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ANTISOCIAL PERSONALITY DISORDER
 




Prediction: Lasts For Decades

      Occupational-Economic:
  • Works poorly with others (significant periods of unemployment; failure to honor financial obligations)
      Wisdom vs Irrationality: N/A
      Courage vs Negative Emotion: N/A
      Helping Others vs Detachment:
  • Callous unemotional behavior lacking kindness or compassion
      Self-Control vs Disinhibition:
  • Reckless thrill-seeking, impulsiveness, desire for casual or illicit sex
      Justice vs Antagonism:
  • Disregard for the law, physical violence
  • Manipulative, greedy, disrespectful, irresponsible, dishonest
  • High risk of: divorce, child abuse or neglect, unstable or erratic parenting, squandering money needed for child care
      Medical: N/A


SYNOPSIS

Dissocial [Antisocial] Personality Disorder F60.2 - ICD10 Description, World Health Organization

Dissocial [antisocial] personality disorder is characterized by disregard for social obligations, and callous unconcern for the feelings of others. There is gross disparity between behaviour and the prevailing social norms. Behaviour is not readily modifiable by adverse experience, including punishment. There is a low tolerance to frustration and a low threshold for discharge of aggression, including violence; there is a tendency to blame others, or to offer plausible rationalizations for the behaviour bringing the patient into conflict with society.
Antisocial Personality Disorder - Diagnostic Criteria, American Psychiatric Association

An individual diagnosed with antisocial personality disorder needs to meet all of the following criteria:

  • A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by at least 3 of the following:

    • Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.

    • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.

    • Impulsivity or failure to plan ahead.

    • Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

    • Reckless disregard for safety of self or others.

    • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

    • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

  • There is evidence of conduct disorder with onset before age 15 years. A conduct disorder is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated, as manifested by the presence of three of the following 15 criteria from any of the categories below:

    • Aggression to People and Animals

    • Often bullies, threatens, or intimidates others.

    • Often initiates physical fights.

    • Has used a weapon that can cause serious physical harm to others (e.g., a bat, brick, broken bottle, knife, gun).

    • Has been physically cruel to people.

    • Has been physically cruel to animals.

    • Has stolen while confronting a victim (e.g., mugging, purse snatching, extortion, armed robbery).

    • Has forced someone into sexual activity.

    • Destruction of Property

    • Has deliberately engaged in fire setting with the intention of causing serious damage.

    • Has deliberately destroyed others' property (other than by fire setting).

    • Deceitfulness or Theft

    • Has broken into someone else's house, building, or car.

    • Often lies to obtain goods or favors or to avoid obligations (i.e., "cons" others).

    • Has stolen items of nontrivial value without confronting a victim (e.g., shoplifting, but without breaking and entering; forgery).

    • Serious Violations of Rules

    • Often stays out at night despite parental prohibitions, beginning before age 13 years.

    • Has run away from home overnight at least twice while living in parental or parental surrogate home, or once without returning for a lengthy period.

    • Is often truant from school, beginning before age 13 years.

  • The conduct disorder caused clinically significant impairment in social, academic, or occupational functioning.

  • The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.
Like all personality disorders, dissocial [antisocial] personality disorder is a deeply ingrained and enduring behaviour pattern, manifesting as an inflexible response to a broad range of personal and social situations. This behavior represents an extreme or significant deviation from the way in which the average individual in a given culture relates to others. This behaviour pattern tends to be stable. It may not cause subjective distress, but does cause problems in social performance.

Core Features

Individuals with antisocial personality disorder grow up being lawless and impulsive. The core features of this disorder are: (1) antagonism (manipulativeness, callousness, deceitfulness, hostility), and (2) disinhibition (risk taking, impulsivity, irresponsibility). This disorder is only diagnosed if: (1) the individual is at least 18, (2) these behaviors occur at home, work, and in the community, and (3) these behaviors lead to clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Lack Of Social Skills And Personality Disorders

There are certain social skills that are essential for healthy social functioning. Individuals with antisocial personality disorder lack the essential social skills of respect, responsibility, and honesty. They lack cooperation/generosity and kindness (that are also lacking in individuals with narcissistic personality disorder); and they lack chastity and caution (that are also lacking in individuals with histrionic personality disorder). They lack control of anger (that is also lacking in individuals with borderline personality disorder).

    Social Skills That Are Lacking In Antisocial Personality Disorder

    SOCIAL SKILL LOW LEVEL HIGH LEVEL
    Respect Disrespect for others Treating others with respect and making them feel appreciated
    Responsibility Irresponsibility Being reliable and careful; being able to accept blame, heed correction and make amends
    Honesty Dishonesty Not lying, stealing or cheating
    Control of Anger Hostility Absence of anger or irritability in response to minor slights; absence of mean or vengeful behavior
    Cooperation/Generosity Being manipulative or greedy Cooperating with others and doing a fair share of the work; unselfishly helping others
    Kindness Callousness Being a kind, considerate, loving person; feeling another’s suffering & wanting to alleviate it
    Chastity Desire for casual or illicit sex Avoidance of casual sex (“one night stands”) AND absence of intense desire for illicit sex
    Caution Harmful impulsiveness Thinking carefully before acting or speaking; being cautious

Antisocial personality disorder, narcissistic personality disorder, histrionic personality disorder, and borderline personality disorder are so closely related that they are referred to as the "antagonistic" cluster of personality disorders.

    Social Skills That Are Lacking In The "Antagonistic" Cluster Of Personality Disorders

    PERSONALITY DISORDER LACKING LACKING LACKING
    Antisocial Personality Respect (instead has disrespect) Responsibility (instead has irresponsibility) Honesty (instead has dishonesty)
    Narcissistic Personality Humility (instead has arrogance) Cooperation or Generosity (instead has being manipulative or greedy) Kindness (instead has callousness)
    Borderline Personality Emotional Stability (instead has emotional instability) Stable Self-Image (instead has unstable self-image) Social Stability (instead has social instability)
    Histrionic Personality Genuineness (instead has attention-seeking) Chastity (instead has desire for casual or illicit sex) Caution (instead has harmful impulsiveness)

Social Functioning

Individuals with antisocial personality disorder often are divorced, have alcohol/drug abuse, anxiety, depression, unemployment, homelessness, and criminal behavior. However, some individuals with this disorder rise to high positions of power in society by becoming masters of manipulation and deceit.

Delinquency

In childhood, these individuals usually have oppositional defiant disorder (towards parents and teachers) which develops into conduct disorder (delinquency) in adolescence. This delinquency takes the form of reckless thrill-seeking, physical violence (towards people or animals), and law-breaking. These individuals become the school bullies, thieves, vandals, and drug-dealers. Most adolescent delinquents grow out of this behavior as they enter adulthood. However, those that increase their delinquent behavior as they enter adulthood have their diagnosis changed from conduct disorder to antisocial personality disorder.

Antisocial [Psychopathic] Traits

In adulthood, these individuals become more antagonistic. They show an exaggerated sense of self-importance, insensitivity towards the feelings and needs of others, and callous exploitation of others. Their increased manipulativeness, callousness, deceitfulness, and hostility repeatedly puts them at odds with other people.

    Psychopathic Traits - From Hare Psychopathology Checklist
    • Glibness/superficial charm
    • Grandiose sense of self-worth
    • Pathological lying
    • Conning/manipulative
    • Lack of remorse or guilt
    • Shallow affect (genuine emotion is short-lived and egocentric)
    • Callousness; lack of empathy
    • Failure to accept responsibility for his or her own actions
    • Parasitic lifestyle
    • Poor behavioral control
    • Lack of realistic long-term goals
    • Juvenile delinquency
    • Early behavior problems
    • Revocation of conditional release
    • Criminal versatility
    • Many short-term (marital) relationships

    Antisocial Traits - From American Psychiatric Association
    • Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
    • Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
    • Impulsivity or failure to plan ahead.
    • Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
    • Reckless disregard for safety of self or others.
    • Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
    • Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Disinhibition

In adulthood, individuals with antisocial personality disorder also become more disinhibited. They show increased risk taking, impulsivity, and irresponsibility. They want immediate gratification, and act without consideration of future consequences. Disinhibition is the opposite of conscientiousness. Research has shown that conscientiousness (or "grit") is even more important than intelligence in predicting scholastic and vocational success.

    Disinhibition
    • Need for stimulation/proneness to boredom
    • Impulsivity
    • Promiscuous sexual behavior
    • Irresponsibility

Ineffective Therapy

There are no randomized controlled trials that show that any psychological or pharmaceutical treatment is effective in improving the core features of this disorder. Most therapists believe that this disorder is very difficult to treat. Psychological treatment in prison often makes this disorder worse. Fortunately, this disorder often slowly improves after age 40.

Childhood prevention: The most intensive psychosocial intervention ever fielded was a multi-component prevention program targeting antisocial behavior. The intervention identified children at school entry and provided intervention services over a 10-year period. This study concluded that these intensive youth prevention services did not significantly reduce antisocial behavior.

Individuals with this disorder seldom voluntarily present for treatment. Usually, their only contact with a therapist is either to have a Court ordered psychiatric assessment, or to try to manipulate the therapist into giving them an undeserved disability pension, insurance compensation, or favorable psychiatric assessment for some upcoming civil legal battle. A trusting relationship with a primary care physician (who refuses to be manipulated) is probably the best therapy.

Which Behavioral Dimensions Are Involved?

The ancient Greek civilization lasted for 1,300 years (8th century BC to 6th century AD). The ancient Greek philosophers taught that the 5 pillars of their civilization were: wisdom, courage, helping others, self-control, and justice. Psychiatry named the opposite of each of these 5 ancient themes as being a major dimension of psychopathology (i.e., irrationality, negative emotion, detachment, disinhibition, and antagonism). (Psychology named these same factors the "Big 5 dimensions of personality": "intellect", "neuroticism", "extraversion", "conscientiousness", and "agreeableness")

    Antisocial Personality Disorder: Detachment, Disinhibition, Antagonism
            Wisdom vs Irrationality: N/A
            Courage vs Negative Emotion: N/A
            Helping Others vs Detachment:
      • Callous unemotional behavior lacking kindness or compassion
            Self-Control vs Disinhibition:
      • Reckless thrill-seeking, impulsiveness, desire for casual or illicit sex
            Justice vs Antagonism:
      • Disregard for the law, violence
      • Manipulative, greedy, disrespectful, irresponsible, dishonest
      • High risk of: divorce, child abuse or neglect, unstable or erratic parenting, squandering money needed for child care
Psychopaths:

A diagnosis of antisocial personality disorder has limited predictive validity with respect to institutional adjustment, response to treatment, and behavior following release from prison. In contrast, the diagnosis of being a psychopath has considerable predictive validity with respect to treatment outcome, institutional adjustment, recidivism and violence (Hare 1991). Dr. Robert D. Hare's "Psychopathy Checklist-Revised (PCL-R)" is the psycho-diagnostic tool most commonly used to assess psychopaths. On this checklist, psychopaths have the majority of the following traits:
  • Selfish, callous and remorseless use of others:
    • Glibness/superficial charm (smooth-talking, engaging and slick)
    • Grandiose sense of self-worth (greatly inflated idea of one's abilities and self-esteem, arrogance and a sense of superiority)
    • Pathological lying
    • Conning/manipulative (uses deceit to cheat others for personal gain)
    • Lack of remorse or guilt (no feelings or concern for losses, pain and suffering of others)
    • Emotional poverty (limited range or depth of feelings)
    • Callous/lack of empathy (a lack of feelings toward others; cold, contemptuous and inconsiderate)
    • Failure to accept responsibility for own actions

  • Chronically unstable, antisocial and socially deviant lifestyle:
    • Need for stimulation/proneness to boredom (an excessive need for new, exciting stimulation and risk-taking)
    • Parasitic lifestyle (exploitative financial dependence on others)
    • Poor behavioral control (frequent verbal abuse and inappropriate expressions of anger)
    • Promiscuity (numerous brief, superficial sexual affairs)
    • Lack of realistic, long-term goals
    • Impulsivity
    • Irresponsibility (repeated failure to fulfill or honor commitments and obligations)
    • Juvenile delinquency (criminal behavioral problems between the ages of 13-18)
    • Early behavior problems (before age 13)
    • Revocation of conditional release (violating parole or other conditional release)
    • Many short-term marital relationships (lack of commitment to a long-term relationship)
    • Criminal versatility (diversity of criminal offenses, whether or not the individual has been arrested or convicted)

Prevalence

The prevalence of antisocial personality disorder in the general population is 0.2% to 3%. However, the prevalence is greater than 70% in prison populations and in substance abuse clinics.

Course

The course of antisocial personality disorder is chronic. However, this disorder often improves in middle age.

Risk Factors

The first-degree biological relatives of individuals with antisocial personality disorder have an increased risk of having antisocial personality disorder and substance use disorders if they are male, and somatic symptom disorder if they are female. Both adopted and biological children of parents with antisocial personality disorder have an increased risk of developing antisocial personality disorder, somatic symptom disorder, and substance use disorders. Adopted-away children resemble their biological parents more than their adoptive parents, but the adoptive family may decrease the risk of developing this disorder. This disorder is often associated with low socioeconomic status and urban settings. This disorder is much more common in males than females (but females may be underdiagnosed).

Complications

Individuals with antisocial personality disorder have an increased risk of dying prematurely by violent means (e.g., suicide, accidents, and homicide). Prolonged unemployment, interrupted education, broken marriages, irresponsible parenting, homelessness, and frequent incarceration are common with this disorder.

Comorbidity

Some other disorders frequently occur with this disorder.

    Non-Personality Disorders

            Depressive Disorders:
      • Persistent depressive disorder (dysthmia); substance/medication-induced depressive disorder
            Somatic Symptom and Related Disorders:
      • Somatic symptom disorder
            Disruptive, Impulse-Control, and Conduct Disorders:
      • Gambling and other impulse control disorders
            Substance-Related and Addictive Disorders:
      • Substance use disorders

    Personality Disorders

            Antagonistic Cluster:
      • Narcissistic, borderline and histrionic personality disorders

        Note: Antisocial, narcissistic, borderline, and histrionic personality disorders are all closely related since they all share the same core feature of antagonism. This core feature is an exaggerated sense of self-importance, insensitivity towards the feelings and needs of others, and callous exploitation of others. These antagonistic behaviors put the individual at odds with other people. If an individual has one of these antagonistic personality disorders, they are very likely to have another.

Associated Laboratory Findings

No laboratory test has been found to be diagnostic of this disorder.

Primate Evolution

There appears to be three different ways in which primates have evolved socially:
  • The chimpanzees have evolved to be socially antagonistic, competitive, callous, and manipulative. Thus chimpanzee social behavior most closely mirrors the antagonistic behavior of the antisocial-narcissistic-borderline-histrionic cluster of personality disorders.

  • In contrast, the bonobos have evolved to be socially anxious, peaceful, cooperative, and loving. Thus bonobo social behavior most closely mirrors the negative emotion (anxious) behavior of the avoidant-dependent cluster of personality disorders.

  • Another separate evolutionary path was followed by the orangutans. They evolved to become solitary hermits. Thus orangutan social behavior most closely mirrors the detached behavior of the paranoid-schizoid-schizotypal cluster of personality disorders.


Core Behaviors Of The Antagonistic Cluster Of Personality Disorders

Cleopatra Seducing Caesar and Mark Antony


In this cluster of personality disorders, the males tend to be like Caesar and have antisocial and/or narcissistic personality disorders, and the females tend to be like Cleopatra and have borderline and/or histrionic personality disorders. The core feature of this cluster of personality disorders is antagonism. These individuals seem to be unconcerned about how their actions harm or upset others.

    Antagonism: The Core Feature Of The Antagonistic Cluster Of Personality Disorders

    • manipulativeness:
      In the past week, did you "con" or take advantage of someone?
    • callousness:
      In the past week, did you harm someone, but not care?
    • deceitfulness:
      In the past week, did you lie, steal, or cheat?
    • hostility:
      In the past week, were you actively hostile towards someone?
    • attention-seeking:
      In the past week, did you go out of your way to be the center of attention?
    • grandiosity:
      In the past week, did you treat others as if they were inferior to you?

Parental Behaviors Which Increase The Risk Of Developing A Personality Disorder

Research has shown that genetic, environmental, and prenatal factors all play important roles in the development of personality disorder. Recent research has also shown that low parental affection and harsh parenting increase the risk of a child later developing a personality disorder.

"Low affection" was defined as: low parental affection, low parental time spent with the child, poor parental communication with the child, poor home maintenance, low educational aspirations for the child, poor parental supervision, low paternal assistance to the child's mother, and poor paternal role fulfillment. "Harsh parenting" was defined as: harsh punishment, inconsistent maternal enforcement of rules, frequent loud arguments between the parents, difficulty controlling anger toward the child, possessiveness, use of guilt to control the child, and verbal abuse.

Setting Goals In Therapy

    Questions To Ask When Setting Goals

    In The Past Week:
    • WHO: was your problem?
    • EVENT: what did he/she do?
    • RESPONSE: how did you respond to that event?
    • OUTCOME: did your response help?
    • TRIGGER: what did you do that could have triggered this problem?
    • GOAL: what life skill(s) do you have to work on? (from checklist)

    Example Of Setting Goals In Interviewing A Person With Antisocial Personality Disorder

    In The Past Week:
    • WHO: was your problem?
      "My boss."

    • EVENT: what did he/she do?
      "This Tuesday, my boss threatened to fire me."

    • RESPONSE: how did you respond to that event?
      "I didn't fight with him, but I told the other guys at work that I thought my boss was an asshole."

    • OUTCOME: did your response help?
      "No, I hate my job, but I have to put up with this shit."

    • TRIGGER: what did you do that could have triggered this problem?
      "Last weekend I partied a lot; so I was too hungover to come to work on Monday when my boss needed me."

    • GOAL: what life skill(s) do you have to work on? (from checklist)
      "I don't think there is anything wrong with my life skills." (Patient refuses to cooperate.)

Individuals With Antisocial Personality Rarely Want Psychotherapy

Usually, the only time a therapist ever sees an individual with antisocial personality disorder is when the Court has ordered a psychological or psychiatric assessment. Individuals with antisocial personality disorder don't see their behavior as being abnormal; hence they don't see the necessity of changing their personality. They have a callous disregard for the harm they are causing to others. Usually their lawless and impulsive behavior persists into middle age; then their life of crime usually decreases after they have lost almost everything and "burned all their bridges". Unfortunately, antisocial personality disorder can persist for a lifetime if its criminal behavior is never punished.

Dictators Usually Have A Dangerous Combination of Personality Disorders

All of history's worst dictators had a combination of Paranoid + Narcissistic + Psychopathic Personality Disorders.

    Social Skills That Are Lacking In History's Worst Dictators

    PERSONALITY DISORDER LACKING LACKING LACKING
    Paranoid Personality Trust (had suspiciousness) Forgiveness (had bearing grudges) Gratitude (had feeling victimized)
    Narcissistic Personality Humility (had arrogance) Cooperation or generosity (had being manipulative or greedy) Kindness (had callousness)
    Psychopathic Personality Respect (had disrespect) Responsibility (had irresponsibility) Honesty (had dishonesty)

Given the amount of harm that these dictators created (e.g., Hitler, Mussolini, Stalin, Mao Zedong); it could be argued that the social skills that dictators lack are the most important of all the social skills. Thus it should come as no surprise that all of the world's religions emphasize the importance of these social skills (e.g., trust, forgiveness, gratitude, humility, cooperation, generosity, kindness, respect, responsibility, and honesty).


Dictators have a total disregard for the casaulties they cause in war. To them, war is just a chess game, and soldiers are just pawns to be sacrificed. For example, during the Napoleonic Wars, Napoleon had 3 million troops, of which 1.7 million were killed. The following movie correctly depicts how Napoleon sacrificed his troops for his own personal glory and wealth.

Waterloo (full movie)


The story of Adolf Hitler will always be a testament to how extremely dangerous a leader with Paranoid + Narcissistic + Psychopathic Personality Disorder can be. The following documentary movie is an excellent summary of the senseless slaughter of millions caused by Adolf Hitler.

Adolf Hitler (1 hour documentary)


Hate-filled, Hitler-like individuals with Paranoid + Narcissistic + Psychopathic Personality Disorder must be stopped before they ever assume power.

How Would You Diagnose Bill O'Reilly?


Certain individuals with Narcissistic + Psychopathic Personality Disorder have amassed great power and wealth. These fabulously rich individuals totally neglect the poor and the starving, and care only about accumulating more wealth, fame and power - even if it means oppressing half of humanity.

The 85 Richest People Are As Wealthy As The Poorest Half Of The World


Description


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Rating Scales


Hare Psychopathy Checklist (PCL-R)

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