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Antisocial Personality Disorder

Antisocial Personality Disorder (ASPD), like all personality disorders represents a stable, pervasive pattern
of behavior that is present for an individuals entire life. In ASPD particularly, the pattern 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 individuals work and school record. ASPD
traits make listening to authority figures nearly impossible so most of these individuals have spotty
educational and work histories.

These behavioral markers are the outcome of several 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 meet 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:

1) 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.

2) There must also be proof in the 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 individuals 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.

3) 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,
Antisocial Personality Disorder

manipulativeness, irresponsibility and a parasitic lifestyle. It is commonly conceptualized that

psychopathy is a more severe form of ASPD 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 reflected by early socialization experiences.

Secondary Classifications
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 Miller created a series of 5 subtypes of ASPD:

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

Nomadicthis 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.

Malevolentthis 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-takingthis 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-defendingthis 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.

Two of the most difficult discrepancies for ASPD 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 ASPD the individual feels that they are entitled and special and that they can break the
rules because of this fact. The ASPD 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.

Antisocial Personality Disorder

Symptom Overlap Between Antisocial and Narcissistic/Histrionic

Antisocial Histrionic Narcissistic

Lacking remorse Demonstrates rapidly shifting Lacking empathy
and shallow expression of
Dishonesty Is manipulative with others

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 effect 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 showed a positive relationship between early onset of alcohol use and the transition of
conduct disorder to ASPD. 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. (Duggan,
Howard and Khalifa)

Gender Differences
There is a very wide disparity between the number of men and women who meet the criteria for
diagnosis with ASPD. Epidemiological research suggests that as many as 3% of men have ASPD while
less than 1% of women do. Some theorists, like Miller, have argued that the Differences in men and
women in ASPD is mirrored by the same Differences 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 ASPD 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

Antisocial Personality Disorder

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, Blanco and Petry) 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. (M. K. Brook) 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 theorists conceptualize ASPD begins in the early childhood phase of trust vs. mistrust.
Children who will later show evidence of conduct disorder and then ASPD do not have adequate social
associations 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. (Shores) 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 ASPD also have no conscience and
little motivation to change who they are naturally which further compounds treatment difficulty. 1
Antisocial individuals also tend to have a very low frustration tolerance which makes seeing treatment
through to its conclusion very difficult.

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

1 People receiving treatment by the order of the legal system have little cause for change.

Antisocial Personality Disorder

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)

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 study 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, Hawes and Murrie) 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

Biological theorists have begun using psychotropic medications on individuals with ASPD. 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)

Antisocial Personality Disorder is a challenging 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 portion 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)

In addition to failing individuals with ASPD 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.

Antisocial Personality Disorder

Works Cited
Alegria, A.A., et al. "Sex Differences in Antisocial Personality Disorder: Results from the National
Epidemiological Survey on Alcohol and Related Conditions." Personality Disorders: Theory,
Research, and Treatment (2013): 1037.
Arntz,, A., M. Cima and J. Lobbestael. "The Relationship Between Adult Reactive and Proactive
Aggression, Hostile Interpretation Bias and Antisocial Personality Disorder." Journal of Personality
Disorders (2013): 53-66.
Boccaccini, M.T., et al. "When Experts Disagreed, Who Was Correct? A Comparison of PCL-R Scores
From Independent Raters and Opposing Forensic Experts." Law and Human Behavior (2012): 527-
Brook, M. and D.S. Kosson. "Impaired Cognitive Empathy in Criminal Psychopathy: Evidence From a
Laboratory Measure of Empathetic Accuracy." Journal of Abnormal Psychology (2013): 156-166.
Brook, M., Kosson, D.S. n.d.
Duggan, C., et al. "The Relationship Between Childhood Conduct Disorder and Adult Antisocial Behavior
is Partially Mediated by Early-Onset Alcohol Abuse." Personality Disorders: Theory, Research, and
Treatment (2012): 423-432.
Lewis, K., M.E. Olver and S.C. Wong. "Risk Reduction Treatment of High-Risk Psychopathic Offenders: The
Relationship of Psychopathy and Treatment Change to Violent Recidivism." Personality Disorders:
Theory, Research, and Treatment (2013): 160-167.
Shores, M. "Encouraging New Therapies in the Treatment of Psychopathy ." Journal of Sociology (2014):