Antisocial Personality Disorder Essay Sample

Antisocial personality disorder is a cluster B personality disorder. It manifests itself as an inability to conform to societal norms that generally control a person’s behaviors. One of the hallmarks of the disorder is engaging in criminal acts – although the disease does not necessarily equate with criminality. It is a more common diagnosis in males than in females and interestingly males with the disorder tend to come from larger families, whereas females tend to come from small families (Kaplan and Sadock, 2007, p.798).
The etiology is multifactorial and likely dependent on the interplay of environment and genetic susceptibility. Patients often show abnormal EEG results suggestive of brain damage in childhood (Kaplan and Sadock, 2007, p.798). Several researchers have claimed to find a link between disordered serotonin metabolism and the disease, and some have implicated limbic system maldevelopment (Kaplan and Sadock, 2007, p.792). Furthermore, there is a link between childhood conduct disorders and the development of future antisocial personality disorder. Alcohol has also been shown to play a role in the etiology of the disease (Kaplan and Sadock, 2007, p.798).
Interestingly, in a birth cohort study by Robertson, McAnally, and Hancox (2013), it was found young children who watched excessive amounts of children had a significantly higher rate of antisocial personality disorder and therefore they concluded that television viewing should be limited to a maximum of two hours per day. Furthermore, in a study by Lobbestael, Arntz, and Sieswerda (2005) antisocial personality disordered patients had several reproducible maladaptive schema with the most prominent being Angry Child and Bull and Attack Modes. These maladaptive schema modes are linked to child abuse. In fact, the literature supports the theory that antisocial personality disorder may be a “male version” of borderline personality disorder (Lobbestael, Arntz, and Sieswerda, 2005).
Diagnosis is based on the diagnostic criteria as stated in the DSM-IV include a pattern of disregard of rights of other since the age of 15, >18 years old, conduct disorder from before age 15, and the antisocial behavior is not associated with schizophrenia. It is important to obtain information from a wide variety of sources regarding diagnosis and this includes, family, friends, and colleagues who may have been affected by the patient’s disease. Furthermore, prison records are often used to help establish a diagnosis (Oxford, 2005, p. 496)
There are many tools that aid in the establishment of a diagnosis of personality disorder. The Structured Clinical Interview for DSM-IV of personality assessment (SCID-II) provides the fundamental basis of diagnosis. The Personality Diagnostic Questionnaire (PDQ-4) and the Schema Mode Inventory (SMI) may also prove useful in guiding towards a diagnosis. Patients can trick questionnaires though and ultimately a diagnosis relies on the ‘ars medica’ of the practitioner. (Oxford, 2005, p. 497)
However, it must be noted that diagnosis is difficult due to the fact that the patients may appear genuine, but beneath a “mask of sanity” there is usually hostility, irritability and rage and ‘stress interviews’ may be useful to uncover the pathology. Clinically, the patients often exhibit no anxieties or depression, even though it would seem inconsistent with their situation. They often have good reality testing and good verbal intelligence. They are classic con-men and will perform any number of despicable acts and characteristically will not have any remorse (Kaplan and Sadock, 2007, p.798). Differential diagnosis includes substance and alcohol abuse and the diagnosis is unwarranted in patients with mental retardation, schizophrenia, or mania.
Treatment options include psychotherapy, which is viable if the patient is immobilized in a psychiatric hospital and if the therapist sets firm limits. Furthermore, it has been shown that self-help groups have greater efficacy in changing behavior than jails. Other treatment options include pharmacotherapy, with drugs to control impulsive behavior being the most favored. Adrenergic receptor antagonists have been used to control aggression and psychostimulants have proven useful in cases where there is evidence of ADHD (Kaplan and Sadock, 2007, p.798).
In sum, antisocial personality disorder does not necessarily result in a jail sentence. Some individuals have better control over their disease and are too “slick” to get a jail sentence, and in others, interventions can prove useful in mitigating the tendency to violate the rights of others.
Sadock, B.J., Sadock, V.A., (2007). Personality Disorders. In J.A Grebb & C.S. Patatki & N. Sussman (Eds.), Kaplan & Sadock's Synopsis of Psychiatry (10th ed.). (791-812). New York: Lippincott Williams & Wilkins.
Semple, D., Smyth, R., Burns, J., Darjee, R., McIntosh, A. (eds.). (2005). Personality Disorders. Oxford Handbook of Psychiatry. (440-469). Oxford: Oxford University Press.
Lobbestael, J., Arntz, A., Sieswerda, S. (2005). Schema Modes and Childhood Abuse in Borderline and Antisocial Personality Disorders. Journal of Behavior Therapy and Experimental Psychiatry, 36, 240-253 doi:10.1016/j.jbtep.2005.05.006
Robertson, L.A., McAnally, H.M., Hancox, R.J. (2013). Childhood and Adolescent Television Viewing and Antisocial Behavior in Early Adulthood. Pediatrics, 131 (439) DOI: 10.1542/peds.2012-1582