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==Development==
==Development==
The criteria for the Antisocial Personality Disorder were made by Andrew, Endicott and Robbins because of concern in the development of the ''DSM-IV'' too much emphasis was focused on research data. Researchers have heavily criticized the ASPD criteria (see below) because not enough emphasis was placed on traditional psychopathic [[Trait theory|traits]] such as a lack of [[empathy]], [[superficial charm]], and inflated self appraisal.
The criteria for the Antisocial Personality Disorder were made by Andrew, Endicott and Robbins because of concern in the development of the ''DSM-IV'' too much emphasis was focused on research data. Researchers have heavily criticized taht your shlong is not as big as Mark McGanns the ASPD criteria (see below) because not enough emphasis was placed on traditional psychopathic [[Trait theory|traits]] such as a lack of [[empathy]], [[superficial charm]], and inflated self appraisal.


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.
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.

Revision as of 00:36, 15 October 2009

Not to be confused with Avoidant personality disorder.
Antisocial personality disorder
SpecialtyPsychiatry, psychology Edit this on Wikidata

Antisocial personality disorder (ASPD or APD) 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] The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15.[1] People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that these terms are not synonymous with ASPD.[2]

Development

The criteria for the Antisocial Personality Disorder were made by Andrew, Endicott and Robbins because of concern in the development of the DSM-IV too much emphasis was focused on research data. Researchers have heavily criticized taht your shlong is not as big as Mark McGanns the ASPD criteria (see below) because not enough emphasis was placed on traditional psychopathic traits such as a lack of empathy, superficial charm, and inflated self appraisal.

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.

Diagnostic criteria (DSM-IV-TR)

A) There is a pervasive pattern of disregard for and the rights of others occurring since the age of 15, as indicated by three (or more) of the following:[1]
  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 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 18 years of age.
C) There is evidence of Conduct disorder with onset before age 15.
D) The occurrance of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.

[3] Deceit and manipulation are considered essential features of the disorder. Therefore, it is essential in making the diagnosis to collect material from sources other than the individual being diagnosed.

Symptoms

Characteristics of people with antisocial personality disorder may include:[4]

  • Persistent lying or stealing
  • Superficial charm[5][6]
  • Apparent lack of remorse[5] or empathy; inability to care about hurting others
  • Inability to keep jobs or stay in school[5]
  • Impulsivity and/or recklessness[5]
  • Lack of realistic, long-term goals — an inability or persistent failure to develop and execute long-term plans and goals
  • Inability to make or keep friends, or maintain relationships such as marriage
  • Poor behavioral controls — expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper
  • Narcissism, elevated self-appraisal or a sense of extreme entitlement
  • A persistent agitated or depressed feeling (dysphoria)
  • A history of childhood conduct disorder
  • Recurring difficulties with the law
  • Tendency to violate the boundaries and rights of others
  • Substance abuse
  • Aggressive, often violent behavior; prone to getting involved in fights
  • Inability to tolerate boredom
  • Disregard for the safety of self or others
  • Persistent attitude of irresponsibility and disregard for social rules, obligations, and norms
  • Difficulties with authority figures [7]

Prevalence

The National Comorbidity Survey, which uses DSM-III-R criteria, discovered that 5.8 percent of males and 1.2 percent of females showed evidence of a lifelong chance of obtaining the disorder.[8] According to DSM-IV, Antisocial Personality disorder is diagnosed in approximately three percent of all males and one percent of all females.[1]

Prevalence estimates within clinical settings vary from three to 30 percent, depending on the predominant characteristics of the populations being sampled. [9] The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders). [10] Similarly, the prevalence of APD 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.[11]

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[citation needed], mostly on the social deviance and behavioral aspects of the PCL-R, not the affective/interpersonal factor dimensions.

The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that psychopathy and sociopathy are obsolete synonyms for antisocial personality disorder. The World Health Organization takes a similar stance in its ICD-10 by referring to psychopathy, sociopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.

Millon's variations

Theodore Millon identified five variations of antisocials [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

Potential markers

In the past, the presence of three behavioral markers, known as the Macdonald triad, was found in some children who went on to develop sociopathy. The triad consists of bedwetting, a tendency to abuse animals, and pyromania.[13]

The APD etiology is currently associated with abusive, chaotic, or emotionally deprived home environments and with low socioeconomic status and urban settings. However, there are concerns that this diagnosis is misapplied to individuals in which this behavioral strategy is contingent with economic or other survival[14]. APD is also highly co-morbid with ADHD and Substance-Abuse Disorders[14].

Current neuropsychology recognizes that in addition to the outwardly antisocial behaviors (lying, manipulation, and disregard for the law or other people), APD individuals show impairment in both their orbitofrontal cortex (problems with task-switching and other executive functioning) and their amygdala (shown through their impaired fear response and emotional reaction)[15][16]. APD patients also have poor fear conditioning (which implicates the hippocampus) and show a general under-arousal to stimuli[17]. Indeed, in children as young as three, a slower heart rate correlates with aggression (though not specifically psychopathy) [1].

Criticism of the DSM-IV criteria

Many have argued [weasel words] that psychopathy/sociopathy are incorrectly put together under ASPD. These clinicians and researchers [who?] are upset that an important distinction has been lost between these two disorders. In other words, ASPD and psychopathy are considered 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.[18]

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 scores (using the Hare Psychopathy Checklist-Revised (PCL-R)) is found in only ~20% of inmates and PCL-R is considered one of the best predictors of violent recidivism.[citation needed] Also, the DSM-IV field trials never included incarcerated populations.

Causes

The exact cause of ASPD is not known, but biological or genetic factors may play a role. Brain structure deregulation, specifically within the prefrontal cortex and amygdala, plays an important contribution.

If the parent of an individual has had the disorder, that individual has a greater chance of having the disorder. A number of environmental factors in the childhood home, school, and community may also contribute to the disorder. 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 ASPD, whereas females tended to show an increased incidence of somatization disorder instead.[19]

Bowlby (1944) saw a connection between antisocial personality disorder and maternal deprivation in the first five years of life. Glueck and Glueck (1968) saw reasons to believe that the mothers of children who developed this personality disorder usually did not discipline their children and showed little affection towards them. But it is also important to point out that correlation does not imply causation.

Adoption studies show that both genetic and environmental factors can contribute to the development of the disorder. These studies have also shown that genetic factors are more important for adults with the disorder, while environmental factors are more important in antisocial children. [19][20]

Currently, genetic and environmental factors are thought to contribute to the organic causes of the disorder, namely, deregulation of the amygdala and orbitofrontal cortex. The prefrontal lobes are responsible for forming goals and objectives, coordinating skills, and evaluating our actions. The OFC of the prefrontal lobes has connections to the amygdala, is part of the limbic system, and is specifically noted for regulating and modulating stress/arousal responses, as well as response-reversal [2] [21].

Antisocial individuals, because of an impaired amygdala show impaired initial response learning. Additionally, when psychopaths and amygdalar-lesioned patients are presented with a peripheral emotional image (e.g. a picture of a corpse, or the sound of a crying baby) while completing a simple task, their performance remains relatively unaffected. They show impaired recognition of, and reaction to, fearful facial and vocal affect.

In general, the combination of an inattentiveness to emotionally charged stimuli (whether presented in full view or as a peripheral distraction) as well as an inability to shift attention to an alternative route of reward (and thus, avoid punishment) can account for much of a APD individual’s deviant behavior. They do not notice emotion and are unable to empathize—and thus feel unaffected when their actions have detrimental effects on other people.

They also continue to commit acts of crime or violence long after the rewards have stopped and the punishment has begun (e.g. repeat offenders who have been incarcerated multiple times)[15]. They also are quick to display aggressive and impulsive behavior. This reactive antisocial aggression is perhaps in part a result of elevated levels of frustration experienced when they are unable to modify their behavior in the ever-changing environment[22]

See also

References

  1. ^ a b c d American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association. pp. 645–650. ISBN 0-89042-061-0. {{cite book}}: Cite has empty unknown parameter: |coauthors= (help)
  2. ^ Mayo Clinic Staff (2006-10-09). "Antisocial personality disorder -". MayoClinic.com. Retrieved 2008-08-17.
  3. ^ "Antisocial Personality Disorder". Retrieved 2007-12-15. {{cite web}}: Cite has empty unknown parameter: |month= (help)
  4. ^ "Antisocial Personality, Sociopathy, and Psychopathy"
  5. ^ a b c d "Antisocial Personality Disorder". Psychology Today. 2005. Retrieved 2007-02-20. {{cite web}}: Text "Psychology Today Staff" ignored (help)
  6. ^ "Antisocial Personality Disorder". Mayo Foundation for Medical Education and Research. 2006. Retrieved 2007-02-20.
  7. ^ "Antisocial Personality Disorder Treatment". Psych Central. 2006. Retrieved 2007-02-20. {{cite web}}: Text "John M. Grohol" ignored (help)
  8. ^ "Antisocial Personality Disorder". Antisocial Personality Disorder for professionals. Armenian Medical Network. 2006. Retrieved 2007-02-20. {{cite web}}: Text "J. Reid Meloy, Ph.D." ignored (help)
  9. ^ Diagnostic and Statistical Manual of Mental Disorders
  10. ^ Hare 1983
  11. ^ "Antisocial Personality Disorder, Alcohol, and Aggression" (PDF). Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. 2006. Retrieved 2007-02-20. {{cite web}}: Text "F. Gerard Moeller, M.D., and Donald M. Dougherty, Ph.D." ignored (help)
  12. ^ Millon, Theodore, Personality Disorders in Modern Life, 2004
  13. ^ J. M. MacDonald. The Threat to Kill. American Journal of Psychiatry, 125-130 (1963)
  14. ^ a b DSM-IV-TR
  15. ^ a b Blair, Mitchell, et al., 2006
  16. ^ Kumari, Taylor, Barkataki et al., 2009
  17. ^ Mitchell, Leonard, Richell, & Blair, 2006
  18. ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (pdf file)
  19. ^ a b "Antisocial Personality Disorder (APD)". Armenian Medical Network. 2006. Retrieved 2007-02-20. {{cite web}}: Text "Anne-Marin B. Cooper, M.D." ignored (help)
  20. ^ Lyons et al., 1995
  21. ^ Muller, et al., 2003
  22. ^ Crowe & Blair, 2008
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