Antisocial personality disorder
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
ASPD must be differentiated from disorders with similar symptomology, including:[8]
- Substance abuse disorders
- Schizophrenia
- Bipolar disorder
- Narcissistic personality disorder
- Histrionic personality disorder
- Borderline personality disorder
- Criminal behavior
Epidemiology and Demographics
Prevalence
- Overall, 3% of men and 1% of women in the general population meet the criteria for ASPD.[1]
- The 12-month prevalence of ASPD is 1.0% of the United States adult population.[1]
Incidence
Gender
- ASPD is more common in men than in women.[1] The male to female ratio is 2 to 1.[5]
- Basal testosterone levels are positively related to incidence of antisocial behaviors.[9]
Age
- Symptoms tend to be most severe in early adulthood, and may diminish over time, as a person ages.[2]
Race
Special Populations
- Approximately 1 in 2 male prisoners and 1 in 5 female prisoners suffer from ASPD.[3]
- Prisoners are roughly ten times more likely to have antisocial personality disorder than members of the general population.[3]
Risk Factors
Risk factors for the development of ASPD include:[8][2][5]
- Male gender
- Genetics
- Family history of ASPD
- Antisocial/alcoholic parent
- Alcohol abuse
- Child abuse
- Drug abuse
- Incarceration
- Childhood hyperactivity / conduct disorder
Screening
Natural History, Complications and Prognosis
Natural History
Complications
Complications of ASPD can include:[2]
- Law-breaking / Imprisonment
- Drug abuse
- ASPD patients are more likely to experience alcohol-related consequences than non-ASPD alcoholics.[7]
- Violence
- Inability to sustain employment
- Homelessness
- Self-harm or suicide
Prognosis
Without treatment, the prognosis of ASPD is varied.
- Symptoms commonly peak in the late teenage years and the early 20s. Sometimes, symptoms improve on their own as the patient nears middle age.[2]
- Among ASPD patients, heavy alcohol usage and low socioeconomic status are predictive of poor neuropsychological outcomes.[8][10]
With treatment, the prognosis is improved, though concrete data are unavailable.[2]
- Though behavior may improve with treatment, the elements of personality that are central to ASPD, such as an inability to empathize with others, often remain.[4]
Diagnosis
Diagnostic Criteria
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.
Symptoms
Common symptoms of ASPD include:[11][12][1][2][4][13]
- 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
- Impulsivity or recklessness
- A sense of extreme entitlement
- Inability to make or keep friends or maintain long-term, healthy relationships
- Lack of remorse for wrongdoing
- Persistent difficulty interacting with authority figures
- Macdonald triad in childhood
- Longer-than-normal period of bedwetting
- Cruelty to animals
- Pyromania
Physical Examination
ASPD is diagnosed based on the results of a psychiatric evaluation, during which the clinician will consider the nature of the patient’s symptoms, how long they have been present, and how severe they are. For a diagnosis of ASPD to be made, the patient must have exhibited behavioral and emotional problems during childhood.[2]
Laboratory Findings
Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
ASPD is often regarded among mental health professionals as one of the most difficult personality disorders to treat effectively, largely because individuals with this disorder are unlikely to seek treatment on their own and might do so only on the orders of a court.[2]
Behavioral treatments or talk therapy (CBT or MBT), as well as patient support groups, may be useful for some patients.[2][4]
- It is also important to treat patients for any comorbid conditions, including substance abuse disorder or mood disorder.[2]
- Relatively little evidence exists to support the use of medication to treat ASPD. Carbamazepine or lithium may be useful for minimizing aggressive behavior, while SSRIs can help improve disposition issues.[4]
Surgery
Prevention
Primary Prevention
Secondary Prevention
References
- ↑ 1.0 1.1 1.2 1.3 1.4 1.5 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.
- ↑ 2.00 2.01 2.02 2.03 2.04 2.05 2.06 2.07 2.08 2.09 2.10 2.11 2.12 2.13 2.14 U.S. National Library of Medicine. (2016). MedlinePlus: “Antisocial personality disorder.” Retrieved 4 October 2016.
- ↑ 3.0 3.1 3.2 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 4.2 4.3 4.4 4.5 NHS Choices. (2015). “Antisocial personality disorder.” Retrieved 4 October 2016.
- ↑ 5.0 5.1 5.2 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.
- ↑ 7.0 7.1 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 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
- ↑ Menelaos L, et al. (2012). Testosterone and Aggressive Behavior in Man. Int J. Endocrinol. Metab.
- ↑ Oscar-Berman M, Valmas MM, Sawyer KS, Kirkley SM, Gansler DA, Merritt D; et al. (2009). "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder". Neuropsychiatr Dis Treat. 5: 309–26. PMC 2699656. PMID 19557141.
- ↑ "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)