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Antisocial Personality Disorder (APD)

Before 1980, the research and medical community usually referred to patients with this condition as ‘psychopathic’. These patients were typically egocentric, deceitful, manipulative, selfish and showed no remorse or guilt for harm done to others, nor did they exhibit signs of guilt for violent or cruel behavior. After 1980, the disorder was named Antisocial Personality Disorder and doctors looked for characteristics like violation of social norms, lying, stealing, arrests and erratic work and school behavior. In 1987, doctors attempted to define the symptoms more clinically so that Antisocial Personality Disorder (APD) patients could be more objectively identified and treated. APD is the most common of these disorders. Patients with more severe symptoms are often classified as sociopathic or psychopathic. Patients with antisocial personality disorder act out conflict and ignore the rules that most people follow in society. They are impulsive, irresponsible, and seem to be callous toward the feelings and well-being of others. APD patients often have a history of legal problems, are known for their belligerent, aggressive behavior, and often have violent relationships, and they are at a higher risk for substance abuse, and alcoholism. Patients can be charming, but relationships are typically self-serving and manipulative in nature. They are expert at finding and exploiting weaknesses in others through deceit and intimidation. Patients are quick to anger, but do not hold grudges, and no matter what emotion they express, it does not seem to influence their future thought or action. APD patients rarely hold long-term jobs, they become bored and need constant change and stimulation. They are focused on immediate reward and instant gratification. The cause of antisocial personality disorder isn't known. Research seems to indicate that genetic factors and a history of child abuse may play a role.

What are the symptoms?

Symptoms usually appear before age 15, but are usually not diagnosed until age 18. Symptoms can include:

• Repeated lying
• Drug abuse, alcohol abuse
• Does not conform to rules or norms
• Always in trouble at work or school or home
• Unconscionable behavior, no guilt
• Cannot fulfill work or financial obligations
• Stealing, breaking the law
• Reckless behavior, unaware of consequences
• Aggression, violence, often gets into fights
• Unable to sustain long-term relationships, unconcerned about the feelings of others
• Deceitful, manipulative, shows no remorse
• Blames others for problems patient creates
• Sense of entitlement, "it’s rightfully mine", "I deserve this" even when taking from others

How is it diagnosed and treated?

Patients with antisocial personality disorder, are typically diagnosed with Conduct Disorder during childhood. Since those with APD usually have poor insight into their own behavior, they will often reject the diagnosis. In the early 1980s a diagnostic tool was developed, in an attempt to distinguish between the various forms of this personality disorder (antisocial personality disorder, sociopathic disorder, psychopathic disorder). The Hare Psychopathy Checklist is a 20-item scale using interview, case history and specific diagnostic criteria. In 1994, The MacArthur Foundation used a 12-item version. In 1995, The Diagnostic and Statistical Manual for Mental Health Disorders introduced a 10-item version of this diagnostic tool. Most psychopaths meet the criteria for APD, but most patients with APD are not psychopaths. Because of this diagnostic gap, it is sometimes difficult for doctors to predict treatment response and validity. To diagnose APD, doctors typically require that the patient be at least 18 years of age and exhibit at least 3 of the following diagnostic criteria:

• Patient has been diagnosed with a Conduct Disorder
• Patient is impulsive, fails to plan ahead and does not look at the consequences of his behavior
• Patient is consistently irritable and aggressive
• Irresponsible, cannot keep a job or relationship, fails to meet financial obligations
• Failure to conform to social norms and respect the law
• Deceitful behavior, lying, using fake names, running ‘cons’ to cheat people out of belonging or money
• Fighting and assault are common
• Indifferent to the feelings of others, shows no remorse or guilt after hurting or mistreating someone

Treatment depends on the severity of the condition. Patients who exhibit long-term symptoms and are over 40 years of age are less likely to respond to therapy and treatment. Treatment(s) can include:

• Psychotherapy
• Family and Marriage Counseling
• Incarceration in Hospital or Prison (in severe cases)
• Cognitive Behavioral Therapy
• Self-Help and Group Therapy Groups
• Medication as appropriate, lithium, dilantin, carbamazepine, valproate, propranolol, buspirone, trazodone.

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