The individual must be age 18 or older, as well as have a documented history of a conduct disorder Conduct disorder is a psychiatric comedy marked by a pattern of repetitive behavior wherein the rights of others or social norms are violated before the age of 15.[1] People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths Psychopathy is a personality disorder whose hallmark is a lack of empathy. Researcher Robert Hare, whose Hare Psychopathy Checklist is widely used, describes psychopaths as "intraspecies predators who use charm, manipulation, intimidation, sex and violence to control others and to satisfy their own needs. Lacking in conscience and empathy,", although some researchers believe that these terms are not synonymous with ASPD.[2]

Contents

History

The history of the origins of antisocial personality disorder are closely related to the history of psychopathy - see history of psychopathy Psychopathy is a personality disorder whose hallmark is a lack of empathy. Researcher Robert Hare, whose Hare Psychopathy Checklist is widely used, describes psychopaths as "intraspecies predators who use charisma, manipulation, intimidation, sexual intercourse and violence to control others and to satisfy their own needs. Lacking in.

Symptoms

Characteristics of people with antisocial personality disorder may include:[3]

Diagnostic criteria (DSM-IV-TR = 301.7)

The Diagnostic and Statistical Manual of Mental Disorders The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides diagnostic criteria for mental disorders. It is used in the United States and in varying degrees around the world, by clinicians, researchers, psychiatric drug regulation agencies, health insurance companies, pharmaceutical fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders A mental disorder or mental illness is a psychological or behavioural pattern that occurs in an individual and is thought to cause distress or disability that is not expected as part of normal development or culture. The recognition and understanding of mental health conditions has changed over time and across cultures, and there are still, defines antisocial personality disorder (in Axis II Cluster B Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders) as:[1]

A) There is a pervasive pattern of disregard for and the rights of others occurring since the age of 15, as indicated by three (or more) of the following:
  1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
  2. deceitfulness Deception, beguilement, deceit, bluff, mystification, and subterfuge are acts to propagate beliefs that are not true, or not the whole truth . Deception can involve dissimulation, propaganda, sleight of hand. It can employ distraction, camouflage or concealment. There is also self-deception, as indicated by repeatedly lying A lie is a type of deception in the form of an untruthful statement, especially with the intention to deceive others, often with the further intention to maintain a secret or reputation, protect someone's feelings or to avoid a punishment or repercussion for one's actions. To lie is to state something that one knows to be false or that one does, use of aliases, or conning others for personal profit or pleasure;
  3. impulsivity Impulsivity is a personality trait characterized by the inclination of an individual to initiate behavior without adequate forethought as to the consequences of their actions, acting on the spur of the moment. Eysenck and Eysenck related impulsivity to risk taking, lack of planning, and making up one’s mind quickly. Impulsivity has been shown to or failure to plan ahead;
  4. irritability Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration and aggressiveness In psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause pain or harm. Predatory or defensive behavior between members of different species is not normally considered "aggression." Aggression takes a variety of forms among humans and can be, as indicated by repeated physical fights or assaults;
  5. reckless disregard for safety of self or others;
  6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
  7. lack of remorse Remorse is an emotional expression of personal regret felt by a person after he or she has committed an act which they deem to be shameful, hurtful, or violent. Remorse is closely allied to guilt and self-directed resentment. When a person regrets an earlier action or failure to act, it may be because of remorse or in response to various other, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
B) The individual is at least 18 years of age.
C) There is evidence of Conduct disorder Conduct disorder is a psychiatric comedy marked by a pattern of repetitive behavior wherein the rights of others or social norms are violated with onset before age 15.
D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia Schizophrenia , from the Greek roots skhizein (σχίζειν, "to split") and phrēn, phren- (φρήν, φρεν-; "mind") is a psychiatric diagnosis that describes a neuropsychiatric and mental disorder characterized by abnormalities in the perception or expression of reality. It most commonly manifests as auditory or a manic episode Mania is a state of abnormally elevated or irritable mood, arousal, and/ or energy levels, which is a criterion for certain psychiatric diagnoses.

Deceit and manipulation are considered essential features of the disorder. Therefore, it is essential in making the diagnosis to collect material from sources other than the individual being diagnosed.[7]

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders.

Criticism

Researchers have heavily criticized the ASPD DSM-IV criteria because not enough emphasis was placed on traditional psychopathic traits In psychology, Trait theory is a major approach to the study of human personality. Trait theorists are primarily interested in the measurement of traits, which can be defined as habitual patterns of behavior, thought, and emotion. According to this perspective, traits are relatively stable over time, differ among individuals , and influence such as a lack of empathy The English word is derived from the Greek word ἐμπάθεια , "physical affection, passion, partiality" which comes from ἐν (en), "in, at" + πάθος (pathos), "passion" or "suffering". The term was adapted by Theodore Lipps to create the German word Einfühlung ("feeling into") from, superficial charm Superficial charm, also called glibness, is a common manipulative technique using positive reinforcement. The "charm" is entirely insincere. It may manifest itself as flattery. It is an important attribute of psychopathic personalities. It is often used by abusers early on in an abusive relationship to attract and groom the abused person, and inflated self appraisal.

These latter traits are harder to assess than behavioral problems (like impulsivity and acting out). Thus, the DSM-IV framers sacrificed validity for reliability. That is, the ASPD diagnosis focuses on behavioral traits, but only limited emphasis is placed on affective and unemotional interpersonal traits.

Many have argued[weasel words] that psychopathy/sociopathy are incorrectly put together under ASPD. These clinicians and researchers[who?] are upset that an important distinction has been lost between these two disorders. In other words, ASPD and psychopathy are considered to be the same, or similar. However, they are not the same since antisocial personality disorder is diagnosed via behavior and social deviance, whereas psychopathy also includes affective and interpersonal personality factors.[8]

Also, ASPD, unlike psychopathy, does not have biological markers confirmed to underpin the disorder.[citation needed] Other criticisms of ASPD are that it is essentially synonymous with criminality. Nearly 80%–95% of felons will meet criteria for ASPD — thus ASPD predicts nothing in criminal justice populations. Whereas, psychopathy scores (using the Hare Psychopathy Checklist-Revised (PCL-R)) is found in only ~20% of inmates and PCL-R is considered one of the best predictors of violent recidivism.[citation needed] Also, the DSM-IV field trials never included incarcerated populations.

The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that psychopathy and sociopathy are obsolete synonyms for antisocial personality disorder. The World Health Organization takes a similar stance in its ICD-10 by referring to psychopathy, sociopathy, antisocial personality, asocial personality, and amoral personality Amoralism is the complete absence of moral beliefs, and/or the unequivocal belief that the theory of morality is immaterial as synonyms for dissocial personality disorder The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15. People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that these terms are not synonymous with ASPD.[citation needed]

Diagnostic criteria (ICD-10) - dissocial personality disorder‎

The World Health Organization The World Health Organization is a specialized agency of the United Nations (UN) that acts as a coordinating authority on international public health. Established on 7 April 1948, and headquartered in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health Organization, which had been an agency of the's ICD-10 The International Statistical Classification of Diseases and Related Health Problems 10th Revision is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). The code set allows more than 155,000 different codes defines a conceptually similar disorder to antisocial personality disorder called (F 60.2) Dissocial personality disorder.[9]

It is characterized by at least 3 of the following:
  1. Callous unconcern for the feelings of others and lack of the capacity for empathy The English word is derived from the Greek word ἐμπάθεια , "physical affection, passion, partiality" which comes from ἐν (en), "in, at" + πάθος (pathos), "passion" or "suffering". The term was adapted by Theodore Lipps to create the German word Einfühlung ("feeling into") from.
  2. Gross and persistent attitude of irresponsibility and disregard for social norms Social norms are the behavioral expectations and cues within a society or group. This sociological term has been defined as "the rules that a group uses for appropriate and inappropriate values, beliefs, attitudes and behaviors." These rules may be explicit or implicit. Failure to follow the rules can result in severe punishments,, rules, and obligations.
  3. Incapacity to maintain enduring relationships.
  4. Very low tolerance to frustration Frustration is a common emotional response to opposition. Related to anger and disappointment, it arises from the perceived resistance to the fulfillment of individual will. The greater the obstruction, and the greater the will, the more the frustration is likely to be. Causes of frustration may be internal or external. In people, internal and a low threshold for discharge of aggression In psychology, as well as other social and behavioral sciences, aggression refers to behavior between members of the same species that is intended to cause pain or harm. Predatory or defensive behavior between members of different species is not normally considered "aggression." Aggression takes a variety of forms among humans and can be, including violence Violence is the expression of physical or verbal force against self or other, compelling action against one's will on pain of being hurt. Worldwide, violence is used as a tool of manipulation and also is an area of concern for law and culture which take attempts to suppress and stop it. The word violence covers a broad spectrum. It can vary from.
  5. Incapacity to experience guilt Guilt is a cognitive or an emotional experience that occurs when a person realizes or believes—accurately or not—that they have violated a moral standard, and is responsible for that violation. It is closely related to the concept of remorse and to profit from experience, particularly punishment Punishment is the practice of imposing something unpleasant or aversive on a person or animal or property, usually in response to disobedience, defiance, or behavior deemed morally wrong by individual, governmental, or religious principles.
  6. Markedly prone to blame Blame is the act of censuring, holding responsible, making negative statements about an individual or group that their action or actions are socially or morally irresponsible, the opposite of praise. When someone is morally responsible for doing something wrong their action is blameworthy. By contrast, when someone is morally responsible for doing others or to offer plausible rationalizations In psychology and logic, rationalization is an informal fallacy of reasoning in which one constructs a logical justification for a belief, decision, action or lack thereof that was originally arrived at through a different mental process. It is a defense mechanism in which perceived controversial behaviors or feelings are explained in a rational for the behavior bringing the subject into conflict.
  7. Persistent irritability Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration.
The criteria specifically rule out conduct disorders Conduct disorder is a psychiatric comedy marked by a pattern of repetitive behavior wherein the rights of others or social norms are violated.[10] Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.[11]

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors that the American Psychiatric Association defines as "an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it". Personality disorders.

Millon's subtypes

Theodore Millon Theodore Millon is an American psychologist known for his work on personality disorders identified five subtypes of antisocial [12][13]. Any individual antisocial may exhibit none, one or more than one of the following:

Differential diagnosis: associated and overlapping conditions

The following conditions commonly coexist with antisocial personality disorder:[14]

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[15]

Prevalence (epidemiology)

Antisocial personality disorder in the general population is about 3% in males and 1% in females.[1][14]

It is seen in 3% to 30% of psychiatric outpatients.[1][14] The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders).[16] 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.[17]

Causes (etiology)

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

If the parent of an individual has had the disorder, that individual has a greater chance of having the disorder. A number of environmental factors in the childhood home, school, and community may also contribute to the disorder, such as losing respect or "giving up" on authority figures after observance of their hypocrisy and/or misbehaviors. Robins (1966) found an increased incidence of sociopathic characteristics and alcoholism in the fathers of individuals with antisocial personality disorder. He found that, within such a family, males had an increased incidence of ASPD, whereas females tended to show an increased incidence of somatization disorder instead.[18]

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

Adoption studies show that both genetic and environmental factors can contribute to the development of the disorder. These studies have also shown that genetic factors are more important for adults with the disorder, while environmental factors are more important in antisocial children. [18][19]

Currently, genetic and environmental factors are thought to contribute to the organic causes of the disorder, namely, deregulation of the amygdala and orbitofrontal cortex. The prefrontal lobes are responsible for forming goals and objectives, coordinating skills, and evaluating our actions. The OFC of the prefrontal lobes has connections to the amygdala, is part of the limbic system, and is specifically noted for regulating and modulating stress/arousal responses, as well as response-reversal. [20][21]

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

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

They also continue to commit acts of crime or violence long after the rewards have stopped and the punishment has begun (e.g. repeat offenders who have been incarcerated multiple times)[22]. They also are quick to display aggressive and impulsive behavior. This reactive antisocial aggression is perhaps in part a result of elevated levels of frustration experienced when they are unable to modify their behavior in the ever-changing environment.[23]

Potential markers

In the past, the presence of three behavioral markers, known as the Macdonald triad, was found in some children who went on to develop sociopathy. The triad consists of bedwetting, a tendency to abuse animals, and pyromania.[24]

The ASPD etiology is currently associated with abusive, chaotic, or emotionally deprived home environments and with low socioeconomic status and urban settings. However, there are concerns that this diagnosis is misapplied to individuals in which this behavioral strategy is contingent with economic or other survival[1]. ASPD is also highly co-morbid with ADHD and Substance-Abuse Disorders[1].

Current neuropsychology recognizes that in addition to the outwardly antisocial behaviors (lying, manipulation, and disregard for the law or other people), ASPD individuals show impairment in both their orbitofrontal cortex (problems with task-switching and other executive functioning) and their amygdala (shown through their impaired fear response and emotional reaction)[22][25]. ASPD patients also have poor fear conditioning (which implicates the hippocampus) and show a general under-arousal to stimuli[26]. Indeed, in children as young as three, a slower heart rate correlates with aggression (though not specifically psychopathy) [27].

Treatment

This section requires expansion.

To date there have been no controlled studies reported which found an effective treatment for ASPD[28]. Some studies have found that the presence ASPD does not significantly interfere with treatment for other disorders, such as substance abuse[29], although others have reported contradictory findings[30].

See also

References

  1. ^ a b c d e f g Antisocial personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000) - pages 645–650
  2. ^ Mayo Clinic Staff (2006-10-09). "Antisocial personality disorder -". MayoClinic.com. http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829. Retrieved 2008-08-17.
  3. ^ "Antisocial Personality, Sociopathy, and Psychopathy"
  4. ^ a b c d "Antisocial Personality Disorder". Psychology Today. 2005. http://psychologytoday.com/conditions/antisocial.html. Retrieved 2007-02-20.
  5. ^ "Antisocial Personality Disorder". Mayo Foundation for Medical Education and Research. 2006. http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829. Retrieved 2007-02-20.
  6. ^ "Antisocial Personality Disorder Treatment". Psych Central. 2006. http://psychcentral.com/disorders/sx7t.htm. Retrieved 2007-02-20.
  7. ^ "Antisocial Personality Disorder". http://www.behavenet.com/capsules/disorders/antisocialpd.htm. Retrieved 2007-12-15.
  8. ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (pdf file)
  9. ^ Dissocial personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  10. ^ 602 "F60.2 Dissocial personality disorder". World Health Organization. http://www.who.int/classifications/apps/icd/icd10online/?gf60.htm+F602. Retrieved 2008-01-12.
  11. ^ Early Prevention of Adult Antisocial Behavior. Cambridge University Press. p. 82. http://books.google.com/books?id=KtXU8R8oZYwC&pg=PA82&lpg=PA82&dq=dissocial+personality+disorder&source=web&ots=lVx_gb_9mM&sig=U_bMqyc-KlzHKEvzXBdeZxplN2E. Retrieved 2008-01-12.
  12. ^ Millon, Theodore, Personality Disorders in Modern Life, 2004
  13. ^ Millon, Theodore - Personality Subtypes
  14. ^ a b c Internet Mental Health - antisocial personality disorder
  15. ^ Oscar-Berman M; Valmas M, Sawyer K, Kirkley S, Gansler D, Merritt D, Couture A (April 2009). "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder". Neuropsychiatric Disease and Treatment 2009 (5): 309–326. PMID 19557141. http://www.dovepress.com/getfile.php?fileID=4829.
  16. ^ Hare 1983
  17. ^ "Antisocial Personality Disorder, Alcohol, and Aggression". Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. 2006. http://pubs.niaaa.nih.gov/publications/arh25-1/5-11.pdf. Retrieved 2007-02-20.
  18. ^ a b "Antisocial Personality Disorder (APD)". Armenian Medical Network. 2006. http://www.health.am/psy/antisocial-personality-disorder/. Retrieved 2007-02-20.
  19. ^ Lyons et al., 1995
  20. ^ http://brain.oxfordjournals.org/cgi/content/abstract/123/6/1122
  21. ^ Muller, et al., 2003
  22. ^ a b Blair, Mitchell, et al., 2006
  23. ^ Crowe & Blair, 2008
  24. ^ J. M. MacDonald. The Threat to Kill. American Journal of Psychiatry, 125-130 (1963)
  25. ^ Kumari, Taylor, Barkataki et al., 2009
  26. ^ Mitchell, Leonard, Richell, & Blair, 2006
  27. ^ Random Samples
  28. ^ J. E. Fisher & W. T. O'Donohue (eds). (2006). Practitioner's Guide to Evidence-Based Psychotherapy, p63
  29. ^ S. Darke, R. Finlay-Jones, S. Kaye, & T. Blatt. Anti-social personality disorder and response to methadone maintenance treatment. Drug and Alcohol Review, vol. 15, 271-276 (1996)
  30. ^ A. I. Alterman, M. J. Rutherford, J. S. Cacciola, J. R. McKay, & C. R. Boardman. Prediction of 7 months methadone maintenance treatment response by four measures of antisociality. Drug & Alcohol Dependence, vol. 49, 217-223 (1998)

External links

Look up antisocial in Wiktionary, the free dictionary.
DSM personality disorders
DSM-III-R only Sadistic · Self-defeating (masochistic)
DSM-IV
Cluster A (odd) Paranoid · Schizoid · Schizotypal
Cluster B (dramatic) Antisocial · Borderline · Histrionic · Narcissistic
Cluster C (anxious) Avoidant · Dependent · Obsessive-compulsive
Personality disorder not otherwise specified
Appendix B (proposed) Depressive · Negativistic (passive-aggressive)
ICD-10 personality disorders
Schizotypal Schizotypal
Specific
Anankastic · Anxious (avoidant) · Dependent · Dissocial · Emotionally unstable · Histrionic · Paranoid · Schizoid ·
Other Eccentric · Haltlose type · Immature · Narcissistic · Passive-aggressive · Psychoneurotic
Unspecified Unspecified
Mixed and other Mixed and other

Categories: Abnormal psychology | Forensic psychology | Personality disorders | Psychopathy

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