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Antisocial  Personality  Disorder,  like  all  personality  disorders  represents  a  stable,  pervasive  pattern  of  behavior  that   is  present  for  an  individual’s  entire  life.  In  ASPD  particularly,  the  configuration  is  primarily  one  of  a  disregard  for,   and  a  violation  of,  the  rights  of  others.  This  manifests  itself  in  the  individual  fundamentally  not  caring  about  the   wants,  needs,  and  desires  of  others.  The  result  of  this  core  belief  that  others  do  not  matter  is  behavior  that   typically  leads  to  arrest  for  petty  offenses  like  theft.  Though  these  crimes  are  not  personality  traits,  the  record  that   they  create  is  reliable  and  traceable,  making  a  good  diagnostic  tool.  Another  similar  diagnostic  tool  is  the   individual’s  work  and  school  record.  ASDD  traits  make  listening  to  authority  figures  nearly  impossible  so  most  of   these  individuals  have  spotty  educational  and  work  histories.  

These  behavioral  markers  are  the  result  of  severel  personality  traits.  One  of  these  chief  characteristics  is   impulsiveness.  Individuals  with  ASPD  do  not  stop  to  carefully  consider  the  consequences  of  their  activity,  rather   they  simply  do  what  they  want  for  themselves  in  the  moment.  This  impulsivity  can  lead  to  reckless  and  dangerous   activity  both  for  their  own  safety  and  for  the  safety  of  others.  They  may  drive  with  excessive  speed  or  push  others   near  a  traffic  filled  intersection.  If  they  desire  the  property  of  others  and  they  can  take  it,  they  will.  This  same   attitude  that  is  used  toward  property  is  used  toward  other  people.  They  will  lie  or  con  others  in  order  to  fulfill  their   personal  desires.  

If  the  individual  with  ASPD  is  not  able  to  met  their  desires  through  theft  or  con  they  will  not  stop  trying  to  fulfill   their  needs.  They  are  prone  to  get  very  irritable  and  often  get  very  aggressive  towards  others.  Fighting  with  others   will  likely  be  prevalent  in  their  personal  history.  At  the  end  of  their  theft,  maltreatment,  and  aggressiveness  they   will  not  feel  sorry  for  their  actions.  They  will  either  not  care  that  they  have  caused  harm  or  rationalize  the   situation.  

In  order  to  qualify  for  the  diagnosis  three  other  criteria  must  be  met:  

The  individual  must  be  at  least  18  years  old.  Individuals  who  are  growing  up  and  going  through  puberty  do  not   have  the  stable  personality  required  to  be  diagnosed  with  a  personality  disorder.  

There  must  also  be  proof  in  their  developmental  history  that  the  individual  had  antisocial  traits  as  a  child.  This  is   demonstrated  by  fulfilling  criteria  for  Conduct  Disorder  before  age  15.  Diagnosticians  want  to  know  that  the   individual’s  personality  has  been  set.  They  would  like  to  know  that  the  individual  was  like  this  before  puberty  and   will  be  like  this  long  after  puberty  before  diagnosing  a  personality  disorder.  

The  antisocial  behavior  must  not  be  exclusively  during  schizophrenia  or  a  manic  episode.  The  behavior  should  not   be  because  of  an  Axis  I  condition.  

Psychopathy  &  Sociopathy  

In  the  literature  there  is  a  much  greater  emphasis  on  studying  psychopathy  and  sociopathy  than  there  is  antisocial   personality  disorder.  These  three  are  related  but  are  not  identical.  Antisocial  personality  disorder  is  the  only  one  of   these  three  terms  that  exists  in  the  DSM-­‐IV-­‐TR.  Psychopathy  is  defined  by  characteristics  such  as  a  lack  of  empathy   and  remorse,  criminality,  antisocial  behavior,  egocentricity,  manipulativeness,  irresponsibility  and  a  parasitic   lifestyle.  It  is  commonly  conceptualized  that  psychopathy  is  a  more  severe  form  of  ASDD  and  this  thinking  is   reasonably  accurate.  Almost  all  individuals  who  fulfill  the  requirements  to  receive  the  label  of  psychopathy  fulfill   the  requirements  for  ASPD  but  most  of  the  individuals  who  fulfill  the  requirements  of  ASPD  do  not  also  get  the   label  of  psychopath.  The  term  sociopath  is  an  attempt  to  demystify  the  term  psychopath  since  many  generalize  the   term  psycho  in  psychopath  to  apply  to  other  terms  like  psychotic.  Sociopathy  is  also  an  attempt  by  some  clinicians   to  explain  the  etiology  of  the  condition  as  characterized  by  early  socialization  experiences.  

Subtypes  

One  of  the  diagnostic  challenges  with  any  personality  disorder  is  that  there  is  typically  significant  overlap  between   the  personality  disorders.  This  is  due  both  to  the  diagnostic  overlap  in  the  definition  of  each  of  the  personality  

disorders  and  the  fact  that  individuals  typically  display  many  different  traits  throughout  their  lifetime.  In  order  to   get  a  better  understanding  of  the  common  personality  trait  overlaps,  Theodore  Millon  created  a  series  of  5   subtypes  of  ASPD:  

Coveteus—this  type  is  purely  made  up  of  ASDD  traits.  This  individual  feels  intentionally  denied  and  deprived  and   seeks  to  get  the  things  s/he  covets  but  gets  little  satisfaction  from  ownership.  

Nomadic—this  type  is  ASPD  with  schizoid,  schizotypal  and  avoidant  features.  This  individual  feels  cast  aside  and  is   typically  a  drifter  and  societal  dropout.  When  this  individual  acts  out  it  is  against  that  impulse.  

Malevolent—this  type  is  a  mix  of  ASPD  with  paranoid  personality  features.  This  individual  is  typically  more  violent   than  the  other  personality  disorder  types.  He  expects  betrayal  and  punishment  and  attempts  to  get  revenge  in  a   pre-­‐emptive  manner.  

Risk-­‐taking—this  type  is  a  mix  of  ASPD  and  histrionic  features.  This  individual  has  the  risk  taking  features  of  ASPD   amplified  heavily.  They  are  very  audacious  and  bold  to  the  point  of  recklessness  and  they  continuously  pursue   perilous  adventures.  

Reputation-­‐defending—this  type  is  a  mix  between  ASPD  and  narcissistic  features.  This  individual  has  a  need  to  be   thought  of  as  unflawed  and  formidable  and  will  react  extremely  negatively  to  perceived  slights  to  status.  

Differentials  

Two  of  the  most  difficult  differentials  for  ASDD  are  Narcissistic  and  Histrionic  personality  disorder.  Narcissistic   Personality  Disorder  shows  similar  distorted  thinking  about  others.  they  care  little  for  the  wants  and  needs  of   others  and  have  limited  empathy.  Individuals  with  Narcissistic  PD  can  be  manipulative  as  well.  However,   Narcissistic  individuals  rarely  show  evidence  of  conduct  disorder  in  youth  or  antisocial  aggression.  The  underlying   thought  process  behind  their  rules  and  norms  breaking  behavior  is  different  as  well.  With  NPD  the  individual  feels   that  they  are  entitled  and  special  and  that  they  can  break  the  rules  because  of  this  fact.  The  ASDD  individual  does   not  need  the  rationalization,  typically  they  do  what  they  want  because  they  want  to  do  it.  

Individuals  with  Histrionic  PD  are  often  impulsive,  show  very  little  depth  in  their  empathy  and  understanding  of   others.  Their  dramatic  flair  can  be  seen  as  impulsivity  and  can  do  things  like  maintaining  affairs  that  can  be   characterized  as  violating  social  norms.  However,  histrionic  individuals  are  not  aggressive  and  will  not  show   evidence  of  Conduct  Disorder  in  typical  presentation.  

Symptom  Overlap  Between  Antisocial  PD  and  Narcissistic/Histrionic  PD  

 

Etiology  

The  nature  of  personality  disorders  makes  their  etiology  more  difficult  to  pin  down  than  other  disorders.  ASPD   requires  even  more  evidence  of  prolonged  atypical  functioning  than  other  personality  disorders  because  it  requires   evidence  of  maladaptive  functioning  before  age  18.  This  requirement  muddies  the  already  murky  waters  that  are   the  interplay  of  genetics  and  environment  and  their  expression  in  both  brain  anatomy  and  psychological  activity.  

Irregularities  of  the  serotonin  network  in  the  brain  responsible  for  the  release,  use,  and  reuptake  of  the   neurotransmitter  are  linked  to  individuals  with  ASPD.  This  network  has  been  linked  separately  both  to  individuals   diagnosed  with  ASPD  and  to  highly  impulsive  behavior.  The  theory  is  that  this  deficit  can  lead  either  to  arousal   thresholds  being  too  low  in  individuals  who  show  impulsivity  or  the  arousal  threshold  is  too  high  in  individuals  who   are  cold  or  callous.  

Psychological  and  family  systems  factors  have  also  been  shown  to  have  an  affect  on  the  expression  of  ASPD.  The   researchers  used  national  epidemiological  survey  and  found  individuals  from  a  data  set  of  alcohol  users  who  also   were  antisocial,  finding  1200  individuals  on  which  to  base  their  results.  They  found  that  significant  childhood  

experiences  of  abuse  and  neglect  significantly  predict  eventual  display  of  ASPD.  These  early  experiences  of   violence  or  abandonment  have  significant  effects  on  attachment  and  relationship  formation.  

Duggan  (Duggan,  et  al.  2012)  showed  a  positive  relationship  between  early  onset  of  alcohol  use  and  the  transition   of  conduct  disorder  to  ASDD.  Those  who  used  alcohol  and  other  substances  at  an  earlier  age  more  often  wound  up   being  diagnosed  with  ASPD  than  those  who  did  not.  This  effect  can  easily  by  hypothesized  to  have  an  etiological   function  in  either  biological  or  social  bases.  Perhaps  the  drug  use  affected  neurological  pathways  to  make  the   individuals  more  susceptible.  Perhaps  early  onset  drug  use  was  indicative  of  a  social  network  that  was  more   conducive  to  reinforcing  antisocial  behavior.  

Gender  Disparity  

There  is  a  very  wide  disparity  between  the  number  of  men  and  women  who  meet  the  criteria  for  diagnosis  with   ASPD.  Epidemiological  research  suggest  that  as  many  as  3%  of  men  have  ASPD  while  less  than  1%  of  women  do.   Some  theorists,  like  Millon,  have  argued  that  the  disparity  in  men  and  women  in  ASPD  is  mirrored  by  the  same   disparity  with  the  diagnosis  of  Borderline  Personality  Disorder.  Women  are  proportionately  more  likely  to  receive   that  diagnosis  than  men  are  to  receive  a  diagnosis  of  ASPD.  This  may  be  due  to  the  fact  that  the  criteria  for  ASDD   are  heavily  gender  biased.  Where  men  will  use  naked  aggression  in  a  way  that  leads  to  multiple  arrests  (criteria  A-­‐1   and  criterion  A-­‐4)  women  tend  to  use  relational  aggression  which  has  very  different  outcomes.  The  same   underlying  etiology  and  pathology  lead  to  very  different  behaviors  because  these  behaviors  are  mediated  by   cultural  norms.  The  masculine  ideal  in  the  United  States  contains  many  antisocial  traits.  Men  are  encouraged  to  be   self-­‐reliant,  independent,  and  to  use  physical  force  when  necessary.  They  are  taught  to  be  stoic  and  unemotional.   This  antisocial  personality  is  an  overextension  of  that  ideal.  Women,  on  the  other  hand,  are  not  taught  to  be   unemotional  or  physically  violent,  so  they  manifest  that  same  aggression  in  different  ways.  Alegria  (Alegria,  et  al.   2013)  found  that  women  have  to  have  a  significantly  higher  lifetime  loading  of  abuse  and  neglect  to  show   antisocial  traits  than  men  do.  

The  top  theoretical  explanations  for  antisocial  personality  traits  unfortunately  leave  little  for  individual  agency.  The   difficulty  is  that  the  diagnosis  of  ASPD  requires  that  the  individual  gain  their  personality  traits  when  they  are  least   able  to  defend  against  them  -­‐  during  or  before  their  teen  years.  The  biological  explanation  leaves  basically  no  room   for  personal  agency.  It  is  impossible  to  willfully  change  your  brain  chemistry.  Other  theoretical  standpoints  argue   that  childhood  maltreatment  and  neglect  are  to  blame.  A  neglected  or  abused  child  has  little  ability  to  even  avoid   their  maltreatment,  let  alone  recover  from  their  own  psychological  load.  One  simple  step  that  is  clear  from  the   literature  is  to  delay  the  onset  of  alcohol  and  substance  use.  Using  substances  at  an  early  age  is  a  significant   loading  factor  for  ASPD.  Avoiding  early  alcohol  use  can  positively  affect  brain  chemistry  and  alter  future  habitual   activity  for  the  better.  

Theoretical  Conceptualization  

Psychodynamic  

Psychodynamic  theorists  conceptualize  ASPD  begins  in  the  early  childhood  phase  of  trust  vs.  mistrust.  Children   who  will  later  show  evidence  of  conduct  disoder  and  then  ASPD  do  not  have  adequate  social  relationships  as   children.  These  inadequate  relationships  center  on  a  lack  of  parental  love.  A  lack  of  parental  love  can  lead  a  child  in   many  different  pathological  directions  and  is  not  necessarily  indicative  of  ASPD  in  and  of  itself.  Some  subset  of   these  children  respond  to  the  lack  of  love  demonstrated  by  their  parents  by  becoming  emotionally  aloof.  They   begin  to  develop  the  relational  style  that  they  are  taught  at  home  by  bonding  with  others  through  overt  power   dynamics  instead  of  a  shared  emotional  bond.  Psychodynamic  theorists  can  point  to  the  evidence  of  pervasive   early  childhood  trauma  in  individuals  who  eventually  develop  ASPD  as  proof  of  their  conceptual  framework.  

Unfortunately,  psychodynamic  theoretical  framework  is  largely  ineffective.  There  are  a  number  of  hypothesized   reasons  for  this  therapeutic  failure.  The  first  is  that  almost  no  one  with  ASPD  is  in  treatment  voluntarily.  In  addition  

to  this  difficulty,  individuals  with  ASDD  also  have  no  conscience  and  little  motivation  to  change  who  they  are   naturally  which  further  compounds  treatment  difficulty.  Antisocial  individuals  also  tend  to  have  a  very  low   frustration  tolerance  which  makes  seeing  treatment  through  to  its  conclusion  very  difficult.  

Cognitive-­‐Behavioral  

Cognitive-­‐Behavioral  therapists  conceptualize  antisocial  activity  as  a  modeled  behavior.  Children  may  be   reenacting  the  violent  behavior  that  they  experience  in  a  far  too  personal  manner.  Theorists  also  believe  that  the   negative  acting  out  and  violent  behaviors  may  be  reinforced  by  the  attention  that  they  receive.  Parents  may  give  in   to  violent  outbursts  simply  to  restore  the  peace  once  individuals  have  acted  out.  

Cognitive-­‐behavioral  therapists  do  not  attempt  to  repair  the  causes  of  ASPD,  consistent  with  their  treatment   modalities.  They  target  problem  behavior.  Therapists  attempt  to  give  ASPD  individuals  skills  to  understand  moral   issues  and  conceptualize  the  needs  of  others.  Some  prisons  and  hospitals  have  tried  to  put  ASPD  individuals  in   group  settings  to  teach  responsibility.  This  approach  does  not  seem  to  have  any  effect  in  most  cases.  (Arntz,,  Cima   and  Lobbestael  2013)  

Biological  

Biological  theorists  have  begun  using  psychotropic  medications  on  individuals  with  ASDD.  Atypical  Antipsychotic   drugs  have  been  used  to  treat  ASPD.  These  newer  antipsychotic  medications  bind  to  multiple  dopamine  receptor   but  also  have  an  effect  on  serotonin.  These  therapies  have  not  been  evaluated  in  large  scale  trials  to  date.  (Brook   and  Kosson  2013)  

Biological  models  have  many  findings  pertinent  to  individuals  with  ASPD.  First,  as  was  stated  in  depth  earlier,   serotonin  deficits  may  be  responsible  for  ASPD  traits,  especially  in  individuals  who  display  highly  impulsive   behavior.  Another  area  of  research  is  the  frontal  lobes.  Many  individuals  with  ASPD  have  smaller  or  deficient   frontal  lobes.  Lastly,  it  appears  that  many  individuals  with  ASPD  have  very  low  resting  levels  of  anxiety.  Low  levels   of  anxiety  explain  why  it  is  difficult  for  individuals  to  learn  from  past  negative  experiences.  (Boccaccini,  et  al.  2012)   The  biological  model  theorizes  multiple  etiologies  for  these  deficiencies.  They  may  come  from  genetic  factors  that   cause  malformation  as  children,  nutritional  deficiencies  at  key  periods  in  development,  the  effect  of  viruses,  or   from  physical  harm  such  as  brain  lesions.  

Conclusions  

Antisocial  Personality  Disorder  is  a  difficult  but  influential  disorder.  It  is  an  important  problem  both  for  the   psychological  community  and  for  society.  The  psychological  community  has  not  been  able  to  offer  any  meaningful   therapeutic  approaches.  Part  of  the  reason  that  this  is  the  case  has  to  do  with  the  very  recalcitrant  nature  of  the   disorder  itself.  Another  significant  part  of  that  reason  is  that  the  psychological  community  cannot  decide  where  to   focus  its  research.  Many  very  distinguished  individuals  have  been  trying  to  dissect  a  tiny  subset  of  the  ASPD   population  because  they  are  very  scary  and  are  good  for  getting  grant  money.  Society  at  large  has  a  vested  interest   in  ASPD  because  it  makes  up  such  a  significant  porton  of  the  prison  population.  These  individuals  are  likely  to   recidivate  and  likely  to  commit  violent  crimes.  Understanding  this  population  better  is  vital  for  long  term   meaningful  prison  reform.  (Lewis,  Olver  and  Wong  2013)  

In  addition  to  failing  individuals  with  ASDD  in  terms  of  treatment,  it  is  relevant  to  note  that  society  is  failing   individuals  with  ASPD  in  their  formative  years.  Recurrent  episodes  of  neglect  and  abuse  are  run-­‐of-­‐the-­‐mill  for   individuals  with  ASPD.  Society  at  large  needs  to  do  a  better  job  of  policing  this  kind  of  abuse  and  neglect  and   provide  safe,  rehabilitative  experiences  for  those  who  are  victims  of  it.