Antisocial Personality Disorder

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Abstract
Antisocial Personality Disorder (ASPD) could possible be the most alarming of all
personality disorders, as well as one of the most difficult to diagnose. Generally, personality
disorders are defined as inflexible, maladaptive, personality traits that cause personal distress or
an inability to get along with others. According to the Mayo clinic, ASPD is a type of chronic
mental condition in which a person's ways of thinking, perceiving situations and relating to
others are dysfunctional and destructive. People with antisocial personality disorder typically
have no regard for right and wrong and often disregard the rights, wishes and feelings of others.
Those with antisocial personality disorder tend to antagonize, manipulate or treat others either
harshly or with callous indifference. They may often violate the law, landing in frequent trouble,
yet they show no guilt or remorse. They may lie, behave violently or impulsively, and have
problems with drug and alcohol use. These characteristics typically make people with antisocial
personality disorder unable to fulfill responsibilities related to family, work or school.

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ASPD can possibly develop in childhood, however, it cannot be diagnosed until the age
of eighteen. Children whom exhibit symptoms of ASPD can be diagnosed as having Conduct
Disorder. Conduct Disorder carries almost identical symptoms to ASPD. Patterns of clear
disregard for rules and authority, aggression, habitual lying, a tendency toward stealing and
destruction of property that occurs early in life could be used to help diagnose ASPD as an adult.
In lamest terms, it seems that somewhere during development, and early childhood moral
development simply did not occur. Studies have also shown that symptoms of the ASPD may
begin to decrease later on in life, with violent crimes dropping off but crimes such as theft can
continue until very late in life. According to the Mayo Clinics website, the these are the possible
symptoms of ASPD:
Disregard for right and wrong
Persistent lying or deceit to exploit others
Using charm or wit to manipulate others for personal gain or for sheer personal pleasure
Intense egocentrism, sense of superiority and exhibitionism
Recurring difficulties with the law
Repeatedly violating the rights of others by the use of intimidation, dishonesty and
misrepresentation
Child abuse or neglect
Hostility, significant irritability, agitation, impulsiveness, aggression or violence
Lack of empathy for others and lack of remorse about harming others

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Unnecessary risk-taking or dangerous behaviors

Poor or abusive relationships
Irresponsible work behavior
Failure to learn from the negative consequences of behavior
Looking at the flip side of the coin, a person may appear normal in childhood and still be
diagnosed with ASPD as an adult. This was the case with serial killer was the case with Ted
Bundy. From the outside looking in, Ted was an average child, quiet and a good student. It wasn't
until he reached his teens that indirect signs of ASPD began to appear. He has stated that he
began to feel something was different about himself around the time he entered junior high.
While all the other boys were turning their attention to girls, he could not understand what they
were feeling or why. It was also about that time that he learned the person he thought of as his
older sister was instead his mother and he began to have problems getting along with his stepfather. From there his "differences became increasingly evident to him yet he managed to mask
the madness building within, managing to go undetected until he had slaughtered and sexually
abused more than twenty young women. Mr. Bundy lied extensively about the details of his life,
abused alcohol and dabbled in drugs, could not hold a job for a long period, dropped in and out
of college many times (lying his way in) and exhibited kleptomaniac behavior, stealing anything
and everything from anywhere. He could not maintain an intimate, long lasting relationship with
a woman. In fact, he says that he did not understand intimacy - what it was or how to achieve it.
Even after his conviction, he rationalized that he knew so many details about the murders
because he had been at the center of the investigation for so long as a suspect. In interviews, he
spoke as a third person, observing and analyzing the killing as though someone else had done it.

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All of the people around him, in day to day life still claim that they can't believe this is the same
guy they knew.
EPIDEMIOLOGY
Due to the deceitfulness of ASPD, the true origin of the epidemiology is unclear. Many
people who are considered to have ASPD may only be displaying some aspects of antisocial
behavior. Also, it is very important to realize, not all people with ASPD will commit the violent
crimes that eventually reveal this diagnoses. According to the Health Research Funding website,
there ASPD has been found to occur in roughly 3% of males in the U.S. and about 1% of
females. In prison populations, however, ASPD is found to be evident in as much as 75% overall,
with about 80% of male prisoners and about 65% of female prisoners having it. Individuals in
lower income brackets and those residing in inner cities also tend to have higher incidence rates.
(healthresearchfunding.org)
There are many different disorders that are related to and can sometimes be confused with
ASPD. Substance Abuse Disorder (SAD) is amongst the disorders that is usually confused with
ASPD. Due to the effects of the drugs and/or alcohol, SAD are often a brief explanation for
delinquent behavior. However SAD, are often a sign of ASPD. Therefore, in treating SAD, a
determination of earlier delinquent behavior or Conduct Disorder in childhood should be created
before a diagnosis of ASPD is rendered. Also, Schizophrenic or manic episodes that embodies
some delinquent behavior cannot be declared ASPD unless the symptoms present at different
times. Egotistical, Histrionic, Borderline and Paranoid Temperament Disorders closely mimics
the signs and symptoms ASPD, but every looks to lack the aggression issue that ASPD carries,
minus the aggression. Others disorders that are comorbid to ASPD is Depressive, Anxiety,
Somatiform and Pathological Gambling Disorder.

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ETIOLOGY
As with many of mental disorders, there seems to be no single, clear cause of origin of
ASPD. In depth analysis has been done and continues to be done however to very little avail as
of today. However, some theories have been developed that states children who have the signs of
ASPD, is correlated with both biological and environmental factors. Neglect or abuse in early,
childhood inflicting attachment issues, broken trust problems and failure to be told the way to
provide or receive love would seem to be a prominent cause, particularly once we assume in
terms of the disregard of the rights or feelings of others being a sign of ASPD. Abuse has also
been shown to cause violence in many adults who endured it as a child. Neglect could also
encompass the lack of moral teaching as a child being an origin of failure to follow societal
norms and ignoring laws as an adult. Having parents who were substance abusers also appears to
offer up a greater risk for developing ASPD, considering that those who are alcoholics or drug
addicts are most often abusive or neglectful.
When taking Biological factors into consideration, one must include inheriting a disposition for
ASPD, abnormalities in the brain and even physiological changes in the brain due to neglect. In
the adopted child study, those who were adopted out from biological parents who had ASPD or
other disorders still maintained the risk of development although, however, in these cases, being
adopted into an environment of nurturing lessened it. Some abnormality in the development of
the brain and/or central nervous system is also suspect due to a study that showed persons with
ASPD have lower electrical conductance of the skin in response to situations that would cause
fear in a "normal person. There have been studies that have shown differences in the frontal and
parietal lobes of some violent offenders studied in 1977 in Texas is thought to be yet another

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possibility in causing ASPD. Even with all the research that has been done there are no answers
with regards to biology.
Reseachers also hypothesized that damage to brain via injury is another possibility for cause of
ASPD. Damage to certain parts of the brain can indeed interrupt impulse control and emotional
responsiveness. This was the case of John Wayne Gacy, Jr., the "killer clown. For the most part,
he had a normal childhood except for the fact that he suffered abuse at the hand of an alcoholic
father. Then, at 11 years old, he was hit in the head by a swing. At first, there appeared to be no
serious injury but then he began to have blackouts. The blackouts continued until he reached 16,
when it was discovered that he had a blood clot in his brain. He was given drugs to dissolve the
clot, no surgery was performed. After that he began to display signs of ASPD. He dropped out of
school, after having attended four different ones, and moved to Las Vegas. There he held a series
of odd jobs none of which lasted long. Then he met a woman he thought he loved and they were
eventually married. Going to work for his father in law selling cars was ideal for Gacy who was
a smooth talker. He felt an intense need to belong and satisfied it by becoming a member of
many civic groups such as the Jaycees. He even dressed as a clown to entertain children. But the
facade began to crumble when a 17-year-old boy accused Gacy of tricking him into being
handcuffed and then sexually assaulting him. Gacy denied the charges by saying that some
higher members of the Jaycees were "out to get him. Later, he was accused again and this time
was convicted. While on parole, Gacy could not resist picking up yet another young boy and
sexually assaulting him. That time he landed in jail. When he was released, the downward decent
to hell continued and in the end, more than thirty bodies of boys were found in his house and
more were found in area rivers and woods. While monster would seem to be the only appropriate
word to describe him (albeit inadequate), his friends and neighbors couldn't believe that the man

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who had thrown such wonderful luaus and bar-b-ques could have done these things. Even his
next door neighbor, who smelled the dead bodies at Gacy's house, believed him when he
explained it as a sewer line problem. So, in the end, it is doubtful that an injury at the age of 11,
could be the lone cause of such a horror. ( http://www.biography.com/people/john-wayne-gacy)
Finally, there is the idea of environment as cause. Children of lower economic status and ethnic
minority also appear to be at greater risk for ASPD. Since persons of lower economic status tend
to live in higher crime, inner city areas where drugs are prevalent, they may learn disregard for
others and the law at an early age. Violent and aggressive responses are learned in order to
survive. Parental guidance may also be lacking due to the high rate of absent fathers, mothers
who must work long,late hours away from home and the prevalence of substance abuse.
Environment, biology, genes, brain injury - all appear viable causes and yet it cannot be
determined which actually is. More likely it is a combination of all of them. Perhaps the
researchers should turn in the direction of finding ways to end poverty, stop child abuse and rid
the country of drugs if they ever intend to put a cure to this disorder.
DIAGNOSTIC CRITERIA FOR ANTISOCIAL PERSONALITY DISORDER
FROM DSM V
According to the DSM-5, there are four diagnostic criterion, of which Criterion A has seven subfeatures.
A. Disregard for and violation of others rights since age 15, as indicated by one of the seven sub
features:

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1. Failure to obey laws and norms by engaging in behavior which results in criminal arrest, or
would warrant criminal arrest
2. Lying, deception, and manipulation, for profit tor self-amusement,
3. Impulsive behavior
4. Irritability and aggression, manifested as frequently assaults others, or engages in fighting
5 Blatantly disregards safety of self and others,
6 A pattern of irresponsibility and
7. Lack of remorse for actions (American Psychiatric Association, 2013)
The other diagnostic Criterion are:
B. The person is at least age 18,
C. Conduct disorder was present by history before age 15
D. and the antisocial behavior does not occur in the context of schizophrenia or bipolar disorder
(American Psychiatric Association, 2013)

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POSSIBLE COURSES OF TREATMENT

The prognosis for someone with ASPD isnt good. Due to the results of characteristics of
mistrust, lack of ruefulness and also the lack of most any feelings in the least, they will be seen
by professionals as untreatable. Additionally, since those seeking treatment for ASPD is due
solely to legal circumstances, they will lack the motivation to actively participate in their
treatment. And since the medication prescribed don't end in any gratifying sensations, obtaining
the patient with ASPD to take the medications could prove to be problematic. The problem in
making an attempt to urge the patient to attach their behaviors to feelings will appear virtually
impossible. Then, there's the matter of getting a person who is suffering from ASPD to get past
their issues with people in authority.
Hospitalization is another choice however not very viable since most seeking treatment
are already in a jail setting and also the care can be long term. Some specialized in- patient
treatment settings area unit in development like the Patuxent Institute settled in Jessup, Mo.
There a strict behavioral approach of putting patients on a behavior modification supported their
progress is employed.
Medications is another type of treatment but they'll solely treat the symptoms and don't
change the disorder. Lithium, Fluoxetine, Sertraline, Busiprone and different anti-psychotic
medication is also prescribed. However, as stated before, if the drug doesn't carry gratifying
sensations, it's possible that the patient with ASPD won't take it. Also, since substance abuse and
manipulation are symptoms themselves, the patient might attempt to alter or pretend to have
different symptoms to receive the medication they want.
Conclusion

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The Antisocial Personality Disorder is a disorder with several variations and types, but with the
same harmful effects. People, mostly men, with this disorder almost always tend to act in
criminal ways, beginning early in life (age 15) all the way through adulthood and even
sometimes into the senior years. Criminologists need to be well aware of what they are dealing
with when a criminal with APD enters the scene. Since antisocial personalities are good liars,
con artists, charmers, and tricksters, they could easily con their way out of court and be turned
loose on the streets yet again. They have no sympathy for their victims and show no remorse for
their actions, so there is no stopping them from committing crimes time and time again.

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References
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