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Antisocial Personality Disorder: Signs and Treatment


Antisocial personality disorder (ASPD), sometimes, but not commonly referred to as AP, is a cluster B personality disorder, categorized as dramatic, impulsive, and emotional personalities. The individuals with ASPD are described as dismissive of other people, deceitful, and impulsive. They commonly violate the rights of others, lie, and tend to not conform to societal norms and regulations.

Prevalence and distribution

The recent literature suggests that the estimated lifetime prevalence of ASPD is between 1% to 4% in the general population.

The prevalence for the ASPD is usually reported as a range of percentage given the varied count in different age groups. It is rather uncommon to have large differences in prevalence rates but in this case, it is explained by changes in the personality traits as a process of aging, as well as increased risk of early mortality of individuals with ASPD.

There are quite significant gender differences when it comes to ASPD prevalence with men being three to five times more likely to be diagnosed when compared with women. The prevalence rates between genders are indicated around 2% for women and 6% for men in the general population.

Because of the nature of ASPD, traits such as disregard for rules and regulations, as well as lack of remorse, often leads to trouble with law enforcement. The prevalence of ASPD has been suggested to be around 50% among incarcerated individuals.

On the other hand, studies indicate that only 47% of the individuals who meet the diagnostic criteria for ASPD have a significant criminal record. This shows that even though delinquency is one of the core traits of APSD, the relationship between the PD and criminality is not straightforward.

Risk factors

While the general rule of diagnosing ASPD dictates that for an official diagnosis, an individual should be above 18 years of age with their personality traits fully developed, the ASPD is an exception.

Research indicates that there are signs manifesting before maturity that are highly predictive of ASPD. Children with conduct disorder are likely to be diagnosed with ASPD later in life.

Conduct disorder in children

Conduct Disorder (CD) is a diagnosis that is given to children or adolescents, who are displaying a pattern of antisocial behaviors.

Antisocial behavior in this context is used as an umbrella term for a pervasive pattern of aggression toward others, cruelty, and extreme violations of set rules or social norms. These behaviors need to be present regardless of the social environment, i.e. at home, with friends, relatives, in school, or after school activities.

Symptoms of CD

The symptoms of CD include, but are not limited to:

  • Bullying others.
  • Aggression or hostility towards others (e.g., initiating fights).
  • Cruelty toward others or animals.
  • Delinquent behaviors (e.g., fire setting, destroying property, breaking in, stealing, using guns).
  • Running away.
  • Pervasive lying.
  • Deceit either to personal gain or pleasure.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), at least three of the symptoms have to be present for the past 12 months. It is important to note that CD is a disorder that is characterized by a pattern of troublesome behaviors, not “getting into trouble” as an isolated incident, even if it happens a couple of times.

Other risk factors

It has been suggested that substance abuse is linked to the diagnosis of ASPD, however this relationship is correlational, meaning that substance abuse does not cause ASPD, however can be a contributing factor to antisocial behaviors.

In addition, incomplete education as well as low IQ scores are associated with ASPD. Therefore, leaving the education system early is seen as an additional predictor of future ASPD diagnosis.

Causes

It is suggested that both genetic and environmental factors play a role in the developing ASPD. Genetic research has suggested a significant contribution of heritability when it comes to ASPD, which rates vary from 38% to 69%.

Negative experiences during childhood have shown to be strongly correlated to the development of ASPD. Children who grew up in dysfunctional families are more likely to be diagnosed with ASPD, than those who grew up in nurturing environments. For example, experiencing a physical or sexual abuse, neglect, emotional abuse growing up contributes to developing antisocial behaviors.

Signs and symptoms of ASPD

ASPD is a lifelong disorder. In some cases, the certain symptoms, often the criminal behaviors may decrease over time, however it is not clear whether this is caused by aging or an increased awareness of the consequences of antisocial behavior.

An individual with ASPD will exhibit at least several of the below behaviors:

  • Tendency to manipulate or deceive others, for both personal gain and personal pleasure (e.g., lying, assuming false identities, creating false conflict).
  • Attempting to charm, pursue them romantically or socially, lead on others for personal gain or personal pleasure.
  • Tendency of arrogance, a sense of superiority and being extremely opinionated.
  • Tendency of arrogance, a sense of superiority and being extremely opinionated.
  • Antisocial behaviors.
  • Tendency to be over impulsive (e.g., frequent, and significant job or relationship changes).
  • Irresponsible behaviors (in occupational, social, and financial settings).
  • Disregard for personal safety or the safety of others (e.g., reckless driving, neglecting a child).
  • Highly irritable traits or aggressive behavior (leading to physical fights, uncalled confrontations).

Help, treatment, and consequences

The main treatment for ASPD is therapy, however the studies on various approaches, e.g., cognitive behavioral therapy, psychotherapy, etc., have been shown to have limited success.

Due to the nature of ASPD therapy is usually offered as an outpatient care, where permanent hospitalization is rare, primarily due to highly disruptive behaviors that result in risk and disruption toward other patients and clinicians.

Living with someone with ASPD can be extremely difficult and taxing, primarily due to their lack of remorse and consideration towards others. ASPD will affect all factors of an individual's life, their relationships, employment, and education.

As mentioned previously, the rates of incarceration of individuals with ASPD are extremely high.

Conclusion

If you believe someone close to you is exhibiting antisocial behavior, encourage them to seek treatment, which could be a lifelong commitment to therapy. However, it is suggested that with effort, individuals with ASPD might develop coping skills and behavioral patterns that could help them assimilate in the healthy social environments, maintain jobs, and complete their education.

Key takeaways

Antisocial personality disorder is a cluster B personality disorder.

Individuals with ASPD commonly violate the rights of others, lie, and tend to not conform to societal norms and regulations.

Research indicates that there are signs manifesting before maturity that are highly predictive of ASPD, when children are diagnosed with Conduct Disorder.

It is suggested that both genetic and environmental factors play a role in the developing ASPD.

The main treatment for ASPD is therapy.

With effort, individuals with ASPD may develop coping skills that can help them behave in healthy social environments, maintain jobs, and complete their education.

References:

Fisher, K.A., and Hany, M. (2019). Antisocial Personality Disorder.

Kazdin, A.E. (1997). Practitioner review: Psychosocial treatments for conduct disorder in children. Journal of Child Psychology and Psychiatry.

Moran, P. (1999). The epidemiology of antisocial personality disorder. Social Psychiatry and Psychiatric Epidemiology.

Skilling, T.A., Harris, G.T., Rice, M.E., and Quinsey, V.L. (2002). Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria. Psychological Assessment.

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