may increase the likelihood that conduct disord er will evolve into antisocial personality
disorder.
Prevalence
Twelve-month prevalence rates of antisocial personality diso rder, using criteria from pre-
vious DSMs, are between 0.2% and 3.3%. The highest prevalence of antisocial personality
disorder (greater than 70%) is among most se vere samples of males with alcohol use dis-
order and from substance abuse clinics, prison s, or other forensic settings. Prevalence is
higher in samples affected by adverse socioeconomic (i.e., poverty) or sociocultural (i.e.,
migration) factors.
Development and Course
Antisocial personality disorder has a chronic course but may become less evident or remit
as the individual grows older, particularly by the fourth deca de of life. Although this re-
mission tends to be particularly evident with respect to engaging in criminal behavior,
there is likely to be a decrease in the full spectrum of antisocial behaviors and substance
use. By definition, antisocial personalit y cannot be diagnosed before age 18 years.
Risk and Prognostic Factors
Genetic and physiological. Antisocial personality disorder  is more common among the
first-degree biological relatives of those with the disorder than in the general population.
The risk to biological relatives of females with  the disorder tends to be higher than the risk
to biological relatives of males with the disorder. Biological  relatives of individuals with
this disorder are also at in creased risk for somatic symptom disorder and substance use
disorders. Within a family that has a member with antisocial personality disorder, males
more often have antisocial personality disord er and substance use disorders, whereas fe-
males more often have somatic symptom disorder. However, in such families, there is an