Major mental disorder and antisocial personality disorder: a criminal combination.

Much evidence now suggests that patients with major mental disorders are at increased risk for crimes and violence. Leading experts in forensic psychiatry have proposed that the illegal behaviors are a consequence of these major disorders. Yet, longitudinal studies have consistently indicated that adult criminality is preceded by a childhood history of antisocial behavior. We hypothesized that among offenders with major mental disorders there are two groups: (1) the first group has a secondary diagnosis of antisocial personality disorder (APD), and a childhood history of antisocial and criminal behavior preceding the onset of the major disorder; (2) the second group do not meet the criteria for APD, and behave criminally only as adults. This hypothesis was tested on a representative sample of penitentiary inmates with major mental disorders. It was found that those with APD had a significant childhood history of criminal activity and antisocial behavior, endorsing, on average, eight of ten possible indices. In comparison, the mentally disordered inmates without APD endorsed on average two indices. The mentally disordered offenders with APD began their criminal careers earlier, and had significantly more convictions and more convictions for nonviolent offenses than those without APD. APD was not associated with violence among men with major mental disorders.