Antisocial personality disorder Health Article

Definition

Also known as psychopathy, sociopathy or dyssocial personality disorder, antisocial personality disorder (APD) is a diagnosis applied to persons who routinely behave with little or no regard for the rights, safety or feelings of others. This pattern of behavior is seen in children or young adolescents and persists into adulthood.

The most recent edition of the Diagnostic and Statistical Manual of Mental Disorders,(the fourth edition, text revision or DSM-IV-TR) classifies APD as one of four "Cluster B Personality Disorders" along with borderline, histrionic, and narcissistic personality disorders.

Description

People diagnosed with APD in prison populations act as if they have no conscience. They move through society as predators, paying little attention to the consequences of their actions. They cannot understand feelings of guilt or remorse. Deceit and manipulation characterize their interpersonal relationships.

Men or women diagnosed with this personality disorder demonstrate few emotions beyond contempt for others. Their lack of empathy is often combined with an inflated sense of self-worth and a superficial charm that tends to mask an inner indifference to the needs or feelings of others. Some studies indicate people with APD can only mimic the emotions associated with committed love relationships and friendships that most people feel naturally.

People reared by parents with antisocial personality disorder or substance abuse disorders are more likely to develop APD than members of the general population. People with the disorder may be homeless, living in poverty, suffering from a concurrent substance abuse disorder, or piling up extensive criminal records, as antisocial personality disorder is associated with low socioeconomic status and urban backgrounds. Highly intelligent individuals with APD, however, may not come to the attention of the criminal justice or mental health care systems and may be underrepresented in diagnostic statistics.

Some legal experts and mental health professionals do not think that APD should be classified as a mental disorder, on the grounds that the classification appears to excuse unethical, illegal, or immoral behavior. Despite these concerns, juries in the United States have consistently demonstrated that they do not regard a diagnosis of APD as exempting a person from prosecution or punishment for crimes committed.

Furthermore, some experts disagree with the American Psychiatric Association's (APA's) categorization of antisocial personality disorder. The APA considers the term psychopathy as another, synonymous name for APD. However, some experts make a distinction between psychopathy and APD. Dr. Robert Hare, an authority on psychopathy and the originator of the Hare Psychopathy Checklist, claims that all psychopaths have APD but not all individuals diagnosed with APD are psychopaths.

Causes

Studies of adopted children indicate that both genetic and environmental factors influence the development of APD. Both biological and adopted children of people diagnosed with the disorder have an increased risk of developing it. Children born to parents diagnosed with APD but adopted into other families resemble their biological more than their adoptive parents. The environment of the adoptive home, however, may lower the child's risk of developing APD.

Researchers have linked antisocial personality disorder to childhood physical or sexual abuse; neurological disorders (which are often undiagnosed); and low IQ. But, as with other personality disorders, no one has identified any specific cause or causes of antisocial personality disorder. Persons diagnosed with APD also have an increased incidence of somatization and substance-related disorders.

DSM-IV-TR adds that persons who show signs of conduct disorder with accompanying attention-deficit/hyperactivity disorder before the age of ten have a greater chance of being diagnosed with APD as adults than do other children. The manual notes that abuse or neglect combined with erratic parenting or inconsistent discipline appears to increase the risk that a child diagnosed with conduct disorder will develop APD as an adult.