Antisocial Personality Disorder

What is Antisocial personality disorder?

This personality disorder is characterized by ambition, persistence, goal-directed behavior, an apparent need to control the environment, and an unwillingness to trust the abilities of others. The antisocial personality demonstrates antisocial or criminal acts but is not synonymous with criminality. There is an inability to conform to social standards, and this has been termed the dyssocial personality disorder.

Antisocial personality disorder applies to an individual if there is a pervasive pattern of disregard for and violation of the rights of others occurring since age fifteen. As seen through the eyes of others, their behavior appears as a spectrum from fearless in milder forms, to reckless in the more severe forms of the disorder. They tend to be impulsive, forceful, aggressive, irresponsible, and seldom inhibited by danger or fear of punishment. Risk taking behavior often provides a feeling of exhilaration for them. They tend to have an inherent lack of consideration for the rights of others.

In more severe antisocial individuals, this lack of consideration becomes a reckless disregard for the rights and welfare of self and others. They may feel little remorse in using others to achieve their own desired goals. Their difficulty in developing and maintaining close interpersonal relationships may stem from their fear that others will harm them in some way. They can be argumentative, abusive and cruel. In severe forms, they can be belligerent and vindictive.

The prevalence of this disorder is three percent in men and one percent in women. The onset of the disorder is before the age of fifteen with a higher prevalence in urban areas of the lower socioeconomic class. Prevalence in the prison population may be as high as 75%.

How is it diagnosed?

History of an individual with antisocial characteristics would reveal an individual who, in early teenage years, began to get into trouble with the law. At first, it might be minor infractions, disturbing the peace, or fighting at school, and then offenses that are more serious can occur. Alcohol and drug abuse is prevalent in a large number of individuals with this disorder and tends to escalate problems with law enforcement agencies. Noteworthy also is the genetic disposition of this disorder. A familial pattern has been shown to be present, in that it is five times more common among first-degree relatives of males with the disorder than among controls.

A history of disordered life functioning may include the following: lying, truancy, running away from home, thefts, fights, substance abuse. In recounting their past life of crime, child and spousal abuse, and promiscuity, they will generally show no remorse with an apparent lack of conscience.

Psychiatric interview and the mental status exam is the primary method of diagnosis for this disorder as with all personality disorders. Observation of the individual's orientation, dress, mannerisms, behavior and content of speech provide essential signs to diagnose the illness. The diagnosis of antisocial personality disorder cannot be made if schizophrenia, mania or mental retardation can explain the symptoms.

Physical exam is not helpful in diagnosing this disorder.

Tests: This part of the work up should include an EEG (electroencephalogram) and a thorough neurological exam. Individuals with this disorder may show abnormal EEG results and neurological signs suggestive of minimal brain damage in childhood.

How is Antisocial personality disorder treated?

Group and individual psychotherapy is most commonly utilized for the antisocial personality disorder. Once these individuals are among peers and in a hospital setting, they may become cooperative with treatment. Self-help groups have also been useful. Medications are used to control the incapacitating symptoms of anxiety, depression, and physical violence. The draw back is high incidence of substance abuse and caution must be used in selecting and prescribing drug therapy. At times, an antisocial personality will have attention-deficit/hyperactivity disorder (ADHD) concurrently and may require a central nervous system stimulant to control the associated symptoms.

Medications

Zyprexa (Olanzapine), Lithobid (Lithium), Clozaril (Clozapine)

What might complicate it?

Either real or perceived control by person(s), figures of authority, or institutions, is often reciprocated with resistance and, at times, aggressive behavior. As previously mentioned, substance abuse, including alcohol, is commonly associated with this disorder and can produce significant complications.

Predicted outcome

Antisocial personality disorder is considered a life-long illness with an unremitting course once it begins in late adolescence. Prognosis is variable with some studies reporting decreasing symptoms with age. The most predictable outcome is that these individuals usually die prematurely from drug overdose or from involvement in high risk criminal behaviors, or they become incarcerated.

Alternatives

In antisocial personality disorder, there is likely to be combinations of narcissistic, histrionic and paranoid personalities. Psychiatric disorders commonly associated are anxiety disorders and paranoid disorders.

Appropriate specialists

Psychologist, psychiatrist and licensed clinical social worker.

Last updated 20 June 2015