Antisocial personality disorder

"ASPD" redirects here. For the sleep disorder, see Advanced sleep phase disorder. For the former trade union, see Amalgamated Society of Painters and Decorators.
Antisocial personality disorder
Classification and external resources
Specialty psychiatry
ICD-10 F60.2
ICD-9-CM 301.7
MedlinePlus 000921
Patient UK Antisocial personality disorder
MeSH D000987

Antisocial personality disorder, or dissocial personality disorder (also known as psychopathy or sociopathy) is a personality disorder, characterized by a pervasive pattern of disregard for, or violation of, the rights of others. An impoverished moral sense or conscience is often apparent, as well as a history of crime, legal problems, and/or impulsive and aggressive behavior.[1]

Antisocial personality disorder (ASPD) is the name of the disorder as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Dissocial personality disorder (DPD) is the name of a similar or equivalent concept defined in the International Statistical Classification of Diseases and Related Health Problems (ICD), where it states that the diagnosis includes antisocial personality disorder. Both manuals have similar but not identical criteria for diagnosing the disorder.[2] Both have also stated that their diagnoses have been referred to, or include what is referred to, as psychopathy or sociopathy, but distinctions have been made between the conceptualizations of antisocial personality disorder and psychopathy, with many researchers arguing that psychopathy is a disorder that overlaps with but is distinguishable from ASPD.[3][4][5][6][7]

Diagnosis

DSM IV-TR

The APA's Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR), defines antisocial personality disorder (Cluster B):[8]

A) 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. deception, as indicated by repeatedly 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 consistent work behavior or honor financial obligations;
  7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
B) The individual is at least age 18 years.
C) There is evidence of conduct disorder with onset before age 15 years.
D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.

Antisocial Personality Disorder (ASPD) falls under the dramatic/erratic cluster of personality disorders, the so-called "Cluster B."

ICD-10

The WHO's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), has a diagnosis called dissocial personality disorder (F60.2):[9][10]

It is characterized by at least 3 of the following:
  1. Callous unconcern for the feelings of others;
  2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
  3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
  4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
  5. Incapacity to experience guilt or to profit from experience, particularly punishment;
  6. Marked readiness to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.

The ICD states that this diagnosis includes "amoral, antisocial, asocial, psychopathic, and sociopathic personality". Although the disorder is not synonymous with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature.[10][11]

It is a requirement of the ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.[10]

Further considerations

Psychopathy

Main article: Psychopathy

Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for remorse, and poor behavioral controls.[7][12][13][14] Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL-R).[15] "Psychopathy" is not the official title of any diagnosis in the DSM or ICD, but both have stated that their diagnoses have been referred to (or include what is referred to) as psychopathy or sociopathy.[7][9][14][16][17]

American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM has stated that ASPD has also been referred to as psychopathy.[3][7] However, critics have argued that ASPD is not synonymous with psychopathy as the diagnostic criteria are not exactly the same, since criteria relating to personality traits are emphasized relatively less in the former. These differences exist in part because it was believed that such traits were difficult to measure reliably and it was "easier to agree on the behaviors that typify a disorder than on the reasons why they occur".[3][4][5][6][7]

Although the diagnosis of ASPD covers two to three times as many prisoners than the diagnosis of psychopathy, Robert Hare believes that the PCL-R is better able to predict future criminality, violence, and recidivism than a diagnosis of ASPD.[3][4] He suggests that there are differences between PCL-R-diagnosed psychopaths and non-psychopaths on "processing and use of linguistic and emotional information", while such differences are potentially smaller between those diagnosed with ASPD and without.[4][5] Additionally, Hare argued that confusion regarding how to diagnose ASPD, confusion regarding the difference between ASPD and psychopathy, as well as the differing future prognoses regarding recidivism and treatability, may have serious consequences in settings such as court cases where psychopathy is often seen as aggravating the crime.[4][5]

Nonetheless, psychopathy has been proposed as a specifier under an alternative model for ASPD. In the DSM-5, under "Alternative DSM-5 Model for Personality Disorders", ASPD with psychopathic features is described as characterized by "a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviors (e.g., fraudulence)." Low levels of withdrawal and high levels of attention-seeking combined with low anxiety are associated with "social potency" and "stress immunity" in psychopathy.[18]:765 Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components.[19]

Theodore Millon's subtypes

Theodore Millon suggested 7 subtypes of ASPD. However, none of these are recognized in the DSM or ICD.[20][21]

Subtype Features Description
Nomadic (including schizoid and avoidant features) Feels jinxed, ill-fated, doomed, and cast aside; peripheral, drifters; gypsy-like roamers, vagrants; dropouts and misfits; itinerant vagabonds, tramps, wanderers; impulsively not benign. Although the most widely held impression is that antisocials are incorrigible criminals who undermine the values of the surrounding culture, some seek simply to run away from a society in which they feel unwanted, cast aside, or abandoned. Although most antisocials react antagonistically to social rejection, these individuals drift along at the margins of society, scavenging whatever slim resources they come across. The nomadic variant combines antisocial with schizoid and/or avoidant characteristics. Most see themselves as jinxed or doomed and desire only to exist at the edge of a world that would almost certainly reject them. Mired in self-pity, they drop out of society to become gypsy-like roamers, vagabonds, or wanderers. With little regard for their personal safety or comfort, they may drift from one setting to another as homeless persons involved in prostitution and substance abuse. Adopted children who feel uneasy about their place in the world sometimes follow the path of the nomadic antisocial, wandering from place to place in an apparently symbolic search for their true home or natural parents. Their sense of “being no place” signifies alienation from self and others. For this reason, nomadics often appear vaguely disconnected from reality and lack any clear sense of self-identity. Compared to other variants, nomadic antisocials often seem relatively harmless because of their attitude of indifference and disengagement. Some are indeed vacant and fearful, but others are deeply angry and resentful. As a consequence of alcohol or substance abuse, they may act out impulsively, discharging their frustrations in brutal assaults or sexual attacks on those weaker than themselves.
Malevolent (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless. As a blend of the antisocial and paranoid or sadistic personalities, malevolent antisocials are often seen as the least attractive antisocials. Belligerent, rancorous, vicious, malignant, brutal, callous, vengeful, and vindictive, they perform actions charged with a hateful and destructive defiance of conventional social life. Like the paranoid, they anticipate betrayal and punishment. Rather than merely issue verbal threats, however, they seek to secure their boundaries with a cold-blooded ruthlessness that avenges every mistreatment they believe others have inflicted on them in the past. For them, tender emotions are a sign of weakness. They interpret the goodwill and kindness of others as hiding a deceptive ploy for which they must always be on their guard. Where sadistic traits are prominent, they may display a chip-on-the-shoulder attitude and a willingness to con- firm their strong self-image by victimizing those too weak to retaliate or those whose terror might prove particularly entertaining. When confronted with displays of strength, malevolents are experts at the art of posturing and enjoy pressuring their opponents until they cower and withdraw. Most make few concessions and instead escalate confrontations as far as necessary, backing down only when clearly outgunned.
Covetous (variant of "pure" pattern) Feels intentionally denied and deprived; rapacious, begrudging, discontentedly yearning; envious, seeks retribution, and avariciously greedy; pleasure more in taking than in having. The covetous antisocial is a variant resembling a “pure” prototypal pattern. Here, ag- grandizement, the desire to possess and dominate, is seen in a distilled form. These individuals feel that life has not given them “their due”; they have been deprived of their rightful amount of love, support, or material reward; and others have received more than their share. Jealous of those who have received the bounty of a good life, they are driven by an envious desire for retribution to take what destiny has refused them. Whether through deceit or destruction, their goal is compensation for the emptiness of life, rationalized by the assertion that they alone can restore the imbal- ance fated to them. Seething with anger and resentment, their greatest pleasure lies in taking control of the property and possessions of others. Some are overtly criminal. Many possess an enormous drive for revenge, manipulating others like pawns in a power game. Regardless of their success, however, covetous antisocials usually remain insecure about their power and status, never feeling that they’ve been compensated for life’s impoverishments. Ever jealous and envious, pushy and greedy, they may make ostentatious or wasteful displays of materialism and conspicuous consumption such as buying exotic cars, mansions, and elaborate jewelry as a means of exhibiting their power and achievements to others. Most feel a deep sense of emptiness, juxtaposed with vague images of how different life might have been had opportunity blessed them, as it has so many others. Some are simple thieves, while others become manipulative entrepreneurs who exploit people as objects to satisfy their desires. Although they have little compassion for or guilt about the effects of their behavior, they never feel that they have acquired quite enough, never achieve a sense of contentment, and feel unfulfilled regardless of their successes, remaining forever dissatisfied and insatiable.
Risk-taking (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, impulsive, heedless; unbalanced by hazard; pursues perilous ventures. Minor risk taking within a controlled environment provides a normal outlet for excitement and sensation seeking; many people love a roller coaster, for example. However, there are individuals for whom risk taking is intended to impress others with a front of courageous indifference to potentially painful consequences. Risk-taking antisocials, who combine antisocial and histrionic traits, wish others to see them as unaffected by what almost anyone else would surely experience as dangerous or frightening. While others shrink in fear, they are unfazed by the possibility of gambling with death or serious injury. Risk is proactively sought as its own reward, a means of feeling stimulated and alive, not a means of material gain. Although their pretense is being dauntless, intrepid, and bold, their hyperactive search for hazardous challenges is seen by neurotypical individuals as foolhardy, if not stupid. In effect, they are thrill seekers infatuated by the opportunity to test their mettle by performing for the attention, applause, and amazement of an audience. Otherwise, they would simply feel trapped by the responsibility and boredom of everyday life. The most important factors making them antisocial is the irresponsibility of their actions and their failure to consider the consequences for their own life, or the lives of others, as they pursue ever more daring challenges.
Reputation-defending (including narcissistic features) Needs to be thought of as infallible, unbreakable, invincible, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Not all antisocials covet material possessions or power. Those who share traits with the narcissistic personality are motivated by the desire to defend and extend a reputation of bravery and toughness. Antisocial acts are designed to ensure that others notice them and accord them the respect that they deserve. As such, they are perpetually on guard against the possibility of belittlement. Society should know that the reputation- defending antisocial is someone significant, not to be easily dismissed, treated with indifference, taken lightly, or pushed around. Whenever their status or ability is slighted, they may erupt with ferocious intensity, posturing, and threatening until their rivals back down. Some reputation-defending antisocials are loners, some are involved in adolescent gang activities, and still others simply seek to impress peers with aggressive acts of leadership or violence that secure their status as the alpha male, the dominant member of the pack. Being tough and assertive is essentially a defensive act intended to prove their strength and guarantee a reputation of indomitable courage.
Unprincipled (including narcissistic features) Deficient conscience; unscrupulous, amoral, disloyal, fraudulent, deceptive, arrogant, exploitative; a conman and charlatan; dominating, contemptuous, vindictive. Unprincipled narcissists combine the self-confidence of the narcissist with the recur- rent aberrant behavior of antisocial personality patterns. Many of these individuals achieve success in society by exploiting legal boundaries to the verge of unlawfulness. Others may inhabit drug rehabilitation programs, centers for youth offenders, and jails and prisons. Still others are opportunists and con men, who take advantage of others for personal gain. Most people who demonstrate a pattern combining these styles are vindictive and contemptuous of their victims. Whereas many narcissists have normal super- ego development, unprincipled narcissists are skilled in the ways of social influence but have few internalized moral prohibitions. They are experienced by others as unscrupulous, amoral, and deceptive. More than merely disloyal and exploitative, these narcissists show a flagrant indifference to the welfare of others, a willingness to risk harm, and fearlessness in the face of threats and punitive action. Vengeful gratification is often ob- tained by humiliating and dominating others. Joy is obtained by gaining the trust of others and then outwitting or swindling them. Their attitude is that those who can be taken advantage of deserve it. Because they are focused on their own self-interest, unprincipled narcissists are in- different to the truth. If confronted, they are likely to display an attitude of justified innocence, denying their behavior through a veneer of politeness and civility. If obviously guilty, they are likely to display an attitude of nonchalance or cool strength, as if the vic- tim were to blame for not having caught on sooner. To them, achievement deficits and social irresponsibility are justified by expansive fantasies and frank lies. Those who dis- play more antisocial traits may put up a tough, arrogant, and fearless front, acting out their malicious tendencies and producing frequent family difficulties and occasional legal entanglements. Relationships survive only as long as the narcissist has something to gain. So strong is their basic narcissism and desire to exploit others that people may be dropped from their lives with complete indifference to the anguish they might experience or how their lives will be affected. In many ways, the unprincipled narcissist is similar to the disingenuous histrionic (a combination of histrionic and antisocial pat- terns; see Chapter 9). The unprincipled narcissist preys on the weak and vulnerable, en- joying their dismay and anger. In contrast, the disingenuous histrionic seeks to hold the respect and affection of those they dismiss in their pursuit of love and admiration.
Tyrannical (including negativistic and sadistic features) Relishes menacing and brutalising others, forcing them to cower and submit; verbally cutting and scratching, accusatory and destructive; intentionally surly, abusive, inhumane, unmerciful. The tyrannical sadist and the malevolent antisocial are perhaps the most frightening and cruel of the personality disorder subtypes. Some are physically violent, whereas others overwhelm their victims by unrelenting criticism, forceful anger, and vulgar and bitter tirades. Tyrannical sadists seem to relish the act of menacing and brutalizing others in the most unmerciful and inhumane ways. More than any other personality, they derive a deep satisfaction from creating suffering, observing its effects, and reflecting on their actions. Violence may be employed intentionally to inspire terror and intimidation. Resistance only seems to stimulate them more. Often calculating and cool, tyrannical sadists are selective in their choice of victims, identifying scapegoats who are easily intimidated and unlikely to react with violence in return. Frequently, their goal is not only to inflict terror but also to impress the audience with their total, unre- strained power. Most intentionally dramatize their surly behavior. Although these indi- viduals are in many respects the purest form of the psychopathic sadist, they also exhibit characteristics of the negativistic or paranoid personalities.
Spineless (including avoidant personality disorder features) Basically Insecure, bogus, Spineless, venomous dominance is counterphobic, public swaggering, selects powerless scapegoats, is diminished with group support Not all sadists are intrinsically dominant, cruel, and vicious like the tyrannical and enforcing subtypes. Some are deeply insecure, even cowardly. Spineless sadists are a combination of the avoidant and sadistic personalities; their private world is peopled by aggressive and powerful enemies. Attack can only be forestalled by creating an image of strength, a sense of mutual ensured destruction. For spineless sadists, aggressive hostility is a counterphobic act, designed to master their own inner fearfulness, while sending a message of strength to the public that they will not be intimidated. Displays of courage serve to divert and impress the audience with a façade of potency that says, “I will not be pushed around.” Neither naturally mean-spirited nor intrinsically violent, the spineless sadist caricatures the swaggering tough-guy or petty tyrant. Having been repeatedly subject to physical brutality and intimidation, these individuals have learned to employ aggression instrumentally against others who seem threatening and abusive. Fearful of real danger, they strike first, hoping to induce a measure of fearfulness that forestalls further antagonisms. Many spineless sadists join groups that search for a shared scapegoat, a people or ethnic population set aside by the majority culture as a receptacle for hate and prejudice.

Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk-taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special ... Taxonomies may be put forward at levels that are more coarse or more fine-grained."[22]

Comorbidity

The following conditions commonly coexist with ASPD:[23]

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[24]

Causes and pathophysiology

Personality disorders seem to be caused by a combination of these genetic and environmental influences. Genetically, it is the temperament and the kind of personality a person is born with, and environmentally, it is the way in which a person grows up and the experiences they have had.[25]

Hormones and neurotransmitters

Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development.[26] Aggressiveness and impulsivity are among the possible symptoms of ASPD. Testosterone is a hormone that plays an important role in aggressiveness in the brain.[27] For instance, criminals who have committed violent crimes tend to have higher levels of testosterone than the average person.[27] The effect of testosterone is counteracted by cortisol which facilitates the cognitive control on impulsive tendencies.[27]

One of the neurotransmitters that have been discussed in individuals with ASPD is serotonin, also known as 5HT.[26] A meta-analysis of 20 studies found significantly lower 5-HIAA levels (indicating lower serotonin levels), especially in those who are younger than 30 years of age.[28]

J.F.W. Deakin of University of Manchester's Neuroscience and Psychiatry Unit has discussed additional evidence of a connection between 5HT (serotonin) and ASPD. Deakin suggests that low cerebrospinal fluid concentrations of 5-HIAA, and hormone responses to 5HT, have displayed that the two main ascending 5HT pathways mediate adaptive responses to post and current conditions. He states that impairments in the posterior 5HT cells can lead to low mood functioning, as seen in patients with ASPD. It is important to note that the dysregulated serotonergic function may not be the sole feature that leads to ASPD but it is an aspect of a multifaceted relationship between biological and psychosocial factors.

While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5HT metabolism but may be the most essential psychopathological aspect linked with such dysfunction.[29] Correspondingly, the DSM classifies "impulsivity or failure to plan ahead" and "irritability and aggressiveness" as two of seven sub-criteria in category A of the diagnostic criteria of ASPD.[8]

Some studies have found a relationship between monoamine oxidase A and antisocial behavior, including conduct disorder and symptoms of adult ASPD, in maltreated children.

Limbic neural maldevelopment

Cavum septi pellucidi (CSP) is a marker for limbic neural maldevelopment, and its presence has been loosely associated with certain mental disorders, such as schizophrenia and post-traumatic stress disorder.[30][31][32] One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.[32]

Cultural influences

The socio-cultural perspective of clinical psychology views disorders as influenced by cultural aspects; since cultural norms differ significantly, mental disorders such as ASPD are viewed differently.[33] Robert D. Hare has suggested that the rise in ASPD that has been reported in the United States may be linked to changes in cultural mores, the latter serving to validate the behavioral tendencies of many individuals with ASPD.[34] While the rise reported may be in part merely a byproduct of the widening use (and abuse) of diagnostic techniques,[35] given Eric Berne's division between individuals with active and latent ASPD – the latter keeping themselves in check by attachment to an external source of control like the law, traditional standards, or religion[36] – it has been plausibly suggested that the erosion of collective standards may indeed serve to release the individual with latent ASPD from their previously prosocial behavior.[37]

There is also a continuous debate as to the extent to which the legal system should be involved in the identification and admittance of patients with preliminary symptoms of ASPD.[38]

Environment

Some studies suggest that the social and home environment has contributed to the development of antisocial behavior.[39] The parents of these children have been shown to display antisocial behavior, which could be adopted by their children.[39]

Head injuries

Researchers have linked physical head injuries with antisocial behavior.[40][41][42] Since the 1980s, scientists have associated traumatic brain injury, including damage to the prefrontal cortex, with an inability to make morally and socially acceptable decisions.[40][42] Children with early damage in the prefrontal cortex may never fully develop social or moral reasoning and become "psychopathic individuals ... characterized by high levels of aggression and antisocial behavior performed without guilt or empathy for their victims."[40][41] Additionally, damage to the amygdala may impair the ability of the prefrontal cortex to interpret feedback from the limbic system, which could result in uninhibited signals that manifest in violent and aggressive behavior.[40]

Treatment

ASPD is considered to be among the most difficult personality disorders to treat.[43][44] Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.[43] They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment.[45] Studies have shown that outpatient therapy is not likely to be successful, however the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.[46]

Those with ASPD may stay in treatment only as required by an external source, such as a parole. Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended.[43] There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.[47] Schema therapy is also being investigated as a treatment for ASPD.[48] A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However this treatment requires complete cooperation and participation of all family members.[49] Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance abuse,[50] although others have reported contradictory findings.[51]

Therapists of individuals with ASPD may have considerable negative feelings toward clients with extensive histories of aggressive, exploitative, and abusive behaviors.[43] Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those afflicted with this disorder may limit the effectiveness of even this form of therapy.[52]

No medications have been approved by the FDA to treat ASPD, although certain psychiatric medications may alleviate conditions sometimes associated with the disorder and with symptoms such as aggression, including antipsychotic, antidepressant or mood-stabilizing medications.[53] Antidepressants, specifically the tricyclic antidepressant, Nortriptyline has been found to help treat individuals with ASPD and substance abuse problems.[54] Additionally, the anticonvulsant Phenytoin has been found to lessen impulsivity and aggressiveness individuals with ASPD.[54]

Prognosis

According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience, "childhood hyperactivity and conduct disorder showed equally strong prediction of antisocial personality disorder (ASPD) and criminality in early and mid-adult life. Lower IQ and reading problems were most prominent in their relationships with childhood and adolescent antisocial behaviour."[55]

Epidemiology

ASPD is seen in 3% to 30% of psychiatric outpatients.[23] The prevalence of the disorder is even higher in selected populations, like prisons, where there is a preponderance of violent offenders.[56] A 2002 literature review of studies on mental disorders in prisoners stated that 47% of male prisoners and 21% of female prisoners had ASPD.[57] 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.[58]

A University of Colorado Colorado Springs study comparing personality disorders and Myers-Briggs Type Indicator types found that the disorder had a significant correlation with the Intuitive (N), Thinking (T), and Perceiving (P) preferences.[59]

History

The first version of the DSM in 1952 listed sociopathic personality disturbance. Individuals to be placed in this category were said to be "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals". There were four subtypes, referred to as "reactions"; antisocial, dyssocial, sexual and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge.

The DSM-II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize.[60] The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM-II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.[61]

The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up".[62] However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.[63]

The DSM-IV maintained the trend for behavioral antisocial symptoms while noting "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".[19]

See also

References

  1. ↑ "Overview - Antisocial personality disorder - Mayo Clinic". www.mayoclinic.org. Retrieved 12 April 2016.
  2. ↑ David P. Farrington, Jeremy Coid (16 June 2003). Early Prevention of Adult Antisocial Behavior. Cambridge University Press. p. 82. ISBN 978-0-521-65194-3. Retrieved 12 January 2008.
  3. 1 2 3 4 Patrick, Christopher (2005). Handbook of Psychopathy. Guilford Press. ISBN 9781606238042. Retrieved 18 July 2013.
  4. 1 2 3 4 5 "Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion". Robert D. Hare, PhD Psychiatric Times. Vol. 13 No. 2. 1 February 1996.
  5. 1 2 3 4 Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (PDF).
  6. 1 2 Semple, David (2005). The Oxford Handbook of Psychiatry. USA: Oxford University Press. pp. 448–449. ISBN 0-19-852783-7.
  7. 1 2 3 4 5 Skeem, J. L.; Polaschek, D. L. L.; Patrick, C. J.; Lilienfeld, S. O. (15 December 2011). "Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy". Psychological Science in the Public Interest 12 (3): 95–162. doi:10.1177/1529100611426706.
  8. 1 2 American Psychiatric Association (2000). "Diagnostic criteria for 301.7 Antisocial Personality Disorder". BehaveNet. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Retrieved 8 July 2013.
  9. 1 2 Dissocial personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  10. 1 2 3 WHO (2010)ICD-10: Clinical descriptions and diagnostic guidelines: Disorders of adult personality and behavior
  11. ↑ "F60.2 Dissocial personality disorder". World Health Organization. Retrieved 12 January 2008.
  12. ↑ R. James R. Blair. "Neurobiological basis of psychopathy". Retrieved 15 May 2013.
  13. ↑ Merriam-Webster Dictionary. "Definition of psychopathy". Retrieved 15 May 2013.
  14. 1 2 Encyclopedia of Mental Disorders. "Hare Psychopathy Checklist". Retrieved 15 May 2013.
  15. ↑ Hare, R. D. (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems.
  16. ↑ American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision
  17. ↑ World Health Organization (1992). International Statistical Classification of Diseases and Related Health Problems-10th revision
  18. ↑ Kupfer, David; Regier, Darrell, eds. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC and London, England: American Psychiatric Publishing (accessed on Google Play). ISBN 0890425558.
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