Sometimes, people with certain psychological disorders commit acts against others without regret. Their behavior may be aggressive and cause harm. Doctors diagnose people who exhibit these behaviors as having an antisocial personality disorder, or ASPD. People with ASPD do not consider the consequences of their actions, nor do they consider the rights of others. Depending on specific indicators of some individuals, doctors may also identify them as sociopaths or psychopaths.
ASPD occurs in about 3% of the general population. The wide range of symptoms varies in severity. Most individuals with ASPD are charming on the surface, yet lack empathy for others, consistently putting their own needs before the needs of others. They tend to be manipulative and exploitive. Lying is common, and people with ASPD become bored easily and express frequent somatic complaints. They may refuse to allow others to push them around and react aggressively if someone tells them what to do. Those with ASPD violate the rights of others without remorse, ignore societal norms, and usually experience strained relationships in work, social, and family environments. Although ASPD is a lifelong condition for a majority of individuals, the symptoms ease in advanced age.
Doctors base their diagnosis of ASPD on how the individual relates to others and may talk with friends and family to obtain insight into the patient's behavior. The physician performs a full medical evaluation to rule out any non-psychological medical conditions. If the physician determines there are sufficient signs of a personality disorder, he or she usually refers the individual to a mental health professional for further psychological evaluation. This secondary process may include a review of behavior patterns, thought processes, relationships, and family history. The mental health professional analyzes the results and compares them with symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders to determine a diagnosis. ASPD is a Cluster B personality disorders. Doctors diagnosis three times as many men as women with the condition.
Research at Washington University in St. Louis and Harvard in the 1930s, 40s, and 50s led to the development of the diagnostic criteria for antisocial personality disorder. The studies followed more than 1000 children into adulthood, many of whom were in the correctional system or considered delinquent. In the end, the researchers concluded that criminality and other deviant behavior noted in adulthood followed severe antisocial behavior exhibited in childhood. One researcher determined ASPD was a chronic disorder that did not decrease as the children became adults.
Mental health experts say environmental factors may lead to ASPD, especially in children also diagnosed with conduct disorder. Adversity during childhood contributes to the onset of the condition. Inconsistent parenting and discipline styles are other environmental factors that may lead to ASPD. Parental or caretaker abuse or neglect can increase risk, as can alcohol or substance abuse in the home. Genetics play a role as well, especially in conjunction with negative environments.
Researchers say that genetics contributes about 50% to the likelihood of a child developing ASPD. Those with a parent or sibling with the condition are more likely to develop the condition if the environmental factors also contribute. For example, adopted children of parents with ASPD can still develop the condition if they live in an environment with negative role models or are not taught to respect the rights of others.
Although mental health professionals do not diagnose children under the age of 18 with ASPD, around 80% of individuals develop symptoms by age 11. Diagnostic criteria for ASPD includes a conduct disorder diagnosis before the age of 15. Children diagnosed with conduct disorder, attention deficit disorder, or hyperactivity disorder before the age of ten are at a higher risk of diagnosis with ASPD as adults. A 1987 study showed that problem behaviors such as habitual lying, shoplifting, and property damage often lead to a diagnosis of conduct disorder. Researchers say children who display a disregard for others’ pain may be at risk of developing ASPD in late adolescence.
In numerous studies dating back to the 1800s, behavioral scientists researched prison populations and the prevalence of ASPD within those populations. A 2010 study of 320 newly incarcerated individuals found that 113 of them had ASPD. People with ASPD are unlikely to learn from either negative consequences or punishment, so there was also a higher tendency for these individuals to re-offend. Incarcerated people with ASPD show a greater risk of suicide and higher rates of substance abuse, ADHD, anxiety, and somatic symptom disorder. Previous studies indicate between 40 and 80% of incarcerated offenders had behavioral histories that met the criteria for ASPD.
Many behavioral experts consider sociopathy to be an outdated term. However, professionals list the condition in the Diagnostic and Statistical Manual of Mental Disorders under the heading of ASPD. Mental health professionals use the term to emphasize specific characteristics. Although people exhibiting sociopathic characteristics share common traits with psychopaths, they also exhibit unique ones. A person who is sociopathic is prone to emotional outbursts. Often unable to form attachments with individuals or groups, they may live on the fringes of society. Criminals with sociopathic tendencies generally haphazardly commit crimes. Behavioral scientists believe sociopaths learn their behavior and are a product of nurture or their environment.
People who are psychopaths use manipulation to gain the trust of others. They mimic people’s emotions but are unable to actually feel those emotions. Unlike sociopaths, psychopaths are usually well educated, hold steady jobs, and tend to be charismatic. When committing a crime, psychopaths meticulously plan out every detail. They are calm and organized. It is not unusual for family members and others in long term relationships with a psychopath to never discover their condition. Considered to be the most dangerous of all ASPDs, psychopaths can completely dissociate from their emotions and show no remorse about their action. Studies show that about 40% of serial killers are psychopaths.
Treatment for ASPD is challenging, and there is no evidence that any specific treatment provides long-term improvement. There are no FDA-approved medications available for treating ASPDs. Because many individuals with this diagnosis have a potential for substance abuse, doctors prescribe medications with extreme caution, usually to treat depression or anxiety symptoms. In some cases, doctors may prescribe mood stabilizers for those with a tendency toward aggressive or impulsive behaviors. To begin treatment, the person with ASPD must admit he or she has a serious mental health condition and be willing to accept treatment. Psychotherapy is sometimes effective, along with anger and violence management.
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