Antisocial personality disorder
|Antisocial personality disorder|
|Other names||Dissocial personality disorder (DPD), sociopathy|
|Specialty||Psychiatry, clinical psychology|
|Symptoms||Pervasive deviance, deception, impulsivity, irritability, aggression, recklessness, and callous and unemotional traits|
|Usual onset||Childhood or early adolescence|
|Risk factors||Family history, poverty|
|Differential diagnosis||Substance use disorder, bipolar disorder, borderline personality disorder, schizophrenia, criminal behavior|
|Frequency||1.8% during a year|
|Cluster A (odd)|
|Cluster B (dramatic)|
|Cluster C (anxious)|
Antisocial personality disorder (ASPD or APD) is a personality disorder characterized by a long term pattern of disregard for, or violation of, the rights of others. A low moral sense or conscience is often apparent, as well as a history of crime, legal problems, or impulsive and aggressive behavior.
Antisocial personality disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Dissocial personality disorder (DPD), a similar or equivalent concept, is defined in the International Statistical Classification of Diseases and Related Health Problems (ICD), which includes antisocial personality disorder in the diagnosis. Both manuals provide similar criteria for diagnosing the disorder. 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.
- 1 Signs and symptoms
- 2 Causes and pathophysiology
- 3 Diagnosis
- 4 Treatment
- 5 Prognosis
- 6 Epidemiology
- 7 History
- 8 See also
- 9 References
- 10 Further reading
- 11 External links
Signs and symptoms
Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others. Individuals with this personality disorder will typically have no compunction in exploiting others in harmful ways for their own gain or pleasure and frequently manipulate and deceive other people, achieving this through wit and a façade of superficial charm or through intimidation and violence. They may display arrogance, think lowly and negatively of others, and lack remorse for their harmful actions and have a callous attitude to those they have harmed. Irresponsibility is a core characteristic of this disorder: they can have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations, and people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.
Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardize their own safety and the safety of others and place themselves and others in danger. They are often aggressive and hostile and display a dysregulated temper and can lash out violently with provocation or frustration. Individuals are prone to substance abuse and addiction, and the abuse of various psychoactive substances is common in this population. These behaviors lead such individuals into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behavior and criminal infractions stemming back before adulthood.
Serious problems with interpersonal relationships are often seen in those with the disorder. Attachments and emotional bonds are weak, and interpersonal relationships often revolve around the manipulation, exploitation, and abuse of others. While they generally have no problems in establishing relationships, they may have difficulties in sustaining and maintaining them. Relationships with family members and relatives are often strained due to their behavior and the frequent problems that these individuals may get into.
While antisocial personality disorder is a mental disorder diagnosed in adulthood, it has its precedent in childhood. The DSM-5's criteria for ASPD require that the individual have conduct problems evident by the age of 15. Persistent antisocial behavior as well as a lack of regard for others in childhood and adolescence is known as conduct disorder and is the precursor of ASPD. About 25–40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.
Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD and is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. Children with the disorder often display impulsive and aggressive behavior, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism or get into fights with other children and adults. This behavior is typically persistent and may be difficult to deter with threat or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population, and children with the disorder may also engage in substance abuse." CD is differentiated from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, and property, though many children diagnosed with ODD are subsequently rediagnosed with CD.
Two developmental courses for CD have been identified based on the age at which the symptoms become present. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of aggression and violence. The second is known as the "adolescent-onset type" and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood. In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood onset subtype, especially if callous and unemotional traits are present, tends to have a worse treatment outcome.
Causes and pathophysiology
Personality disorders are seen to be caused by a combination and interaction of genetic and environmental influences. Genetically, it is the intrinsic temperamental tendencies as determined by their genetically influenced physiology, and environmentally, it is the social and cultural experiences of a person in childhood and adolescence encompassing their family dynamics, peer influences, and social values. People with an antisocial or alcoholic parent are considered to be at higher risk. Fire-setting and cruelty to animals during childhood are also linked to the development of antisocial personality. The condition is more common in males than in females, and among people who are in prison.
Research into genetic associations in antisocial personality disorder is suggestive that ASPD has some or even a strong genetic basis. Prevalence of ASPD is higher in people related to someone afflicted by the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behavior and conduct disorder.
In the specific genes that may be involved, one gene that has seen particular interest in its correlation with antisocial behavior is the gene that encodes for Monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norephinephrine. Various studies examining the genes' relationship to behavior have suggested that variants of the gene that results in less MAO-A being produced, such as the 2R and 3R alleles of the promoter region, have associations with aggressive behavior in men. The association is also influenced by negative experience in early life, with children possessing a low-activity variant (MAOA-L) who experience such maltreatment being more likely to develop antisocial behavior than those with the high-activity variant (MAOA-H). Even when environmental interactions (e.g. emotional abuse) are controlled for, a small association between MAOA-L and aggressive and antisocial behavior remains.
The gene that encodes for the serotonin transporter (SCL6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behavior and personality traits. Genetic associations studies have suggested that the short "S" allele is associated with impulsive antisocial behavior and ASPD in the inmate population. However, research into psychopathy find that the long "L" allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e.g. lack of empathy, fearlessness) and interpersonal (e.g. grandiosity, manipulativeness) personality disturbances. This is suggestive of two different forms, one associated more with impulsive behavior and emotional dysregulation, and the other with predatory aggression and affective disturbance, of the disorder.
Various other gene candidates for ASPD have been identified by a genome-wide association study published in 2016. Several of these gene candidates are shared with attention-deficit hyperactivity disorder, with which ASPD is comorbid.
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. Aggressiveness and impulsivity are among the possible symptoms of ASPD. Testosterone is a hormone that plays an important role in aggressiveness in the brain. For instance, criminals who have committed violent crimes tend to have higher levels of testosterone than the average person. The effect of testosterone is counteracted by cortisol which facilitates the cognitive control of impulsive tendencies.
One of the neurotransmitters that have been discussed in individuals with ASPD is serotonin, also known as 5HT. 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.
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. 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.
Antisocial behavior may be related to head trauma. Antisocial behavior is associated with decreased grey matter in the right lentiform nucleus, left insula, and frontopolar cortex. Increased volumes have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post central cortex.
People that exhibit antisocial behavior demonstrate decreased activity in the prefrontal cortex. The association is more apparent in functional neuroimaging as opposed to structural neuroimaging. The prefrontal cortex is involved in many executive functions, including behavior inhibitions, planning ahead, determining consequences of action, and differentiating between right and wrong.
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. One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.
Some studies suggest that the social and home environment has contributed to the development of antisocial behavior. The parents of these children have been shown to display antisocial behavior, which could be adopted by their children.
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. 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.:136 While the rise reported may be in part merely a byproduct of the widening use (and abuse) of diagnostic techniques, 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 – it has been suggested that the erosion of collective standards may indeed serve to release the individual with latent ASPD from their previously prosocial behavior.:136–7
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. Controversial clinical psychiatrist Pierre-Édouard Carbonneau suggested that the problem with legal forced admittance is the rate of failure when diagnosing ASPD. He states that the possibility of diagnosing and coercing a patient into prescribing medication to someone without ASPD, but is diagnosed with it could be potentially disastrous, but the possibility of not diagnosing it and seeing a patient go untreated because of a lack of sufficient evidence of cultural or environmental influences is something a psychiatrist must ignore, and in his words, "play it safe".
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:
A. Significant impairments in personality functioning manifest by:
- 1. Impairments in self functioning (a or b):
- a. Identity: Ego-centrism; self-esteem derived from personal gain, power, or pleasure.
- b. Self-direction: Goal-setting based on personal gratification; absence of prosocial internal standards associated with failure to conform to lawful or culturally normative ethical behavior.
- 2. Impairments in interpersonal functioning (a or b):
- a. Empathy: Lack of concern for feelings, needs, or suffering of others; lack of remorse after hurting or mistreating another.
- b. Intimacy: Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion; use of dominance or intimidation to control others.
B. Pathological personality traits in the following domains:
- 1. Antagonism, characterized by:
- a. Manipulativeness: Frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one's ends.
- b. Deceitfulness: Dishonesty and fraudulence; misrepresentation of self; embellishment or fabrication when relating events.
- c. Callousness: Lack of concern for feelings or problems of others; lack of guilt or remorse about the negative or harmful effects of one's actions on others; aggression; sadism.
- d. Hostility: Persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; mean, nasty, or vengeful behavior.
- 2. Disinhibition, characterized by:
- a. Irresponsibility: Disregard for – and failure to honor – financial and other obligations or commitments; lack of respect for – and lack of follow-through on – agreements and promises.
- b. Impulsivity: Acting on the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of outcomes; difficulty establishing and following plans.
- c. Risk taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom proneness and thoughtless initiation of activities to counter boredom; lack of concern for one's limitations and denial of the reality of personal danger.
C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations.
D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment.
E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).
F. The individual is at least age 18 years.
Antisocial personality disorder falls under the dramatic/erratic cluster of personality disorders, "Cluster B".
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):
- It is characterized by at least 3 of the following:
- 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 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.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL-R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy.
American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. However, critics argue ASPD is not synonymous with psychopathy as the diagnostic criteria are not the same, since criteria relating to personality traits are emphasized relatively less in the former. These differences exist in part because it was believed 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".
Although the diagnosis of ASPD covers two to three times as many prisoners than the diagnosis of psychopathy, Robert Hare believes the PCL-R is better able to predict future criminality, violence, and recidivism than a diagnosis of ASPD. He suggests 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. Additionally, Hare argued 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.
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.:765 Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components.
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|Nomadic antisocial (including schizoid and avoidant features)||Drifters; roamers, vagrants; adventurer, itinerant vagabonds, tramps, wanderers; they typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility.|
|Malevolent antisocial (including sadistic and paranoid features)||Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals, including serial killers Ted Bundy, Harvey Glatman, and mass murderers Anders Behring Breivik and Eric David Harris fit these criteria.|
|Covetous antisocial (including negativistic features)||Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having.|
|Risk-taking antisocial (including histrionic features)||Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures.|
|Reputation-defending antisocial (including narcissistic features)||Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights.|
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.":223
ASPD commonly coexists with the following conditions:
The rates of antisocial personality disorder tends to be around 40-50% in male alcohol and opiate addicts.
ASPD is considered to be among the most difficult personality disorders to treat.[verification needed] Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. 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. 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.[verification needed] Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.
Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions.[verification needed] Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended. There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions. Psychotherapy also known as talk therapy is found to help treat patients with ASPD.Schema therapy is also being investigated as a treatment for ASPD. 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. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance abuse, although others have reported contradictory findings.
Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. 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 with this disorder may limit the effectiveness of even this form of therapy.
The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2010 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.
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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."
ASPD is seen in 3% to 30% of psychiatric outpatients. The prevalence of the disorder is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. A 2002 literature review of studies on mental disorders in prisoners stated that 47% of male prisoners and 21% of female prisoners had ASPD. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) abuse treatment programs than in the general population, suggesting a link between ASPD and AOD abuse and dependence.
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".[verification needed] 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 in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.
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. 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.
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". 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.
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".
The APA's Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) defines antisocial personality disorder as:
- 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:
- failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
- deception, 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.
- B) The individual is at least 18 years old.
- 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". National Library of Medicine. Retrieved 16 May 2018.
- American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, p. 661, ISBN 978-0890425558
- Mayo Clinic Staff (2 April 2016). "Overview- Antisocial personality disorder". Mayo Clinic. Retrieved 12 April 2016.
- Berger FK (29 July 2016). "Antisocial personality disorder: MedlinePlus Medical Encyclopedia". MedlinePlus. Retrieved 1 November 2016.
- Farrington DP, Coid J (2004). Early Prevention of Adult Antisocial Behavior. Cambridge, England: Cambridge University Press. p. 82. ISBN 978-0-521-65194-3. Retrieved 12 January 2008.
- Patrick CJ (2005). Handbook of Psychopathy. Guilford Press. ISBN 9781606238042. Retrieved 18 July 2013.
- Hare RD (1 February 1996). "Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion". Psychiatric Times. New York City: UBM Medica. 13 (2). Retrieved 19 May 2017.
- Hare RD, Hart SD, Harpur TJ (August 1991). "Psychopathy and the DSM-IV criteria for antisocial personality disorder" (PDF). Journal of Abnormal Psychology. 100 (3): 391–8. doi:10.1037/0021-843x.100.3.391. PMID 1918618. Archived from the original (PDF) on 26 September 2007. Retrieved 19 May 2017.
- Semple D, Smyth R, Burns J, Darjee R, McIntosh A (2005). The Oxford Handbook of Psychiatry. Oxford, England: Oxford University Press. pp. 448–449. ISBN 978-0-19-852783-1.
- Skeem JL, Polaschek DL, Patrick CJ, Lilienfeld SO (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. PMID 26167886.
- "Antisocial Personality Disorder". Psychology Today. New York City: Sussex Publishers. Retrieved 18 February 2018.
- "Antisocial personality disorder". NHS. Retrieved 11 May 2016.
- "Antisocial personality disorder: prevention and management". NICE. March 2013. Retrieved 11 May 2016.
- "Differences Between a Psychopath vs Sociopath". World of Psychology. 12 February 2015. Retrieved 18 February 2018.
- McCallum, David (2001). Personality and dangerousness : genealogies of antisocial personality disorder. Cambridge, England: Cambridge University Press. ISBN 978-0521008754. OCLC 52493285.
- Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association. 2000.
- Zoccolillo M, Pickles A, Quinton D, Rutter M (November 1992). "The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder". Psychological Medicine. Cambridge, England: Cambridge University Press. 22 (4): 971–86. doi:10.1017/s003329170003854x. PMID 1488492.
- Kupfer D, Regier D, eds. (2013). Diagnostic and Statistical Manual of Mental Disorders (5 ed.). Washington, DC: American Psychiatric Association. ISBN 978-0890425558.
- Hinshaw SP, Lee SS (2003). "Conduct and Oppositional Defiant Disorders" (PDF). In Mash EJ, Barkely RA (eds.). Child Psychopathology (2 ed.). New York City: Guilford Press. pp. 144–198. ISBN 978-1-57230-609-7.
- Lynskey MT, Fergusson DM (June 1995). "Childhood conduct problems, attention deficit behaviors, and adolescent alcohol, tobacco, and illicit drug use". Journal of Abnormal Child Psychology. Springer Science+Business Media. 23 (3): 281–302. doi:10.1007/bf01447558. PMID 7642838.
- Loeber R, Keenan K, Lahey BB, Green SM, Thomas C (August 1993). "Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder". Journal of Abnormal Child Psychology. 21 (4): 377–410. doi:10.1007/bf01261600. PMID 8408986.
- Moffitt TE (October 1993). "Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy". Psychological Review. 100 (4): 674–701. doi:10.1037/0033-295x.100.4.674.
- Moffitt TE, Caspi A (June 2001). "Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females". Development and Psychopathology. 13 (2): 355–75. doi:10.1017/s0954579401002097. PMID 11393651.
- Baumgärtner G, Soyka M (November 2013). Translated by Welsh S. "[DSM-5—what has changed in therapy for and research on substance-related and addictive disorders?]" (PDF). Fortschritte der Neurologie-Psychiatrie. 81 (11): 648–54. doi:10.1159/000356537. PMID 24194058. Retrieved 20 May 2017.
- "Antisocial Personality Disorder | MentalHealth.gov". www.mentalhealth.gov. Retrieved 18 February 2018.
- Baker LA, Bezdjian S, Raine A (1 January 2006). "Behavioral Genetics: The Science of Antisocial Behavior". Law and Contemporary Problems. 69 (1–2): 7–46. PMC 2174903. PMID 18176636.
- Guo G, Ou XM, Roettger M, Shih JC (May 2008). "The VNTR 2 repeat in MAOA and delinquent behavior in adolescence and young adulthood: associations and MAOA promoter activity". European Journal of Human Genetics. 16 (5): 626–34. doi:10.1038/sj.ejhg.5201999. PMC 2922855. PMID 18212819.
- Guo G, Roettger M, Shih JC (August 2008). "The integration of genetic propensities into social-control models of delinquency and violence among male youths" (PDF). American Sociological Review. 73 (4): 543–568. doi:10.1177/000312240807300402. Archived from the original (PDF) on 3 March 2016. Retrieved 20 November 2016. "Archived copy" (PDF). Archived from the original on 2 December 2008. Retrieved 16 February 2009.CS1 maint: archived copy as title (link) CS1 maint: BOT: original-url status unknown (link)
- Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW, Taylor A, Poulton R (August 2002). "Role of genotype in the cycle of violence in maltreated children". Science. 297 (5582): 851–4. Bibcode:2002Sci...297..851C. doi:10.1126/science.1072290. PMID 12161658. Lay summary – eurekalert.org (1 August 2002).
- Frazzetto G, Di Lorenzo G, Carola V, Proietti L, Sokolowska E, Siracusano A, Gross C, Troisi A (May 2007). "Early trauma and increased risk for physical aggression during adulthood: the moderating role of MAOA genotype". PLOS ONE. 2 (5): e486. Bibcode:2007PLoSO...2..486F. doi:10.1371/journal.pone.0000486. PMC 1872046. PMID 17534436.
- Ficks CA, Waldman ID (September 2014). "Candidate genes for aggression and antisocial behavior: a meta-analysis of association studies of the 5HTTLPR and MAOA-uVNTR". Behavior Genetics. 44 (5): 427–44. doi:10.1007/s10519-014-9661-y. PMID 24902785.
- Aluja A, Garcia LF, Blanch A, De Lorenzo D, Fibla J (July 2009). "Impulsive-disinhibited personality and serotonin transporter gene polymorphisms: association study in an inmate's sample". Journal of Psychiatric Research. 43 (10): 906–14. doi:10.1016/j.jpsychires.2008.11.008. PMID 19121834.
- Glenn AL (January 2011). "The other allele: exploring the long allele of the serotonin transporter gene as a potential risk factor for psychopathy: a review of the parallels in findings". Neuroscience and Biobehavioral Reviews. 35 (3): 612–20. doi:10.1016/j.neubiorev.2010.07.005. PMC 3006062. PMID 20674598.
- Yildirim BO, Derksen JJ (August 2013). "Systematic review, structural analysis, and new theoretical perspectives on the role of serotonin and associated genes in the etiology of psychopathy and sociopathy". Neuroscience and Biobehavioral Reviews. 37 (7): 1254–96. doi:10.1016/j.neubiorev.2013.04.009. PMID 23644029.
- Rautiainen MR, Paunio T, Repo-Tiihonen E, Virkkunen M, Ollila HM, Sulkava S, Jolanki O, Palotie A, Tiihonen J (September 2016). "Genome-wide association study of antisocial personality disorder". Translational Psychiatry. 6 (9): e883. doi:10.1038/tp.2016.155. PMC 5048197. PMID 27598967.
- Black D. "What Causes Antisocial Personality Disorder?". Psych Central. Retrieved 1 November 2011.
- Batrinos ML (2012). "Testosterone and aggressive behavior in man". International Journal of Endocrinology and Metabolism. 10 (3): 563–8. doi:10.5812/ijem.3661. PMC 3693622. PMID 23843821.
- Moore TM, Scarpa A, Raine A (2002). "A meta-analysis of serotonin metabolite 5-HIAA and antisocial behavior". Aggressive Behavior. 28 (4): 299–316. doi:10.1002/ab.90027.
- Brown S, Botsis A, Van Praag HM (1994). "Serotonin and Aggression". Journal of Offender Rehabilitation. 3–4. 21 (3): 27–39. doi:10.1300/J076v21n03_03.
- 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.
- Huizinga D, Haberstick BC, Smolen A, Menard S, Young SE, Corley RP, Stallings MC, Grotpeter J, Hewitt JK (October 2006). "Childhood maltreatment, subsequent antisocial behavior, and the role of monoamine oxidase A genotype". Biological Psychiatry. 60 (7): 677–83. doi:10.1016/j.biopsych.2005.12.022. PMID 17008143.
- Séguin, JR (June 2004). "Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account". Brain and Cognition. 55 (1): 185–97. doi:10.1016/S0278-2626(03)00273-2. PMC 3283581. PMID 15134852.
- Aoki Y, Inokuchi R, Nakao T, Yamasue H (August 2014). "Neural bases of antisocial behavior: a voxel-based meta-analysis". Social Cognitive and Affective Neuroscience. 9 (8): 1223–31. doi:10.1093/scan/nst104. PMC 4127028. PMID 23926170.
- Yang Y, Raine A (November 2009). "Prefrontal structural and functional brain imaging findings in antisocial, violent, and psychopathic individuals: a meta-analysis". Psychiatry Research. 174 (2): 81–8. doi:10.1016/j.pscychresns.2009.03.012. PMC 2784035. PMID 19833485.
- Galarza M, Merlo AB, Ingratta A, Albanese EF, Albanese AM (2004). "Cavum septum pellucidum and its increased prevalence in schizophrenia: a neuroembryological classification". The Journal of Neuropsychiatry and Clinical Neurosciences. 16 (1): 41–6. doi:10.1176/appi.neuropsych.16.1.41. PMID 14990758.
- May FS, Chen QC, Gilbertson MW, Shenton ME, Pitman RK (March 2004). "Cavum septum pellucidum in monozygotic twins discordant for combat exposure: relationship to posttraumatic stress disorder". Biological Psychiatry. 55 (6): 656–8. doi:10.1016/j.biopsych.2003.09.018. PMC 2794416. PMID 15013837.
- Raine A, Lee L, Yang Y, Colletti P (September 2010). "Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy". The British Journal of Psychiatry. 197 (3): 186–92. doi:10.1192/bjp.bp.110.078485. PMC 2930915. PMID 20807962.
- Lock MP (November 2008). "Treatment of antisocial personality disorder". The British Journal of Psychiatry. 193 (5): 426, author reply 426. doi:10.1192/bjp.193.5.426. PMID 18978330.
- Stout M (2006). The sociopath next door: the ruthless versus the rest of us (1st ed.). New York: Broadway Books. ISBN 978-0-7679-1582-3.
- Sutker PB, Allain AN (2002). "Antisocial Personality Disorder". In Sutker PB, Adams HE (eds.). Comprehensive Handbook of Psychopathology (3rd ed.). Boston, MA: Springer. pp. 445–490. doi:10.1007/0-306-47377-1_16. ISBN 978-0-306-46490-4.
- Berne E (1976). A Layman's Guide to Psychiatry and Psychoanalysis (first ed.). New York, NY: Grove. pp. 241–2. ISBN 978-0-394-17833-2.
- McCallum D (2001). Personality and Dangerousness: Genealogies of Antisocial Personality Disorder. New York: Cambridge Univ. Press. p. 7. ISBN 978-0-521-00875-4.
- Archer, Robert; Wheeler, Elizabeth (2006). Forensic Uses of Clinical Assessment Instruments. Routledge. pp. 247–250.
- "DSM-IV and DSM-5 Criteria for the Personality Disorders" (PDF). American Psychiatric Association. 2012.
- WHO (2010)ICD-10: Clinical descriptions and diagnostic guidelines: Disorders of adult personality and behavior
- "F60.2 Dissocial personality disorder". World Health Organization. Retrieved 12 January 2008.
- Blair RJ (January 2003). "Neurobiological basis of psychopathy". The British Journal of Psychiatry. 182: 5–7. doi:10.1192/bjp.182.1.5. PMID 12509310.
- Merriam-Webster Dictionary. "Definition of psychopathy". Retrieved 15 May 2013.
- Encyclopedia of Mental Disorders. "Hare Psychopathy Checklist". Retrieved 15 May 2013.
- Hare RD (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems.
- DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders (Fourth ed.). United States: American Psychiatric Association Press Inc. 2000. ISBN 978-0-89042-025-6.
- "International Statistical Classification of Diseases and Related Health Problems" (10th ed.). World Health Organization. 2016.
- Horley J (2014). "The emergence and development of psychopathy". History of the Human Sciences. 27 (5): 91–110. doi:10.1177/0952695114541864.
- Nussbaum A (2013). The Pocket Guide to the DSM-5 Diagnostic Exam. Arlington: American Psychiatric Association. ISBN 978-1-58562-466-9. Retrieved 5 January 2014.
- Millon T (2000). Personality Disorders in Modern Life (Second ed.). Hoboken, New Jersey: John WIley & Sons, Inc. pp. 158–161. ISBN 978-0-471-23734-1.
- Millon, Theodore – Personality Subtypes. Millon.net. Retrieved on 7 December 2011.
- Internet Mental Health – antisocial personality disorder Archived 4 June 2013 at the Wayback Machine. Mentalhealth.com. Retrieved on 7 December 2011.
- Oscar-Berman M, Valmas MM, Sawyer KS, Kirkley SM, Gansler DA, Merritt D, Couture A (April 2009). "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder". Neuropsychiatric Disease and Treatment. 5: 309–26. doi:10.2147/NDT.S4882. PMC 2699656. PMID 19557141.
- Gerstley, Linda J; Alterman, Arthur I; McLellan, A Thomas; Woody, George E (February 1990). "Antisocial Personality Disorder in Patients with Substance Abuse Disorders: A Problematic Diagnosis?". American Journal of Psychiatry. 147 (2).
- Gabbard, Glen O., Gunderson John G. (2000) Psychotherapy for Personality Disorders. First Edition. American Psychiatric Publishing. ISBN 978-0-88048-273-8.
- Stone, Michael H. (1993). Abnormalities of Personality. Within and Beyond the Realm of Treatment. Norton. ISBN 978-0-393-70127-2.
- Nolen-Hoeksema, Susan, 1959-2013. (2 December 2013). Abnormal psychology (Sixth ed.). New York, NY. ISBN 9780078035388. OCLC 855264280.CS1 maint: multiple names: authors list (link)
- Meloy, J. R., & Yakeley, A. J. (2011). Antisocial personality disorder.CS1 maint: multiple names: authors list (link)
- Oldham, John M.; Skodol, Andrew E.; Bender, Donna S. (2005). The American Psychiatric Publishing Textbook of Personality Disorders. American Psychiatric Publishing. ISBN 978-1-58562-159-0.
- Salekin RT (February 2002). "Psychopathy and therapeutic pessimism. Clinical lore or clinical reality?". Clinical Psychology Review. 22 (1): 79–112. doi:10.1016/S0272-7358(01)00083-6. PMID 11793579.
- McRae, Leon (February 2013). "Rehabilitating antisocial personalities: Treatment through self-governance strategies". Journal of Forensic Psychiatry & Psychology. 24 (1): 48–70. doi:10.1080/14789949.2012.752517. PMC 3756620. PMID 24009471.
- Derefinko KJ, Widiger TA (2008). Antisocial Personality Disorder. The Medical Basis of Psychiatry. pp. 213–226. doi:10.1007/978-1-59745-252-6_13. ISBN 978-1-58829-917-8.
- "Treatment – Mayo Clinic". Mayo Clinic. Retrieved 13 June 2017.
- Bernstein DP, Arntz A, Vos Md (2007). "Schema Focused Therapy in Forensic Settings: Theoretical Model and Recommendations for Best Clinical Practice" (PDF). International Journal of Forensic Mental Health. 6 (2): 169–183. doi:10.1080/14999013.2007.10471261. Archived from the original (PDF) on 26 July 2011.
- Gatzke LM, Raine A (2000). "Treatment and prevention implications of antisocial personality disorder". Current Psychiatry Reports. 2 (1): 51–5. doi:10.1007/s11920-000-0042-2. PMID 11122932.
- Darke S, Finlay-Jones R, Kaye S, Blatt T (September 1996). "Anti-social personality disorder and response to methadone maintenance treatment". Drug and Alcohol Review. 15 (3): 271–6. doi:10.1080/09595239600186011. PMID 16203382.
- Alterman AI, Rutherford MJ, Cacciola JS, McKay JR, Boardman CR (February 1998). "Prediction of 7 months methadone maintenance treatment response by four measures of antisociality". Drug and Alcohol Dependence. 49 (3): 217–23. doi:10.1016/S0376-8716(98)00015-5. PMID 9571386.
- Beck AT, Freeman A, Davis DD (2007). Cognitive Therapy of Personality Disorders (Second ed.). New York: Guilford Press. ISBN 978-1-59385-476-8.
- Mayo Clinic staff (12 April 2013). "Antisocial personality disorder: Treatments and drugs". Mayo Clinic. Mayo Foundation for Medical Education and Research. Retrieved 17 December 2013.
- Khalifa N, Duggan C, Stoffers J, Huband N, Völlm BA, Ferriter M, Lieb K (2010). "Pharmacological interventions for antisocial personality disorder". The Cochrane Database of Systematic Reviews (8): CD007667. doi:10.1002/14651858.CD007667.pub2. PMC 4160654. PMID 20687091.
- Simonoff E, Elander J, Holmshaw J, Pickles A, Murray R, Rutter M (February 2004). "Predictors of antisocial personality. Continuities from childhood to adult life". The British Journal of Psychiatry. 184 (2): 118–27. doi:10.1192/bjp.184.2.118. PMID 14754823.
- Hare RD (1983). "Diagnosis of antisocial personality disorder in two prison populations". The American Journal of Psychiatry. 140 (7): 887–90. doi:10.1176/ajp.140.7.887. PMID 6859306.
- Fazel S, Danesh J (February 2002). "Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys". Lancet. 359 (9306): 545–50. doi:10.1016/S0140-6736(02)07740-1. PMID 11867106.
- Moeller FG, Dougherty DM (2006). "Antisocial Personality Disorder, Alcohol, and Aggression" (PDF). Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. Retrieved 20 February 2007.
- G., Forrest, Gary (1994). Chemical dependency and antisocial personality disorder : psychotherapy and assessment strategies. New York: Haworth Press. ISBN 978-1560243083. OCLC 25246264.
- Diagnostic and Statistical Manual of Mental Disorders (DSM-II) (PDF). Washington, D. C.: American Psychiatric Association. 1968. p. 43. Archived from the original (PDF) on 1 November 2014.
- International Handbook on Psychopathic Disorders and the Law, Volume 1, Alan Felthous, Henning Sass, 15 Apr 2008, e.g. Pgs 24 – 26
- Kendler KS, Muñoz RA, Murphy G (February 2010). "The development of the Feighner criteria: a historical perspective". The American Journal of Psychiatry. 167 (2): 134–42. doi:10.1176/appi.ajp.2009.09081155. PMID 20008944.
- The DSM-IV Personality Disorders W. John Livesley, Guilford Press, 1995, Page 135
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- DSM-IV-TR Criteria for Antisocial personality disorder
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