Antisocial personality disorder

Antisocial personality disorder
Specialty	Psychiatry, psychology

Antisocial personality disorder (APD) is a psychiatric condition characterized by an individual's common disregard for social rules, norms, and cultural codes, as well as impulsive behavior, and indifference to the rights and feelings of others. Antisocial personality disorder is terminology used by the American Psychiatric Association's Diagnostic and Statistical Manual, while the World Health Organization's ICD-10 refers to Dissocial personality disorder.

Antisocial personality disorder is often misunderstood by both professionals and laypeople. The term antisocial is often, incorrectly, confused with unsociable or shy.

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 18 years of age.
• 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."

Sex differences: APD is diagnosed much more frequently in men than in women. The DSM-IV diagnostic criteria does not take into account relational aggression, in which women are more likely to engage than physical aggression.

Causes

The cause of this disorder is unknown, but biological or genetic factors may play a role.

A family history of the disorder — such as having an antisocial parent — increases the chances of developing the condition. A number of environmental factors within the childhood home, school and community, such as an overly punitive home or school environment may also contribute.

Robins (1966) found an increased incidence of sociopathic characteristics and alcoholism in the fathers of individuals with antisocial personality disorder. He found that, within such a family, males had an increased incidence of APD, whereas females tended to show an increased incidence of somatization disorder instead.

Bowlby (1944) saw a connection between antisocial personality disorder and maternal deprivation in the first five years of life. Glueck and Glueck (1968) saw indications that the mothers of children who developed this personality disorder tended to display a lack of consistent discipline and affection, and an abnormal tendency to alcoholism and impulsiveness. These factors all contribute to a failure to create a stable and functional home with consistent structure and behavioral boundaries.

Adoption studies support the role of both genetic and environmental contributions to the development of the disorder. Twin studies also indicate an element of hereditability of antisocial behaviour in adults and have shown that genetic factors are more important in adults than in antisocial children or adolescents where shared environmental factors are more important. (Lyons et al., 1995)

Symptoms

Common characteristics of people with antisocial personality disorder include:

• Persistent lying or stealing
• Recurring difficulties with the law
• Tendency to violate the rights and boundaries of others (property, physical, sexual, emotional, legal)
• Substance abuse
• Aggressive, often violent behavior; prone to getting involved in fights
• A persistent agitated or depressed feeling (dysphoria)
• Inability to tolerate boredom
• Disregard for the safety of self or others
• A childhood diagnosis of conduct disorders
• Lack of remorse for hurting others
• Superficial charm
• Impulsiveness
• A sense of extreme entitlement
• Inability to make or keep friends
• Lack of guilt
• Recklessness, impulsivity

People who have antisocial personality disorder often experience difficulties with authority figures.

Prevalence

The National Comorbidity Survey, which used DSM-III-R criteria, found that 5.8 percent of males and 1.2 percent of females showed evidence of a lifetime risk for the disorder. In penitentiaries, the percentage is estimated to be as high as 75 percent. Prevalence estimates within clinical settings have varied from three to 30 percent, depending on the predominant characteristics of the populations being sampled. {Diagnostic and Statistical Manual of Mental Disorders} Perhaps not surprisingly, the prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders) (Hare 1983). 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.

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).

Potential markers

Although antisocial personality disorder cannot be formally diagnosed before age 18, three markers for the disorder, known as the MacDonald Triad, can be found in some children. These are, a longer-than-usual period of bedwetting, cruelty to animals, and pyromania.

It is not known how many children who exhibit these signs grow up to develop antisocial personality disorder, but these signs are often found in the histories of diagnosed adults. Because it is unknown how many children have these symptoms and who do not develop antisocial personality disorder, the predictive value (ie, the usefulness of these symptoms for predicting future antisocial personality disorder) is unclear.

These three traits are now included in the Diagnostic and Statistical Manual of Mental Disorders IV-TR under conduct disorder.

A child who shows signs of antisocial personality disorder may be diagnosed as having either conduct disorder or oppositional defiant disorder. Not all of these children, however, will grow up to develop antisocial personality disorder.

See also

• Attachment theory
• Attachment disorder

External links

• "Into the Abyss." Article on street crime referencing the roots and consequences of sociopathic behavior
• DSM IV-TR Criteria for Antisocial personality disorder
• The Sociobiology of Antisocial personality disorder
• Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion
• Profile of the Sociopath
• Dopaminergic and Serotinergic Pathways Implicated in Antisocial Disorder
• Antisocial Personality Disorder Differs from Psychopathy
• Antisocial personality, Sociopathy, and psychopathy North Carolina Wesleyan College, 2005
• http://jrc.sagepub.com/cgi/content/abstract/28/2/227 Recent Studies Implicate Slow Monoamine Oxidase Enzyme/High Circulating T3 in Antisocial Behavior/Aggression/Violence 2007
• http://wiki.answers.com/Q/Who_gave_antisocial_personality_disorder_its_name Theories on Chemical Pathways