Diagnostic Features:
Antisocial Personality Disorder is a condition characterized by persistent disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Deceit and manipulation are central features of this disorder. For this diagnosis to be given, the individual must be at least 18, and must have had some symptoms of Conduct Disorder (i.e., delinquency) before age 15. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing.
Diagnostic Criteria:
Three or more of the following are required:
- 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 repeatedly 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
Since these antisocial behaviors are commonly observed in children and adolescents, this disorder is only diagnosed if these antisocial behaviors persist into adulthood (i.e., if age is 18 or older). The diagnosis of Antisocial Personality requires that there was evidence of delinquency (Conduct Disorder) with onset before age 15 years. This is in contrast to the (non-DSM-IV) diagnosis of being a psychopath which does not require a prior diagnosis of Conduct Disorder. The diagnosis of Antisocial Personality Disorder is not made if the occurrence of antisocial behavior occurs exclusively during the course of Schizophrenia or a Manic Episode.
Psychopaths:
About 80-85% of incarcerated criminals have Antisocial Personality Disorder. However, only about 20% of these criminals would qualify for a diagnosis of being a psychopath. Most psychopaths meet the criteria for Antisocial Personality Disorder, but most individuals with Antisocial Personality Disorder are not psychopaths. Psychopaths account for 50 percent of all the most serious crimes committed, including half of all serial killers and repeat rapists.
A diagnosis of Antisocial Personality Disorder has limited utility for making differential predictions of 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)
Complications:
Individuals with this 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:
Anxiety Disorders, Depressive Disorders, Substance-Related Disorders, Somatization Disorder, Pathological Gambling (and other impulse control disorders), and other Personality Disorders (especially Borderline, Histrionic, and Narcissistic) frequently co-occur with this disorder.
Associated Laboratory Findings:
No laboratory test has been found to be diagnostic of this disorder.
Prevalence:
The prevalence of Antisocial Personality Disorder in the general population is about 3% in males and 1% in females. It is seen in 3% to 30% of psychiatric outpatients.
Course:
The course of this disorder is chronic. This disorder is usually worse in young adulthood and often improves in middle age.
Familial Pattern:
This disorder is more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders and Somatization Disorder.
|
