There is
a pervasive pattern of disregard for and violation of the rights
of others occurring since age 18 years, as indicated by three
(or more) of the following:
Failure to conform to social norms with respect to lawful behaviors
as indicated by repeatedly performing acts that are grounds
for arrest.
Deceitfulness,
as indicated by repeated lying, use of aliases, or conning others
for personal profit or pleasure
impulsivity or failure to plan ahead.
Irritability
and aggressiveness, as indicated by repeated physical fights
or assaults
reckless disregard for safety of self or others.
Consistent
irresponsibility, as indicated by repeated failure to sustain
consistent work behavior or honor financial obligations.
Lack
of remorse, as indicated by being indifferent to or rationalizing
having hurt, mistreated, or stolen from another
DSM-IV Code: 304.7
The individual is at least 18 years old (under 18 see Conduct
Disorder ). There is evidence of Conduct Disorder with onset
before age 15 years and the
occurrence of antisocial behavior is not exclusively during
the course of Schizophrenia or a Manic Episode
Associated Features:
Depressed
Mood.
Addiction.
Dramatic or Erratic or Antisocial
Personality.
Differential
Diagnosis:
Some disorders
have similar symptoms. The clinician, therefore, in his diagnostic
attempt has to differentiate against the following disorders
which need to be ruled out to establish a precise diagnosis.
Substance-Related
Disorder;
Schizophrenia
Manic Episode
Narcissistic
Personality Disorder
Histrionic
Personality Disorder
Borderline
Personality Disorders
Paranoid Personality
Disorder
Adult Antisocial
Behavior.
Cause:
The cause
of this disorder is unknown, but biological or genetic factors
may play a role. The incidence of antisocial personality is
higher in people who have an antisocial biological parents.
Although the diagnosis is limited to those over 18 years of
age, there is usually a history of similar behaviors before
age 15, such as repetitive lying, truancy, delinquency, and
substance abuse. This disorder tends to occur more often in
men and in people whose predominant role model had antisocial
features.
Twin studies
have confirmed the hereditability of antisocial behaviour in
adults and shown that genetic factors are more important in
adults than in antisocial children or adolescents where shared
environmental factors are more important. (Lyons et a11995)
Cadoret
et al (1995) studied the family environment as well as the parentage
of adoptees separated at birth from parents. Antisocial Personality
Disorder in the biological parents predicted antisocial disorder
in the adopted away children. However, adverse factors in the
adoptive environment (for example, "marital problems or
substance abuse) independently predicted adult antisocial behaviours.
Treatment:
Counseling
and Psychotherapy [ See
Therapy Section ]:
Effective
treatment of antisocial behavior and personality is limited.
Group psychotherapy can be helpful. If the person can develop
a sense of trust, individual psychotherapy or cognitive behavioral
therapy can also be beneficial. There is no research that supports
the use of medications for direct treatment of antisocial personality
disorder, though.
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.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
Medications
should only be utilized to treat clear, acute and serious Axis
I concurrent diagnoses. No research has suggested that any medication
is effective in the treatment of this disorder.
Self-Help
[ See Self-Help
Section ]
Self-help
methods for the treatment of this disorder are often overlooked
by the medical profession because very few professionals are
involved in them. Groups can be especially helpful for people
with this disorder, if they are tailored specifically for antisocial
personality disorder. Individuals with this disorder typically
feel more at ease in discussing their feelings and behaviors
in front of their peers in this type of supportive modalit.
