ANTISOCIAL PERSONALITY DISORDER - Antisocial Personality Disorder - NCBI Bookshelf
a New York City sex and relationship expert, of dating sociopaths—that is, individuals diagnosed with anti-social personality disorder (ASPD). People with antisocial personality disorder tend to be manipulative and (3) But to date, it is not known what leads to these differences. Antisocial personality disorder is not just about not liking other people; it's a defined social disorder with both biological and environmental.
This pattern is similar to, yet different, than seen in narcissists, where an unjustified self-confidence assumes that all that is desired will come to them with minimal effort on their part. The antisocial assumes the contrary. Moreover, these actions serve to fend off the malice that one anticipates from others, and undo the power possessed by those who wish to exploit the antisocial.
In summary, its criteria focus more than DSM -IV on interpersonal deficits for example, incapacity to experience guilt, a very low tolerance of frustration, proneness to blame others, and so on and less on antisocial behaviour per se.
It does not require symptoms of conduct disorder in childhood. Psychopathy Cleckleyin his influential book The Mask of Sanity, attempted to identify the underlying traits of those who behaved in an exploitative manner and thereby provided a description of psychopathy.
The first of these related to the more narcissistic variant of personality abnormality, emphasising traits such as selfishness, egocentricity and callousness. The second referred to a more antisocial lifestyle with frequent criminal behaviour, early and persistent delinquency, a low tolerance for frustration, and so on.
More recent work has expanded the description of psychopathy as comprising three or four factors. The four factor model Neumann et al. The alternative three-factor model of Cooke and Mitchie differs in that it does not include an antisocial factor because this is seen as a concomitant, rather then a core feature, of psychopathy Blackburn, The disorder of psychopathy, while associated with antisocial personality disorder, is distinct in that while most of those who score highly on the PCL-R Hare et al.
Cute but Psychopath | A Look into Antisocial Personality Disorder • Psych N Sex
In this guideline, psychopathy is referred to only briefly and with reference to practice in tertiary care. The practical implications of this are that those who score highly on the PCL-R and who present to services, or are coerced into doing so, will do so largely to tertiary services.
Although there is disagreement on the diagnostic criteria for antisocial personality disorder, the criteria used in DSM -IV APA, have been adopted in this guideline in order to provide a primary diagnostic anchor point. In addition, nearly all of the evidence examining the efficacy of the interventions focuses on those with a DSM diagnosis.
Course and prognosis Gender affects both the prevalence of antisocial personality disorder see Section 2. Nonetheless, follow-up studies also demonstrate a reduction in the rates of re-offending in men over time Grilo et al. However, Black and colleaguesin one of the few long-term follow-up studies of men with antisocial personality disorder showed that while the men had reduced their impulsive behaviour and hence their criminality with the passage of time, they continued to have significant interpersonal problems throughout their lives Paris, Antisocial personality disorder is associated with an increase in mortality.
An even more striking finding was provided by Black and colleagues in their follow-up of men with antisocial personality disorder. They found that young men with antisocial personality disorder had a high rate of premature death, with those under the age of 40 having an SMR of 33 with the SMR diminishing with increasing age. This increased mortality was due to not only an increased rate of suicide, but to reckless behaviour such as drug misuse and aggression. One of the most striking findings from the literature is that a relatively small number of offenders commit the majority of crimes.
Furthermore, those who commit the majority of crimes, continue to do so throughout most of their life.
This is in contrast to the large number of offenders who desist from criminal activity after adolescence. From the longitudinal Dunedin study, Moffitt was able to characterise life-course-persistent offenders as having inherited or constitutional neuropsychological difficulties that later interact with a criminological environment to produce a phenotype of persistent offending Moffitt, Prevalence of antisocial personality disorder and related conditions The prevalence of antisocial personality disorder in the general population varies depending on the methodology used, and the countries studied, but all show that the condition is much more prevalent among men.
The lifetime prevalence in two North American studies was 4. Two European studies found a prevalence of 1. Despite these relative differences between North American and European studies, the rates of antisocial personality disorder reported indicate that even with the most conservative estimates antisocial personality disorder has the same prevalence in men as schizophrenia, which is the condition that receives the greatest attention from mental health professionals.
Antisocial personality disorder is common in prison settings. By contrast, the prevalence of psychopathy in UK prisoners is only 4. Significant comorbidity exists between antisocial personality disorder and many Axis I conditions.
In the Epidemiological Catchment Area ECA study, when men with and without antisocial personality disorder were compared, those with antisocial personality disorder were three and five times more likely to misuse alcohol and illicit drugs Robins et al. It is also important to note that while women have a significantly lower prevalence of antisocial personality disorder than men, those women with antisocial personality disorder have an even higher prevalence of substance misuse when compared with men Robins et al.
These co-occurring Axis I conditions are important because the presence of antisocial personality disorder is likely to be a negative moderator of treatment response when these conditions are treated by conventional approaches.
Gene-environment interactions As with most psychiatric conditions, antisocial personality disorder is construed as having both a biological and psychosocial aetiology. While it has long been recognised that genes contribute to antisocial behaviour, this field has advanced significantly within the past decade with more sophisticated designs and larger twin and adoptive samples. Two developments are especially noteworthy. First, there is evidence that there is heterogeneity in the antisocial behaviour exhibited by young children.
Moreover, there is evidence that children who offend early and do so with greater aggression have an increased heritability for this behaviour see a review by Viding et al. Hence, children who are genetically vulnerable to behaving in an antisocial manner are likely to also suffer from harsh and inconsistent parenting that, in turn, they may exacerbate by provoking negative responses with their behaviour.
Adoption studies show an interactive effect of genetic vulnerability with an adverse environment so that there is more pathology than one would expect from either acting alone or in combination Cadoret et al. This interactive effect of genes and environment suggests that the genetic risk might be moderated by intervening to reduce negative responses from the parent for example, parent-training programmes, multisystemic therapy, and so on. Knowledge of the genetic vulnerability may inform programme content and delivery and so increase its effectiveness.
For instance, children with callous and unemotional traits respond badly to being punished but positively to rewards and therefore require programmes tailored to their specific needs see Chapter 5.
Biological markers for aggressive behaviour Cross-sectional studies comparing those with and without aggressive behaviour have demonstrated robust differences in physiological responses and in brain structure and function in these groups see a review by Patrick, For instance, individuals prone to aggression have enhanced autonomic reactivity to stress, enhanced EEG slow wave activity, reduced levels of brain serotonin Coccaro et al.
While this increase in understanding in the biology of antisocial behaviour is to be welcomed, it is subject to the following limitations. Most of the studies carried out focus on those with aggressive behaviour and psychopathy rather than on antisocial personality disorder. For instance, children and adolescents who are aggressive have lower levels of autonomic arousal but an enhanced autonomic reactivity to stress Lorber, ; whereas adults who score high on the Psychopathy Checklist have reduced autonomic activity in relation to stress.
The studies suffer, furthermore, from failing to control for confounding factors, such as comorbidity and substance misuse and from a concentration on simple neuropsychological processes such as motor impulsivity or recognition of basic emotions, rather than on more complex behaviour and moral decision making. Finally, they appear to be disconnected from routine clinical work and hence are unlikely to influence current clinical decision making Duggan, In addition to these biological factors, there are numerous adverse environmental influences that are important, including harsh and inconsistent parenting, social adversity, poverty and associating with criminal peers.
This is in contrast to people with borderline personality disorder, many of whom do seek treatment, albeit in a dysfunctional manner Benjamin, Given that those with antisocial personality disorder actively resist having to accept help, and that coercion into treatment directly challenges their core personality structure, it is clear that therapeutic interventions are also likely to be under threat in such circumstances.
Hence, one might expect a high drop-out rate from treatment and indeed that is what has been found Huband et al. Nonetheless, people with antisocial personality disorder do present to healthcare services either willingly or otherwiseso it is important that such services have an understanding of the core personality issues so that they can respond appropriately.
Treatment attrition Dropping out of treatment is a particular problem in the treatment of personality disorder Skodol et al. This suggests that especial care needs to be taken in the management of those with antisocial personality disorder to identify indicators of drop out and actively address them. However, given the propensity of people with antisocial personality disorder not only to reject treatment but also to drop out of treatment, additional efforts to engage people may be required.
These issues are dealt with more fully in Chapter 4 while ethical issues are covered further in Section 2. Extended harm leads not only to high levels of personal injury and financial damage for victims but also to increased costs of policing, security, and so on Welsh et al.
Recognition of these extended costs is important in making a case for what appear to be, on occasion, expensive interventions.
The evidence on the health service costs of antisocial personality disorder is limited. In addition to the paucity of research there are problems in interpreting the current evidence base. There are a number of reasons for this. Health service use specific to antisocial personality disorder is often difficult to estimate because of the significant comorbidity between Axis I and Axis II disorders. In addition, many individuals with the condition do not present for treatment except under duress for example, if they require drug detoxification in prison and, even in cases where the person presents, the condition is often not recognised for example, because people presenting require emergency treatment for an alcohol-related physical health problem or treatment for another comorbid condition.
However, this apparent treatment avoidance can be construed more positively in that many with antisocial personality disorder do not seek help because they are not aware of the interventions available, or, when they do present for help, their presentation is so coloured by the nature of their personality disorder that services are reluctant to respond positively to their demands.
This guideline recognises that those with antisocial personality disorder have many unmet needs and that current service provision may need to be reconfigured in order to meet their expectations. Healthcare service costs incurred by people with dangerous and severe personality disorder have been estimated in a study conducted in Rampton, the high secure hospital in Nottinghamshire Barrett et al.
No other evidence on health and social care costs directly associated with antisocial personality disorder was identified in the existing literature. However, more extensive research has been undertaken on the costs associated with conduct disorder.
Romeo and colleagues estimated such costs in a sample of young children aged from 3 to 8 years with conduct disorder in the UK, adopting a broad societal perspective that included health services, education, social care and costs borne to the family.
Another study conducted in the UK compared the total costs incurred by children with conduct disorder, children with some conduct disorder traits and children without conduct disorder, from the age of 10 and up to the age of 28 years Scott et al. A wide perspective was adopted in this study, which considered special educational, health, foster and residential care services, crime costs, state benefits received in adulthood and breakdown of relationships reflected in domestic violence and divorce.
Similar findings were reported in a US study that compared the costs of children with conduct disorder, oppositional defiant disorder and elevated levels of problem behaviour, with a group of children without any of these disorders Foster et al. Comorbid conduct disorder has been shown to significantly increase costs in adults who were diagnosed with depression in childhood: Knapp and colleagues demonstrated that adults who had depression and comorbid conduct disorder as children incurred more than double the costs compared with those who were diagnosed with depression but no conduct disorder in childhood.
Cute but Psychopath | A Look into Antisocial Personality Disorder
Conversely, it has been suggested that comorbid depression increases costs incurred by young offenders in custody or in contact with youth offending teams Barrett et al. Besides depressed mood, younger age was also shown to result in an increase in total costs.
For those who engage in criminal behaviour there are the obvious costs of such behaviour, including emotional and physical damage to victims, damage to property, police time, involvement with the criminal justice system and prison services. This estimate included costs incurred in anticipation of crime, such as security expenditure and insurance administration, costs directly resulting from crime, such as stolen or damaged property, lost output, emotional and physical impact on victims, health and victim services, as well as costs to the criminal justice system, including police services.
Nevertheless, other important consequences of crime, such as the fear of crime and its impact on quality of life were not taken into account in the estimation of the above figure.
Fear of crime and other intangible costs to crime victims, such as pain, grief and suffering, have been the subject of research of a growing literature aiming at estimating the wider cost implications of crime to the society Dolan et al.
Mental healthcare needs of victims of crime should not be ignored because these have been shown to substantially contribute to the costs associated with crime: Equally important to the above costs are the costs associated with lost employment opportunities, family disruption, relationship breakdown, gambling and problems related to alcohol and substance misuse Myers et al.
Strangling girls and women. Holding girls and women hostage in various locations for up to three days. Beating girls and women with open palms and fists. Verbal threats to kill, torture, and burn down property. That burning down a high school portable example I gave earlier?
He claimed to have done that as a kid. The cheating, domestic violence, and theft pretty much cover this one. Besides these acts, however, he has also said hurtful things which show a general disregard for the feelings or lives of others.
For example, insulting the bodies and appearances of people who considered him a friend or with whom he had slept with. He has also repeatedly abandoned and then re-entered or attempted to re-enter the lives of his children, partners, and friends, with seemingly no sympathy for the emotional havoc imposed by this touch-and-go behavior.
He has fathered three children that I know of, but has never actively parented any of them. He has no idea what real parenting is; his only involvement has been visitations, gift giving, and text messages; simple responsibilities which he abandons at his leisure.
He refuses to acknowledge or genuinely apologize for his violence. Despite my diagnosis, which I have received from multiple providers, he insists he did not cause me to develop PTSD.
His go-to tactics are denial, blaming others, and lying. He shows no remorse. I did love him. But I can no longer understand why. He was silly to the point of being stupid. His selfishness was beyond compare. He was arrogant, entitled, and careless. I guess what drew me to him was his independence. I was a teenager. It probably also helped that he kinda looked like Kurt Cobain.
So what did it feel like? To love someone incapable of loving me back? It felt like absolute, utter desperation.
Often, he would profess his love for me, then disappear for days. It got to the point that I was literally asking the trees if he still loved me, because I simply had no way of quantifying it. Or, I would obsessively consult my tarot deck. Did he still love me?
Had he just broken up with me without saying anything? Would he do that? Would he break up with me at all? He had taken a fourteen year old girl with no romantic interest in him and played a vicious back and forth with my self-esteem; skyrocketing it with declarations of perfect love, then completely destroying it, until I saw no place for myself in this world besides as his girlfriend. I was fueled by desperation. Desperate for him to look at me without seeming like he was looking through me.
Desperate to feel I was enough for him; pretty enough or sexy enough or just enough! Desperate to be able to rely on him when I needed him. My needs never mattered. Romantically, sexually, physically; not even on a basic level. He reciprocated oral sex maybe five times in four years.
I remember spending my seventeenth birthday crying on the couch next to my mom while I waited hours for him to show up and take me out as planned. When I finally gave up and went for a walk, I found him down the street, digging through a dumpster.
My eighteenth birthday was even worse. Even my friends I secretly despised, because The Ex had turned them into competitors for his affection. His affection became the only thing I cared about, and it was something I could never truly get.
Throughout the entire relationship I was plagued by anxiety and self-doubt. I never believed I was pretty enough to deserve love.