Personality Disorder 101: Antisocial Personality Disorder

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Personality disorder is a category of mental health disorders where the person is not aware of how their behavior affects others. Antisocial personality disorder specifically is a mental health condition where a person exhibits a long-term pattern of manipulating, exploiting, or violating the rights of others without showing any remorse. This behavior can cause problems in relationships and can often lead to illegal actions.

The various forms of personality disorder include the following:

  • Antisocial personality disorder
  • Avoidant personality disorder
  • Borderline personality disorder
  • Dependent personality disorder
  • Histrionic personality disorder
  • Narcissistic personality disorder
  • Obsessive-compulsive personality disorder
  • Paranoid personality disorder
  • Schizoid personality disorder
  • Schizotypal personality disorder

When discussing antisocial personality disorder, many doctors and scientists believe that psychopathic disorder is the same thing because the patients with these disorders tend to lack empathy, are cruel to animals, and engage in criminal behavior without understanding why it’s wrong. To dig into antisocial personality disorder, we need to understand the causes, symptoms, and treatment options.

Causes, Risk Factors, and Diagnosing of Antisocial Personality Disorder

Doctors and scientists have not yet decided definitively what causes antisocial personality disorder. Personality is the combination of emotions, thoughts, and behaviors that makes everyone unique. It’s how we understand, view, and relate to the world, as well as how we see ourselves. Personality forms during the childhood years, shaped by an interaction of inherited predispositions and environmental influences.

It is believed that genes may make someone vulnerable to developing antisocial personality disorder — and certain situations may trigger its development. It could be that changes in brain function may happen during childhood.

There are factors that seem to increase the risk of developing antisocial personality disorder:

  • Unstable, violent or chaotic family life during childhood
  • Diagnosis of childhood conduct disorder
  • Family history of antisocial personality disorder, other personality disorders, or mental health issues
  • Being abused or neglected during childhood
  • Gender – men are at higher risk of having antisocial personality disorder than women

Complications, problems, and consequences of antisocial personality disorder may include the following:

  • Alcohol or substance abuse
  • Spouse abuse or child abuse or neglect
  • Gang participation
  • Being in jail or prison
  • Homicidal or suicidal behaviors
  • Having other mental health disorders such as depression or anxiety
  • Low social and economic status, or homelessness
  • Premature death, usually as a result of violence

To diagnose people with antisocial personality disorder is difficult because the person is unlikely to believe he or she needs help. However, they could seek help from their doctor or therapist due to accompanying symptoms like depression, anxiety, angry outbursts, or treatment of substance abuse.

People with antisocial personality disorder may not provide an accurate account of signs and symptoms; they simply may not recognize certain behaviors as symptoms. A key factor in diagnosis is how the person relates to other people. During evaluation, family and friends could provide helpful information.

After ruling out other medical conditions, the doctor or therapist may make a referral to a psychiatrist for further evaluation. A psychiatrist can not only provide psychotherapy, but he or she can also prescribe medication and, as needed, admit a patient to the hospital.

Diagnosis of antisocial personality disorder is typically based on:

  • A psychological evaluation that explores thoughts, feelings, relationships, behavior patterns and family history
  • Personal and medical history
  • Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Though antisocial personality disorder isn’t usually diagnosed before age 18, some signs and symptoms may occur in childhood or adolescence. Usually there is evidence of conduct disorder symptoms before age 15. Knowing what those symptoms are is key for parents of teens who may be acting out or exhibiting disturbing behavior.

Symptoms of Antisocial Personality Disorder

While many personality disorders have similar symptoms, it is important to know the specific symptoms of antisocial personality disorder in adults and teens:

  • Disregard for right and wrong
  • Hostility, significant irritability, agitation, aggression or violence
  • Using charm or wit to manipulate others for personal gain or personal pleasure
  • Persistent lying or deceit to exploit others
  • Being callous, cynical and disrespectful of others
  • Arrogance, a sense of superiority and being extremely opinionated
  • Repeatedly violating the rights of others through intimidation and dishonesty
  • Impulsiveness or failure to plan ahead
  • Lack of empathy for others and lack of remorse about harming others
  • Unnecessary risk-taking or dangerous behavior with no regard for the safety of self or others
  • Poor or abusive relationships
  • Failure to consider the negative consequences of behavior or learn from them
  • Being consistently irresponsible and repeatedly failing to fulfill work or financial obligations
  • Aggression toward people and animals
  • Recurring problems with the law, including criminal behavior
  • Destruction of property
  • Deceitfulness
  • Stealing
  • Serious violation of rules

Taken individually, these signs are not always an indication of antisocial personality disorder. To be diagnosed with the condition, the health professional will usually see a group or cluster of symptoms that indicate a personality disorder should be considered as a diagnosis.

Once the diagnosis is confirmed by mental health care professionals, there are some steps that can be taken to treat the patient, though there is no cure.

Treatment Options for Antisocial Personality Disorder

Though antisocial personality disorder is difficult to treat, for some patients, treatment, and follow-up over the long term can be beneficial. However, it is important that the medical and mental health professionals chosen to treat the person have experience in treating antisocial personality disorder.

Treatment depends on each person’s situation, their willingness to be treated, and the severity of the symptoms.

Psychotherapy

Psychotherapy, we know it as talk therapy, is sometimes used to treat antisocial personality disorder. Therapy may include anger and violence management, treatment for substance abuse, or treatment for other mental health conditions. However, psychotherapy doesn’t always work, especially if the symptoms are severe and the person won’t admit that he or she has serious problems.

Cognitive therapy — first used to help depressed patients— has been utilized for treating antisocial personality disorder. The therapist will set guidelines for the patient, including regular visits, active participation, and completion of any homework outside of the office. But therapy must be more than a means by which the antisocial tries to elude the consequences of his or her behavior. The main goal in cognitive therapy is to help the patient see how he or she creates his or her own problems and how distorted perceptions prevent him or her from seeing the way others view him or her.

Because patients with antisocial personality disorder tend to blame others, have either a low or no tolerance for frustration, are impulsive and don’t trust others, working with these patients is incredibly difficult. People with antisocial personality disorder often lack the motivation to improve and are resistant to observing their own behavior. They do not see themselves as other people do.

Therapists must remain vigilant during treatment to prevent their own emotional responses to their patients from interfering with the therapy process. No matter how determined the therapist may be to help an antisocial personality disorder patient, it is possible that the patient’s criminal history, lack of personal responsibility, and unpredictable tendency toward violence may make the patient thoroughly unlikable. It is in the best interest of the patient to find a therapist or psychiatrist with many years of experience treating the disorder as those professionals have the ability to respond to the patient without getting emotional.

Medications

There are currently no medications approved by the Food and Drug Administration to treat antisocial personality disorder. Mental health professionals can prescribe medications for conditions sometimes associated with antisocial personality disorder, such as anxiety or depression, or for outward displays of aggression. Drugs are rarely prescribed because some have the potential for abuse. Specifically, there are several drugs that have been shown to reduce aggression, a frightening symptom displayed by many patients with antisocial personality disorder.

The best-researched medicine is lithium carbonate, which has been found to reduce anger, threatening behavior, and aggression. The drug has been shown to reduce behaviors like bullying, fighting and temper tantrums in aggressive children. Dilantin, an anti-convulsant, has also been shown to reduce impulsive aggression. Other drugs have been used to treat aggression: carbamazepine, valproate, propranolol, buspirone, and trazodone.

Antipsychotic medications also have been used. They can deter aggression, but potentially induce irreversible side effects. Tranquilizers are potentially addictive and may lead to loss of behavioral control.

Medication may help alleviate other psychiatric disorders that coexist with antisocial personality disorder, including clinical depression, anxiety disorder, or attention-deficit/hyperactivity disorder, and controlling these conditions can reduce antisocial behavior.

It is crucial that all patients with antisocial personality disorder are given their own treatment plans. While the symptoms can be universal, each patient is unique. When thinking about treatment, it is natural to think about how antisocial personality disorder might be prevented.

Prevention

There’s no sure way to prevent antisocial personality disorder from taking hold in those who are most at risk. Because antisocial behavior is thought to start developing in childhood, parents, teachers, and pediatricians could spot the early warning signs. It could help to try to detect those at highest risk, like children who show signs of conduct disorder, and then provide early intervention.

It’s also important to remember that the development of conduct disorder or related problems in childhood and the teen years does not mean that a person is guaranteed to develop antisocial personality disorder. Researchers suggest that children who develop conduct disorder or related problems have a 40% to 70% chance of going on to develop antisocial personality disorder.

Even though researchers seem to disagree about the probabilities, there is nothing wrong with applying preventive interventions that target conduct disorders in children; it has the potential to significantly reduce antisocial personality disorder occurrence and/or severity. There is the added benefit of reducing the stress and damage caused to children and their families by a child’s chronic conduct problems.

If you have a child displaying signs of conduct disorder, it is essential to begin effective and appropriate discipline, teach lessons in behavior modification, practice social and problem-solving skills, attend family therapy, and offer individual psychotherapy to the child; these interventions could help reduce the chance that at-risk children go on to develop antisocial personality disorder.

Recently, most scientists and researchers began working on interventional therapies for children who have been identified with conduct disorder.

Cognitive problem-solving skills training

This intervention focuses on children’s thought processes that impact on how they behave in interpersonal situations. The intervention includes several steps:

  • structured tasks such as games and stories to aid the development of skills
  • teaching a step-by-step approach to solving interpersonal problems
  • combining a variety of approaches including modelling and practice, role playing, and reinforcement

Anger control training

This includes teaching the child a number of cognitive and behavioral techniques similar to cognitive problem-solving skills training. However, this includes training of skills such as relaxation and positive social skills, specifically focusing on managing anger. This is usually helpful to school-age children who are aggressive.

Social problem skills training

This is a special form of cognitive problem-solving skills training that aims to adjust and expand the child’s interpersonal judgment processes through developing a more complete understanding of desires and beliefs in others and to improve the child’s ability to regulate his or her own emotional responses.

With these interventions, a child identified with symptoms of conduct disorder or other personality disorder symptoms may have a chance of not developing antisocial personality disorder in the future.

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Conclusion

Early intervention is key to reducing the number of people who present with antisocial personality disorder. Those who suffer from this disorder are often completely unaware that their behavior is inappropriate or even criminal. Antisocials simply don’t understand why people react the way they do to them.

While science continues to work on ways to prevent and treat antisocial personality disorder, it is important that the public be made aware of the signs and symptoms of the personality disorder and get help for those who exhibit these symptoms.

At Beachside, we pride ourselves on providing comprehensive mental health treatment for teenagers who are struggling with mental health issues and may need residential treatment to help them manage it. Have your parent or guardian contact us today!

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