research on assessment of antisocial personality disorder (ASPD) and psychopathy and their relationship with offending has focused on male populations. Relatively little is known about the generalisabilty of these findings to female samples. This article sets out to selectively review the literature on rates of antisocial personality disorder and psychopathy and their clinical presentation in women. Furthermore, a systematic literature review on the reliability and validity of the main assessment instruments identifying these disorders in women will be presented.