Why is it difficult to tell whether antisocial personality disorder causes crime?

Determining whether antisocial personality disorder (ASPD) causes crime is difficult because of the way the disorder is diagnosed. The clinical criteria used to identify ASPD heavily emphasize the commission of crimes and the engagement in crimelike behaviors.1

Consequently, it remains unclear whether the disorder functions as an underlying cause of criminal activity or if the diagnosis serves primarily as a psychiatric label applied to individuals who are already identified as criminals. While ASPD is strongly associated with criminality and is more prevalent in prison populations, the circular nature of these diagnostic criteria complicates efforts to establish a direct causal link.12