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Abstract
Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) have an overlap in both symptoms and risk factors,
suggesting that they might reflect the same form of psychopathology, shaped by gender. However other lines of evidence point to the
presence of partly unique, albeit overlapping, trait dimensions, specifically affective instability which differentiates BPD from ASPD. Our
conclusion is that ASPD and BPD are separate disorders.
2013 Elsevier Inc. All rights reserved.
1. Defining disorders
Fifteen years ago, our research group [1] suggested that
ASPD and BPD could have a common base in personality
traits, and that their behavioral differences could be largely
attributable to gender. This review aims to update research
on these relationships, and to reconsider earlier conclusions.
To examine this question, we conducted a literature search.
Using the keyword antisocial personality disorder and
borderline personality disorder, we found 331 articles published
since 1950, but of these, only 31 were relevant to the issue of
differential diagnosis. The selection was augmented by including
papers that examine theoretical issues related to our question.
ASPD has a very large empirical literature. First described
in the early nineteenth century, terms such as psychopathy,
sociopathy, or dyssocial personality have also been used to
describe this clinical picture [2]. While dissocial personality is
the preferred term in the International Classification of
Diseases [3], psychopathy describes a more specific syndrome
emphasizing abnormal personality traits rather than criminal
and irresponsible patterns of behavior [4], and some of these
traits can be identified early in development [5].
In DSM-5 [6], patients must meet overall criteria for a
personality disorder: impairments in self and interpersonal
relationships, associated with pathological personality traits.
DSM-5 requires general overall criteria for a personality
disorder, with a characteristic trait profile marked by
antagonism (manipulativeness, deceitfulness, callousness,
Corresponding author.
E-mail address: joel.paris@mcgill.ca (J. Paris).
0010-440X/$ see front matter 2013 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.comppsych.2012.10.006
322
3. Risk factors
Like other mental disorders, ASPD and BPD can be
understood in a biopsychosocial model [31]. Genetic
factors account for approximately 40% of the variance in
both personality dimensions [32] and disorders [33].
Although twin studies have not been conducted on
ASPD, heritability has been established for criminality
[34], and for behavioral patterns and traits related to the
disorder [35]. In BPD, twin studies find that genetic factors
account for nearly half the variance [33]. However, the
nature of the vulnerabilities to both disorders is unknown:
while a relationship between impulsive and affective trait
dimensions with central serotonergic activity has been
suggested in BPD [36], no specific genetic polymorphisms
or biomarkers have been identified.
The psychosocial risk factors for ASPD and BPD clearly
overlap. In ASPD, paternal antisocial features, associated
with family dysfunction and parental inconsistency, are long
established risks [37]. Studies of psychological factors in
BPD strongly implicate parental psychopathology family
dysfunction, and psychological trauma, with similar risks in
males and females [38]. However, since these risk factors are
not specific to any mental disorder, their presence in both
ASPD and BPD cannot determine whether they should be
considered separate.
6. Diagnostic boundaries
The ultimate source of confusion in separating BPD and
ASPD lies in the way that DSM-IV criteria, the basis for most
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7. Conclusions
The strength of the research literature on ASPD and BPD
supported the retention of these categories in DSM-5, and
both diagnoses will continue to have an impact on practice.
Applying the DSM-5 view of personality disorders, which
focuses on trait profiles, the differences between these
disorders are rooted in trait dimensions shaped by gender.
For this reason, the influence of gender on symptoms is not
an artefact, but a factor that partly determines specific
psychopathological constellations.
In summary, several lines of evidence suggest that BPD
and ASPD are different disorders associated with unique
trait profiles. We therefore reject our earlier conclusion [1],
that ASPD and BPD are different aspects of the same
underlying psychopathology.
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