DIAGNOSIS OF ANTISOCIAL PERSONALITY DISORDER (ASPD): CLINICAL ASSESSMENT AND CHALLENGES

Abstract

Introduction and Objective: Antisocial Personality Disorder (ASPD) is characterized by a persistent pattern of violation of others' rights, impulsivity, and lack of remorse. Due to its etiological complexity and high rate of comorbidities, its clinical recognition is challenging. This study aims to synthesize recent scientific evidence on clinical assessment protocols and the main obstacles in the diagnosis of ASPD. Methodology: This is a narrative literature review, based on articles published in the last five years in the PubMed database, using descriptors related to the diagnosis and assessment of the disorder. Results: The literature indicates that diagnosis (based on DSM-5 TR) is frequently hampered by strong overlap with Substance Use Disorders (SUD). Furthermore, neurobiological challenges are evident, such as the imbalance between arousal and inhibition (S/I) systems, and a diagnostic invisibility in women, whose antisocial traits are commonly masked by internalizing comorbidities such as depression and anxiety. Conclusion: The diagnosis of ASPD requires a multidimensional approach that transcends the mere observation of delinquent behaviors, integrating longitudinal history, management of comorbidities, and gender particularities.