Antisocial personality disorder

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Antisocial personality disorder (APD) is a mental disorder defined by the American Psychiatric Association's Diagnostic and Statistical Manual: "The essential feature for the diagnosis is 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]

Contents

[edit] Development

The criteria for the Antisocial Personality Disorder was made by Spitzer, Endicott and Robbins because of concern in the development of the DSM-IV that too much emphasis was focused on research data and not enough on more traditional psychopathic traits such as a lack of empathy, superficial charm, and inflated self appraisal. Lack of remorse is not included among other things because of cases that show that it does exist. For example the antisocial person may show guilt or remorse and offer excuses and rationalizations. However, over a period of time, remorse or guilt over an action/crime may be lost.[2]

[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 3% of all males and 1% of all females.[1]

[edit] Symptoms

Common characteristics of people with antisocial personality disorder include:[citation needed]

  • Persistent lying or stealing
  • Recurring difficulties with the law
  • Tendency to violate the rights and boundaries of others (property, physical, sexual, emotional, legal)
  • Substance abuse
  • Aggressive, often violent behavior; prone to getting involved in fights
  • A persistent agitated or depressed feeling (dysphoria)
  • Inability to tolerate boredom
  • Disregard for the safety of self or others
  • A childhood diagnosis of conduct disorders - this is not a symptom but "a history of"
  • Lack of remorse, related to hurting others
  • Superficial charm
  • Impulsiveness
  • A sense of extreme entitlement
  • Inability to make or keep friends
  • Recklessness, impulsivity[4][5]
  • 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 3% of all males and 1% of all females.[1]

In penitentiaries, the percentage is estimated to be as high as 75 percent.[citation needed] Prevalence estimates within clinical settings have varied[weasel words] from three to 30 percent, depending on the predominant characteristics of the populations being sampled. {Diagnostic and Statistical Manual of Mental Disorders} The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders) (Hare 1983). 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.[8] David Korten also reports research that shows a high proportion of these traits amongst CEOs of major corporations [9].

[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] 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 or, the Macdonald triad, can be found in some children. This consists of bedwetting, a tendency to be cruel to animals, and pyromania[10].

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

[edit] Criticism of the DSM-IV criteria

The DSM-IV confound: Some have found a problem in that both sociopathy and psychopathy are put together under APD. These people are upset that an important distinction has been lost between these two disorders. In other words they are now considered by many to be the same, or very similar."[11]

[edit] Causes

The reason for APD is not known, but biological or genetic factors may play a role. However, since the statistical correlation between the disorder and biological factors is weak, many experts to not believe there is a link .{{Fact|date=December 2007

If a family member has had the disorder (especially the parents)it inceases 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 APD, whereas females tended to show an increased incidence of somatization disorder instead.[12]

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. They would also usually be alchoholics, and be very impulsive and/or violent. These factors all could lead to an unstable home.

Adoption studies show that both genetic and environmental can contribute to the development of the disorder. These studies have also have shown that genetic factors are more important for adults with the disorder, while environmental factors are more important in antisocial children. (Lyons et al., 1995)[12]

[edit] See also

[edit] References

  1. ^ a b c d e American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders. Washington, DC: American Psychiatric Association, 645-650. ISBN 0-89042-061-0. 
  2. ^ Widiger et al., Thomas (1995). Personality Disorder Interview-IV, Chapter 4: Antisocial Personality Disorder. Psychological Assessment Resources, Inc., 47. ISBN 0-911907-21-1. 
  3. ^ Antisocial Personality Disorder. Retrieved on 2007-12-15.
  4. ^ 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. ^ Antisocial Personality Disorder, Alcohol, and Aggression. Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism (2006). Retrieved on 2007-02-20.
  9. ^ Korten, David (2001), "When Corporations Rule the World" (Berret-Kohler Publications)
  10. ^ J. M. MacDonald. The Threat to Kill. American Journal of Psychiatry, 125-130 (1963)
  11. ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (pdf file)
  12. ^ a b Antisocial Personality Disorder (APD). Armenian Medical Network (2006). Retrieved on 2007-02-20.

[edit] External links

Look up antisocial in
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DSM-IV Personality Disorders
Cluster A (Odd)
Cluster B (Dramatic)
Cluster C (Anxious)