Antisocial personality disorder - AbsoluteAstronomy.com

Antisocial personality disorder (ASPD) is described by the American Psychiatric Association

American Psychiatric Association

The American Psychiatric Association is the main professional organization of psychiatrists and trainee psychiatrists in the United States, and the most influential worldwide. Its some 38,000 members are mainly American but some are international...

's Diagnostic and Statistical Manual, fourth edition (DSM-IV-TR), as an Axis II personality disorder

Personality disorder

Personality disorders, formerly referred to as character disorders, are a class of personality types and behaviors. Personality disorders are noted on Axis II of the Diagnostic and Statistical Manual of Mental Disorders or DSM-IV-TR of the American Psychiatric Association.Personality disorders are...

characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."

The World Health Organization

World Health Organization

The World Health Organization is a specialized agency of the United Nations that acts as a coordinating authority on international public health. Established on 7 April 1948, with headquarters in Geneva, Switzerland, the agency inherited the mandate and resources of its predecessor, the Health...

's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), defines a conceptually similar disorder to antisocial personality disorder called Dissocial personality disorder.

The American Psychiatric Association

American Psychiatric Association

's Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders

The Diagnostic and Statistical Manual of Mental Disorders is published by the American Psychiatric Association and provides a common language and standard criteria for the classification of mental disorders...

incorporated various concepts of psychopathy/sociopathy/antisocial personality in early versions but, starting with the DSM-III in 1980, used instead a diagnosis of antisocial personality disorder

Antisocial personality disorder

Antisocial personality disorder is described by the American Psychiatric Association's Diagnostic and Statistical Manual, fourth edition , as an Axis II personality disorder characterized by "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood...

. This was based on some of the criteria put forward by Cleckley but operationalized in behavioral terms and more specifically related to conduct and criminality. The World Health Organization

World Health Organization

's ICD incorporates a similar diagnosis of Dissocial Personality Disorder. Both the DSM and the ICD state that psychopathy (or sociopathy) are synonyms of their diagnosis.

Psychopathy

Psychopathy

Psychopathy is a mental disorder characterized primarily by a lack of empathy and remorse, shallow emotions, egocentricity, and deceptiveness. Psychopaths are highly prone to antisocial behavior and abusive treatment of others, and are very disproportionately responsible for violent crime...

and sociopathy are terms related to ASPD. ASPD replaced psychopathy as a diagnosis in the DSM but the terms are not identical. Psychopathy is now (like sociopathy) usually seen as a subset of ASPD. Many people with this disorder are not violent unless significantly and specifically provoked.

DSM-IV

The Diagnostic and Statistical Manual of Mental Disorders

Diagnostic and Statistical Manual of Mental Disorders

, fourth edition (DSM IV-TR), defines antisocial personality disorder (in Axis II Cluster B) as:

A) There is 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
Norm (sociology)
Social norms are the accepted behaviors within a society or group. This sociological and social psychological 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...

with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
deception
Deception
Deception, beguilement, deceit, bluff, mystification, bad faith, and subterfuge are acts to propagate beliefs that are not true, or not the whole truth . Deception can involve dissimulation, propaganda, and sleight of hand. It can employ distraction, camouflage or concealment...

, as indicated by repeatedly lying
Lie
For other uses, see Lie A lie is a type of deception in the form of an untruthful statement, especially with the intention to deceive others....

, use of aliases, or conning others for personal profit or pleasure;
impulsiveness or failure to plan ahead;
irritability
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
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 humiliation, pain, or harm. Ferguson and Beaver defined aggressive behavior as "Behavior which is intended to increase the social dominance of...

, 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
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...

, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another;

B) The individual is at least age 18 years.

C) There is evidence of conduct disorder

Conduct disorder

Conduct disorder is psychological disorder diagnosed in childhood that presents itself through a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated...

with onset before age 15 years.

D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia

Schizophrenia

Schizophrenia is a mental disorder characterized by a disintegration of thought processes and of emotional responsiveness. It most commonly manifests itself as auditory hallucinations, paranoid or bizarre delusions, or disorganized speech and thinking, and it is accompanied by significant social...

or a manic episode.

New evidence points to the possibility that children often develop antisocial personality disorder as a result of environmental as well as genetic influence. The individual must be at least 18 years of age to be diagnosed with this disorder (Criterion B), but those commonly diagnosed with ASPD as adults were diagnosed with conduct disorder as children. The prevalence of this disorder is 3% in males and 1% from females, as stated in the DSM IV-TR.

ICD-10

The World Health Organization

World Health Organization

's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), defines a conceptually similar disorder to antisocial personality disorder called Dissocial personality disorder.

It is characterized by at least 3 of the following:

Callous unconcern for the feelings of others and lack of the capacity for empathy
Empathy
Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...

.
Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
Incapacity to maintain enduring relationships.
Very low tolerance to frustration
Frustration
This article concerns the field of psychology. The term frustration does, however, also concern physics. In this context, the term is treated in a different article, geometric frustration....

and a low threshold for discharge of aggression
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 humiliation, pain, or harm. Ferguson and Beaver defined aggressive behavior as "Behavior which is intended to increase the social dominance of...

, including violence
Violence
Violence is the use of physical force to apply a state to others contrary to their wishes. violence, while often a stand-alone issue, is often the culmination of other kinds of conflict, e.g...

.
Incapacity to experience guilt
Guilt
Guilt is the state of being responsible for the commission of an offense. It is also a cognitive or an emotional experience that occurs when a person realizes or believes—accurately or not—that he or she has violated a moral standard, and bears significant responsibility for that...

and to profit from experience, particularly punishment
Punishment
Punishment is the authoritative imposition of something negative or unpleasant on a person or animal in response to behavior deemed wrong by an individual or group....

.
Markedly prone to blame
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...

others or to offer plausible rationalization
Rationalization (psychology)
In psychology and logic, rationalization is an unconscious defense mechanism in which perceived controversial behaviors or feelings are logically justified and explained in a rational or logical manner in order to avoid any true explanation and made consciously tolerable by plausible means...

s for the behavior bringing the subject into conflict.
Persistent irritability
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 disorder

Conduct disorder

s. Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Millon's subtypes

Theodore Millon

Theodore Millon is an American psychologist known for his work on personality disorders.-Biography:Millon was born in 1928, the only child of immigrant Jewish parents from Lithuania and Poland. His 19th-century ancestors came from the town of Valozhyn, then a part of the Russian Empire...

identified five subtypes of antisocial behavior. Any antisocial individual may exhibit none, one or more than one of the following:

covetous antisocial - variant of the pure pattern where individuals feel that life has not given them their due.
reputation-defending antisocial - including narcissistic
Narcissistic personality disorder
Narcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity...

features
risk-taking antisocial - including histrionic
Histrionic personality disorder
Histrionic personality disorder is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriately seductive behavior, usually beginning in early...

features
nomadic antisocial - including schizoid
Schizoid personality disorder
Schizoid personality disorder is a personality disorder characterized by a lack of interest in social relationships, a tendency towards a solitary lifestyle, secretiveness, emotional coldness, and sometimes apathy, with a simultaneous rich, elaborate, and exclusively internal fantasy world...

, avoidant
Avoidant personality disorder
Avoidant personality disorder is a personality disorder recognized in the Diagnostic and Statistical Manual of Mental Disorders handbook in a person characterized by a pervasive pattern of social inhibition, feelings of inadequacy, extreme sensitivity to negative evaluation, and avoidance of...

features
malevolent antisocial - including sadistic
Sadistic personality disorder
Sadistic personality disorder is a diagnosis which appeared only in an appendix of the revised third edition of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders . The current version of the DSM does not include it, so it is no longer considered a valid...

, paranoid
Paranoid personality disorder
Paranoid personality disorder is a psychiatric diagnosis characterized by paranoia and a pervasive, long-standing suspiciousness and generalized mistrust of others....

features.

Differential diagnosis

The following conditions commonly coexist with antisocial personality disorder:

Anxiety disorders
Depressive disorder
Substance-related disorders
Somatization disorder
Somatization disorder
Somatization disorder is a psychiatric diagnosis applied to patients who persistently complain of varied physical symptoms that have no identifiable physical origin...
Borderline personality disorder
Borderline personality disorder
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person , characterized by depth and variability of moods.The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the...
Histrionic personality disorder
Histrionic personality disorder
Histrionic personality disorder is defined by the American Psychiatric Association as a personality disorder characterized by a pattern of excessive emotionality and attention-seeking, including an excessive need for approval and inappropriately seductive behavior, usually beginning in early...
Narcissistic personality disorder
Narcissistic personality disorder
Narcissistic personality disorder is a personality disorder in which the individual is described as being excessively preoccupied with issues of personal adequacy, power, prestige and vanity...

When combined with alcoholism

Alcoholism

Alcoholism is a broad term for problems with alcohol, and is generally used to mean compulsive and uncontrolled consumption of alcoholic beverages, usually to the detriment of the drinker's health, personal relationships, and social standing...

, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.

Epidemiology

Antisocial personality disorder is seen in 3% to 30% of psychiatric outpatients. The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many 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 anti-social personality disorder. 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.

Treatment

To date there have been no controlled studies reported which found an effective treatment for ASPD, although contingency management programs, or a reward system, has been shown moderately effective for behavioral change. 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.
Schema Therapy

Schema Therapy

Schema Therapy was developed by Dr. Jeffrey E. Young for use in treatment of personality disorders and chronic Axis I disorders, such as when patients fail to respond or relapse after having been through other therapies...

is being investigated as a treatment for antisocial personality disorder. Cognitive behavioral strategies are being studied as a means to combat personality disorders, and they appear to help at least some antisocial persons. Medications targeting comorbid psychiatric disorders may help to reduce antisocial behaviors.

Psychopathy and sociopathy

Psychopathy

and sociopathy are terms related to ASPD. ASPD replaced psychopathy as a diagnosis in the DSM but the terms are not identical. Psychopathy is now (like sociopathy) usually seen as a subset of ASPD.

Psychopathy

Psychopathy (s) was, until 1980, the term used for a personality disorder

Personality disorder

characterized by an abnormal lack of empathy

Empathy

Empathy is the capacity to recognize and, to some extent, share feelings that are being experienced by another sapient or semi-sapient being. Someone may need to have a certain amount of empathy before they are able to feel compassion. The English word was coined in 1909 by E.B...

combined with strongly amoral

Amoral

Amoral may refer to:*Amorality, the absence of morality; for example, a stone, a chair, or the sky may be considered amoral**Specific amorality, the absence of some particular moral standard, principle, code, or knowledge...

conduct but masked by an ability to appear outwardly normal. The publication of DSM-III changed the name of this mental disorder to Antisocial Personality Disorder and also broadened the diagnostic criteria considerably by shifting from clinical inferences to behavioral diagnostic criteria. The ICD-10

ICD-10

The International Statistical Classification of Diseases and Related Health Problems, 10th Revision is a medical classification list for the coding of diseases, signs and symptoms, abnormal findings, complaints, social circumstances, and external causes of injury or diseases, as maintained by the...

diagnostic criteria of the World Health Organization

World Health Organization

also lacks psychopathy as a personality disorder, its 1992 manual including Dissocial (Antisocial) Personality Disorder, which encompasses amoral, antisocial, asocial, psychopathic, and sociopathic personalities.

Psychopathy is normally seen as a subset of the antisocial personality disorder, but Blair believes that the antisocial personality disorder and psychopathy may be separate conditions altogether.

Some researchers are critical of the changed diagnostic criteria. Antisocial personality disorder is diagnosed via behavior and social deviant behaviors, whereas a diagnosis of psychopathy also includes affective and interpersonal personality factors. The Hare Psychopathy Checklist

Hare Psychopathy Checklist

In contemporary research and clinical practice, Robert D. Hare's Psychopathy Checklist-Revised is the psycho-diagnostic tool most commonly used to assess psychopathy...

is better able to predict future criminality, violence, and recidivism than the diagnosis of ASPD using the DSM-III-R. Robert D. Hare writes that there are also differences between psychopaths and others on "processing and use of linguistic and emotional information" while such differences are small between those diagnosed with ASPD and not. However, the Hare Psychopathy Checklist requires the use of a rather long interview and availability of considerable additional information as well as depending in part on judgements of character rather than observed behavior. Hare writes that the field trials for the DSM-IV found personality traits judgements to be as reliable as those diagnostic criteria relying only on behavior but that the personality traits criteria were dropped in part because it was feared that the average clinician would not use them correctly. Hare criticizes the instead used DSM-IV criteria for being poorly empirically tested. In addition, the introductory text description describes the personality characteristics typical of psychopathy, which Hare argues make the manual confusing and actually containing two different sets of criteria. He also argues that 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.

The DSM-V working party is recommending a revision of Antisocial Personality Disorder to include "Antisocial/Psychopathic Type", with the diagnostic criteria having a greater emphasis on character than on behavior.

Sociopathy

Hare writes that the difference between sociopathy and psychopathy may "reflect the user's views on the origins and determinates of the disorder." The term sociopathy may be preferred by sociologists that see the causes as due to social factors. The term psychopathy may be preferred by psychologists who see the causes as due to a combination of psychological, genetic, and environmental factors.

David T. Lykken

David T. Lykken

David Thoreson Lykken was a behavioral geneticist and Professor Emeritus of Psychology and Psychiatry at the University of Minnesota...

proposed psychopathy and sociopathy are two distinct kinds of antisocial personality disorder. He believed psychopaths are born with temperamental differences such as impulsivity, cortical underarousal, and fearlessness that lead them to risk-seeking behavior and an inability to internalize social norms

Norm (sociology)

Social norms are the accepted behaviors within a society or group. This sociological and social psychological 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...

. On the other hand, he claimed that sociopaths have relatively normal temperaments; their personality disorder being more an effect of negative sociological factors like parental neglect, delinquent peers, poverty

Poverty

Poverty is the lack of a certain amount of material possessions or money. Absolute poverty or destitution is inability to afford basic human needs, which commonly includes clean and fresh water, nutrition, health care, education, clothing and shelter. About 1.7 billion people are estimated to live...

, and extremely low or extremely high intelligence. Both personality disorders are the result of an interaction between genetic predispositions and environmental factors, but psychopathy leans towards the hereditary whereas sociopathy tends towards the environmental.

External links

The source of this article is wikipedia, the free encyclopedia. The text of this article is licensed under the GFDL.

DSM-IV

ICD-10

Millon's subtypes

Differential diagnosis

Epidemiology

Treatment

Psychopathy and sociopathy

Psychopathy

Sociopathy

See also

External links