Antisocial Personality Disorder

National Organization for Rare Disorders, Inc.

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It is possible that the main title of the report Antisocial Personality Disorder is not the name you expected.

Disorder Subdivisions

  • None

General Discussion

Antisocial personality disorder (ASP disorder) is a mental illness that usually becomes apparent during adolescence, before the age of fifteen. Symptoms usually include antisocial behavior in which there is little concern for the rights of others such as indifference to the moral or legal standards of the region or community. Behavior patterns usually include excessive drinking, fighting and irresponsibility. A key to the disorder is long lasting, persistent, manipulative, exploitive actions and manners that determinedly ignore others. For a diagnosis, some clinicians insist that the behavioral pattern be exhibited during childhood. Some clinicians believe that genetic makeup contributes to the cause of the disorder, but a detailed understanding of the cause remains elusive.

Symptoms

Most people with ASP disorder will, in early childhood, exhibit behaviors such as: lying, stealing, fighting, truancy, and resisting authority. By adolescence, affected individuals will have broken the law frequently and will willfully ignore their own safety and the safety of others; repeatedly lie, steal or brawl; and show neither guilt nor remorse for any or all anti-social behaviors.



By adulthood, a person with ASP disorder will have a history of legal problems, substance abuse problems, and/or sexual abuse problems. It should be noted that a person with ASP disorder may be charming, glib, persuasive and intimidating.



The behavior difficulties usually last into late adult life with markedly impaired capacity to sustain lasting, close, warm, and responsible relationships with family, friends, or sexual partners. The disorder may result in failure to become an independent, self-supporting adult. Disrespect for authority leads to problems with the law in most cases.

Causes

The cause of ASP disorder is unknown. There are many ideas and theories as to the cause of this disorder, but it continues to remain little understood. Some clinicians believe that there is not one cause but a complicated interaction of a variety of causes.



It may be caused by the absence of parental discipline in the home, extreme poverty, removal from the home, and growing up without parental figures of both sexes. Lack of educational achievement and the use of drugs may also be contributing causes of ASP disorder, as well as symptoms of the disorder. There may be predisposing factors to ASP disorder such as attention deficit disorder (ADD) and conduct disorder during the formative years before puberty.

Affected Populations

ASP disorder is thought to affect about three percent of American males and one percent of American females. Males are also affected at a much earlier age than females, usually during early childhood.

Diagnosis

Diagnostic Criteria



The general practice for making a diagnosis of ASP disorder is to observe an individual for three or more of the following characteristics. Among those characteristics is the failure to conform to social norms by repeatedly performing acts that are grounds for arrest. Deceitfulness, repeated lying, the use of aliases, or conning others for personal profit or pleasure are considered signs of ASP disorder as is impulsiveness and failure to plan ahead. Irritability and aggressiveness, especially when those behaviors result in repeated physical fights, assaults, and the reckless disregard for the safety of self or others are also chief characteristics. Other characteristics include a repeated failure to sustain work or honor financial obligations and a general lack of remorse or indifference for causing hurt or mistreatment to others. Most diagnosis criteria require the individual to be at least 18-years-old before a diagnosis is made. Additionally, the criteria asks that evidence of anti-social conduct before the age of 15 be present. Antisocial behavior should not be limited exclusively to the course of schizophrenia or a manic episode. It should be noted that at different junctures, these diagnostic criteria have been severely criticized, on many fronts, by various professional groups.

Standard Therapies

Treatment



Treatment of ASP disorder is challenging. Effective results occur in only a small proportion of cases. For many cases, psychological counseling or psychotherapy is the preferred treatment. In the more serious cases, psychiatric hospitalization may be necessary. Other treatment is symptomatic and supportive.

Investigational Therapies

Information on current clinical trials is posted on the Internet at www.clinicaltrials.gov. All studies receiving U.S. government funding, and some supported by private industry, are posted on this government website.



For information about clinical trials being conducted at the National Institutes of Health (NIH) in Bethesda, MD, contact the NIH Patient Recruitment Office:



Tollfree: (800) 411-1222



TTY: (866) 411-1010



Email: prpl@cc.nih.gov



For information about clinical trials sponsored by private sources, contact:



www.centerwatch.com



A clinical study sponsored by the National Institute of Child Health and Human Development is currently (2004) evaluating antisocial behavior in families from one generation to the next. This study is part of the continuing Mauritius Child Health Project, which began by testing 1,795 three-year-old children on psychophysiological, behavioral, nutritional, and cognitive measures. The children from the original study are now adults. This study will re-test those adults, their previously untested spoused, and their children. Further information is available on the clinicaltrials.gov web site or by calling:



Kjetil Mellingen



(230) 453-9123

References

TEXTBOOKS



Frances A. Chmn. Bd. eds. Diagnostic and Statistical Manual of Mental Disorders: DSM IV. 4th ed. American Psychiatic Association. Washington, DC; 1994:645-650.



Meloy JR. Antisocial Personality Disorder. In: Gabbard GO. ed. Treatment of Psychiatric Disorders. 2nd ed. American Pychiatric Association. Washington, DC; 1995:2273-90.



Perry JC. Vaillant GE. Personality Disorders. In: Kaplan HI, Sadock BJ. Eds. Comprehensive Textbook of Psychiatry/V. 5th ed. William & Wilkins. Baltimore, MD; 1989.



REVIEW ARTICLES



Goodman M, New A, Siever L. Trauma, genes, and the neurobiology of personality disorders. Ann N Y Acad Sci. 2004;1032:104-16.



Black DW, Blum N, Pfohl B, et al. Suicidal behavior in borderline personality disorder: prevalence, risk factors, prediction, and prevention. J Personal Disord. 2004;18:226-39.



MarkovitzPJ. Recent trends in the pharmacotherapy of personality disorders. J Personal Disord. 2004;18:90-101.



Paris J. Personality disorders over time: precursors, course and outcome. J Personal Disord. 2003;17:479-88.



Links PS, Gould B, Ratnayake R. Assessing suicidal youth with antisocial, borderline, or narcissistic personality disorder. Can J Psychiatry. 2003;48:301-10.



Hill J. Early identification of individuals at risk for antisocial personality disorder. Br J Psychiatry Suppl. 2003;44:S11-14.



Sher KJ, Trull TJ. Substance use disorder and personality disorder. Curr Psychiatry Rep. 2002;4:25-29.



FROM THE INTERNET



Dilley JW. Antisocial personality disorder. MedlinePlus. Medical Encyclopedia. Update Date: 12/9/2004. 2pp.



www.nlm.nih.gov/medlineplus/ency/article000921.htm



Antisocial Personality Disorder. Provided by Psychology Today. Last Editorial Review: 9/24/2004.



Definition of Antisocial Personality Disorder. 2pp.



Antisocial Personality Disorder Symptoms)



Causes of Antisocial Personality Disorder), 2pp.



Antisocial Personality Disorder Treatment, 5pp.



www.medicinenet.com

Supporting Organizations

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For a Complete Report

This is an abstract of a report from the National Organization for Rare Disorders, Inc.® (NORD). Cigna members can access the complete report by logging into myCigna.com. For non-Cigna members, a copy of the complete report can be obtained for a small fee by visiting the NORD website. The complete report contains additional information including symptoms, causes, affected population, related disorders, standard and investigational treatments (if available), and references from medical literature. For a full-text version of this topic, see http://www.rarediseases.org/search/rdblist.html.