Antisocial Personality Disorder

A behavior disorder developed by a small percentage of children with conduct disorder whose behavior does not improve as they mature. Also known as sociopathy or psychopathy.

About 3% of males and 1% of females develop antisocial personality disorder, which is essentially the adult version of childhood conduct disorder. Antisocial personality disorder is only diagnosed in people over age 18, the symptoms are similar to those of conduct disorder, and the criteria for diagnosis include the onset of conduct disorder before the age of 15. According to the Diagnostic and Statistical Manual of Mental Disorders (DSMIV), people with antisocial personality disorder demonstrate a pattern of antisocial behavior since age 15.

The adult with antisocial personality disorder displays at least three of the following behaviors:

• Fails to conform to social norms, as indicated by frequently performing illegal acts, and pursuing illegal occupations.
• Is deceitful and manipulative of others, often in order to obtain money, sex, or drugs.
• Is impulsive, holding a succession of jobs or residences.
• Is irritable or aggressive, engaging in physical fights.
• Exhibits reckless disregard for safety of self or others, misusing motor vehicles or playing with fire.
• Is consistently irresponsible, failing to find or sustain work or to pay bills and debts.
• Demonstrates lack of remorse for the harm his or her behavior causes others.

An individual diagnosed with antisocial personality disorder will demonstrate few of his or her own feelings beyond contempt for others. This lack of affect is strangely combined with an inflated sense of self-worth and often a superficial charm, which tends to mask their inner apathy. Authorities have linked antisocial personality disorder with abuse, either physical or sexual, during childhood, neurological disorders (which are often undiagnosed), and low IQ. Those with a parent with an antisocial personality disorder or substance abuse problem are more likely to develop the disorder. The antisocially disordered person may be poverty-stricken, homeless, a substance abuser, or have an extensive criminal record. Antisocial personality disorder is associated with low socioeconomic status and urban settings.

Treatment

Antisocial personality disorder is highly unresponsive to any form of treatment. Although there are medications available that could quell some of the symptoms of the disorder, noncompliance or abuse of the drugs prevents their widespread use. The most successful treatment programs are long-term, structured residential settings in which the patient systematically earns privileges as he or she modifies behavior. Some form of dynamic psychotherapy is usually given along with the behavior modification. The therapist's primary task is to establish a relationship with the patient, who has usually had very few relationships in his or her life and is unable to trust, fantasize, feel, or learn. The patient should be given the opportunity to establish positive relationships with as many people as possible and be encouraged to join self-help groups or prosocial reform organizations.