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Antisocial personality disorder

Antisocial personality disorder (APD or ASPD) is a psychiatric diagnosis that interprets antisocial and impulsive behaviours as symptoms of a personality disorder. Psychiatry defines only pathological antisocial behavior; it does not address potential benefits of positive antisocial behavior or define the meaning of 'social' in contrast to 'antisocial'. more...

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Professional psychiatry generally compares APD to sociopathy and psychopathic disorders (not to be confused with psychosis). Approximately 3% of men and 1% of women are thought to have some form of antisocial personality disorder according to DSM-IV.

Characteristics/symptoms

A common misconception is that many of the individuals diagnosed with antisocial personality disorder can be found in prisons. It should be noted that criminal activity does not automatically warrant a diagnosis of antisocial personality disorder, nor does a diagnosis of antisocial personality disorder imply that a person is a criminal. It is hypothesized that many high achievers exhibit antisocial personality disorder characteristics. This, however, brings much criticism upon the diagnostic criteria specified for those exhibiting antisocial personality disorder and the PCL-R. Both of these tests depend upon the person in question being a criminal or having participated in criminal activities.

Research has shown that individuals with antisocial personality disorder are indifferent to the possibility of physical pain or many punishments, and show no indications that they experience fear when so threatened; this may explain their apparent disregard for the consequences of their actions, and their lack of empathy to the suffering of others.

Central to understanding individuals diagnosed with antisocial personality disorder is that they do not appear to experience true human emotions, or at least, they do not appear to experience a full range of human emotions. This can explain the lack of empathy for the suffering of others, since they cannot experience emotion associated with either empathy or suffering. Risk-seeking behavior and substance abuse may be attempts to escape feeling empty or emotionally void. The rage exhibited by psychopaths and the anxiety associated with certain types of antisocial personality disorder may represent the limit of emotion experienced, or there may be physiological responses without analogy to emotion experienced by others.

One approach to explaining antisocial personality disorder behaviors is put forth by sociobiology, a science that attempts to understand and explain a wide variety of human behavior based on evolutionary biology. One route to doing so is by exploring evolutionarily stable strategies; that is, strategies that being successful will tend to be passed on to the next generation, thus becoming more common in the gene pool. For example, in one well-known 1995 paper by Linda Mealey, chronic antisocial/criminal behavior is explained as a combination of two such strategies.

According to the older theory of Freudian psychoanalysis, a sociopath has a strong id and ego that overpowers the superego. The theory proposes that internalized morals of our unconscious mind are restricted from surfacing to the ego and consciousness.

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Antisocial personality disorder
From Gale Encyclopedia of Psychology, 4/6/01

About 3% of males and 1% of females develop antisocial personality disorder, which is essentially the adult version of childhood conduct disorder. Antisocial personality disorder is only diagnosed in people over age 18, the symptoms are similar to those of conduct disorder, and the criteria for diagnosis include the onset of conduct disorder before the age of 15. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), people with antisocial personality disorder demonstrate a pattern of antisocial behavior since age 15.

The adult with antisocial personality disorder displays at least three of the following behaviors:

Fails to conform to social norms, as indicated by frequently performing illegal acts, and pursuing illegal occupations.

Is deceitful and manipulative of others, often in order to obtain money, sex, or drugs.

Is impulsive, holding a succession of jobs or residences.

Is irritable or aggressive, engaging in physical fights.

Exhibits reckless disregard for safety of self or others, misusing motor vehicles or playing with fire.

Is consistently irresponsible, failing to find or sustain work or to pay bills and debts.

Demonstrates lack of remorse for the harm his or her behavior causes others.

An individual diagnosed with antisocial personality disorder will demonstrate few of his or her own feelings beyond contempt for others. This lack of affect is strangely combined with an inflated sense of self-worth and often a superficial charm, which tends to mask their inner apathy. Authorities have linked antisocial personality disorder with abuse, either physical or sexual, during childhood, neurological disorders (which are often undiagnosed), and low IQ. Those with a parent with an antisocial personality disorder or substance abuse problem are more likely to develop the disorder. The antisocially disordered person may be poverty-stricken, homeless, a substance abuser, or have an extensive criminal record. Antisocial personality disorder is associated with low socioeconomic status and urban settings.

Treatment

Antisocial personality disorder is highly unresponsive to any form of treatment. Although there are medications available that could quell some of the symptoms of the disorder, noncompliance or abuse of the drugs prevents their widespread use. The most successful treatment programs are long-term, structured residential settings in which the patient systematically earns privileges as he or she modifies behavior. Some form of dynamic psychotherapy is usually given along with the behavior modification. The therapist's primary task is to establish a relationship with the patient, who has usually had very few relationships in his or her life and is unable to trust, fantasize, feel, or learn. The patient should be given the opportunity to establish positive relationships with as many people as possible and be encouraged to join self-help groups or prosocial reform organizations.

Gale Encyclopedia of Psychology, 2nd ed. Gale Group, 2001.

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