Antisocial Personality Disorder
Justin Ballard
Tacoma Community College
March 2018
Definitions and Diagnostic Requirements
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, (American Psychiatric Association, 2013) Antisocial Personality Disorder is defined as a habitual disregard to the wellbeing of others, as well as harmful actions against others, committed without regret or remorse. The diagnosis requires three or more symptoms to be present in the individual after adolescence. While the deviant behaviors may be present throughout the individual's childhood, a diagnosis will not be given until the individual has reached adulthood, at 18 years of age.
There are four diagnostic criteria in regard to Antisocial Personality Disorder, per the DSM-V. They are the disregard for and violation of others' rights, the individual is at least 18 years of age, evidence of Conduct Disorder was apparent before adolescence and that the behavior is not comorbid with or occurring due to Schizophrenia or Bipolar Disorder (American Psychiatric Association, 2013).
Of the first diagnostic criteria, there are seven traits or behaviors considered to be diagnostically relevant in defining the applicability of said criteria. Those behaviors are categorized as (1) disobedience and rejection of laws and social norms; (2) manipulative or deceptive behavior for personal gain or enjoyment; (3) impulsivity; (4) aggression manifesting in violent behavior and fighting; (5) a disregard for the safety of both the self and other people; (6) irresponsibility in their actions; and (7) a lack of remorse for their actions (American Psychiatric Association, 2013).
It is worth noting that these behaviors need to be present not only throughout childhood, but after the individual reaches adolescence and beyond (age 15), in order to prevent a misdiagnosis based on childish behavior during the individual's development, from which the individual may grow out. This is also why a diagnosis cannot be made until an individual is 18 years of age.
History of the Disorder
Antisocial Personality Disorder is relatively "new" in that it did not appear in the DSM until the Third Edition, which was published in 1980. While individuals exhibiting its symptoms have been present throughout history, the nature of their disorder has worn many labels. Before psychology and neuroscience existed as disciplines, those who exhibited these traits were viewed as evil, or under the influence of demonic forces. With the newfound interest and advancement in psychological science in the 19th and 20th century, many of these maladies once attributed to extradimensional influences began to be considered sicknesses. The term "psychopath" became the de facto way to categorize these individuals, and though scientists and researchers still debate the nuances (if any) that exist between the terms "psychopathy" and "sociopathy," the key trait psychologists and psychiatrists characterized was the individual's lack of remorse in their actions (Perez, 2012).
Scientists needed a new way to explain the often hyperviolent and depraved acts committed by people who exhibited no typical signs of lunacy, insanity or mania. The individuals instead appeared well adjusted and socially competent and defied traditional investigatory and diagnostic approaches. In 1980, the American Psychiatric Association established Antisocial Personality Disorder in the Third Edition of the DSM as an overarching diagnosis. Now, a common line of inquiry and research in the psychiatric community is whether Antisocial Personality Disorder is an adequate predictor in and of itself of violent or psychopathic behavior, as more research has discovered a frequent comorbidity between Antisocial Personality Disorder and other issues such as substance abuse disorders (Ogloff, Talevski, Lemphers, Wood & Simmons, 2015).
The causes of Antisocial Personality Disorder are currently unknown, and while there have been speculations as to specific genetic or environmental origins, there have yet to be conclusive findings in this regard. While neuroscientists have identified that aberrations, poor development or injuries to different regions of the brain have affected behavior, cognition, emotional responses and personality, there has yet to be a precise and accepted identification of biological events that could be considered responsible for Antisocial Personality Disorder.
Life Impact
Sufferers of Antisocial Personality Disorder are extremely likely to have their lives impacted negatively by the disorder. Antisocial Personality Disorder commonly exhibits comorbidity with substance abuse disorders (Ogloff, Talevski, Lemphers, Wood & Simmons, 2015) and psychopathy (Riser & Kosson, 2013). It is notable that, according to Riser and Kosson, who conducted a study on a prison population of individuals without Antisocial Personality Disorder, those with the disorder, and those with both the disorder and psychopathy, that while the majority of individuals with Antisocial Personality Disorder are not psychopathic, individuals with Antisocial Personality Disorder are more likely to be charged with more violent and nonviolent crimes than individuals without. Individuals with comorbid diagnoses of Antisocial Personality Disorder and psychopathy are more likely to receive violent and nonviolent charges than individuals with Antisocial Personality Disorder, but without psychopathy (2013).
This is not to say that individuals with Antisocial Personality Disorder are more likely to be criminal. Per the DSM-V, Antisocial Personality Disorder does not necessarily correlate to criminality. A more accurate conclusion would be that criminals who have Antisocial Personality Disorder are likely to be more violent and more prolific criminals (American Psychiatric Association, 2013).
Treatment
Treatment for Antisocial Personality Disorder can be difficult, as it requires an accurate diagnosis in addition to diagnoses of any comorbid conditions. In 1991, the Epidemiologic Catchment Area Survey conducted by Robins, Tipp & Przybeck found that over 90% of individuals who met the criteria for Antisocial Personality Disorder had a comorbid condition (1991). This requires the comorbid condition to be diagnosed as well as the Antisocial Personality Disorder, and both to be treated.
Once any and all existing comorbid disorders are found, the treatment can begin, with different treatment methods for different disorders. Citing McKendrick, Sullivan, Banks and Sacks (2006), Hatchett proposes that treatment-as-usual as well as cognitive behavior therapy have shown reductions in recidivism and aggressive behavior (2015). While the root causes of the disorder remain elusive, psychologists now know that these individuals can be treated, and that doing so would be of benefit to not only the afflicted individual, but to greater society at large.
It is worth reiterating that treatment for substance abuse alone is not adequate in treating Antisocial Personality Disorder, as individuals with dual diagnoses have reported less significant improvements in regard to substance abuse disorders than those without Antisocial Personality Disorder, suggesting an almost symbiotic coexistence between the disorders, or a certain psychological reinforcement that demands both disorders to be treated with separate techniques but synchronously.
Legal Issues and Complications
While the stereotype that individuals with Antisocial Personality Disorder are all criminals and serial killers is unfounded and unfair, the nature of the disorder does increase the risk of criminality (American Psychiatric Association, 2013). Though Antisocial Personality Disorder is uncommon in the total population, about half of the prison population exhibit the necessary criteria for diagnosis (Moran, 1999). Half of the individuals who met criteria for Antisocial Personality Disorder in the Epidemiologic Catchment Area Survey were reported to have criminal histories as well (Robins, Tipp & Przybeck, 1991).
Now that neural imaging has been able to reveal a physiological impairment and dysfunction in the brains of individuals with Schizophrenia, a significant discussion is taking place in law enforcement and psychiatric communities regarding culpability. If a Schizophrenic has no agency or control over themselves in the midst of a violent act, and is therefore not legally responsible for their actions, the same theory could apply to those who suffer from Antisocial Personality Disorder. The issue will continue to be debated as scientific understanding grows and the causes and biological nature of the disorder can be identified, and proactive treatments can be established. Until then, those who suffer from Antisocial Personality Disorder, and especially those with comorbid Psychopathy or Substance Abuse Disorder, are at high risk of committing criminal and violent acts.
References
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text revision). Washington, DC: Author.
Hatchett, G. T. (2015). Treatment Guidelines for Clients with Antisocial Personality Disorder. Journal of Mental Health Counselling Vol. 37 Issue 1, 15-27. Accession Number: 100177754
McKendrick, K., Sullivan, C., Banks, S., & Sacks, S. (2006). Modified therapeutic community treatment for offenders with MICA disorders: Antisocial personality disorder and treatment outcomes. Journal of Offender Rehabilitation 44, 133-159. Doi: 10.1300/J076v44n02_06
Moran, P. (1999). The epidemiology of antisocial personality disorder. Social Psychiatry and Psychiatric Epidemiology 34, 231-242. Doi: 10.1007/s001270050138
Ogloff, J. R. P., Talevski, D., Lemphers, A., Wood, M., & Simmons, M. (2015). Co-occurring mental illness, substance use disorders, and antisocial personality disorder among clients of forensic mental health services. Psychiatric Rehabilitation Journal 38(1), 16-23. Identifier: prj-38-1-16. Accession Number: 2015-12225-003.
Perez, P. R. (2012). The etiology of psychopathy: A neuropsychological perspective. Aggression and Violent Behavior 17, 458-461.
Riser, R. E., & Kosson, D. S. (2013). Criminal behavior and cognitive processing in male offenders with antisocial personality disorder with and without comorbid psychopathy. Personality Disorders: Theory, Research and Treatment Vol. 4(4), 332-340. PMID: 24378159. Identifier: per-4-4-332. Accession Number: 2013-45025-003.
Robins, L. N., Tipp, J., & Przybeck, T. (1991). Antisocial personality. In L. N. Robins & D. A. Regier (Eds.), Psychiatric disorders in America: The Epidemiologic Catchment Area Study, 259-290). New York, NY: Free Press.