Antisocial personality disorder (APD) is a mental disorder. It is 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] People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that Psychopathy/Sociopathy are not synonymous with AsPD.[2]
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The criteria for the Antisocial Personality Disorder were 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. Note that 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.
Three or more of the following are required:[1]
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]
Characteristics of people with antisocial personality disorder may include:
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 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.[10] David Korten also reports research that shows a high proportion of these traits among CEOs of major corporations. [11]
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., mostly on the social devaince 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.
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 APD. 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.
The DSM-IV confound: Many have argued that psychopathy/sociopathy are incorrectly put together under APD (Indeed, there appear to be no scientists arguing that APD 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, APD 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. Also, APD, unlike psychopathy, does not have biological markers confirmed to underpin the disorder. [13]. Other criticisms of APD are that it is essentially synonymous with criminality. Nearly 80-95% of felons will meet criteria for APD - thus APD 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.
The exact cause of APD 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 APD, 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]
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