There are currently 28 core texts on my shelf on personality disorder, spanning from Theophrastus in 200 bce to Tyrer & Mulder (Personality Disorder: From Evidence to Understanding, Cambridge University Press) and Howard & Duggan in 2022. Antisocial Personality: Theory, Research, Treatment stands up well against its predecessors. Strengths include its salience, breadth and command. It is clichéd to say that its strengths are also its weaknesses, but at times the narrowness and the meticulously argued recommendations of this book prompt me to look longingly back at the differing perspectives of some of the other 27 works. Most important, this book is contemporary. Unlike Howard & Duggan, the great publications by the late Theodore Millon and Larry Siever can never again shed light on the specifics of the most recent national clinical guidelines, international diagnostic classification systems, university research and ethically illuminating political missteps.

The amount of detail and breadth packed into 165 pages of text is skilful. Fundamental concepts, latest research, guidance on assessment, recommendations on treatment and ethical pitfalls are all well covered. The three chapters on developmental, interpersonal and brain perspectives neatly span divides between the mind and brain, eschewing unnecessary rabbit holes that less pragmatic authors have gone down in the past. There is no sacrifice of neuroscientific realities on the altar of recommendations to deliver more psychological treatment and prescribe less psychopharmacological medications. A slight weak point is that brain imaging and electrophysiology are focused on but not other foundations of neuroscience, such as biochemistry, pharmacological challenge and genetics.

The tiered chapters separating general from specialist approaches are commanding. Here the strength of the recommendations and the detailed appeal to evidence are particularly strong. Building directly on Livesley's many summaries on pragmatic staged care, Howard & Duggan stamp their own personal but empirically informed opinions, with a focus on offenders with personality disorder, who understandably have some different and particular needs in contrast to patients who are not detained in prison custody or live life under the supervision of probation officers in the community. Like the increasingly popular structured clinical management for people with high levels of negative affectivity and suicidal crises, these two chapters offer general adult psychiatrists realistic achievable ways to work with patients with antisocial personalities who we might otherwise be too scared to treat. For me the best nuggets for all practitioners are the five principles tucked away at the back of the chapter on specialist approaches. Perhaps here the thinness of the book does struggle to grapple with specific guidance navigating the full panoply of different tested psychotherapeutic treatments for personality disorder.

There are multiple incisive and stimulating questions focusing on specialist debates, such as the comparisons between the group-based cognitive–behavioural treatment recommended by NICE guidelines and broader interventions, concerns about treatability, the particular challenges of sexual sadism and the potential harms of intervention. The chapter on ethics is particularly illuminating about the impact of the political oversights of the 2000s, which continue to affect the lives of thousands enmeshed by the ‘dangerous and severe personality disorder’ and indeterminate ‘imprisonment for public protection’ policies of the UK government. In this chapter Howard & Duggan perhaps go too far in their directiveness to not assess personality disorder needs prior to sentencing. Sidestepping matters of criminal responsibility and the impact of sentencing on mental health management perhaps represents where pragmatism meets avoidance. This outspoken tone of the book makes it more stimulating and valuable. The thread of discontent about the loss of individual narratives and other potential harms of diagnostic classification is healthy. When books dare to write the words personality and antisocial in 2022, uproar from lively critical activists is perhaps inevitable, but the contents of this book lead me to imagine that the authors welcome such challenge and debate.