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It has been suggested that Sociopaths in Society be merged into this article. (Discuss) Proposed since January 2011.

Antisocial personality disorder
Specialty	Psychiatry, psychology

Antisocial personality disorder (ASPD) is defined by the American Psychiatric Association's Axis II (personality disorders) of the Diagnostic and Statistical Manual (DSM-IV-TR) as "...a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood."

Antisocial personality disorder is sometimes referred to as psychopathy or sociopathy; however, many scholars make distinctions among these terms, though there remains no academic consensus as to their definitions. Currently, for this reason, neither psychopathy nor sociopathy are valid diagnoses described in the Diagnostic and Statistical Manual of Mental Disorders, and the ICD-10 of the World Health Organization also lacks psychopathy as a diagnostic disorder. Psychopathy is normally seen as a subset of the antisocial personality disorder, but Blair believes that the antisocial personality disorder and psychopathy may be separate conditions altogether. Many people with this disorder are not violent.

Diagnosis

DSM

The Diagnostic and Statistical Manual of Mental Disorders fourth edition, DSM IV-TR = 301.7, a widely used manual for diagnosing mental disorders, defines antisocial personality disorder (in Axis II Cluster B) as:

A) There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following:

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
2. deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
3. impulsiveness or failure to plan ahead;
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults;
5. reckless disregard for safety of self or others;
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another;

B) The individual is at least age 18 years.

C) There is evidence of conduct disorder with onset before age 15 years.

D) The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.

New evidence points to the possibility that children often develop antisocial personality disorder as a result of environmental as well as genetic influence. The individual must be at least 18 years of age to be diagnosed with this disorder (Criterion B), but those commonly diagnosed with ASPD as adults were diagnosed with conduct disorder as children. The prevalence of this disorder is 3% in males and 1% from females, as stated in the DSM IV-TR.

WHO

The World Health Organization's ICD-10 defines a conceptually similar disorder to antisocial personality disorder called (F60.2) Dissocial personality disorder.

It is characterized by at least 3 of the following:

1. Callous unconcern for the feelings of others and lack of the capacity for empathy.
2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations.
3. Incapacity to maintain enduring relationships.
4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence.
5. Incapacity to experience guilt and to profit from experience, particularly punishment.
6. Markedly prone to blame others or to offer plausible rationalizations for the behavior bringing the subject into conflict.
7. Persistent irritability.

The criteria specifically rule out conduct disorders. Dissocial personality disorder criteria differ from those for antisocial and sociopathic personality disorders.

It is a requirement of ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.

Millon's subtypes

Theodore Millon identified five subtypes of antisocial behavior. Any antisocial individual may exhibit none, one or more than one of the following:

• covetous antisocial - variant of the pure pattern where individuals feel that life has not given them their due.
• reputation-defending antisocial - including narcissistic features
• risk-taking antisocial - including histrionic features
• nomadic antisocial - including schizoid, avoidant features
• malevolent antisocial - including sadistic, paranoid features.

Differential diagnosis

The following conditions commonly coexist with antisocial personality disorder:

• Anxiety disorders
• Depressive disorder
• Substance-related disorders
• Somatization disorder
• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.

Treatment

This section needs expansion. You can help by adding to it. (November 2009)

To date there have been no controlled studies reported which found an effective treatment for ASPD, although contingency management programs, or a reward system, has been shown moderately effective for behavioral change. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance abuse, although others have reported contradictory findings. Schema therapy is being investigated as a treatment for antisocial personality disorder, as well as medicinal marijuana treatments.

Epidemiology

Antisocial personality disorder is seen in 3% to 30% of psychiatric outpatients. The prevalence of the disorder is even higher in selected populations, such as people in prisons (who include many violent offenders). A 2002 literature review of studies on mental disorders in prisoners stated that 47% of male prisoners and 21% of female prisoners had anti-social personality disorder. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) abuse treatment programs than in the general population (Hare 1983), suggesting a link between ASPD and AOD abuse and dependence.

Psychopathy and sociopathy

Psychopathy and sociopathy are terms related to ASPD. Psychopathy once referred to ASPD in general, but is now (like sociopathy) occasionally classified as a subset of ASPD. No scientific or academic consensus exists as to the specific differences between the three terms.

Researchers debate about whether psychopathy/sociopathy are incorrectly put together under ASPD. These clinicians and researchers who believe that it was incorrect to label the two in the same category are upset that an important distinction has been lost between these two disorders. In other words, the DSM-IV-TR considers ASPD and psychopathy to be the same, or similar. However, they are not the same since antisocial personality disorder is diagnosed via behavior and social deviance, whereas psychopathy also includes affective and interpersonal personality factors.

The official stance of the American Psychiatric Association as presented in the DSM-IV-TR is that "psychopathy" and "sociopathy" are obsolete synonyms. The World Health Organization takes a similar stance in its ICD-10 by referring to psychopathy, antisocial personality, asocial personality, and amoral personality as synonyms for dissocial personality disorder.

The DSM-V working party is recommending a revision of antisocial personality disorder to include "Antisocial/Psychopathic Type", with the diagnostic criteria having a greater emphasis on character than on behavior.

Psychopathy

Psychopathy (/saɪˈkɒpəθi/) was, until 1980, the term used for a personality disorder characterized by an abnormal lack of empathy combined with strongly amoral conduct but masked by an ability to appear outwardly normal. The publication of DSM-III changed the name of this mental disorder to Antisocial Personality Disorder and also broadened the diagnostic criteria considerably by shifting from clinical inferences to behavioral diagnostic criteria. However, the DSM-V working party is recommending a revision of Antisocial Personality Disorder to include "Antisocial/Psychopathic Type", with the diagnostic criteria having a greater emphasis on character than on behavior. The ICD-10 diagnostic criteria of the World Health Organization also lacks psychopathy as a personality disorder, its 1992 manual including Dissocial (Antisocial) Personality Disorder, which encompasses amoral, antisocial, asocial, psychopathic, and sociopathic personalities.

Sociopathy

Hare writes that the difference between sociopathy and psychopathy may "reflect the user's views on the origins and determinates of the disorder." The term sociopathy may be preferred by sociologists that see the causes as due to social factors. The term psychopathy may be preferred by psychologists who see the causes as due to a combination of psychological, genetic, and environmental factors.

In the preface to the fifth edition of The Mask of Sanity, Cleckly stated, "... revisions of the nomenclature have been made by the American Psychiatric Association. The classification of psychopathic personality was changed to that of sociopathic personality in 1958", suggesting that he did not recognize any difference between the conditions.

David T. Lykken proposed psychopathy and sociopathy are two distinct kinds of antisocial personality disorder. He believed psychopaths are born with temperamental differences such as impulsivity, cortical underarousal, and fearlessness that lead them to risk-seeking behavior and an inability to internalize social norms. On the other hand, he claimed that sociopaths have relatively normal temperaments; their personality disorder being more an effect of negative sociological factors like parental neglect, delinquent peers, poverty, and extremely low or extremely high intelligence. Both personality disorders are the result of an interaction between genetic predispositions and environmental factors, but psychopathy leans towards the hereditary whereas sociopathy tends towards the environmental.

See also

• DSM-IV codes (personality disorders)
• The Mask of Sanity
• Malignant narcissism
• Conduct disorder
• Substance abuse
• Anti-Social Behaviour Order
• Oppositional defiant disorder

References

1. ^ Antisocial personality disorder - Diagnostic and Statistical Manual of Mental Disorders Fourth edition Text Revision (DSM-IV-TR) American Psychiatric Association (2000) - pages 645–650
2. http://www.psychiatrictimes.com/dsm-iv/content/article/10168/54831
3. http://www.mentalhealth.com/icd/p22-pe04.html
4. Blair, J; Mitchel D; Blair K (2005). Psychopathy: Emotion and the Brain. Blackwell Publishing. pp. 16. ISBN 0631233369.
5. Dissocial personality disorder - International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)
6. ₆₀₂ "F₆₀.2 Dissocial personality disorder". World Health Organization. Retrieved 12 January 2008.
7. Early Prevention of Adult Antisocial Behavior. Cambridge University Press. 16 June 2003. p. 82. ISBN 9780521651943. Retrieved 12 January 2008. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
8. Millon, Theodore, Personality Disorders in Modern Life, 2004
9. Millon, Theodore - Personality Subtypes
10. ^ Internet Mental Health - antisocial personality disorder
11. Oscar-Berman M (2009). "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder". Neuropsychiatric Disease and Treatment. 2009 (5): 309–326. PMC 2699656. PMID 19557141. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help)
12. J. E. Fisher & W. T. O'Donohue (eds). (2006). Practitioner's Guide to Evidence-Based Psychotherapy, p63
13. S. Darke, R. Finlay-Jones, S. Kaye, & T. Blatt. Anti-social personality disorder and response to methadone maintenance treatment. Drug and Alcohol Review, vol. 15, 271-276 (1996)
14. A. I. Alterman, M. J. Rutherford, J. S. Cacciola, J. R. McKay, & C. R. Boardman. Prediction of 7 months methadone maintenance treatment response by four measures of antisociality. Drug & Alcohol Dependence, vol. 49, 217-223 (1998)
15. iafmhs.org (PDF)
16. Hare 1983
17. Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1016/S0140-6736(02)07740-1, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1016/S0140-6736(02)07740-1 instead.
18. Moeller, F. Gerard; Dougherty, Donald M. (2006). "Antisocial Personality Disorder, Alcohol, and Aggression" (PDF). Alcohol Research & Health. National Institute on Alcohol Abuse and Alcoholism. Retrieved 20 February 2007.
19. Hare, R.D., Hart, S.D., Harpur, T.J. Psychopathy and the DSM—IV Criteria for Antisocial Personality Disorder (pdf file)
20. "Proposed revision" (Document). DSM5Template:Inconsistent citations {{cite document}}: Unknown parameter |url= ignored (help)CS1 maint: postscript (link).
21. American Heritage Dictionary
22. Merriam-Webster's Online Dictionary
23. http://www.psychiatrictimes.com/dsm-iv/content/article/10168/54831
24. http://www.dsm5.org/ProposedRevisions/Pages/proposedrevision.aspx?rid=16#
25. http://www.mentalhealth.com/icd/p22-pe04.html
26. Hare, Robert D. Without Conscience: The Disturbing World of Psychopaths Among Us, (New York: Pocket Books, 1993) pg 23.
27. Lykken, David T. The Antisocial Personalities. Hillsdale N.J: L. Erlbaum, 1995. Print.

External links

• Interview with Dr. Martha Stout, author of The Sociopath Next Door on the Living Hero podcast, November 2010.
• "Into the Abyss." Article on street crime referencing the roots and consequences of sociopathic behavior
• DSM IV-TR Criteria for Antisocial personality disorder
• Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion
• Recent Studies Implicate Slow Monoamine Oxidase Enzyme/High Circulating T3 in Antisocial Behavior/Aggression/Violence 2007
• Sociopathic - Research into personality disorders A collaborative to better understand personality disorders such as sociopathy, borderline, paranoid.
• The Unreal World of Narcissists and Sociopaths, with host Jari Chevalier for Living Hero. Numerous experts, including Nina W. Brown, Linda Martinez-Lewi, Gabor Mate, Martha Stout, Philip Zimbardo

• Articles to be merged from January 2011
• Use dmy dates from January 2011
• Abnormal psychology
• Forensic psychology
• Personality disorders
• Psychopathy