DECONSTRUCTING A DSM DIAGNOSISRichter-Appelt, H., & Sandberg, D. E. (2010).Should disorders of sex development be anexclusion criterion for gender identitydisorder in DSM 5? International Journalof Transgenderism, 12(2), 94-99. doi:10.1080/15532739.2010.515181Smith, Y. L. S., Van Goozen, Stephanie H. M.,Kuiper, A. J., & Cohen-Kettenis, P.(2005). Sex reassignment: Outcomes andpredictors of treatment for adolescent andadult transsexuals. PsychologicalMedicine, 35(1), 89-99. doi:10.1017/S0033291704002776Stone, A. R. (as Sandy Stone) (1991). The empirestrikes back: A posttranssexual manifesto.In: Body Guards: The Cultural Politics ofGender Ambiguity, eds. J. Epstein & K.Straub. New York: Routeledge, p. 280-304.STP (Stop Trans Pathologisation). (2012).Reflections on the SOC-7. Retrieved fromhttp://www.stp2012.info/STP2012_Reflections_SOC7.pdfVance, S. R., Cohen-Kettenis, P., Drescher, J.,Meyer-Bahlburg, H., Pfäfflin, F., &Zucker, K. J. (2010). Opinions about theDSM gender identity disorder diagnosis:Results from an international surveyadministered to organizations concernedwith the welfare of transgender people.International Journal of Transgenderism,12(1), 1-14.doi:10.1080/15532731003749087Winters, K. (2005). Gender dissonance:Diagnostic reform of gender identitydisorder for adults. Journal of <strong>Psychology</strong>& Human Sexuality, 17(3-4), 71-89. doi:10.1300/J056v17n03_04WPATH Board of <strong>Direct</strong>ors. (2010). Depsychopathologisationstatement releasedMay 26, 2010. Retrieved fromhttp://www.wpath.org/announcements_detail.cfm?pk_announcement=17WPATH. (2012). Standards of Care for the Healthof Transsexual, Transgender, and GenderNonconforming People. (7th ed.).Retrieved fromhttp://www.wpath.org/documents/SOC%20V7%2003-17-12.pdfZucker, K. J., & Spitzer, R. L. (2005). Was thegender identity disorder of childhooddiagnosis introduced into DSM-III as abackdoor maneuver to replacehomosexuality? A historical note. Journalof Sex & Marital Therapy, 31(1), 31-42.doi: 10.1080/00926230590475251Zucker, K. J. (2006). Commentary on Langer andMartin's (2004) "how dresses can makeyou mentally ill: Examining genderidentity disorder in children". Child &Adolescent Social Work Journal, 23(5-6),533-555. doi: 10.1007/s10560-006-0074-5Zucker, K. J. (2009). Report of the DSM-5Sexual and Gender Identity DisordersWork Group. Retrieved fromhttp://www.dsm5.org/progressreports/pages/0904reportofthedsmvsexualandgenderidentitydisordersworkgroup.aspxZucker, K. J. (2010). The DSM diagnostic criteriafor gender identity disorder in children.Archives of Sexual Behavior, 39(2), 477-498. doi: 10.1007/s10508-009-9540-4Zucker, K. J., & Lawrence, A. A. (2009).Epidemiology of gender identity disorder:Recommendations for the standards ofcare of the world professional associationfor transgender health. InternationalJournal of Transgenderism, 11(1), 8-18.doi: 10.1080/15532730902799946
© 2013 WUPJ, September 2013, Volume 1 ClinicalThe Relationship Between Oppositional Defiant Disorder, Conduct Disorder, AntisocialPersonality Disorder and Psychopathy: A Proposed TrajectoryTaylor Salisbury*This review paper critically examines the literature on oppositional defiant disorder(ODD), conduct disorder (CD), antisocial personality disorder (APD) and psychopathy.Through examining diagnostic criteria laid out in the DSM-IV along with statistics relatedto diagnosis and prognosis, the idea that ODD, CD, and APD may fall on a developmentaltrajectory as opposed to being distinct, categorical entities is proposed. Additionally, thenotion that these three disorders may represent narrow, behavioural indicators of a generalpsychopathic personality is suggested using comparisons to Hare’s Psychopathy ChecklistRevised (PCL-R). Several implications related to child development, family instabilityand violence, as well as labeling and stigma are discussed and the importance of familyintervention and involvement is highlighted. Finally, a number of implications related tothe criminal justice system, including the prediction of conviction and recidivism rates,are explored.The construct of psychopathy has had along history within the literature of clinical andforensic psychopathology, constantly evolvingthrough revisions of the Diagnostic andStatistical Manual of Mental Disorders (DSM)used extensively by psychologists. It wasidentified by clinical psychologists as one of thefirst acknowledged personality disorders, called‘Psychopathic Personalities’ and was publishedin the first edition of the DSM as ‘SociopathicPersonality Disorders’ (Ogloff, 2006). TheDSM-II changed this label to ‘PersonalityDisorder, Antisocial Type’ in 1968 (Ogloff,2006), which has ultimately progressed to thecurrent title ‘Antisocial Personality Disorder(APD)’ in the most recent version, the DSM-IV-TR (American Psychological <strong>Association</strong>,2000). Historically, the terms asocial, sociopath,psychopath, and APD have been usedinterchangeably; however, recent improvementsin nosology have helped to clarify thedistinction between them. The largely casestudy/clinical description-based format of theDSM-II evoked criticisms of poor inter-raterreliability which led to the development of thespecific-criteria approach used in currentversions of the DSM today (Ogloff, 2006).Now, criteria in the DSM are based on overtbehavioural traits that can be observed andmeasured instead of relying on the oftenambiguous interpersonal and affectivepersonality characteristics used to inferdiagnoses in the past (Coid & Ullrich, 2010).This improvement helped distinguish betweenAPD and general psychopathy, with the formerconstruct focusing on the overt antisocialbehaviours of such individuals and the lattercharacterizing a more overarching personalitystyle involving interpersonal, affective, andbehavioural dimensions (Ogloff). Drawing thisdistinction between behavioural and personalityfactors undoubtedly helped resolve some of theinter-rater reliability criticisms from the past.However, in doing so, it has generated thenotion that overt behaviours can actually beseparated from personality factors, and thatmental disorders and personality disorders arereal and distinct categorical entities withindependent characteristics. That being said, alarge body of literature supports the idea thatAPD, and several other disorders diagnosed inchildhood and adolescence, are actually on acontinuum with psychopathy and may bespecific points along a developmental trajectoryrather than distinct diagnostic categories (Burke,Waldman, & Lahey, 2010; Coid & Ullrich). Adiagnosis of Oppositional Defiant Disorder(ODD) and/or Conduct Disorder (CD) inchildhood or adolescence often precedes the*Initially submitted for <strong>Psychology</strong> 3310F at the University of <strong>Western</strong> Ontario. For inquiries regarding thearticle, please email the author at tsalisb4@uwo.ca.
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