Comorbid Autism Spectrum Disorder and Antisocial Personality Disorder in Forensic Settings

[摘要] autism spectrum disorderpersonality disorderreflectionautismcountertransferenceheuristicsAutism spectrum disorders (ASD) refer to a group of lifelong neurodevelopmental disorders, the core features of which include difficulties with social interaction and social communication and a preference for stereotypic, restricted, and repetitive behaviors or interests. The estimated prevalence of ASDs in the general population is thought to be one to two percent.1 Although outcomes of individuals with ASDs vary, some experience repeated contact with psychiatric services, have psychiatric comorbidity, and are overrepresented in forensic settings relative to the general population.2,3 In our clinical experience in a high security psychiatric hospital environment, those with an ASD who have violently offended and, by the criteria of admission, pose a grave and imminent risk to the public, often have a comorbid psychiatric diagnosis. This is supported by unpublished audit data conducted in 2020 that showed 52.9 percent of individuals with an ASD admitted to Broadmoor Hospital in the preceding five years had a comorbid personality disorder (PD). Of these, individuals with a dual diagnosis of an ASD and antisocial PD (ASPD) can present marked challenges in assessment and management. For consistency with the Diagnostic and Statistical Manual (DSM)4 and clinical guidelines from the National Institute for Health and Care Excellence (NICE),5 we will use the term “ASPD” though we do acknowledge that the term “dissocial PD” is preferred in the International Classification of Diseases (ICD).

[学科分类] 儿科学

[关键词] autism spectrum disorder;personality disorder;reflection;autism;countertransference;heuristics