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Dissocial personality disorder
Classification and external resources
ICD-10 F60.2
ICD-9 301.7
MeSH D000987

Antisocial personality disorder (ASPD or APD) is defined by the American Psychiatric Association's Diagnostic and Statistical Manual as "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."[1]

The individual must be age 18 or older, as well as have a documented history of a conduct disorder before the age of 15.[1] People having antisocial personality disorder are sometimes referred to as "sociopaths" and "psychopaths", although some researchers believe that these terms are not synonymous with ASPD.[2]

Contents

History

The history of the origins of antisocial personality disorder are closely related to the history of psychopathy - see history of psychopathy.

Symptoms

Characteristics of people with antisocial personality disorder may include:[3]

  • Persistent lying or stealing
  • Superficial charm[4][5]
  • Apparent lack of remorse[4] or empathy; inability to care about hurting others
  • Inability to keep jobs or stay in school[4]
  • Impulsivity and/or recklessness[4]
  • Lack of realistic, long-term goals — an inability or persistent failure to develop and execute long-term plans and goals
  • Inability to make or keep friends, or maintain relationships such as marriage
  • Poor behavioral controls — expressions of irritability, annoyance, impatience, threats, aggression, and verbal abuse; inadequate control of anger and temper
  • Narcissism, elevated self-appraisal or a sense of extreme entitlement
  • A persistent agitated or depressed feeling (dysphoria)
  • A history of childhood conduct disorder
  • Recurring difficulties with the law
  • Tendency to violate the boundaries and rights of others
  • Substance abuse
  • Aggressive, often violent behavior; prone to getting involved in fights
  • Inability to tolerate boredom
  • Disregard for the safety of self or others
  • Persistent attitude of irresponsibility and disregard for social rules, obligations, and norms
  • Difficulties with authority figures [6]

Diagnostic criteria (DSM-IV-TR = 301.7)

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR, a widely used manual for diagnosing mental disorders, defines antisocial personality disorder (in Axis II Cluster B) as:[1]

A) There is a pervasive pattern of disregard for and the rights of others occurring since the age of 15, 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 repeatedly 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 18 years of age.
C) There is evidence of Conduct disorder with onset before age 15.
D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.

Deceit and manipulation are considered essential features of the disorder. Therefore, it is essential in making the diagnosis to collect material from sources other than the individual being diagnosed.[7]

It is a requirement of DSM-IV that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Criticism

Researchers have heavily criticized the ASPD DSM-IV criteria because not enough emphasis was placed on traditional psychopathic traits such as a lack of empathy, superficial charm, and inflated self appraisal.

These latter traits are harder to assess than behavioral problems (like impulsivity and acting out). Thus, the DSM-IV framers sacrificed validity for reliability. That is, the ASPD diagnosis focuses on behavioral traits, but only limited emphasis is placed on affective and unemotional interpersonal traits.

Many have argued that psychopathy/sociopathy are incorrectly put together under ASPD. These clinicians and researchers are upset that an important distinction has been lost between these two disorders. In other words, ASPD and psychopathy are considered to be the same, or similar. However, they are not the same since antisocial personality disorder is diagnosed via behavior and social deviance, whereas psychopathy also includes affective and interpersonal personality factors.[8]

Also, ASPD, unlike psychopathy, does not have biological markers confirmed to underpin the disorder.[citation needed] Other criticisms of ASPD are that it is essentially synonymous with criminality. Nearly 80%–95% of felons will meet criteria for ASPD — thus ASPD predicts nothing in criminal justice populations. Whereas, psychopathy scores (using the Hare Psychopathy Checklist-Revised (PCL-R)) is found in only ~20% of inmates and PCL-R is considered one of the best predictors of violent recidivism.[citation needed] Also, the DSM-IV field trials never included incarcerated populations.

The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that psychopathy and sociopathy are obsolete synonyms for antisocial personality disorder. The World Health Organization takes a similar stance in its ICD-10 by referring to psychopathy, sociopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.[citation needed]

Diagnostic criteria (ICD-10) - dissocial personality disorder‎

The World Health Organization's ICD-10 defines a conceptually similar disorder to antisocial personality disorder called (F60.2) Dissocial personality disorder.[9]

It is characterized by at least 3 of the following:
  1. Callous unconcern for the feelings of others and lack of the capacity for empathy.
  2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
  3. Incapacity to maintain enduring relationships.
  4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
  5. Incapacity to experience guilt and to profit from experience, particularly punishment.
  6. Markedly prone to blame others or to offer plausible rationalizations for the behavior bringing the subject into conflict.
  7. Persistent irritability.
The criteria specifically rule out conduct disorders.[10] Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.[11]

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Millon's subtypes

Theodore Millon identified five subtypes of antisocial [12][13]. Any individual antisocial may exhibit none, one or more than one of the following:

  • covetous antisocial - variant of the pure pattern where individuals feel that life has not given them their due.
  • reputation-defending antisocial - including narcissistic features
  • risk-taking antisocial - including histrionic features

Differential diagnosis: associated and overlapping conditions

The following conditions commonly coexist with antisocial personality disorder:[14]

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[15]

Prevalence (epidemiology)

Antisocial personality disorder in the general population is about 3% in males and 1% in females.[1][14]

It is seen in 3% to 30% of psychiatric outpatients.[1][14] The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders).[16] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) abuse treatment programs than in the general population (Hare 1983), suggesting a link between ASPD and AOD abuse and dependence.[17]

Treatment

To date there have been no controlled studies reported which found an effective treatment for ASPD[18]. Some studies have found that the presence ASPD does not significantly interfere with treatment for other disorders, such as substance abuse[19], although others have reported contradictory findings[20].

See also

References

  1. ^ a b c d e Antisocial personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000) - pages 645–650
  2. ^ Mayo Clinic Staff (2006-10-09). "Antisocial personality disorder -". MayoClinic.com. http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829. Retrieved 2008-08-17. 
  3. ^ "Antisocial Personality, Sociopathy, and Psychopathy"
  4. ^ a b c d "Antisocial Personality Disorder". Psychology Today. 2005. http://psychologytoday.com/conditions/antisocial.html. Retrieved 2007-02-20. 
  5. ^ "Antisocial Personality Disorder". Mayo Foundation for Medical Education and Research. 2006. http://www.mayoclinic.com/health/antisocial-personality-disorder/DS00829. Retrieved 2007-02-20. 
  6. ^ "Antisocial Personality Disorder Treatment". Psych Central. 2006. http://psychcentral.com/disorders/sx7t.htm. Retrieved 2007-02-20. 
  7. ^ "Antisocial Personality Disorder". http://www.behavenet.com/capsules/disorders/antisocialpd.htm. Retrieved 2007-12-15. 
  8. ^ Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (pdf file)
  9. ^ Dissocial personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
  10. ^ 602 "F60.2 Dissocial personality disorder". World Health Organization. http://www.who.int/classifications/apps/icd/icd10online/?gf60.htm+F602. Retrieved 2008-01-12. 
  11. ^ Early Prevention of Adult Antisocial Behavior. Cambridge University Press. p. 82. http://books.google.com/books?id=KtXU8R8oZYwC&pg=PA82&lpg=PA82&dq=dissocial+personality+disorder&source=web&ots=lVx_gb_9mM&sig=U_bMqyc-KlzHKEvzXBdeZxplN2E. Retrieved 2008-01-12. 
  12. ^ Millon, Theodore, Personality Disorders in Modern Life, 2004
  13. ^ Millon, Theodore - Personality Subtypes
  14. ^ a b c Internet Mental Health - antisocial personality disorder
  15. ^ Oscar-Berman M; Valmas M, Sawyer K, Kirkley S, Gansler D, Merritt D, Couture A (April 2009). "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder". Neuropsychiatric Disease and Treatment 2009 (5): 309–326. PMID 19557141. http://www.dovepress.com/getfile.php?fileID=4829. 
  16. ^ Hare 1983
  17. ^ "Antisocial Personality Disorder, Alcohol, and Aggression". Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. 2006. http://pubs.niaaa.nih.gov/publications/arh25-1/5-11.pdf. Retrieved 2007-02-20. 
  18. ^ J. E. Fisher & W. T. O'Donohue (eds). (2006). Practitioner's Guide to Evidence-Based Psychotherapy, p63
  19. ^ S. Darke, R. Finlay-Jones, S. Kaye, & T. Blatt. Anti-social personality disorder and response to methadone maintenance treatment. Drug and Alcohol Review, vol. 15, 271-276 (1996)
  20. ^ A. I. Alterman, M. J. Rutherford, J. S. Cacciola, J. R. McKay, & C. R. Boardman. Prediction of 7 months methadone maintenance treatment response by four measures of antisociality. Drug & Alcohol Dependence, vol. 49, 217-223 (1998)

External links


Template:DiseaseDisorder infobox Dissocial personality disorder is one of several psychopathic personality disorders, each of which has different operational definitions and terminologies depending on the system of classification of mental disorders used.[1] Psychopathy is a general construct that differs from the specific diagnoses of antisocial, psychopathic, dissocial, and sociopathic personality disorders, the various diagnostic classifications for psychopathy.[2] Dissocial personality disorder is the diagnostic category established for psychopathy in the ICD-10 diagnostic criteria developed by the World Health Organization (WHO). It is conceptually similar to the DSM-IV-TR diagnostic criteria for Antisocial personality disorder.[3]

Contents

ICD-10 Criteria for Dissocial Personality Disorder

Specifically, the dissocial personality disorder is described by the World Health Organization by the following criteria:

  1. Callous unconcern for the feelings of others and lack of the capacity for empathy.
  2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
  3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them.
  4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
  5. Incapacity to experience guilt and to profit from experience, particularly punishment.
  6. Marked proneness to blame others or to offer plausible rationalizations for the behavior bringing the subject into conflict.
  7. Persistent irritability.

The criteria specifically rule out conduct disorders.[3] Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.[4]

Confusion in terminology

Although conceptually the antisocial, dissocial, and sociopathic personality disorders are synonymous with psychopathy, operationally the diagnostic criteria for these disorders are definitely distinct. They are not equivalent disorders. The largest difference is the emphasis on delinquent and criminal behaviors found in the DSM-IV-TR's version, the antisocial personality disorder. The dissocial personality disorder pays more attention to the affective, interpersonal and behavioral components not present in DSM-IV-R's criteria.

The criteria for antisocial personality disorder are largely based on observable behaviors while the ICD criteria for dissocial personality disorder focus more on the affective and interpersonal deficits. However, the ICD criteria do not represent the broad personality and behavioral factors of psychopathy. The blurring of distinctions between these diagnostic categories and psychopathy have caused diagnosis confusion. For the mental health and criminal justice system, the distinction between psychopathy and antisocial personality disorder is of considerable importance.

Research findings

Much research into psychopathy, as operationalized by the Hare Psychopathy Checklist Revised (PCL-R), has been conducted. The checklist assesses both interpersonal and affective components as well as lifestyle and antisocial deficits. However, the research results cannot be easily extrapolated to the clinical diagnoses of dissocial personality disorder or antisocial personality disorder. A sample research finding is that between 50% and 80% of prisoners in England and Wales meet the diagnostic criteria of dissocial personality disorder, but only 15% would be predicted to be psychopathic as measured by the PCL-R. Therefore, the findings drawn from psychopathy research have not yet been shown to be relevant as an aid to the diagnosis and treatment of dissocial or antisocial personality disorders.[2]

Attempts to correlate dissocial personality disorder have had methodological problems. Although a high percentage of prisoners in England and Wales were shown in one survey to fulfill the criteria for a dissocial personality, since the diagnosis of dissocial personality includes a disregard for social rules and norms, it is not surprising that the same individuals commit crimes.[5]

Research has been done attempting to assess the co-morbidity of dissocial personality disorder with other conditions. However, the few studies that have been done use too many different methodologies to enable forming solid conclusions, although it seems that there is a low prevalence of antisocial personality disorder/dissocial personality disorder in psychiatric hospitals.[6]

Treatment

In practice, mental health professionals rarely treat dissocial personality disorders as they are considered untreatable and no interventions have proven to be effective. In England and Wales the diagnosis is grounds for detention in secure psychiatric hospitals under the Mental Health Act if individuals with that diagnosis have committed serious crimes, but since such individuals are disruptive for other patients and not responsive to treatment this alternative to prison is not often used.[7]

See also

Footnotes

  1. Irving B. Weiner & Donald K. Freedheim (2003). "Handbook of Psychology". John Wiley and Sons. p. 88. http://books.google.com/books?id=jk8-b9AwmJgC&pg=PA88&ots=CvEoW7H7Am&dq=dissocial+personality+disorder&ei=2SiJR6eQF4Gk6AK4sqGVBg&sig=WoV7N2uYLmMeEIpCDx2llaEccG4#PPA88,M1. Retrieved on 2008-01-12. 
  2. 2.0 2.1 Ogloff, James R.P. (2006). "Psychopathy/antisocial personality disorder conundrum". Blackwell Publishing. http://www.ingentaconnect.com/content/bsc/anp/2006/00000040/F0020006/art00003. Retrieved on 2008-01-12. 
  3. 3.0 3.1 "602 F60.2 Dissocial personality disorder". World Health Organization. http://www.who.int/classifications/apps/icd/icd10online/?gf60.htm+F602. Retrieved on 2008-01-12. 
  4. Early Prevention of Adult Antisocial Behavior. Cambridge University Press. p. 82. http://books.google.com/books?id=KtXU8R8oZYwC&pg=PA82&lpg=PA82&dq=dissocial+personality+disorder&source=web&ots=lVx_gb_9mM&sig=U_bMqyc-KlzHKEvzXBdeZxplN2E. Retrieved on 2008-01-12. 
  5. "Dangerous Severe Personality Disorder". Advances in Psychiatric Treatment. 2003. http://apt.rcpsych.org/cgi/content/full/9/5/349?ck=nck. Retrieved on 2008-01-12. 
  6. Moran, Paul (1999). Antisocial Personality Disorder: An Epidemiological Perspective. Amer Psychiatric Publishing. p. 25. 
  7. Paul Harrison & John Geddes. Lecture Notes: Psychiatry. Blackwell Publishing. pp. 163–165. http://books.google.com/books?id=xjaQa-OseQ0C&pg=PA165&lpg=PA165&dq=dissocial+personality+disorder&source=web&ots=Hx0rs036wg&sig=LwrheM2r9jmuQka5Gb-0eDY60Lg. 

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