Am J Psychiatry 1993; 150:578-583
Copyright © 1993 by American Psychiatric Association
Is antisocial personality a valid diagnosis among the homeless?
CS North, EM Smith and EL Spitznagel
Department of Psychiatry, Washington University School of Medicine, St. Louis, MO 63110.
OBJECTIVE: It has been argued that among the homeless many of the features
of antisocial personality may be artifacts of homelessness and that strict
application of the diagnostic criteria may be insensitive to social and
cultural factors in this group. The authors studied a large group of
homeless men and women to investigate the appropriateness of the diagnosis
of antisocial personality disorder among the homeless. METHOD: Six hundred
homeless men and 300 homeless women were randomly selected from shelters
and street locations in St. Louis and interviewed with the National
Institute of Mental Health Diagnostic Interview Schedule. RESULTS: In this
sample of homeless men and women, most, but not all, adult symptoms of
antisocial personality disorder were significantly associated with number
of childhood conduct disorder symptoms. The onset of symptoms of antisocial
personality disorder usually preceded the onset of homelessness. The rates
of antisocial personality disorder were not significantly affected by
discounting the antisocial disorder symptoms thought to be confounded with
homelessness. CONCLUSIONS: Overall, the data support the appropriateness of
the diagnosis of antisocial personality disorder among homeless
populations. It cannot be said from these data that homelessness often
leads to antisocial behaviors.
