ANTISOCIAL PERSONALITY DISORDER





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INTRODUCTION

Antisocial Personality Disorder falls under the cluster of “Dramatic” personality disorder. That is why the behaviors of people with ASPD, are so dramatic, emotional, or erratic that is almost impossible for them to have relationships that are truly giving and satisfying. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies all ten personality disorders into three clusters ( A, B, and C). Antisocial personality disorder falls into 1 of 4 cluster-B disorders, which also includes Borderline, Narcissistic, and Histrionic.

Antisocial personality disorder simple by other disorders is not often met in a clinical setting, except forensic psychiatry. However, because of its impact on family and social environment, it has an important public health seriousness owing to that it has been extensively studied in academic psychiatry, psychoanalysis, law, sociology, theology, and literature.

 

DEFINITION

 

A personality disorder which shows a general pattern of disregard for and violation of other people’s right is called Antisocial Personality Disorder. Although social deviance is one of the core features of Antisocial personality disorder, it is not synonymous with criminality. These people have a lifelong pattern of unsocialized and irresponsible behavior, without feeling remorse. The term Antisocial Personality Disorder is often used interchangeably with psychopathy. But this is a mistake.

 

ONSET

 

DSM-IV-TR stipulates that a person must be at least 18 years of age to be diagnosed with ASPD. For the diagnosis to be made, the person before age 15 must have shown symptoms of Conduct Disorder, like truancy, running away, cruelty to animals or people, and destroying property. And after age 15, there must also be evidence of such things as repeated unlawful and antisocial behaviors, deceitfulness, impulsivity, aggressiveness, or consistent irresponsibility in work.

 

CLINICAL FEATURES AND DIAGNOSIS

 

Patients with ASPD often appear quite normal. However, their history reveals disturbed functioning in the domain of behavior and self-concept, love and sexuality, interpersonal relations, and cognitive style. Reckless behavior is typical of antisocial individuals, who are exploitative and manipulative. The absence of internalized moral values is manifested by lying, fights, substance abuse and illegal activities, etc. Frequent suicide threats and attempts are also common, as is a somatic preoccupation. Sexual perversions, abuse and pedophilia are frequent.

The cognitive style of the antisocial disorder is characterized by glibness, the folly of knowledge, and a paranoid view of reality.

 

COMORBIDITY

 

The DSM-5 indicates that Antisocial Personality Disorder occurs with depression, substance abuse disorder, and other personality disorders (American Psychiatric Association, 2013). Also, ASPD coexists with,

  • Somatization disorder
  • Impulse control disorder 
  • Bipolar disorder
  •  Attention deficit hyperactivity disorder
  • Sadistic personality disorder.

 

DIFFERENTIAL DIAGNOSIS

 

  • Narcissistic personality disorder (cluster B personality disorder with overlap; exploitive and uncompassionate, but not aggressive or deceitful).
  • Borderline personality disorder( whether, Borderline individuals may show some guilt, Antisocial individuals do not. Unlike ASPD patients, BPD patients do not lack for intimacy and emotional investment of other)
  • Substance use disorder ( Impulsivity and irresponsibility occurring due to substance influence must be ruled out before diagnosing ASPD. ASPD can be diagnosed if substance use is co-occurring).

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COURSE AND PROGNOSIS

 

Antisocial behavior is most common in the early adult years and gradually decreases with age. Having a stable couple or partnership and professional motivation may have beneficial effects.

 

EPIDEMIOLOGY

 

The prevalence of ASPD in the general population is around 2 to 3 percent (Glenn et al., 2013). And it is more frequent in males than females, with sex ratios ranging from 2:1 to 7:1. It is more common among people living in urban areas and lower socioeconomic groups.

 

AETIOLOGY

 

Genetic Factors

 

Twin, adoption, and family studies suggest that Genetic Factors strongly contribute to the development of Antisocial Personality disorder. Many studies have compared consistent rates between monozygotic and dizygotic twins. Others have used the adoption method, comparing rates of criminal behaviors in the adopted-away children of criminals with rates of criminal behaviors in the adopted-away children of ordinary (noncriminal) parents. The results of both kinds of studies show a moderate heritability for antisocial or criminal behavior (Carey & Goldman, 1997; Hare et al., 2012; Sutker & Allain, 2001) and for ASPD (Waldman & Rhee, 2006).

 

Physiological Factors

 

Aggression in Antisocial personality disorder is associated with indexes of reduced brain serotonin activity such as low levels of the serotonin metabolite 5-hydroxy indole-acetic acid in the cerebrospinal fluid and low platelet monoamine oxidase activity. Reports on minimal brain dysfunction resulting in frontal-lobe deficiencies and lack of inhibition have also been described.

 

Environmental Factors

 

Many environmental factors have also been implicated in the development of ASPD. These include low family income, inner-city living, poor supervision by parents, having a young mother, being raised in a single-parent family, the conflict between parents, having a delinquent sibling, neglect, large family size, and also harsh discipline from parents (Farrington,2006; Granic & Patterson,2006).

Risk Factors

 

Certain factors seem to increase the risk of developing an antisocial personality disorder, such as:

  •  Diagnosis of childhood conduct disorder.
  •  Family history of antisocial personality disorder or other personality disorders or mental health disorders.
  •  Being subjected to abuse or neglect during childhood.
  • Unstable, violent, or chaotic family life during childhood

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COMPLICATIONS

 

Complications, consequences, and problems of antisocial personality disorder may include, for example

  •  Spouse abuse or child abuse or neglect.
  •  Problems with alcohol or substance use.
  • Homicidal or suicidal behaviors.
  • Having other mental health disorders such as depression or anxiety.
  • Low social and economic status and homelessness.
  • Premature death, usually as a result of violence

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EVALUATION

 

No current diagnostic modalities, such as tests including serology, are currently accepted standards in diagnosing antisocial personality disorder. However, genetic testing and neuroimaging have been used to evaluate potential causes and patterns, respectively, with ASPD. Patients with antisocial personality disorder are at a higher risk of contracting certain viral infections and sexually transmitted diseases associated with high-risk behavior, including hepatitis C and human immunodeficiency virus, as well as increased mortality rates due to accidents, traumatic injuries, suicides, and homicides.

 

TREATMENTS

 

Treatments for people with Antisocial Personality Disorder are typically ineffective (Hilarski,2007; Reid &Gacono,2000). The efficacy of psychotherapy is very little in antisocial patients. Medication is used to deal with incapacitating symptoms, such as anxiety, depression, and somatic complaints. Selective serotonin reuptake inhibitors, lithium, carbamazepine, clonazepam, and other anticonvulsants have been used to control aggressive behavior. Also, Therapeutic communities based on the principles outlined by Maxwell Jones with a general social adjustment as the main task might give positive results.

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