A 16- to 45-year follow-up of 71 men with antisocial personality disorder.

We examined the long-term outcome of 71 men with antisocial personality disorder (ASPD) admitted to the University of Iowa Psychiatric Hospital. The subjects all met DSM-III criteria for ASPD based on admission records. Patients had been admitted between 1945 and 1970 and were evaluated between 1986 and 1990, an average of 29 years following hospital discharge. We traced 68 (96%), and 26 (36.6%) received a full or partial interview; 17 (23.9%) had died. Based on personal interviews, interviews with informants, and medical and legal records, we were able to rate globally 45: 12 (26.6%) had remitted, 14 (31.1%) had improved but not remitted, and 19 (42.2%) were unimproved. A Diagnostic Interview Schedule (DIS) was administered to 21 subjects; tobacco dependence, alcohol dependence, generalized anxiety disorder, and major depression were frequent lifetime disorders. Remission was associated with lower symptom severity at intake and follow-up evaluation of more than 25 years and current sobriety. Based on the study results, we conclude that for many, ASPD is chronic and is associated with ongoing psychiatric, medical, and social problems.