ASPD, Psychopathy, and Diagnosis

Readers will often ask me about the diagnostic process as it relates to psychopathy.  I must reiterate that my journey is abnormal; I was given the Psychopathy Checklist – Revised outside of the walls of a prison.  In order to receive my diagnosis of ASPD and a confirmation of psychopathy, the stars had to align just right.  I needed a therapist that was willing to challenge the way that I viewed the world and myself and my own dumb luck to achieve such a step in finding out what lies behind my mask.

Most diagnoses of ASPD are made as a result of a pervasive pattern of getting caught.  The adolescent entering adulthood may receive a diagnosis as the result of a pervasive pattern of conduct disorder whose underlying behaviors continue into adulthood.  The chronic criminal may receive a diagnosis of ASPD by a prison psychologist.  It is rare that typical therapists give out such a diagnosis and it is almost always the result of them noticing behavior that the antisocial individual does not.  It took two years for my therapist to dare broach the topic of my antisocial ways.  She heard many anecdotes of my antisocial ways over those years.  She also immediately noticed my lack of empathy.  However, such was not the reason I went to her in the first place.  I went as a means of understanding my depression and as the result of a mandate given to me by my ex-husband.

A confirmation of psychopathy for one outside of prison is even rarer.  I am an inquisitive individual and questioned heavily the relevance of a diagnosis of ASPD.  It did not seem to explain many aspects of my personality as, in many ways, ASPD is a simplistic diagnosis.  My therapist, having an interest in psychopathy herself, asked me to voluntarily receive an administration of the PCL-R.  I agreed solely as a means of understanding my personality better, not as a means of wanting (or not wanting) to be psychopathic.  Confirmation was made and therapy continued.  Most times such confirmation means metaphorical death, but for me, as a free individual who is less criminal than many antisocials, it was a mere tool of learning.

My antisocial readers should not expect to follow a similar path.  It takes a therapist whose will to assist a client is unflappable; most therapists will not touch ASPD and/or psychopathy with a ten foot pole.  It takes a strong character to accept the possibility of diagnosis given the stigma associated with such diagnoses.  And, it takes a willingness to embrace and trust one’s therapist in order to make sure that all of the proper information is given as appropriate.  Odds are you will not enter a therapist’s office and pay them the price they demand solely for a diagnosis of ASPD or a confirmation of psychopathy; you will be there for some other purpose.  If you believe yourself to be antisocial, you probably have reason to.  If you never knew, then that is where the diagnostic process holds its true power.  It is too easy to think that one’s actions and thoughts are “normal”, it is the awakening upon learning that such is “disordered” that the true power of diagnosis takes root.

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