Antisocial personality disorder
| Antisocial personality disorder | |
|---|---|
| Specialty | Psychiatry, psychology  |
| Personality disorders |
|---|
| Cluster A (odd) |
| Cluster B (dramatic) |
| Cluster C (anxious) |
| Not otherwise specified |
| Depressive |
| Others |
Antisocial personality disorder (adyp or Atu) is defined by the American Psychiatric Association's Diagnostic and Statistical Manual as "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."[1]
Antisocial personality disorder is sometimes known as sociopathic personality disorder. It is also sometimes referred to as psychopathy or sociopathy. Some researchers believe that antisocial personality disorder and psychopathic personality are different conditions.
Signs and symptoms
Characteristics of people with antisocial personality disorder may include:[2]
- Persistent lying or stealing
- Apparent lack of remorse[3] or empathy for others
- Cruelty to animals[4]
- Poor behavioral controls — expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper
- A history of childhood conduct disorder
- Recurring difficulties with the law
- Promiscuity
- Tendency to violate the boundaries and rights of others
- Aggressive, often violent behavior; prone to getting involved in fights
- Inability to tolerate boredom
- Disregard for right and wrong
- Poor or abusive relationships
- Irresponsible work behavior
- Disregard for safety
Diagnosis
DSM
The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR = 301.7, a widely used manual for diagnosing mental disorders, defines antisocial personality disorder (in Axis II Cluster B) as:[1]
- A) There is a pervasive pattern of disregard for and violation of the rights of others occurring for as long as either childhood, or in the case of many who are influenced by environmental factors, around age 15, as indicated by three (or more) of the following:
- failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
- deceitfulness, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
- impulsivity or failure to plan ahead;
- irritability and aggressiveness, as indicated by repeated physical fights or assaults;
- reckless disregard for safety of self or others;
- consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
- lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another;
- promiscuity;
- having shallow or seemingly nonexistent feelings.
New evidence points to the fact that children often develop Antisocial Personality Disorder as a cause of their environment, as well as their genetic line. The individual does not need to meet a certain age requirement in order to be diagnosed with this disorder.
Criticism
Researchers have heavily criticized the ASPD DSM-IV criteria because not enough emphasis was placed on traditional psychopathic traits such as a lack of empathy, superficial charm, and inflated self appraisal.[citation needed]
These latter traits are harder to assess than behavioral problems (like impulsivity and acting out). Thus, the DSM-IV framers sacrificed validity for reliability. That is, the ASPD diagnosis focuses on behavioral traits, but only limited emphasis is placed on affective and unemotional interpersonal traits.
Researchers debate about whether psychopathy/sociopathy are incorrectly put together under ASPD. These clinicians and researchers who believe that it was incorrect to label the two in the same category are upset that an important distinction has been lost between these two disorders. In other words, the DSM-IV-TR considers ASPD and psychopathy to be the same, or similar. However, they are not the same since antisocial personality disorder is diagnosed via behavior and social deviance, whereas psychopathy also includes affective and interpersonal personality factors.[5]
Also, ASPD, unlike psychopathy, does not have biological markers confirmed to underpin the disorder.[citation needed] Other criticisms of ASPD are that it is essentially synonymous with criminality. Nearly 80%–95% of felons will meet criteria for ASPD — thus ASPD predicts nothing in criminal justice populations, whereas psychopathy (using the Hare Psychopathy Checklist-Revised (PCL-R)) is found in only roughly 20% of inmates and PCL-R is considered one of the best predictors of violent recidivism. [6] Also, the DSM-IV field trials never included incarcerated populations.
The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that "psychopathy" and "sociopathy" are obsolete synonyms. The World Health Organization takes a similar stance in its ICD-10 by referring to psychopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.[7]
WHO
The World Health Organization's ICD-10 defines a conceptually similar disorder to antisocial personality disorder called (F60.2) Dissocial personality disorder.[8]
- It is characterized by at least 3 of the following:
- Callous unconcern for the feelings of others and lack of the capacity for empathy.
- Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
- Incapacity to maintain enduring relationships.
- Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
- Incapacity to experience guilt and to profit from experience, particularly punishment.
- Markedly prone to blame others or to offer plausible rationalizations for the behavior bringing the subject into conflict.
- Persistent irritability.
- The criteria specifically rule out conduct disorders.[9] Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.[10]
It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.
Millon's subtypes
Theodore Millon identified five subtypes of antisocial.[11][12] Any individual antisocial may exhibit none, one or more than one of the following:
- covetous antisocial - variant of the pure pattern where individuals feel that life has not given them their due.
- reputation-defending antisocial - including narcissistic features
- risk-taking antisocial - including histrionic features
- nomadic antisocial - including schizoid, avoidant features
- malevolent antisocial - including sadistic, paranoid features.
Differential diagnosis
The following conditions commonly coexist with antisocial personality disorder:[7]
- Anxiety disorders
- Depressive disorder
- Substance-related disorders
- Somatization disorder
- Pathological risk-seeking
- Borderline personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[13]
Treatment
![[icon]](/enwiki/wiki/File:Wiki_letter_w_cropped.svg){kind=small} | This section needs expansion. You can help by adding to it. (November 2009) |
To date there have been no controlled studies reported which found an effective treatment for ASPD, although contingency management programs, or a reward system, has been shown moderately effective for behavioral change.[14] Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance abuse,[15] although others have reported contradictory findings.[16] Schema therapy is being investigated as a treatment for antisocial personality disorder, as well as medicinal marijuana treatments. [17]
Epidemiology
Antisocial personality disorder in the general population is about 3% in males and 1% in females.[1][7]
It is seen in 3% to 30% of psychiatric outpatients.[1][7] The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders).[18] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) abuse treatment programs than in the general population (Hare 1983), suggesting a link between ASPD and AOD abuse and dependence.[19]
History
The history of the origins of antisocial personality disorder are closely related to the history of psychopathy.
See also
- DSM-IV codes (personality disorders)
- The Mask of Sanity
- Psychopathy
- Malignant narcissism
- Conduct Disorder
Notes
- ^ a b c d Antisocial personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000) - pages 645–650
- ^ "Antisocial Personality, Sociopathy, and Psychopathy"
- ^ "Antisocial Personality Disorder". Psychology Today. 2005. Retrieved 2007-02-20.
- ^ Goleman, Daniel (7 August 1991), "Child's Love of Cruelty May Hint at the Future Killer", New York Times
- ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (pdf file)
- ^
Serin, Ralph C. "Violent recidivism in criminal psychopaths". Law and Human Behavior. 20 (2). Springer Netherlands: 207–217. doi:10.1007/BF01499355. ISSN (Print) 1573-661X (Online) 0147-7307 (Print) 1573-661X (Online).
{{cite journal}}: Check|issn=value (help); Cite has empty unknown parameter:|coauthors=(help) - ^ a b c d Internet Mental Health - antisocial personality disorder
- ^ 602 "F60.2 Dissocial personality disorder". World Health Organization. Retrieved 2008-01-12.
- ^
Early Prevention of Adult Antisocial Behavior. Cambridge University Press. p. 82. Retrieved 2008-01-12.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Millon, Theodore, Personality Disorders in Modern Life, 2004
- ^ Millon, Theodore - Personality Subtypes
- ^ Oscar-Berman M (2009). "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder". Neuropsychiatric Disease and Treatment. 2009 (5): 309–326. PMID 19557141.
{{cite journal}}: Unknown parameter|coauthors=ignored (|author=suggested) (help); Unknown parameter|month=ignored (help); Unknown parameter|pmcid=ignored (|pmc=suggested) (help) - ^ J. E. Fisher & W. T. O'Donohue (eds). (2006). Practitioner's Guide to Evidence-Based Psychotherapy, p63
- ^ S. Darke, R. Finlay-Jones, S. Kaye, & T. Blatt. Anti-social personality disorder and response to methadone maintenance treatment. Drug and Alcohol Review, vol. 15, 271-276 (1996)
- ^ A. I. Alterman, M. J. Rutherford, J. S. Cacciola, J. R. McKay, & C. R. Boardman. Prediction of 7 months methadone maintenance treatment response by four measures of antisociality. Drug & Alcohol Dependence, vol. 49, 217-223 (1998)
- ^ http://www.iafmhs.org/files/Bernstein.pdf
- ^ Hare 1983
- ^ Moeller, F. Gerard; Dougherty, Donald M. (2006). "Antisocial Personality Disorder, Alcohol, and Aggression" (PDF). Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. Retrieved 2007-02-20.
External links
- [1] Interview with Dr. Martha Stout, author of The Sociopath Next Door on the Living Hero podcast, November 2010.
- "Into the Abyss." Article on street crime referencing the roots and consequences of sociopathic behavior
- DSM IV-TR Criteria for Antisocial personality disorder
- Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion
- Recent Studies Implicate Slow Monoamine Oxidase Enzyme/High Circulating T3 in Antisocial Behavior/Aggression/Violence 2007
- Aftermath: Surviving Psychopathy Foundation(Official Website)