Antisocial personality disorder: Difference between revisions
(→Causes) |
|||
Line 33: | Line 33: | ||
==Causes== | ==Causes== | ||
The cause of ASPD is unknown, though the disorder is commonly associated with both genetics and childhood tumult.<ref name=”#2”>U.S. National Library of Medicine. (2016). MedlinePlus: “Antisocial personality disorder.” Retrieved 4 October 2016.</ref> | |||
The cause of | |||
==Differential Diagnosis== | ==Differential Diagnosis== |
Revision as of 14:46, 4 October 2016
For patient information click here
Template:DiseaseDisorder infobox
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Jesus Rosario Hernandez, M.D. [2], Haleigh Williams, B.S.
Synonyms and keywords: APD; introverted personality disorder; sociopath
Overview
Antisocial personality disorder (ASPD) is a psychiatric condition characterized by a disregard for social rules, norms, and cultural codes, as well as impulsive behavior and indifference to the rights and feelings of others. People with ASPD may lie, endanger the wellbeing of others for their own benefit, and/or show a prominent lack of remorse for wrongdoing.[1] Such behavior is often associated with criminal activity.[2] Sufferers of ASPD may nonetheless be capable of behaving in a flattering, charming, or otherwise likeable and socially acceptable way in the interest of manipulating others and achieving their own ends.[2] Incarcerated people are roughly ten times more likely to have antisocial personality disorder than members of the general population.[3] During childhood, people who will go on to be diagnosed with ASPD may demonstrate pyromania, a prolonged period of bedwetting, and/or cruelty to animals; this set of symptoms is known as the Macdonald triad.[2] Truancy, delinquency, hyperactivity, and conduct disorder are also common in young people with ASPD.[4][5] "Antisocial personality disorder" is the terminology used by the American Psychiatric Association's Diagnostic and Statistical Manual, while the World Health Organization's ICD-10 uses the term Dissocial personality disorder. People with ASPD are sometimes referred to as "sociopaths."[1]
Historical Perspective
Classification
Pathophysiology
Neural Maldevelopment
Individuals with cavum septum pellucidum (CSP), a marker of limbic neural maldevelopment, are significantly more like to have ASPD than control populations. This relationship is observed even when researchers control for trauma and head injury. The early maldevelopment of limbic and septal structures appears to predispose individuals to antisocial behaviors.[6]
- The presence of CSP is more closely related to the aggressive aspect of ASPD symptomology than the deceptive/irresponsible facet.[6]
Common Comorbidities
Conditions that are commonly comorbid with ASPD include:[2][4]
- Psychopathy (sometimes considered a particularly intense form of ASPD)
- Depression
- Substance abuse disorder
Causes
The cause of ASPD is unknown, though the disorder is commonly associated with both genetics and childhood tumult.[2]
Differential Diagnosis
- Substance abuse disorders
- Schizophrenia
- Bipolar disorder
- Narcissistic personality disorder
- Histrionic personality disorder
- Borderline personality disorder
- Criminal behavior[8]
Epidemiology and Demographics
Prevalence
The prevalence of antisocial personality disorder is 200 to 3,300 per 100,000 (0.2% to 3.3%) of the overall population.[8]
Incidence
Gender
Diagnosis of Antisocial personality disorder is documented to be significantly more common among men than among women.[9]
Age
Race
Special Populations
Risk Factors
Risk factors for antisocial personality disorder include:
- Male gender
- Alcohol abuse
- Drug abuse
- People at prison[8]
A family history of the disorder — such as having an antisocial parent — increases the chances of developing the condition. A number of environmental factors within the childhood home, school and community, such as an overly punitive home or school environment may also contribute.[10]
Robins (1966) found an increased incidence of sociopathic characteristics and alcoholism in the fathers of individuals with antisocial personality disorder. He found that, within such a family, males had an increased incidence of APD, whereas females tended to show an increased incidence of somatization disorder instead.[11]
Bowlby (1944) saw a connection between antisocial personality disorder and maternal deprivation in the first five years of life. Glueck and Glueck (1968) saw indications that the mothers of children who developed this personality disorder tended to display a lack of consistent discipline and affection, and an abnormal tendency to alcoholism and impulsiveness. These factors all contributing to failure to create a stable and functional home with consistent structure and behavioral boundaries.[11]
Adoption studies support the role of both genetic and environmental contributions to the development of the disorder. Twin studies also indicate an element of hereditability of antisocial behaviour in adults and have shown that genetic factors are more important in adults than in antisocial children or adolescents where shared environmental factors are more important. (Lyons et al., 1995)[11]
Screening
Natural History, Complications and Prognosis
Natural History
Complications
Prognosis
Poor prognostic factors include:
- Criminal behavior
- Alcohol abuse history
- Drug abuse history
- Adverse socioeconomic factors[8]
Diagnosis
Diagnostic Criteria
Central to identifying individuals exhibiting characteristics of the disorder is that they appear to experience a limited range of human emotions. This can explain their lack of empathy for the suffering of others, since they cannot experience the emotion associated with either empathy or suffering. Risk-seeking behavior and substance abuse may be attempts to escape feeling empty or emotionally void.[citation needed] The rage exhibited by sociopaths, as well as the anxiety associated with certain presentations of antisocial personality disorder, may represent the limit of emotion(s) experienced, or might also suggest physiological responses, without analogy to emotion, experienced by others.[citation needed]
According to the older theory of Freudian psychoanalysis, a person with antisocial personality disorder has a strong id and ego that overpowers the superego. The theory proposes that internalized morals of our unconscious mind are restricted from surfacing to the ego and consciousness. However, this explanation provides no insight into the cause or treatment of the problem.[citation needed]
Research has shown that individuals with antisocial personality disorder are indifferent to the possibility of physical pain or many punishments and show no indications that they experience fear when so threatened.
One approach to explaining antisocial personality disorder behaviors is put forth by sociobiology, a science that attempts to understand and explain a wide variety of human behavior based on evolutionary biology. Sociobiological explanations for antisocial behavior types explore evolutionarily stable strategies, attempting to discern whether the antisocial phenotype has evolved because it gains fitness specifically within, or alongside, the survival strategies of other humans exhibiting different, perhaps complementary behaviors (e.g., in a symbiotic or parasitic manner).[12]
DSM-V Diagnostic Criteria for Antisocial Personality Disorder[8]
“ |
AND
AND
AND
|
” |
ICD-10 Diagnostic Criteria
Chapter V of the tenth revision of the International Classification of Diseases offers a set of criteria for diagnosing the related construct of dissocial personality disorder.
Dissocial Personality Disorder (F60.2), usually coming to a gross disparity between behavior and the prevailing social norms, and characterized by:
- Callous unconcern for the feelings of others;
- Persistent attitude of irresponsibility and disregard for social norms, rules, and obligations
- Incapacity to maintain enduring relationships, though having no difficulty in establishing them
- Very low tolerance to frustration and a low threshold for discharge of aggression, including violence
- Incapacity to experience guilt or to profit from experience, particularly punishment
- Marked proneness to blame others, or to offer plausible rationalizations, for the behavior that has brought the patient into conflict with society
There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.
Establishing the Diagnosis
Antisocial personality disorder and the closely related condition of psychopathy can be assessed and diagnosed through clinical interview, self-rating personality surveys, and ratings from coworkers and family. The Psychopathy Checklist-Revised (PCL-R) is one source for diagnosing psychopathy in forensic male populations.
Symptoms
Common characteristics of people with antisocial personality disorder include:
- Persistent lying or stealing
- Recurring difficulties with the law
- Tendency to violate the rights of others (property, physical, sexual, emotional, legal)
- Substance abuse
- Aggressive, often violent behavior; prone to getting involved in fights
- A persistent agitated or depressed feeling (dysphoria)
- Inability to tolerate boredom
- Disregard for the safety of self or others
- A childhood diagnosis of conduct disorders
- Lack of remorse for hurting others
- Superficial charm
- Impulsiveness
- A sense of extreme entitlement
- Inability to make or keep friends
- Lack of guilt
- Recklessness, impulsivity[13][10]
People who have antisocial personality disorder often experience difficulties with authority figures.[14]
Physical Examination
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Prevention
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 Lenzenweger MF, Lane MC, Loranger AW, Kessler RC (2007). "DSM-IV personality disorders in the National Comorbidity Survey Replication". Biol Psychiatry. 62 (6): 553–64. doi:10.1016/j.biopsych.2006.09.019. PMC 2044500. PMID 17217923.
- ↑ 2.0 2.1 2.2 2.3 2.4 U.S. National Library of Medicine. (2016). MedlinePlus: “Antisocial personality disorder.” Retrieved 4 October 2016.
- ↑ Fazel S, Danesh J (2002). "Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys". Lancet. 359 (9306): 545–50. doi:10.1016/S0140-6736(02)07740-1. PMID 11867106.
- ↑ 4.0 4.1 NHS Choices. (2015). “Antisocial personality disorder.” Retrieved 4 October 2016.
- ↑ Simonoff E, Elander J, Holmshaw J, Pickles A, Murray R, Rutter M (2004). "Predictors of antisocial personality. Continuities from childhood to adult life". Br J Psychiatry. 184: 118–27. PMID 14754823.
- ↑ 6.0 6.1 Raine A, Lee L, Yang Y, Colletti P (2010). "Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy". Br J Psychiatry. 197 (3): 186–92. doi:10.1192/bjp.bp.110.078485. PMC 2930915. PMID 20807962.
- ↑ Moeller FG, Dougherty DM (2001). "Antisocial personality disorder, alcohol, and aggression". Alcohol Res Health. 25 (1): 5–11. PMID 11496966.
- ↑ 8.0 8.1 8.2 8.3 8.4 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Public Health Agency of Canada, A Report on Mental Illnesses in Canada
- ↑ 10.0 10.1 "Antisocial Personality Disorder". Mayo Foundation for Medical Education and Research. 2006. Retrieved 2007-02-20.
- ↑ 11.0 11.1 11.2 "Antisocial Personality Disorder (APD)". Armenian Medical Network. 2006. Retrieved 2007-02-20. Text " Anne-Marin B. Cooper, M.D. " ignored (help)
- ↑ Mealey, Linda (1995). "The Sociobiology of Sociopathy: An Integrated Evolutionary Model". Vol. 18 (3). Behavioral and Brain Sciences. pp. 523–599.
- ↑ "Antisocial Personality Disorder". Psychology Today. 2005. Retrieved 2007-02-20. Text " Psychology Today Staff " ignored (help)
- ↑ "Antisocial Personality Disorder Treatment". Psych Central. 2006. Retrieved 2007-02-20. Text " John M. Grohol " ignored (help)
- CS1 maint: Multiple names: authors list
- Pages with citations using unnamed parameters
- All articles with unsourced statements
- Articles with unsourced statements from June 2007
- Articles with invalid date parameter in template
- Articles with unsourced statements from February 2007
- Psychiatry
- Personality disorders
- Pediatrics