What is your take on the concept of 'the exception' - somebody who people with ASPD are capable of feeling compassion and guilt for? Do you think it has any merit, or do you reckon people who describe having an exception are misdiagnosed?
Personally, I think under the ICD-11 framework for personality disorder, it's possible. Under the classic DSM-5 framework for ASPD, I'm not so sure. The DSM-5 is more restrictive by design and whether that's a good thing or not is entirely personal opinion.
I have never had an exception personally. Though I donât think you need to have absolutely no concern or remorse ever to be described as antisocial/psychopathic, just little. But that could just be my reading. I also would like to note that a lot of descriptions specifically describe a lack of concern including for people close to them, which flies in the face of exceptions as Iâve heard it described. I would say in that way, exception could work only if the guilt and compassion towards exception is still mostly lacking in an objective sense.
I have major issues with both criteria though honestly. Also there are two ASPDs in the ICD-11, conduct-dissocial disorder and personality disorder with dissociality. I think the dissociality thing is too vague and puts too many things under the criteria of lack of empathy to make it hard to say (like manipulation and aggression iirc, etc, like those are several different things); and also requires you to have traits of NPD, its not just aspd, its like a weird mix of both that leaves out a lot of essential traits imo, like its not just a âlack of empathyâ. I would like to hear your explanation though. The conduct-dissocial criteria is solely about antisocial behaviour, and has a specifier of having limited pro social emotions or not, so CDD is probably a the best ASPD equivalent in the book, and the lack of empathy and remorse in LPE can be limited OR absent, so exceptions to a minor degree sound reasonable there, but thatâs not even required.
Honestly my favourite criteria in any of these books is probably the ICD-10 dissocial personality disorder (still has issues imo).
DSM aspd can easily be met without any lack of concern or guilt at all, in fact only half of people who meet that criteria have a lack of remorse.
A lot of this is just diagnosis label semantics, rather then an objective answer, I guess. Nobody can even seem to decide what ASPD even is. I DO think a lot of people need to understand that neurotypicals often donât have concern for adult strangers who arenât close to them. Thatâs not pathological or unusual.