Talk:Antisocial personality disorder

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Relationship to psychopathy[edit]

I removed a part of the article that took a very strong POV stance based upon a single source (a textbook) because it did not come close to addressing the long controversy and dispute in this field. Removed content added below for discussion purposes:

Though the diagnostic criteria for ASPD were based in part on Hervey Cleckley's pioneering work on psychopathy, ASPD is not synonymous with psychopathy and the diagnostic criteria are different.[ref name=Patrick2005a/]

Psychopathy[edit]

Although there are behavioral similarities, ASPD and psychopathy are not synonymous. A diagnosis of ASPD using the DSM criteria is based on behavioral patterns, whereas psychopathy measurements also include more indirect personality characteristics. The diagnosis of antisocial personality disorder covers two to three times as many prisoners as are rated as psychopaths. Most offenders scoring high on the PCL-R also pass the ASPD criteria but most of those with ASPD do not score high on the PCL-R.[ref name=Patrick2005a>Patrick, Christopher J (Editor). (2005) Handbook of Psychopathy. Guilford Press. Page 61.]

The whole point of adding APSD to the DSM was it was supposed to be synonymous with psychopathy and sociopathy. Saying straight out in the Wikipedia article that they are not is a huge violation of NPOV policy and does a horrible disservice to our readers. A lot of comments on this talk page above already address the dispute (though some comments are clearly wrong, like the person who claimed psychopathy was a word that just meant all mental illness in general - not sure how he/she came up with that). It seems ridiculous to me that after all this discussion on this talk page about this very important topic that the article itself did not address it at all except to pick a side and pretend there wasn't anything more to it. DreamGuy (talk) 19:51, 27 January 2013 (UTC)

On top of picking a side and not even admitting there are other views or mention the history, the text above is useless to anyone who doesn't already understand jargon in this field. "PCL-R" is completely unexplained.
For those who don't know, PCL-R is Dr. Hare's Psychopathy Checklist (revised). Dr. Hare has basically set himself up as the world expert on psychopathy and was upset when the APA changed Psychopathy in the official DSM classification to APSD and tried to make it diagnosable with more objective criteria. He decided to make up his own diagnostic criteria for psychopathy and treated the new term of ASPD as if it were a separate diagnosis/mental illness. He now sells the PCL-R to individuals and groups as a "true" test of psychopathy.
As a notable expert on the topic, Hare's views are certainly worth mentioning (and perhaps a link to another article that explains his views in more detail), but we cannot ignore that the official body who comes up with official diagnoses criteria for mental illness disagrees with him. Since this article is about the official APA diagnosis it needs to primarily be about the APA's diagnosis itself and not other views. DreamGuy (talk) 20:29, 27 January 2013 (UTC)

Edit Note: I added psychopathy to the "Also known as" sentence in the opening, as it seems to make sense given that sociopathy was already listed there, and the two are generally considered synonymous now, although Hare would likely object. (Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (PDF).) Mhartsoe (talk) 05:05, 9 March 2016 (UTC)

Of course psychopathy an ASPD are not synonyms. Psychopathy is a term used in fringe research and movies, while ASPD is a diagnosis sanctioned by major health organizations. Petergstrom (talk) 06:00, 7 December 2016 (UTC)

Podcasts in external links[edit]

Three editors have removed podcasts from external links, and one editor added them (haven't gone far back in history long enough to see who originally added them, but it's likely with was another individual). At this point I think that means we keep them out until there is a discussion.

I don't have any general prohibition against podcasts (and neither do the WP:EL rules), but I think in general they are less useful links than text-based links, as they have less information spread out over a longer length of time to absorb it. Good quality podcasts can be helpful, though, especially to people who learn better by hearing than by reading. While the site did interview some reasonably famous people, it still just looked like somebody's personal podcast and not really by any notable group or etc.

Any other views? DreamGuy (talk) 20:15, 27 January 2013 (UTC)

I have also removed quite a lot of Living Hero podcasts in other articles, but when questioned, I couldn't find a WP:ELNO number that fitted. I have tried to get comments about these links here and also left invitations in different places for other editors to comment, but only very few editors did so. My decision was not to remove them anymore, as it was clear to me that there was no consensus that they were ELNO. Lova Falk talk 09:57, 29 January 2013 (UTC)
As of now the podcast links have been removed again. (Done by DeamGuy here.) I think the point about podcasts is little or no fact checking or peer review. The first paragraph in WP:EL mentions "further research that is accurate and on-topic". Some chat on a talk show regardless of the media doesn't fit that description. Richard-of-Earth (talk) 20:42, 29 January 2013 (UTC)

Bullying[edit]

Can someone familiar with the sources and journals on this topic add a section as to how this relates to these people being bullies in childhood and likely even in adulthood? Thank you Technical 13 (talk) 13:47, 23 April 2013 (UTC)

Clarifying antisocial personality disorder, psychopathy, dissocial personality disorder, sociopathy[edit]

Based on various sources, including the DSM, ICD, and page 61 at http://books.google.co.uk/books?id=OuNdrmHcJlgC:

ASPD vs. DPD: may be similar but are technically different. ASPD is defined by the DSM, DPD by the ICD, and there are some differences in the criteria.
ASPD vs. Psychopathy: the DSM based ASPD on psychopathy and the DSM-IV states that ASPD is also known as psychopathy, although notable critics argue that they are different.
Psychopathy vs. DPD: are technically different as a result of the above.
Sociopathy: is used as an informal term to describe any condition that is conceptually similar to or synonymous with any of the above.

I updated the article to clarify the relationship between ASPD, psychopathy, and DPD. Sociopathy, as far as I'm aware, is not a formal term and is thus not mentioned much here. --Humorideas (talk) 03:52, 25 June 2013 (UTC)

Well the above comment has been duplicate-posted on the psychopathy talk page so I'll partially repeat my reply here - though I've since found a partial online source on the new DSM-5, The Pocket Guide to the DSM-5 Diagnostic Exam, cf Pg 236 "Antisocial (Dissocial) Personality Disorder" (with a optional specifier for "psychopathic features"), so will make some edits.
Not sure what you looked at but in fact the ICD-10 online Dissocial PD lists Sociopathy as another term in exactly the same way as Psychopathy (and various others such as Amoral). The DSM-IV-TR does too for Antisocial PD: "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder." NOTE: Contrary to the second sentence of this article now, that wording is NOT the same as the DSM saying that psychopathy is the DSM's own other name for ASPD (and in fact in early DSM it was referred to as sociopathic). COMPARE to the diagnosis of "Social Phobia (Social Anxiety Disorder)" in brackets immediately after (now DSM-5 the other way round possibly). Anyone know how ASPD is worded in the DSM-5?
Finally it's not quite a question of 'critics' arguing the official criteria are different to (some essentialist concept of) psychopathy, it's acknowledged fact they are different to the criteria of Cleckley or Hare. Sighola2 (talk) 22:51, 6 August 2013 (UTC)
Continued discussion here: http://en.wikipedia.org/wiki/Talk:Psychopathy#Clarifying_psychopathy.2C_antisocial_personality_disorder.2C_dissocial_personality_disorder.2C_sociopathy --Humorideas (talk) 00:54, 8 August 2013 (UTC)

Hormones and neurotransmitters - expert help needed![edit]

Unfortunately, I don't have an extensive knowledge of hormones and neurotransmitters, and therefore it is difficult for me to improve the section Antisocial_personality_disorder#Hormones_and_neurotransmitters. But I can see a few problems with this section.

  • Basically, it discusses the role of serotonins in impulsive/aggressive behavior. However, isn't testosterone and cortisol much more important than serotonin?
  • In this section, the Kuepper study Aggression--interactions of serotonin and testosterone in healthy men and women gets quite a bit of space. I don't have access to the article, but in the summary it says: "Results showed significant interaction effects between 5-HT and T for trait aggression in men only (p<0.05). Trait aggression was significantly higher in the combinations "high T+high cortisol responses" (indicating decreased 5-HT availability), and "low T+low cortisol responses" (indicating increased 5-HT availability)..." I copyedited the sentence, but this makes no sense to me at all.

I'll try to work with this section, but I would really, really need some help from someone who knows more about hormones and neurotransmitters. Lova Falk talk 11:27, 28 December 2013 (UTC)

I think that this section of the page relies much too heavily on primary sources. WP:MEDMOS and WP:MEDRS pretty much require that pages about disorders, such as this page, restrict discussion about research to secondary sources. Pruning it in that way will make a lot of the difficulties go away.
  • In particular, I think [1] is completely unsatisfactory as a source.
  • "Testosterone is a hormone that plays an important role in aggressiveness both in the brain and in the muscular system." Aggression comes from the brain, full stop. I get what this means, that T increases muscle mass, but that is not aggression.
OK, all of that said, you are asking about this source: [2]. I'm not wild about giving it much weight here, because the way that they infer the amount of serotonin (5-HT) in the brain is by giving people citalopram and measuring cortisol in the saliva (see: [3]). Citalopram makes cortisol amounts go up, but cortisol should go up the most when 5-HT in the brain is the lowest (there are complicated feedback pathways, so this is an oversimplification). The assumption is the more cortisol, the less 5-HT there must have been, and that's a fairly indirect way of doing things.
So, what the source is claiming is that: In men only, and not women, men who had high testosterone and low 5-HT were more aggressive, and men who had low testosterone and high 5-HT were also more aggressive. --Tryptofish (talk) 21:54, 28 December 2013 (UTC)
Tryptofish Thank you for your explanation! I made some edits - could you check them and correct them if needed? Happy new year! Lova Falk talk 00:15, 1 January 2014 (UTC)
Yes, that looks like a good improvement to me, thanks! Perhaps someone will come here from WT:MED, and I suspect that they will be more hardcore than I am about WP:RS. --Tryptofish (talk) 14:58, 1 January 2014 (UTC)

Hormones[edit]

A high proportion of ASPD women are masculine in appearance and have a mindset, attitude and behaviour pattern that is a world away from average women and instead are very similar to ASPD men. Many women prisoners look more like men than women, and this cannot be a coincidence. Do ASPD women often have abnormally high levels of testosterone? Jim Michael (talk) 03:42, 2 January 2014 (UTC)

A high proportion of ASPD women are masculine in appearance and have a mindset, attitude and behaviour pattern that is a world away from average women and instead are very similar to ASPD men.
Can you cite a source for this claim?
I speculate that the average female prisoner would look more "manly" than the typical woman (whatever typical is) because of the poor hygiene facilities and lack of beauty products in prisons, and the prison uniforms that are not designed with aesthetics in mind.
While various associations have been found between testosterone and ASPD, no study has explicitly examined this relationship in the female ASPD population. Research into ASPD in women is lacking partially because ASPD has a smaller prevalence in females. The fields of ASPD and Psychopathy research are quite small overall; Borderline Personality Disorder is king in personality disorder research, but even research into BPD is dwarfed by the resources poured into major Axis I disorders. --Ireadandcheck (talk) 17:10, 7 April 2016 (UTC)

"Gypsy-like roamers"?[edit]

I feel like the use of this phrase is really out of place and odd. "Gypsy" can or can not be considered an ethnic slur, depending on who you ask, and many Roma take it to be just that (a slur), so I find it wrong to use the term "gypsy-like" in tandem with describing a mental illness.

Maybe the word "Nomad" could be used in place of gypsy. On a totally unrelated and admittedly "racist" note I want to point out that the name gypsy was self applied many generations ago and only sounds like a slur these days because the people it denotes themselves ruined the word's reputation. — Preceding unsigned comment added by 75.93.51.156 (talk) 19:15, 30 April 2015 (UTC)

"gypsy-like" would seem to be Millon's word. Wikipedia policy would suggest leaving the RS language as is: https://en.wikipedia.org/wiki/Wikipedia:What_Wikipedia_is_not#Wikipedia_is_not_censored Eturk001 (talk) 23:37, 30 April 2015 (UTC)

Epidemiology[edit]

According to previous DSM criteria, twelve-month prevalence rates of ASPD is 0.2% to 3.3%. [60] "ASPD is seen in 3% to 30% of psychiatric outpatients.[22] The prevalence of the disorder is even higher in selected populations, like prisons, where there is a preponderance of violent offenders.[52] A 2002 literature review of studies on mental disorders in prisoners stated that 47% of male prisoners and 21% of female prisoners had ASPD.[53] 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.[54]" Males with severe alcohol abuse disorder show the highest prevalence for ASPD, which is 70%. [60]

[60] would be the addition of the DSM-5 (prevalence under the ASPD category) as an added reference.

Clarav93 (talk) 02:59, 13 October 2015 (UTC)

Diagnosis and further considerations[edit]

Add new section under Diagnosis titled "Other diagnostic scales"

"Clinicians often use 'structured clinical interviews' (make this a link to "Structured Clinical Interview for DSM-IV" wikipedia page), specifically the SCID-II to make a diagnosis of ASPD. The ASPD category of the SCID-II is a includes questions that specifically focus on antisocial behavior in childhood that has continued into adulthood. [61] The Millon Clinical Multiaxial Inventory (also a link to this wikipedia page) is a self-report inventory that is also used to diagnose ASPD."[61]

Under further considerations category mention that the study done by Messina et al. shows that there is a disagreement between SCID and MCMI within substance abusers, emphasizing the comorbidity between substance abuse and ASPD. [61]

[61] Messina, N., Wish, E., Hoffman, J., & Nemes, S. (2001). Diagnosing Antisocial Personality Disorder Among Substance Abusers: The Scid Versus The Mcmi-Ii. Am J Drug Alcohol Abuse The American Journal of Drug and Alcohol Abuse, 27(4), 699-717. doi:10.1081/ADA-100107663

Clarav93 (talk) 14:31, 13 October 2015 (UTC)

Edit request Oct 18, 2015[edit]

I tried, but failed, to add Borderline Personality Disorder to the top "Not to be confused with" topics. Seems like a no-brainer to add this one, since it's a term heard fairly commonly, and seems pretty easy to confuse "antisocial" with "borderline". Could someone who knows how, add it? Thanks216.96.78.78 (talk) 21:46, 18 October 2015 (UTC)

It might also need an in-article explanation as to how Borderline Personality Disorder differs from Antisocial Personality Disorder, as both disorders are associated with antisocial behaviour. --14:18, 7 April 2016 (UTC) — Preceding unsigned comment added by 118.103.136.54 (talk)

Treatment: Pharmacological Interventions[edit]

There is a Cochrane review about pharmacological interventions. It looks at 8 different studies involving drugs as treatment for AsPD. The review concluded that there is little good quality evidence for what may be an effective treatment, these studies did find that bromocriptine, nortriptyline, and phenytoin were superior to placebos. This could be added to the treatment section and the cochrane review could be added to the sources.

"Pharmacological interventions for antisocial personality disorder" DOI: 10.1002/14651858.CD007667.pub2

http://onlinelibrary.wiley.com.libproxy.lib.unc.edu/doi/10.1002/14651858.CD007667.pub2/full

Treatment: Psychological Interventions[edit]

There is another cochrane review on the psychological interventions for AsPD. This review examined 11 different studies. Contingency Management and CBT should be added to this page as possible treatment options, and this review should be added as a new source.

"Psychological interventions for antisocial personality disorder" DOI: 10.1002/14651858.CD007668.pub2

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Restructuring the Antisocial personality disorder article[edit]

I would like this article to be restructured to follow the structure of the articles of other mental disorders. The example articles I would like to point to are the articles on Major depressive disorder, Bipolar disorder, Schizophrenia (which has Featured Article status), Borderline personality disorder, and Psychopathy, which all follow the basic headers of Signs and symptoms > Causes > Mechanisms > Diagnosis > Management > Prognosis > Epidemiology > History > Society and Culture --Ireadandcheck (talk) 09:10, 7 April 2016 (UTC)

The Theodore Millon's subtypes section should be condensed[edit]

The table describing the subtypes of ASPD that Theodore Millon proposed is a massive table. However, I believe that this subsection is superfluous; the amount of text that describes these subtypes is not warranted for its importance, and may inflate the perceived importance of the topic of Millon's subtypes concerning this personality disorder to the reader. Millon's subtypes no longer fit into any modern conceptualisation of ASPD, and there are few or no papers in recent scientific literature that discuss them.

My opinion is that the content of the table should be reduced. Most of the other personality disorder articles only list the features without any further elaboration, keeping down their size (e.g. check out the Millon's suptypes sections on the articles for schizoid personality disorder, schizotypal personality disorder, borderline personality disorder, histrionic personality disorder, and avoidant personality disorder). These articles do not include a description column that characterises their Millons subtypes, which neither is necassary for this article. By eliminating the description column and keeping only the list of features, the table can be reduced to a more appropriate size without any serious loss of information about this topic. If you believe that the characterisations are important in the topic of ASPD and do not wish to remove them, then the table might be made collapsible so it won't take up so much article length and screen space by default. However, I strongly suggest that the characterisations should be discarded.

This is how the table will be if the proposed revision is implemented, as compared to how that table is as of 19 April 2016:

Subtype Features
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.
Malevolent (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless.
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.
Risk-taking (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, impulsive, heedless; unbalanced by hazard; pursues perilous ventures.
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.
Unprincipled (including narcissistic features) Deficient conscience; unscrupulous, amoral, disloyal, fraudulent, deceptive, arrogant, exploitative; a conman and charlatan; dominating, contemptuous, vindictive.
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.
Spineless (including [[avoidant personality disorder | features) Basically Insecure, bogus, Spineless, venomous dominance is counterphobic, public swaggering, selects powerless scapegoats, is diminished with group support

--Ireadandcheck (talk) 08:03, 20 April 2016 (UTC)

I also find the tone of the characterisation content an issue. They are lacking in encyclopedic tone, and may not conform to a neutral point of view. To me, they read similar to horoscope profile descriptions. As an article on a condition in psychiatric medicine, the article's content should reflect a medical and scientific viewpoint on the topic. As Millon's personality disorder subtypes have little credence in the current understanding of this disorder nor practical application of its diagnosis, the section discussing them should not dominate the article, much less with its current tone and style. --Ireadandcheck (talk) 19:48, 20 April 2016 (UTC)

I removed the characterizations of the Millon's subtypes. The reasons can be summarized into the folllowing:
  • Millon's subtypes are of little importance in discussing ASPD, and so should not take up a disproportionate amount of article space which may inflate its importance to the reader.
  • The articles on other personality disorders do not include a characterization of their particular Millon's subtypes, reflecting its non-necessity.
  • The style the characterizations are written in are lacking in encyclopedic tone, and read like horoscope profile descriptions.
  • They may also fail to conform to a neutral point of view.
  • Sourcing is dubious.
--Ireadandcheck (talk) 05:25, 10 May 2016 (UTC)

Orphaned references in Antisocial personality disorder[edit]

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How Convenient - Another "Disorder"[edit]

Looks like the pharma industry can finally rope off the remaining citizens and get them on some medication. When I first saw this on Google, I thought it was a joke. Wow. — Preceding unsigned comment added by 98.194.39.86 (talk) 03:53, 7 December 2016 (UTC)

Drug abuse[edit]

Couldn't drug abuse cause many of these symptoms also? Chronic drug use of certain drugs like cocaine or meth seem to shut down all but the primal sections of the brain. Leading to paranoia and a total lack of empathy for others or the end result of criminal actions taken to get more drugs. — Preceding unsigned comment added by Cornersss (talkcontribs) 05:47, 26 June 2017 (UTC)