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Antisocial personality disorder is a type of chronic mental illness in which a person’s ways of thinking, perceiving situations and relating to others are abnormal and destructive. People with antisocial personality disorders typically have no regard for right and wrong. They may often violate the law and the rights of others, landing in frequent trouble or conflict. They may lie, behave violently, and have drug and alcohol problems. And people with antisocial personality disorder may not be able to fulfill responsibilities to family, work or school.
Antisocial personality disorder is sometimes known as sociopathic personality disorder. A sociopath is a particularly severe form of antisocial personality disorder. Most psychopaths meet the criteria for Antisocial Personality Disorder, but most individuals with Antisocial Personality Disorder are not psychopaths. Psychopaths account for 50 percent of all the most serious crimes committed, including half of all serial killers and repeat rapists.
A. 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 bipolar disorder.
Symptoms.
- They lack of conforming to laws and repeatedly commit crimes
- Repeatedly deceitful in relationships
- Failure to think or plan ahead
- Tendency of irritability, anger and aggression
- Disregard for personal safety or safety for others.
- Persistent lack of taking responsibility
- Lack of guilt for any wrong activity.
Studies of adopted children indicate that both genetic and environmental factors influence the development of this disorder. Both biological and adopted children of people diagnosed with the disorder have an increased risk of developing it. Children born to parents diagnosed with antisocial personality but adopted into other families resemble their biological more than their adoptive parents. The environment of the adoptive home, however, may lower the child’s risk of developing the mentioned disorder.
Researchers have linked antisocial personality disorder to childhood physical or sexual abuse, some undiagnosed neurological disorders and low IQ. But, as with other personality disorders, no one has identified any specific cause or causes of antisocial personality disorder. Persons diagnosed with antisocial personality also have an increased incidence of somatization and substance-related disorders.
Treatment.
Antisocial personality disorder is highly unresponsive to any form of treatment, in part because persons with antisocial personality disorder rarely seek treatment voluntarily. There are medications that are effective in treating some of the symptoms of the disorder, noncompliance with medication regimens or abuse of the drugs prevents the widespread use of these medications.
The most successful treatment programs for this personality disorders are long-term structured residential settings in which the patient systematically earns privileges as he or she modifies behavior. It is unlikely, however, that they would maintain good behavior if they left the disciplined environment. Unfortunately, these approaches are rarely if ever effective. Many persons with this disorder use therapy sessions to learn how to turn “the system” to their advantage.
Borderline Personality Disorder.
Borderline personality disorder is a personality disorder described as a prolonged disturbance of personality function in a person, characterized by depth and variability of moods. The disorder typically involves unusual levels of instability in mood; black and white thinking, or splitting; the disorder often manifests itself in idealization and devaluation episodes, as well as chaotic and unstable interpersonal relationships, self-image, identity, and behavior; as well as a disturbance in the individual’s sense of self. In extreme cases, this disturbance in the sense of self can lead to periods of dissociation.
This disorder splitting includes a switch between idealizing and demonizing others. This, combined with mood disturbances, can undermine relationships with family, friends, and co-workers. This disorder disturbances also may include self-harm. Without treatment, symptoms may worsen, leading (in extreme cases) to suicide attempts.
Diagnostic Criteria for Borderline Personality Disorder.
A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity, beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment.
(Note: Do not include suicidal or self-mutilating behavior covered in Criterion 5.)
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (Note: Do not include suicidal or self-mutilating behavior covered in criterion 5.)
5. Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior.
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. Chronic feelings of emptiness.
8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.
Symptoms.
- Frantic efforts to avoid real or imagined abandonment
- A pattern of unstable and intense interpersonal relationships
- Identity disturbance,
- Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating)
- Recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
- Emotional instability due to significant reactivity of mood Chronic feelings of emptiness
- Inappropriate, intense anger or difficulty controlling anger (e.g., frequent plays of temper, constant anger, recurrent physical fights)
- Stress-related paranoid thoughts or severe dissociative symptoms
- Distortions in cognition.
Causes.
It has been seen that borderline personality disorder develops as a result of biological, genetic and environmental factors. There is strong evidence to support a link between distressing childhood experiences, particularly involving caregivers, and borderline personality disorder. The types of experiences that may be associated with this disorder include, but are not limited to, physical and sexual abuse, early separation from caregivers, emotional or physical neglect, emotional abuse, and parental insensitivity.
In particular, studies have shown that a variation in a gene which controls the way the brain uses serotonin (a natural chemical in the brain) may be related to borderline personality disorder. It appears that individuals who have this specific variation of the serotonin gene may be more likely to develop this disorder if they also experience difficult childhood events (e.g., separation from supportive caregivers). In addition, a number of studies have shown that people with this disorder have differences in both the structure of their brain and in brain function. Borderline personality disorder has been associated with excessive activity in parts of the brain that control the experience and expression of emotion.
Treatment.
Schema Focused Therapy: Schema focused therapy for this focuses on confronting maladaptive beliefs that are developed as a result of early life events.
Mentalization Based Therapy: Mentalization based therapy for the disorder focuses on helping the client to recognize mental states, such as thoughts, feelings, and wishes, in themselves and in others.
Transference Focused Psychotherapy: Transference focused psychotherapy uses elements of the relationship between the client and the therapist to help reduce the symptoms.
Medications: Some of the most commonly prescribed medications for the disorder include antidepressants, antipsychotics, anxiolytics (anti-anxiety), and mood stabilizers/anticonvulsants. Other potential treatments, such as omega-3-fatty acids, are also being explored.
Reference,
David H. Barlow, V. Mark Durand. Abnormal Psychology, An Integrative Approach. (7th ed).