Antisocial personality disorder

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Dissocial personality disorder

ICD-10	F60.2
ICD-9	301.7
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Antisocial personality disorder (APD or ASPD) is a psychiatric diagnosis that interprets antisocial and impulsive behaviours as symptoms of a personality disorder. Psychiatry defines only pathological antisocial behavior; it does not address potential benefits of positive antisocial behavior or define the meaning of 'social' in contrast to 'antisocial'.

Professional psychiatry generally compares APD to sociopathy and psychopathic disorders (not to be confused with psychosis). Approximately 3% of men and 1% of women are thought to have some form of antisocial personality disorder according to DSM-IV.

Characteristics/symptoms

A common misconception is that many of the individuals diagnosed with antisocial personality disorder can be found in prisons. It should be noted that criminal activity does not automatically warrant a diagnosis of antisocial personality disorder, nor does a diagnosis of antisocial personality disorder imply that a person is a criminal. It is hypothesized that many high achievers exhibit antisocial personality disorder characteristics. This, however, brings much criticism upon the diagnostic criteria specified for those exhibiting antisocial personality disorder and the PCL-R. Both of these tests depend upon the person in question being a criminal or having participated in criminal activities.

Research has shown that individuals with antisocial personality disorder are indifferent to the possibility of physical pain or many punishments, and show no indications that they experience fear when so threatened; this may explain their apparent disregard for the consequences of their actions, and their lack of empathy to the suffering of others.

Central to understanding individuals diagnosed with antisocial personality disorder is that they do not appear to experience true human emotions, or at least, they do not appear to experience a full range of human emotions. This can explain the lack of empathy for the suffering of others, since they cannot experience emotion associated with either empathy or suffering. Risk-seeking behavior and substance abuse may be attempts to escape feeling empty or emotionally void. The rage exhibited by psychopaths and the anxiety associated with certain types of antisocial personality disorder may represent the limit of emotion experienced, or there may be physiological responses without analogy to emotion experienced by others.

One approach to explaining antisocial personality disorder behaviors is put forth by sociobiology, a science that attempts to understand and explain a wide variety of human behavior based on evolutionary biology. One route to doing so is by exploring evolutionarily stable strategies; that is, strategies that being successful will tend to be passed on to the next generation, thus becoming more common in the gene pool. For example, in one well-known 1995 paper by Linda Mealey, chronic antisocial/criminal behavior is explained as a combination of two such strategies.

According to the older theory of Freudian psychoanalysis, a sociopath has a strong id and ego that overpowers the superego. The theory proposes that internalized morals of our unconscious mind are restricted from surfacing to the ego and consciousness.

Establishing the diagnosis

Antisocial personality disorder and the closely related construct of psychopathy can be assessed and diagnosed through clinical interview, self-rating personality surveys, and ratings from coworkers and family. For diagnosing psychopathy in forensic male populations, the Psychopathy Checklist-Revised (PCL-R) is considered definitive.

Diagnostic criteria (DSM-IV-TR)

The Diagnostic and Statistical Manual of Mental Disorders, a widely used manual for diagnosing mental and behavioral disorders (see also: DSM cautionary statement), defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

The manual lists the following additional necessary criteria:

• The individual is at least age 18 years.
• There is evidence of conduct disorder with onset before age 15 years.
• The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.

Criticism of the DSM-IV criteria

The DSM-IV confound: some argue that an important distinction has been lost by including both sociopathy and psychopathy together under APD. As Hare et al write in their abstract, "The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions", concluding, "... conceptual and empirical arguments exist for evaluating alternative approaches to the assessment of psychopathy ... our hope is that the information presented here will stimulate further research on the comparative validity of diagnostic criteria for psychopathy; although too late to influence DSM-IV." [1]

Diagnostic criteria (ICD-10)

Chapter V of the tenth revision of the International Classification of Diseases offers a set of criteria for diagnosing the related construct of dissocial personality disorder.

Dissocial Personality Disorder (F60.2), usually coming to attention because of a gross disparity between behaviour and the prevailing social norms, and characterized by:

• callous unconcern for the feelings of others;
• gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations;
• incapacity to maintain enduring relationships, though having no difficulty in establishing them;
• very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
• incapacity to experience guilt or to profit from experience, particularly punishment;
• marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society.

There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.

Relationship with other mental disorders

Antisocial Personality Disorder is negatively correlated with all DSM-IV Axis I disorders except substance-abuse disorders. Antisocial Personality Disorder is most strongly correlated with Psychopathy as measured on the Psychopathy Checklist-Revised (PCL-R).

Portrayal in fiction

Antisocial Personality Disorder is often portrayed in popular fiction and movies as the "monster with a soul". The prerequisites are simple. The character must begin life as a relatively normal child in adverse circumstances that drive him, or her, inexorably towards a path of remorseless evil.

Heathcliffe from Emily Brontë's Wuthering Heights might be considered an early example, as might a whole battery of the Victorian "anti-heroes" and "anti-heroines" of Thomas Hardy, whose novels show a preoccupation with the degeneration of his characters into moral or actual ruin, notably Tess of the d'Urbervilles and The Mayor of Casterbridge. Slightly later in France, Emile Zola's Les Rougon-Macquart series of novels, from the Belle Époque contains many similar characters not least being Nana whose descent into vice and destructive behavior is chronicled first in L'Assommoir and then in Nana.

Joan Crawford's character in the 1941 movie A Woman's Face could almost be considered a stereotype for Antisocial Personality Disorder.

Matt Groening takes a more comedic view on antisocial personality disorder with his character Moe Szyslak from the animated comedy The Simpsons. This character has been called sociopathic, depressed, and has homicidal and suicidal tendencies.

A more recent example would be Ralph Fiennes remarkably sensitive and sympathetic portrayal of serial killer Francis Dolarhyde in Thomas Harris' Red Dragon. Similarly the character of Buffalo Bill from The Silence of the Lambs could be considered to have Antisocial Personality Disorder along with some other, far more complex, problems. Even the character of Hannibal Lecter himself, as suggested, with flawed hindsight, in the later novel Hannibal and (purportedly) to be portrayed in the soon to be published Behind the Mask, could be considered to suffer from Antisocial Personality Disorder rather than "a pure psychopath" as hospital's administrator, Frederick Chilton states in The Silence of the Lambs. Lord Voldemort in Harry Potter may be another example.

Angelina Jolie's character, Lisa, in the film Girl, Interrupted is actually diagnosed as a sociopath, but, in the end, we are left wondering just how valid that diagnosis might have been. Antisocial personality disorder would seem more appropriate.

Alec Baldwin's character, Fred Frenger, in the film Miami Blues exhibits many anti-social, sociopathic, and psychopathic tendencies. He compulsively cheats, lies, steals, cons, and kills - with very little planning and no remorse.

Potential warning signs

Though Antisocial personality disorder cannot be formally diagnosed before age 18, three warning signs, known as the MacDonald Triad, can be found in some children. These are:

• a longer-than-usual period of bedwetting
• cruelty to animals
• pyromania.

Obviously, not all children who exhibit these signs grow up develop anti-social personality disorder, but these signs are found in significantly higher proportions than in the general population.

A child who shows signs of anti-social personality disorder will be diagnosed as having either conduct disorder or oppositional defiant disorder. Not all of these children will grow up to develop anti-social personality disorder.

See also

• Conduct disorder
• Psychopathy Checklist-Revised (PCL-R)
• Crime
• Histrionic personality disorder
• Narcissistic personality disorder
• Oppositional defiant disorder
• Psychopathy
• Sadistic personality disorder

References

• Cooke D. J., Michie C. "Refining the construct of psychopathy: Towards a hierarchical model." Psychological Assessment 13 (2): 171-188, 2001.

• Petronix., "The Sociopathic Bible." E-Book, Sociopathic.net, 1-26, 2005.

External links

• Sociopathic and Psychopathic Development at Sociopathic.net
• Definition from PsychCentral.com
• Another opinion
• The Sociobiology of Sociopathy, Mealey, 1995
• Antisocial personality disorders frequent in 'core' STI transmitters, says US study
• The Depressive and the Psychopath--Slate investigation into Columbine killers
• USC Study Finds "Faulty Wiring" In Psychopaths
• Mental Health Matters: Antisocial Personality Disorder
• The Sociopathic or Psychopathic Personality Disorder
• Antisocial Personality Disorder in serial killers
• Antisocial personality, Sociopathy, and Psychopathy

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