Antisocial Personality Disorder

  • Category: Psychology
  • Words: 2965
  • Grade: 90


DEFINITION

Antisocial Personality Disorder (APD) is perhaps the most frightening of all personality disorders, as well as one of the most difficult to diagnose. Personality disorders in general are defined as inflexible, maladaptive, personality traits that cause personal distress or an inability to get along with others. APD specifically is characterized by deceitfulness, lack of regret or remorse over actions, impulsiveness, aggression towards others or animals, irresponsibility and a general failure to conform to the norms of society. The person with APD can be described as one who feels nothing or almost nothing towards any other living thing, except perhaps contempt. However, they can still be quite charming when it suits them (such as con artists)and they can appear quite normal to the average person.
It is possible that the development of APD begins in childhood, although it is not diagnosed as such until after eighteen years of age. In childhood, Conduct Disorder carries almost identical symptoms to APD. Patterns of blatant disregard for rules and authority, aggression, habitual lying, a tendency toward stealing and destruction of property that occur early in life may point to APD as an adult. It appears that somewhere along the line, moral development simply fails. Studies have also shown that symptoms of the disorder may begin to decrease at age 35 "“ 40, with violent crimes dropping off sharply but crimes such as theft and cons continuing until very late in life.
On the other hand, a person may appear normal in childhood and still be diagnosed with APD as an adult. Such was the case with Ted Bundy, the "chi omega killer". By all accounts of family and friends, Ted was an average child, quiet and a good student. It wasn't until he reached his teens that subtle signs of APD began to appear. He has stated that he began to feel something was different about himself around the time he entered junior high. While all the other boys were turning their attention to girls, he could not understand what they were feeling or why. It was also about that time that he learned the person he thought of as his older sister was instead his mother and he began to have problems getting along with his step-father. From there his "differences" became increasingly evident to him yet he managed to mask the madness building within, managing to go undetected until he had slaughtered and sexually abused more than twenty young women.
In classic APD form, he lied extensively about the details of his life, abused alcohol and dabbled in drugs, could not hold a job for a long period, dropped in and out of college many times (lying his way in) and exhibited kleptomaniac behavior, stealing anything and everything from anywhere. He could not maintain an intimate, long lasting relationship with a woman. In fact, he says that he did not understand intimacy "“ what it was or how to achieve it. Even after his conviction, he rationalized that he knew so many details about the murders because he had been at the center of the investigation for so long as a suspect. In interviews, he spoke as a third person, observing and analyzing the killing as though someone else had done it.
All of the people around him, in day to day life still claim that they can't believe this is the same guy they knew. That has got to be the most terrifying aspect of APD "“ that someone so insidious, so very dangerous, can blend into society, assuming any identity, being so very charming and gregarious , looking all the while like "just the guy or girl next door".









EPIDEMIOLOGY

The true epidemiology of APD is unclear due to the nature of deceitfulness involved causing it to remain hidden in many people who have it. Also, many people who might be considered to have APD may only be exhibiting some aspects of antisocial behavior. In addition, not all people with APD will commit the violent crimes that ultimately reveal them.
Currently, some experts believe that as much as 20% of the population of the U.S. may suffer from some type of mental illness. A more conservative estimate is about 12 "“ 15% when researchers narrowed their focus to only those having clusters of symptoms that occur over extended periods and actually impair a persons ability to function. APD has been found to occur in roughly 3% of males in the U.S. and about 1% of females. In prison populations, however, APD is found to be evident in as much as 75% overall, with about 80% of male prisoners and about 65% of female prisoners having it. Individuals in lower income brackets and those residing in inner cities also tend to have higher incidence rates.
Many other disorders are associated with and often confused with APD. Substance Abuse Disorder is one of the often confused disorders because the influence of drugs or alcohol can be a temporary cause of antisocial behavior. Conversely, substance abuse can be a symptom of APD. Therefore, in treating substance abuse, a determination of earlier antisocial behavior or Conduct Disorder in childhood must be made before a diagnosis of APD can be rendered. Also, Schizophrenic or Manic episodes that include that include some antisocial behavior cannot be declared APD unless the symptoms are present at other times. Narcissistic, Histrionic, Borderline and Paranoid Personality Disorders also closely resemble APD, however each seems to lack the aggression factor that APD carries (again this can include things such as con games and does not necessarily mean violence).
Other associated disorders include Depressive, Anxiety, Somatiform and Pathological Gambling Disorder. These can be experienced in addition to APD. Once again though, each of these on its own will lack the aggression seen in APD.






ETIOLOGY

As with so many mental disorders, there seems to be no single, clear cause or origin of APD. Extensive research has been done and continues to be done but to little avail as of yet. However, some theories have developed. In the study of adopted children with APD and other disorders, both biological and environmental factors are indicated.
Neglect or abuse in early, formative years causing attachment problems, broken trust issues and failure to learn how to give or receive love would appear to be a glaring cause. Especially when we think in terms of the disregard of the rights or feelings of others being a symptom of APD. Abuse has also been shown to cause violence in many adults who endured it as a child. Neglect could also encompass the lack of moral teaching as a child being an origin of failure to follow societal norms and ignoring laws as an adult. Having parents who were substance abusers also appears to offer up a greater risk for developing APD, considering that those who are alcoholics or drug addicts are most often abusive or neglectful. Speaking as an adult child of an alcoholic parent I obviously do not have APD and can therefore deduce that there must be a combination of causes.
Biological factors under consideration include inheriting a predisposition for APD, abnormalities in the brain and even physiological changes in the brain due to neglect. In the adopted child study, those who were adopted out from biological parents who had APD or other disorders still maintained the risk of development although, in this case, being adopted into an environment of nurturing lessened it. Some abnormality in the development of the brain and/or central nervous system is also suspect due to a study that showed persons with APD have lower electrical conductance of the skin in response to situations that would cause fear in a "normal" person. Differences in the frontal and parietal lobes of some violent offenders studied in 1977 in Texas is thought to be yet another possibility in causing APD. And in a study of macaque monkeys, when the monkeys were taken away from and raised without mothers, they were found to grow up with lower levels of seratonin, causing aggression, antisocial behavior and depression. Still, with all the research that has been done there are no answers with regards to biology.
Actual damage to the brain through injury is yet another possibility for cause. Damage to certain parts of the brain can indeed interrupt impulse control and emotional responsiveness. Such was the case argued by John Wayne Gacy, Jr., the "killer clown". For the most part, he had a normal childhood except for the fact that he suffered abuse at the hand of an alcoholic father. Then, at 11 years old, he was hit in the head by a swing. At first, there appeared to be no serious injury but then he began to have blackouts. The blackouts continued until he reached 16, when it was discovered that he had a blood clot in his brain. He was given drugs to dissolve the clot, no surgery was performed. After that he began to display signs of APD. He dropped out of school, after having attended four different ones, and moved to Las Vegas. There he held a series of odd jobs none of which lasted long. Then he met a woman he thought he loved and they were eventually married. Going to work for his father in law selling cars was ideal for Gacy who was a smooth talker. He felt an intense need to belong and satisfied it by becoming a member of many civic groups such as the Jaycees. He even dressed as a clown to entertain children. But the façade began to crumble when a 17 year old boy accused Gacy of tricking him into being handcuffed and then sexually assaulting him. Gacy denied the charges by saying that some higher members of the Jaycees were "out to get him". Later, he was accused again and this time was convicted. While on parole, Gacy could not resist picking up yet another young boy and sexually assaulting him. That time he landed in jail. When he was released, the downward decent to hell continued and in the end, more than thirty bodies of boys were found in his house and more were found in area rivers and woods. While monster would seem to be the only appropriate word to describe him (albeit inadequate), his friends and neighbors couldn't believe that the man who had thrown such wonderful luaus and bar-b-ques could have done these things. Even his next door neighbor, who smelled the dead bodies at Gacy's house, believed him when he explained it as a sewer line problem. So, in the end, it is doubtful that an injury at the age of 11, could be the lone cause of such a horror.
Finally, there is the idea of environment as cause. Children of lower economic status and ethnic minority also appear to be at greater risk for APD. Since persons of lower economic status tend to live in higher crime, inner city areas where drugs are prevalent, they may learn disregard for others and the law at an early age. Violent and aggressive responses are learned in order to survive. Parental guidance may also be lacking due to the high rate of absent fathers, mothers who must work long,late hours away from home and the prevalence of substance abuse.
Environment, biology, genes, brain injury "“ all appear viable causes and yet it cannot be determined which actually is. More likely it is a combination of all of them. Perhaps the researchers should turn in the direction of finding ways to end poverty, stop child abuse and rid the country of drugs if they ever intend to put a cure to this disorder.





DIAGNOSTIC CRITERIA FOR ANTISOCIAL PERSONALITY DISORDER
FROM DSM IV


A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

1) failure to conform to social norms with respect to lawful behaviors as
indicated by repeatedly performing acts that are grounds for arrest

2) deceitfulness, as indicated by repeated lying, use of aliases, or conning
others for personal profit or pleasure.
3) impulsivity or failure to plan ahead
4) irritability and aggressiveness, as indicated by repeated physical fights
or assaults
5) reckless disregard for safety of self or others
6) consistent irresponsibility, as indicated by repeated failure to sustain
consistent work behavior or honor financial obligations
7) lack of remorse, as indicated by being indifferent to or rationalizing
having hurt, mistreated or stolen from another
B. The individual is at least age 18 years
C. There is evidence of Conduct Disorder with onset before age 15 years
D. The occurrence of antisocial behavior is not exclusively during the course
Of Schizophrenia or a Manic Episode






POSSIBLE COURSES OF TREATMENT

The prognosis for a person with APD is not good. Because characteristics of mistrust, lack of remorse and the lack of most any feelings at all, they may be seen by professionals as untreatable. Also since those seeking treatment for APD are doing so only due to legal circumstances, they may lack the motivation to actively participate in their treatment. And since the drugs prescribed do not result in any pleasurable sensations, getting the patient with APD to take them may be difficult. The difficulty in trying to get the patient to connect their behaviors to feelings can seem almost insurmountable. Then, there is the problem of getting the APD patient past their extreme problems with authority.
When treatment is sought though, emotions "“ the lack of and learning to connect to "“ should be the main focus of therapy. Ways of reinforcing appropriate behavior should be used in relation to the patient connecting with some sort of human feeling. The trust built with a therapist can be a learning tool in and of itself since most of those with APD have never had a solid, trusting relationship. Group or family therapy can be helpful by putting the patient at ease in a group of similar people, but the group setting can become more of a bragging ground for criminal exploits. Family therapy can also be used as a platform to educate family members about the persons illness and how to deal with it.
Hospitalization is another option but not very viable since most seeking treatment are already in a prison setting and the care can be long term. Some specialized in-patient treatment settings are in development such as the Patuxent Institute located in Jessup, Mo. There a strict behavioral approach of placing patients on a token economy based on their progress is used.
Medications are another form of treatment however they can only treat the symptoms and do not change the disorder. Lithium, Fluoxetine, Sertraline, Busiprone and other anti-psychotic drugs may be prescribed. However, as stated before, if the drug does not carry pleasurable sensations, it is likely that the patient with APD will not take it. Also, since substance abuse and manipulation are symptoms themselves, the patient may try to alter or fake other symptoms to get the drugs they want.

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