• Antisocial Personality Disorder

    (Psychopathy; Sociopathy)

    Definition

    Antisocial personality disorder is a psychiatric condition that causes an ongoing pattern of manipulating others and violating their rights. People with this disorder do not follow society’s norms and often break the law. It is characteristic for people with this diagnosis to be entirely careless about other people's feelings and pain. They also show a pervasive pattern of no regret together with irresponsible decisions.
    Antisocial personality disorder is much more common in males than females. To be diagnosed with the disorder, a person must be at least 18 years old, but have had symptoms of conduct disorder before age 15. These symptoms include aggression toward people or animals, destruction of property, deceitfulness or theft, and serious breaking of rules.
    Seeking treatment is important not only to help the person with the disorder, but also to protect other people who may be affected by the person’s behavior.

    Causes

    This disorder is caused by a combination of genetic (inherited) factors and the person’s environment, especially the family environment. Researchers believe that biological factors may contribute, such as abnormal chemistry in the nervous system and impairment in the parts of the brain that affect judgment, decision-making, planning, and impulsive and aggressive behavior.
    Prefrontal Cortex
    Prefrontal cortex brain
    This area of the brain is thought to be responsible for behavior including appropriate social behavior, judgement, and impulse control. Antisocial personality disorder is thought to develop from chemical imbalances in specific areas of the brain.
    Copyright © Nucleus Medical Media, Inc.

    Risk Factors

    A risk factor is something that increases your chance of getting a disease or condition. The following factors increase the chance of developing antisocial personality disorder:
    • Family history of the disorder
    • Family history of substance abuse disorders

    Symptoms

    Common symptoms of antisocial personality disorder include:
    • Breaking the law repeatedly
    • Deceitfulness, repeated lying
    • Impulsivity (eg, failure to plan ahead)
    • Irritability and aggressiveness (eg, repeated physical fighting)
    • Disregard for safety of oneself or others
    • Irresponsibility (eg, regarding work, family, finances)
    • Lack of guilt over hurting others
    • Inability to feel sympathy or empathy for others
    • Lack of concern for consequences of actions/behavior
    • Inability to learn from experience or change behavior based on past outcomes or predicted future outcomes
    • Bullying or cruelty to animals and/or other humans
    • Destruction of property
    People with antisocial personality disorder often have substance abuse disorders and legal problems. They sometimes have depression , anxiety disorders, or attention deficit hyperactivity disorder .

    Diagnosis

    Diagnosis, usually made by a psychiatrist or other mental health professional, is based on symptoms and medical and mental health history. There are no laboratory tests to help diagnose this disorder. A complete psychiatric assessment is important to determine how severe the disorder is and whether there are any other contributing disorders, such as substance abuse, depression, anxiety disorders, or attention deficit hyperactivity disorder.

    Treatment

    People with antisocial personality disorder often do not admit they have a problem that should be treated. They may need encouragement from others or treatment to be mandated by a court.
    This disorder can be difficult to treat. Treatment may be complicated by other conditions, especially substance abuse. However, the other disorders may be easier to treat than antisocial personality disorder. Treating them may improve overall health and functioning.
    Different kinds of psychotherapy are used with antisocial personality disorder. Group therapy can be useful in helping people learn how to interact better with others. Cognitive behavioral therapy and behavior modification can help change problematic patterns of thinking and encourage positive behaviors.
    Medications are used to deal with specific symptoms, such as aggressiveness and irritability. They may also target other psychiatric disorders that are common with antisocial personality disorder. Mood stabilizers such as lithium or carbamazepine may also be useful to improve impulsivity. In general, medications that are likely to be abused are usually avoided because people with this disorder also often have substance abuse problems.
    Antisocial personality disorder is a chronic condition. However, some symptoms, especially criminal behavior, may decrease slowly on their own with age, starting in one’s thirties.

    Prevention

    There is no known way to prevent antisocial personality disorder. However, treating it earlier in life can help prevent it from becoming worse. With or without treatment, rates of imprisonment and violent death are high among those with antisocial personality disorder.

    RESOURCES

    National Alliance on Mental Illness http://www.nami.org

    National Institute of Mental Health http://www.nimh.nih.gov

    CANADIAN RESOURCES

    HealthLink BC http://www.healthlinkbc.ca/

    Public Health Agency of Canada http://www.phac-aspc.gc.ca

    References

    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text Revision (DSM-IV-TR). Washington, DC: American Psychiatric Association; 2000.

    Daghestani AN, Dinwiddie MD, Hardy DW. Antisocial personality disorder in and out of correctional and forensic settings. Psychiatric Annals . 2001;31(7):441-446.

    Markovitz PJ. Recent trends in the pharmacotherapy of personality disorders. J Pers Disord . 2004;18(1):90-101.

    Moore, Jefferson. Handbook of Medical Psychiatry . 2nd ed. Philadelphia, PA: Mosby; 2004.

    Sher KJ, Trull TJ. Substance use disorder and personality disorder. Curr Psychiatry Rep . 2002;4:25-29.

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