Antisocial personality disorder

From Wikipedia, the free encyclopedia

Jump to: navigation, search
Antisocial personality disorder
Classification and external resources
ICD-10 F60.2
ICD-9 301.8
MeSH D000987

Antisocial personality disorder (ASPD) is defined by the American Psychiatric Association's Diagnostic and Statistical Manual as "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."[1] 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. Also, the individual must be age 18 or older as well as have a documented history of a conduct disorder before the age of 15.[1]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.[2]


[edit] Development

The criteria for the Antisocial Personality Disorder were made by Andrew, Endicott and Robbins because of concern in the development of the DSM-IV too much emphasis was focused on research data. Researchers have heavily criticized the ASPD criteria (see below) because not enough emphasis was placed on traditional psychopathic traits such as a lack of empathy, superficial charm, 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.

[edit] Diagnostic criteria

Three or more of the following are required:[1]

  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, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
  3. Impulsivity or failure to plan ahead;
  4. Irritability and aggressiveness, 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, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

The antisocial behavior must not occur exclusively during an episode of schizophrenia or a manic episode.[3]

Sex differences: According to DSM-IV (in a 1994 publication by the APA), Antisocial Personality disorder is diagnosed in approximately three percent of all males and one percent of all females.[1]

[edit] Symptoms

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

  • Persistent lying or stealing
  • Superficial charm[4][5]
  • Apparent lack of remorse[4] or empathy; inability to care about hurting others
  • Inability to keep jobs or stay in school[4]
  • Impulsivity and/or recklessness[4]
  • Lack of realistic, long-term goals -- an inability or persistent failure to develop and execute long-term plans and goals
  • Inability to make or keep friends, or maintain relationships such as marriage
  • Poor behavioral controls -- expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper
  • Narcissism, elevated self-appraisal or a sense of extreme entitlement
  • A persistent agitated or depressed feeling (dysphoria)
  • A history of childhood conduct disorders
  • Recurring difficulties with the law
  • Tendency to violate the boundaries and "rights" of others
  • Substance abuse
  • Aggressive, often violent behavior; prone to getting involved in fights
  • Inability to tolerate boredom
  • Disregard for the safety of self or others
  • People with a diagnosis of antisocial personality disorder often experience difficulties with authority figures.[6]

[edit] Prevalence

The National Comorbidity Survey, which uses DSM-III-R criteria, discovered that 5.8 percent of males and 1.2 percent of females showed evidence of a lifelong chance of obtaining the disorder.[7] According to DSM-IV, Antisocial Personality disorder is diagnosed in approximately three percent of all males and one percent of all females.[1]

Prevalence estimates within clinical settings vary from three to 30 percent, depending on the predominant characteristics of the populations being sampled. [8] The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders). [9] Similarly, the prevalence of APD is higher among patients in alcohol or other drug (AOD) abuse treatment programs than in the general population (Hare 1983), suggesting a link between APD and AOD abuse and dependence.[10] David Korten also reports research that shows a high proportion of these traits among CEOs of major corporations. [11]

[edit] Relationship with other mental disorders

Antisocial personality disorder is negatively correlated with all DSM-IV Axis I disorders except substance abuse disorders. Antisocial personality disorder is most strongly correlated with psychopathy as measured on the Psychopathy Checklist-Revised.[citation needed], mostly on the social deviance and behavioral aspects of the PCL-R, not the affective/interpersonal factor dimensions. 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 as synonyms for dissocial personality disorder.

[edit] Potential markers

Even though antisocial personality disorder cannot be diagnosed before adulthood, the presence of three behavioral markers, known as the Macdonald triad, can be found in some children who go on to develop ASPD. The triad consists of bedwetting, a tendency to abuse animals, and pyromania.[12]

The number of children who exhibit these signs and grow up to develop antisocial personality disorder is unknown, but these signs are correlated with the traits of diagnosed adults. Because the number is unknown, this evidence is not yet ready to be permissible evidence of the disorder in a child. These three traits are described in the Diagnostic and Statistical Manual of Mental Disorders IV-TR.[citation needed]

[edit] Criticism of the DSM-IV criteria

The DSM-IV confound: Many have argued that psychopathy/sociopathy are incorrectly put together under ASPD (Indeed, there appear to be no scientists arguing that ASPD and psychopathy are the same). These clinicians and researchers 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. [13]. Also, APD, 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. Also, the DSM-IV field trials never included incarcerated populations.

[edit] Causes

The exact cause of ASPD is not known, but biological or genetic factors may play a role.

If a parent has had the disorder it increases the chance of the disorder. A number of environmental factors in the childhood home, school, and community may also contribute to the disorder. 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.[14]

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.

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. [15][14]

[edit] See also

[edit] References

  1. ^ a b c d e American Psychiatric Association Retard Foundation (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association. pp. 645–650. ISBN 0-89042-061-0. 
  2. ^ Mayo Clinic Staff (2006-10-09). "Antisocial personality disorder -". Retrieved on 2008-08-17. 
  3. ^ "Antisocial Personality Disorder". Retrieved on 2007-12-15. 
  4. ^ a b c d "Antisocial Personality Disorder". Psychology Today. 2005. Retrieved on 2007-02-20. 
  5. ^ "Antisocial Personality Disorder". Mayo Foundation for Medical Education and Research. 2006. Retrieved on 2007-02-20. 
  6. ^ "Antisocial Personality Disorder Treatment". Psych Central. 2006. Retrieved on 2007-02-20. 
  7. ^ "Antisocial Personality Disorder". Antisocial Personality Disorder for professionals. Armenian Medical Network. 2006. Retrieved on 2007-02-20. 
  8. ^ Diagnostic and Statistical Manual of Mental Disorders
  9. ^ Hare 1983
  10. ^ "Antisocial Personality Disorder, Alcohol, and Aggression". Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. 2006. Retrieved on 2007-02-20. 
  11. ^ Korten, David (2001), "When Corporations Rule the World" (Berret-Kohler Publications)
  12. ^ J. M. MacDonald. The Threat to Kill. American Journal of Psychiatry, 125-130 (1963)
  13. ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (pdf file)
  14. ^ a b "Antisocial Personality Disorder (APD)". Armenian Medical Network. 2006. Retrieved on 2007-02-20. 
  15. ^ Lyons et al., 1995

[edit] External links

Personal tools