Psychopathy and the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alternative model of personality disorder: a synthesis and critique of the emergent literature

Purpose of review Including the psychopathic specifier within the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition alternative model of personality disorder (AMPD) trait conceptualization of antisocial personality disorder (ASPD) represents a significant development in the history of the conceptualization of ASPD and its relationship to psychopathy. This review presents a synthesis and critique of emerging literature pertaining to AMPD ASPD and the psychopathic specifier. Recent findings The current review draws attention to the utility of ASPD impairment ratings and traits to effectively measure psychopathy, shortcomings of the psychopathic specifier, research efforts to improve upon the conceptualization of AMPD psychopathy, and ASPD and psychopathic specifier trait complexity. AMPD domains and ASPD designated traits converge with interpersonal, antagonistic, and disinhibitory domains of psychopathy but demonstrate poorer convergence with boldness/fearless dominance. The separate assessment of ASPD impairment adds little to the prediction of psychopathy beyond ASPD trait severity. Although the psychopathic specifier maps onto boldness/fearless dominance domains of psychopathy, theoretical and empirical limitations hinder the utility of the psychopathic specifier and reconceptualization will likely be required. Finally, complex ASPD and psychopathic specifier facet interrelationships and diverse relationships with externalizing outcomes suggests the development of advanced interpretive guides for clinical practice should be a high priority.

Automated summary

The inclusion of the psychopathic specifier within the AMPD trait conceptualization of ASPD is a significant development, but has limitations. ASPD impairment ratings and traits show some utility in measuring psychopathy, but improvements are needed. The relationship between ASPD and the psychopathic specifier is complex and requires further research for better understanding.