Professional Documents
Culture Documents
DSM
The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR =
301.7, 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:
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.[citation needed]
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.
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]
Please see our separate note on Treatment, Mental Disorders and Basic Science for
important caveats on the role and definition of diagnostic criteria.
Personality Disorder Description Common to All
Personality Disorders
The following information is reproduced verbatim from the ICD-10 Classification of
Mental and Behavioural Disorders, World Health Organization, Geneva, 1992. (Since the
WHO updates the overall ICD on a regular basis, individual classifications within it may
or may not change from year to year; therefore, you should always check directly with
the WHO to be sure of obtaining the latest revision for any particular individual
classification.) It provides the common description and guidelines referenced by the
diagnostic criteria for each of the individual personalty disorders.
Personality Disorders
Diagnostic Guidelines
For different cultures it may be necessary to develop specific sets of criteria with regard
to social norms, rules and obligations. For diagnosing most of the subtypes listed below,
clear evidence is usually required of the presence of at least three of the traits or
behaviours given in the clinical description.
The current criteria for ASPD, as described in DSM–IV, include a behavioral pattern that
begins before age 15 and comprises at least three of the following behaviors:
Deceitfulness
Impulsiveness
Irresponsibility
Lack of remorse
This pattern of behavior has occurred since age 15 (although only adults 18 years or older can be
diagnosed with this disorder) and consists by the presence of the majority of these symptoms *:
The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia
or a Manic Episode.
Alternative names
The classic person with an antisocial personality is indifferent to the needs of others and
may manipulate through deceit or intimidation. He or she shows a blatant disregard for
what is right and wrong, may have trouble holding down a job, and often fails to pay
debts or fulfill parenting or work responsibilities. They are usually loners.
The diagnostic criteria for antisocial personality disorder are set forth in
table above. DSM-IV states that this disorder is characterized by "a pervasive
pattern of disregard for and violation of the rights of others that begins in childhood or
early adolescence and continues into adulthood." The antisocial features are reflected in
poor job performance, academic failure, participation in a wide variety of illegal
activities, recklessness, and impulsive behavior.
A substantial body of research has shown that only a minority of patients with
antisocial personality disorder have severe psychopathy, and this latter
group has a significantly poorer treatment prognosis than do patients with
nonpsychopathic antisocial personality disorder.
They appear to be incapable of any true emotions, from love to shame to guilt. They are
quick to anger, but just as quick to let it go, without holding grudges. No matter what
emotion they state they have, it has no bearing on their future actions or attitudes.
Antisocial personality disorder tends to remit with time. After 21 years of age, the
remission rate is about 2% of all patients each year. As destructive social behavior
diminishes, patients tend to develop hypochondriacal and depressive disorders.
Epidemiology
The exact causes of antisocial personality disorder are unknown, but experts
believe that both hereditary factors and environmental circumstances influence
development of the condition.
The diagnosis of Antisocial Personality Disorder is not given to individuals under age 18
years and is given only if there is a history of some symptoms of Conduct Disorder
before age 15 years. For individuals over age 18 years, a diagnosis of Conduct Disorder
is given only if the criteria for Antisocial Personality Disorder are not met.
Prevalence
The National Comorbidity Survey, which used DSM-III-R criteria, found that 5.8% of
males and 1.2% of females showed evidence of a lifetime risk for the disorder.
Prevalence estimates within clinical settings have varied from 3% to 30%, depending on
the predominant characteristics of the populations being sampled. Perhaps not
surprisingly, the prevalence of the disorder is even higher in selected populations, such as
people in prisons (who include many violent offenders) (Hare 1983). 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.
Complications
Suicide
Homicide
The most important goals of treating antisocial behavior are to measure and describe the
individual child's or adolescent's actual problem behaviors and to effectively teach him or
her the positive behaviors that should be adopted instead. In severe cases, medication will
be administered to control behavior, but it should not be used as a substitute for therapy.
Effective psychotherapy treatment for this disorder is limited. It is likely, though, that
intensive, psychoanalytic approaches are inappropriate for this population. Approaches
the reinforce appropriate behaviors and attempting to make connections between the
person's actions and their feelings may be more beneficial. Emotions are usually a key
aspect of treatment of this disorder. Patients often have had little or no significant
emotionally-rewarding relationships in their lives. The therapeutic relationship, therefore,
can be one of the first ones. This can be very scary for the client, initially, and it may
become intolerable. A close therapeutic relationship can only occur when a good and
solid rapport has been established with the client and he or she can trust the therapist
implicitly.