Antisocial personality disorder

Antisocial Personality Disorder (ASPD) is a personality disorder characterized by a lack of regard for societal rules and posing a threat to other people and society. Those with antisocial personality disorder are dangerous and manipulative. However, they veil their cruel and destructive nature under charm and deceit. Those afflicted with ASPD also lack remorse/a conscience/an empathetic connection to others, are sensation-seeking, and are prone to boredom. They have low reactivity to social cues, especially to punishments. They suffer from cognitive dysfunctions, as their learning is impaired by low arousal. Their autonomous nervous systems (ANS) are also shown to have less reactivity.

An example of ASPD is one having problematic, spontaneous violent behavior that overrides weeks of planned violence. Rather than sticking to the plan causing "maximal harm", those inflicted with ASPD would prefer to make an impulsive decision to gratify their current desire to cause harm.

DSM diagnostic criteria

• A pattern of disregard for, and violation of, the rights of others
• 3 or more of 7 symptoms:
  • Repeated law-breaking
  • Deceitfulness (lying, aliases, conning for profit or pleasure)
  • Impulsivity or failure to plan ahead
  • Irritability and aggressiveness (physical fights, assults)
  • Reckless disregard for safety of self and others
  • Irresponsibility (not meet work, financial obligations)
  • Lack of remorse
• Must be 18 years of age for diagnosis of ASPD
• Must have had conduct disorder since at least age 15
• Occurrence of antisocial behavior is not exclusively during the course of either bipolar disorder or schizophrenia

Issues in diagnosis

• Difficult to diagnose
• Patients tend to hide
• Not covered by insurance

Causes

• Less active frontal lobes
• Left prefrontal cortex is very impacted

Where ASPD problems come from

• Assortative mating - animals pick mates with similar characteristics
  • Intelligence is most common assortative factor
  • ASPD people’s parents typically both have antisocial factors, plus modeling
• Mutually coercive parenting interactions (Patterson)
  • Both sides won’t back down when parents ask children to do something
  • One of the main factors that causes ODD to advance to CD, and CD to advance to ASPD
• ODD - oppositional defiant disorder
  • Talk back, cause problems, but still developmentally kids
  • Most get better, some develop CD
• CD - conduct disorder
  • Escalation above ODD
  • Violation of rights of others
  • Can either eliminate CD, keep CD, or develop ASPD

Treatment

ASPD is largely untreatable. Group therapy for ASPD, CD, and ODD are iatrogenic because the members of group therapy teach each other bad tricks, makes things worse.