Disease: Antisocial Personality Disorder

    Antisocial personality disorder (ASPD) facts

    • A personality disorder (PD) is a persistent pattern of thoughts, feelings, and behaviors that is significantly different from what is considered normal within the person's own culture.
    • Personality disorders are grouped into clusters A, B, and C based on the dominating symptoms.
    • Antisocial personality disorder is specifically a pervasive pattern of disregarding and violating the rights of others and may include symptoms such as breaking laws, frequent lying, starting fights, lack of guilt and taking personal responsibility, and the presence of irritability and impulsivity.
    • Psychopathy is considered to be a more severe form of antisocial personality disorder. Specifically, in order to be considered a psychopath, an individual must experience a lack of remorse or guilt about their actions in addition to demonstrating antisocial behaviors.
    • Psychopaths tend to be highly suspicious or paranoid, even in comparison to individuals with antisocial personality disorder, which tends to lead the psychopathic person to interpret all aggressive behaviors toward them as being arbitrary and unfair.
    • Antisocial personality disorder is likely the result of a combination of biologic/genetic and environmental factors.
    • Some theories about the biological risk factors for antisocial personality disorder include dysfunction of certain genes, hormones, or parts of the brain.
    • Diagnoses often associated with antisocial personality disorder include substance abuse, attention deficit hyperactivity disorder (ADHD), and reading disorders.
    • Theories regarding the life experiences that put people at risk for antisocial personality disorder include a history of childhood physical, sexual, or emotional abuse; neglect, deprivation, or abandonment; associating with peers who engage in antisocial behavior; or having a parent who is either antisocial or alcoholic.
    • Since there is no specific definitive test that can accurately assess the presence of antisocial personality disorder, health-care professionals conduct a mental-health interview that looks for the presence of antisocial symptoms. If the cultural context of the symptoms is not considered, antisocial personality disorder is often falsely diagnosed as being present.
    • Research indicates ethnic minorities tend to be falsely diagnosed as having antisocial personality disorder, inappropriately resulting in less treatment and more punishment for those individuals.
    • Although antisocial personality disorder can be quite resistant to treatment, the most effective interventions tend to be a combination of firm but fair programming that emphasizes teaching the antisocial personality disorder individuals skills that can be used to live independently and productively within the rules and limits of society.
    • While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions like depression, anxiety, and mood swings that co-occur with this condition.
    • If untreated, people with antisocial personality disorder are at risk for developing or worsening a myriad of other mental disorders. Antisocial personality disorder individuals are also at risk for self-mutilation or dying from homicide or suicide.
    • Many people with antisocial personality disorder experience a remission of symptoms by the time they reach 50 years of age.

    What are antisocial personality disorder symptoms and signs?

    To understand antisocial personality disorder (ASPD or APD), it is necessary to learn what having any personality disorder involves. As defined by the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR, 2000), a personality disorder (PD) is a persistent pattern of thoughts, feelings, and behaviors that is significantly different from what is considered normal within the person's own culture.

    Professionals group personality disorders based on a commonality of symptoms.

    Cluster A personality disorders are those that include symptoms of social isolation, and/or odd, eccentric behavior. These disorders include

    • paranoid personality disorder,
    • schizotypal personality disorder,
    • schizoid personality disorder.

    Cluster B personality disorders are those that include symptoms of dramatic or erratic behaviors (counter-social behaviors). These personality disorders include

    • antisocial personality disorder,
    • borderline personality disorder,
    • histrionic personality disorder,
    • narcissistic personality disorder.

    Cluster C personality disorders are dominated by difficulties with anxiety and inhibited behavior. These disorders are referred to as and include

    • avoidant personality disorder,
    • dependent personality disorder,
    • obsessive compulsive personality disorder (OCD).

    Antisocial personality disorder is specifically a pervasive pattern of disregarding and violating the rights of others. Diagnostic criteria for this disorder state that this pattern must include at least three of the following specific signs and symptoms:

    • Lack of conforming to laws, as evidenced by repeatedly committing crimes
    • Repeated deceitfulness in relationships with others, such as telling lies, using false names, or conning others for profit or pleasure
    • Failure to think or plan ahead (impulsivity)
    • Tendency to irritability, anger, and aggressiveness, as shown by repeatedly assaulting others or getting into frequent physical fights
    • Disregard for personal safety or the safety of others
    • Persistent lack of taking responsibility, such as failing to establish a pattern of good work habits or keeping financial obligations
    • A lack of feeling guilty about wrong-doing

    Other important characteristics of this disorder include that it is not diagnosed in children (individuals younger than 18 years of age), but the affected person must have shown symptoms of this diagnosis at least since 15 years of age. Additionally, it cannot be diagnosed if the person only shows symptoms of antisocial personality disorder at the same time they are suffering from schizophrenia or when having a manic episode. This disorder tends to occur in about 1% of women and 3% of men in the United States. Antisocial personality symptoms in women tend to include self-harm and more of the other symptoms of borderline personality disorder (BPD) than in men.

    What is the difference between antisocial personality disorder and psychopathy?

    Psychopathy, although not a mental health disorder formally recognized by the American Psychiatric Association, is considered to be a more severe form of antisocial personality disorder. Specifically, in order to be considered a psychopath, also called a sociopath, an individual must experience a lack of remorse of guilt about their actions in addition to demonstrating antisocial behaviors. While statistics indicate that 50%-80% of incarcerated individuals have been found to have antisocial personality disorder, only 15% of those convicted criminals have been shown to have the more severe antisocial personality disorder type of psychopathy.

    Psychopaths tend to be highly suspicious or paranoid, even in comparison to individuals with antisocial personality disorder. The implications of this suspicious stance can be dire, in that paranoid thoughts (ideations) tend to lead the psychopathic person to interpret all aggressive behaviors toward them, even those that are justified, as being arbitrary and unfair. A televised case study of a psychopath provided a vivid illustration of the resulting psychopathic anger. Specifically, the criminal featured in the story apparently abducted a girl and sexually abused her over the course of a number of days in an attempt to prove to investigating authorities that his stepdaughter's allegations that he sexually abused her were false.

    What are causes and risk factors of antisocial personality disorder?

    One of the most frequently asked questions about antisocial personality disorder by both professionals and laypeople is whether or not it is genetic. Many wonder if it is hereditary, just as much as hair, eye, or skin color; if this were the case, children of antisocial people would be highly expected to become antisocial themselves, whether or not they live with the antisocial parent. Fortunately, human beings are just not that simple. Like all personality disorders, and most mental disorders, antisocial personality disorder tends to be the result of a combination of biologic/genetic and environmental factors.

    Although there are no clear biological causes for this disorder, research on the possible biologic risk factors for developing antisocial personality disorder indicates that, in those with antisocial personality disorder, the part of the brain that is primarily responsible for learning from one's mistakes and for responding to sad and fearful facial expressions (the amygdala) tends to be smaller and respond less robustly to the happy, sad, or fearful facial expressions of others. That lack of response may have something to do with the lack of empathy that antisocial individuals tend to have with the feelings, rights, and suffering of others. While some individuals may be more vulnerable to developing antisocial personality disorder as a result of their particular genetic background, that is thought to be a factor only when the person is also exposed to life events such as abuse or neglect that tend to put the person at risk for development of the disorder. Similarly, while there are some theories about the role of premenstrual syndrome (PMS) and other hormonal fluctuations in the development of antisocial personality disorder, the disorder can, so far, not be explained as the direct result of such abnormalities.

    Other conditions that are thought to be risk factors for antisocial personality disorder include substance abuse, attention deficit hyperactivity disorder (ADHD), reading disorder, or conduct disorder, which is diagnosed in children. People who experience a temporary or permanent brain dysfunction, also called organic brain damage, are at risk for developing violent or otherwise criminal behaviors. Theories regarding the life experiences that increase the risk for developing antisocial symptoms in teenagers and adults provide important clues for its prevention. Examples of such life experiences include a history of prenatal drug exposure or malnutrition, childhood physical, sexual, or emotional abuse; neglect; deprivation or abandonment; associating with peers who engage in antisocial behavior; or a parent who is either antisocial or alcoholic.

    How is antisocial personality disorder diagnosed?

    There is no specific definitive test, such as a blood test, that can accurately assess whether a person has antisocial personality disorder. Practitioners conduct a mental-health interview that gathers information to look for the presence of the symptoms previously described. Due to the use of a mental-health interview in making the diagnosis and the fact that this disorder can be quite resistant to treatment, it is important that the mental-health professional know to assess the symptoms in the context of the individual's culture so the person is not assessed as having antisocial personality disorder when he or she does not. Unfortunately, research shows that many practitioners lack the knowledge, experience, and sometimes the willingness to factor cultural context into their assessments.

    What are the treatments for antisocial personality disorder?

    Another very common question asked is, can antisocial personality disorder be cured? While it can be quite resistant to change, research shows there are a number of effective treatments for this disorder. For example, teenagers who receive therapy that helps them change the thinking that leads to their maladaptive behavior (cognitive behavioral therapy) have been found to experience a significant decrease the incidence of engaging in repeat antisocial behaviors.

    On the other hand, attempting to treat antisocial personality disorder like other conditions is not often effective. For example, programs that have tried to use a purely reflective (insight-oriented) approach to treating depression or eating disorders in people with antisocial personality disorder often worsen rather than improve outcomes in those individuals. In those cases, a combination of firm but fair programming that emphasizes teaching individuals with antisocial personality disorder the skills that can be used to live independently and productively within the rules and limits of society has been the more effective treatment for this condition.

    While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions that co-occur with this condition. Specifically, depressed or anxious individuals who also have antisocial personality disorder may benefit from antidepressants, and those who exhibit impulsive anger may improve when given mood stabilizers.

    What are antisocial personality disorder symptoms and signs?

    To understand antisocial personality disorder (ASPD or APD), it is necessary to learn what having any personality disorder involves. As defined by the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV-TR, 2000), a personality disorder (PD) is a persistent pattern of thoughts, feelings, and behaviors that is significantly different from what is considered normal within the person's own culture.

    Professionals group personality disorders based on a commonality of symptoms.

    Cluster A personality disorders are those that include symptoms of social isolation, and/or odd, eccentric behavior. These disorders include

    • paranoid personality disorder,
    • schizotypal personality disorder,
    • schizoid personality disorder.

    Cluster B personality disorders are those that include symptoms of dramatic or erratic behaviors (counter-social behaviors). These personality disorders include

    • antisocial personality disorder,
    • borderline personality disorder,
    • histrionic personality disorder,
    • narcissistic personality disorder.

    Cluster C personality disorders are dominated by difficulties with anxiety and inhibited behavior. These disorders are referred to as and include

    • avoidant personality disorder,
    • dependent personality disorder,
    • obsessive compulsive personality disorder (OCD).

    Antisocial personality disorder is specifically a pervasive pattern of disregarding and violating the rights of others. Diagnostic criteria for this disorder state that this pattern must include at least three of the following specific signs and symptoms:

    • Lack of conforming to laws, as evidenced by repeatedly committing crimes
    • Repeated deceitfulness in relationships with others, such as telling lies, using false names, or conning others for profit or pleasure
    • Failure to think or plan ahead (impulsivity)
    • Tendency to irritability, anger, and aggressiveness, as shown by repeatedly assaulting others or getting into frequent physical fights
    • Disregard for personal safety or the safety of others
    • Persistent lack of taking responsibility, such as failing to establish a pattern of good work habits or keeping financial obligations
    • A lack of feeling guilty about wrong-doing

    Other important characteristics of this disorder include that it is not diagnosed in children (individuals younger than 18 years of age), but the affected person must have shown symptoms of this diagnosis at least since 15 years of age. Additionally, it cannot be diagnosed if the person only shows symptoms of antisocial personality disorder at the same time they are suffering from schizophrenia or when having a manic episode. This disorder tends to occur in about 1% of women and 3% of men in the United States. Antisocial personality symptoms in women tend to include self-harm and more of the other symptoms of borderline personality disorder (BPD) than in men.

    What is the difference between antisocial personality disorder and psychopathy?

    Psychopathy, although not a mental health disorder formally recognized by the American Psychiatric Association, is considered to be a more severe form of antisocial personality disorder. Specifically, in order to be considered a psychopath, also called a sociopath, an individual must experience a lack of remorse of guilt about their actions in addition to demonstrating antisocial behaviors. While statistics indicate that 50%-80% of incarcerated individuals have been found to have antisocial personality disorder, only 15% of those convicted criminals have been shown to have the more severe antisocial personality disorder type of psychopathy.

    Psychopaths tend to be highly suspicious or paranoid, even in comparison to individuals with antisocial personality disorder. The implications of this suspicious stance can be dire, in that paranoid thoughts (ideations) tend to lead the psychopathic person to interpret all aggressive behaviors toward them, even those that are justified, as being arbitrary and unfair. A televised case study of a psychopath provided a vivid illustration of the resulting psychopathic anger. Specifically, the criminal featured in the story apparently abducted a girl and sexually abused her over the course of a number of days in an attempt to prove to investigating authorities that his stepdaughter's allegations that he sexually abused her were false.

    What are causes and risk factors of antisocial personality disorder?

    One of the most frequently asked questions about antisocial personality disorder by both professionals and laypeople is whether or not it is genetic. Many wonder if it is hereditary, just as much as hair, eye, or skin color; if this were the case, children of antisocial people would be highly expected to become antisocial themselves, whether or not they live with the antisocial parent. Fortunately, human beings are just not that simple. Like all personality disorders, and most mental disorders, antisocial personality disorder tends to be the result of a combination of biologic/genetic and environmental factors.

    Although there are no clear biological causes for this disorder, research on the possible biologic risk factors for developing antisocial personality disorder indicates that, in those with antisocial personality disorder, the part of the brain that is primarily responsible for learning from one's mistakes and for responding to sad and fearful facial expressions (the amygdala) tends to be smaller and respond less robustly to the happy, sad, or fearful facial expressions of others. That lack of response may have something to do with the lack of empathy that antisocial individuals tend to have with the feelings, rights, and suffering of others. While some individuals may be more vulnerable to developing antisocial personality disorder as a result of their particular genetic background, that is thought to be a factor only when the person is also exposed to life events such as abuse or neglect that tend to put the person at risk for development of the disorder. Similarly, while there are some theories about the role of premenstrual syndrome (PMS) and other hormonal fluctuations in the development of antisocial personality disorder, the disorder can, so far, not be explained as the direct result of such abnormalities.

    Other conditions that are thought to be risk factors for antisocial personality disorder include substance abuse, attention deficit hyperactivity disorder (ADHD), reading disorder, or conduct disorder, which is diagnosed in children. People who experience a temporary or permanent brain dysfunction, also called organic brain damage, are at risk for developing violent or otherwise criminal behaviors. Theories regarding the life experiences that increase the risk for developing antisocial symptoms in teenagers and adults provide important clues for its prevention. Examples of such life experiences include a history of prenatal drug exposure or malnutrition, childhood physical, sexual, or emotional abuse; neglect; deprivation or abandonment; associating with peers who engage in antisocial behavior; or a parent who is either antisocial or alcoholic.

    How is antisocial personality disorder diagnosed?

    There is no specific definitive test, such as a blood test, that can accurately assess whether a person has antisocial personality disorder. Practitioners conduct a mental-health interview that gathers information to look for the presence of the symptoms previously described. Due to the use of a mental-health interview in making the diagnosis and the fact that this disorder can be quite resistant to treatment, it is important that the mental-health professional know to assess the symptoms in the context of the individual's culture so the person is not assessed as having antisocial personality disorder when he or she does not. Unfortunately, research shows that many practitioners lack the knowledge, experience, and sometimes the willingness to factor cultural context into their assessments.

    What are the treatments for antisocial personality disorder?

    Another very common question asked is, can antisocial personality disorder be cured? While it can be quite resistant to change, research shows there are a number of effective treatments for this disorder. For example, teenagers who receive therapy that helps them change the thinking that leads to their maladaptive behavior (cognitive behavioral therapy) have been found to experience a significant decrease the incidence of engaging in repeat antisocial behaviors.

    On the other hand, attempting to treat antisocial personality disorder like other conditions is not often effective. For example, programs that have tried to use a purely reflective (insight-oriented) approach to treating depression or eating disorders in people with antisocial personality disorder often worsen rather than improve outcomes in those individuals. In those cases, a combination of firm but fair programming that emphasizes teaching individuals with antisocial personality disorder the skills that can be used to live independently and productively within the rules and limits of society has been the more effective treatment for this condition.

    While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions that co-occur with this condition. Specifically, depressed or anxious individuals who also have antisocial personality disorder may benefit from antidepressants, and those who exhibit impulsive anger may improve when given mood stabilizers.

    Source: http://www.rxlist.com

    Another very common question asked is, can antisocial personality disorder be cured? While it can be quite resistant to change, research shows there are a number of effective treatments for this disorder. For example, teenagers who receive therapy that helps them change the thinking that leads to their maladaptive behavior (cognitive behavioral therapy) have been found to experience a significant decrease the incidence of engaging in repeat antisocial behaviors.

    On the other hand, attempting to treat antisocial personality disorder like other conditions is not often effective. For example, programs that have tried to use a purely reflective (insight-oriented) approach to treating depression or eating disorders in people with antisocial personality disorder often worsen rather than improve outcomes in those individuals. In those cases, a combination of firm but fair programming that emphasizes teaching individuals with antisocial personality disorder the skills that can be used to live independently and productively within the rules and limits of society has been the more effective treatment for this condition.

    While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions that co-occur with this condition. Specifically, depressed or anxious individuals who also have antisocial personality disorder may benefit from antidepressants, and those who exhibit impulsive anger may improve when given mood stabilizers.

    Source: http://www.rxlist.com

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