Antisocial Personality Disorder
Antisocial personality disorder is a mental disorder in which people display an obvious disregard for laws and the rights of others. Individuals with antisocial personality disorder tend to lie or steal and often fail to fulfill job responsibilities or parenting tasks. "Sociopath" and "psychopath" were the labels once used to describe those individuals who exhibit the antisocial traits of this disorder.
Early adolescence is the time when antisocial personality disorder begins to develop. An adult cannot be given the diagnosis of antisocial personality disorder unless they met the criteria for conduct disorder as an adolescent An adult will not suddenly develop APD. Individuals with the highest risk for developing this personality disorder are those who we raised in an abusive or neglectful home. The disorder affects men three times as often as it does women. And it is more prevalent in the prison population than in the general population.
Antisocial personality disorder is a chronic disorder and it is one of the most difficult personality disorders to treat. Psychotherapy and sometimes medications if appropriate may be helpful in treatment. Most individuals with APD will not be aware of the issues and therefore will not seek out treatment on their own. Usually they will be court ordered or responding to pressure from family when still young. Although the condition is chronic, sometimes, the symptoms of antisocial personality disorder may decrease as the person reaches middle age and beyond.
Signs and Symptoms
The classic case of an individual with an antisocial personality is indifference to the needs and wishes of others; a blatant disregard for right and wrong and typically the individual will be a loner. They may manipulate through lying or intimidation, have trouble holding down a job, and often fails to pay bills or fulfill parenting or work responsibilities.
People with antisocial personality disorder can be aggressive and violent and are likely to have a history of trouble with the law. However, for some antisocial personalities they may utilize charm and wit as a tool in their deception. Although they may meet the criteria for the disorder, they are able to mask it under a facade of charm used to get what they want or hide their actions.
Common characteristics of people with antisocial personality disorder include:
- Persistent lying or stealing
- Recurring arrests
- Tendency to violate the rights of others (property, physical, sexual, emotional, legal)
- Aggressive or violent behavior; physical fights
- Inconstant job history
- A persistent agitated or depressed mood
- Risk taking or excitement seeking
- Disregard for the safety of self or others
- History of conduct disorder
- Lack of remorse
- Superficial charm or wit
- Impulsiveness
- Sense of entitlement
- Inability to develop friendships or healthy relationships
Symptoms tend to peak during the adolescent years and early 20s and then may decrease over time. This decrease may be due to aging or an increased awareness of the consequences of their behavior. Therefore a person with antisocial personality disorder might be noticed early in life due to legal complications and later in life because they are an inadequate spouse or parent and an unreliable employee.
Risk factors
- Genetics do play a role in the development of personality, as do environmental factors, specifically childhood experiences. Most factors that increase the risk of developing antisocial personality relate to a family history of the disorder and an abusive or neglectful childhood. Some of the major risk factors are as follows.
- History of child abuse
- History of child neglect
- Growing up with an antisocial parent
- Growing up with an alcoholic parent
- Growing up with friends that exhibit antisocial behavior
- Having an attention-deficit disorder
- Having a reading or other learning disorder
- Co-occurring anxiety or depression
- Co-occurring substance abuse or addiction
Treatment
In general, there has been little success in treating people with antisocial personality disorder, but there are approaches that may help alleviate symptoms. Since many individuals with antisocial personality disorder often suffer from co-occurring conditions such as anxiety, depression, or other mood disorders, doctors may prescribe antidepressant or antipsychotic medications to help alleviate these symptoms. However, many people with antisocial personality disorder don't take their medications as prescribed or may abuse them.
Psychotherapy can help people with antisocial personality disorder develop appropriate interpersonal skills and a moral code. A strong therapeutic alliance is the catalyst for this change and the biggest challenge to therapy. Typically, insight and a connection is not what these individuals are seeking. They often present as emotionally unstable, inappropriate and prone to impulsive behavior. In some cases, group therapy and family therapy is the recommendation. A group setting can be less threatening for some individuals and they can allow their defenses to lessen.
In some cases, when there is a risk of self-harm or harm to others, people with antisocial personality disorder may require hospitalization.