by Kimberly Allen, RN
Antisocial personality disorder is a member of the cluster B group of personality disorders as described in the DSM-IV-TR. Many people consider antisocial personality disorder to be synonymous with psychopathy, however, they are not. There are different criteria for each. Approximately 30% of psychiatric patients seen on an out patient basis have antisocial personality disorder. A study done on prisons indicated that approximately 50% of the prison population meet the criteria for antisocial personality disorder.. In the general population the incidence of antisocial personality disorder is about 3% among males and 1% among females.
Each personality is a unique composite of our thoughts and emotions as well as behaviors. It’s what makes us individuals. It’s how we see and relate to the world around us as well as how we envision ourselves. Our personality develops during childhood and is determined by both inherited tendencies and our environment. Although some people are more prone to antisocial personality disorder than others. For example, children that are diagnosed with what is called a conduct disorder like ADHD or children that have been abused physically, verbally, or sexually. Children that suffer the loss of their parents whether due to death or through a traumatic and nasty divorce also have an increased chance of developing antisocial personality disorder as well as those that have a family history of antisocial personality disorder.
Recent studies have also indicated there is a link between antisocial disorder and a particular serotonin metabolic called 5-HIAA. the studies that were analyzed showed significantly lower levels of 5-HIAA in people diagnosed with antisocial personality disorder. There has also been evidence linking another neurotransmitter known as 5HT’s with antisocial personality disorder. Experts believe that the hormone reaction to 5HT along with diminished levels of 5-HIAA leads to impaired mood function. There is also evidence that diminished serotonin function is significantly linked with aggression and impulsiveness. Research has also found that there is an extremely high combination of testosterone and cortisol reactions which in turn corresponds with diminished levels of serotonin in people with antisocial personality disorder.
Most people with antisocial personality disorder constantly ignore the rights of others beginning either in childhood or early teens. This disregard for others persists into adulthood. As a child or teen with antisocial personality disorder matures they begin to lie and manipulate the people and situations around them to suit their purpose. There are specific criteria required for a diagnosis of antisocial personality disorder including that all people diagnosed must have a history of a conduct disorder like delinquency. Other criteria that the doctor will assess for include failing to adapt to social norms as evidenced by numerous juvenile arrests, ability to manipulate and deceive others, impulsiveness and inability to plan ahead, anger and aggression like a history of multiple fights and/or assaults. People with antisocial personality disorder also are continuously irresponsible like not paying bills or being able to keep a job and an absolute lack of remorse. In order for a diagnosis of antisocial personality disorder a person must be over 18 years of age and in addition to having a history of a conduct disorder you must demonstrate 3 or more if the listed criteria. The reason you must be 18 years of age is because many teenagers as well as children frequently demonstrate these behaviors as they grow and mature.
Antisocial personality disorder is extremely hard to treat. Many people with this type of disorder usually will not recognize the need for or desire treatment. Any treatment is a lifelong process and usually involves a team which includes your primary care doctor, a psychiatrist and psychotherapist as well as social workers and most importantly family members. Most treatments involve psychotherapy and medications as well as developing anger and stress management skills.
Psychopath or Sociopath?
Both psychopaths and sociopaths are considered antisocial personality disorders. Though many people use the terms interchangeably in recent years scientists have discovered they are in fact two separate conditions. However, both psychopaths and sociopaths have contempt for not only the laws of society but for the rights and feelings of others. Neither feel any guilt or remorse over their actions and are totally self serving with no conscience. It’s also important not to confuse psychopathy or sociopathy with psychosis. I know many people think if someones a psychopath then they are psychotic. The truth is they are not even close. A person that is psychotic has lost touch with reality and tends to have delusions and/or hallucinations. While on the other hand psychopaths and sociopaths both are grounded in reality. In other words they not only know what they are doing but also fully understand the consequences of their exploits, however, they just don’t care. For example, a psychotic may kill your pet because he/she believed it was an alien that was sent here to take over the world where as as psychopath or sociopath would do it just to cause you pain.
Most experts differentiate psychopaths and sociopaths by their cause. The belief is that psychopaths are born with psychopathic tendencies, while sociopaths are a result of their environment. Research indicates that “psychopaths are a stable proportion of any population, can be from any segment of society may constitute a distinct taxonomical class forged by frequency dependent natural selection, and that the mutating of the social emotions is the proximate mechanism that enables psychopaths to pursue their self centered goals without feeling the pangs of guilt. Sociopaths are more the products of adverse environmental experiences that affect autonomic nervous system and neurological development that may lead to physiologic responses similar to those of psychopaths.” (Walsh & Wu 2008) Others differentiate psychopaths from sociopaths by their behavior. For example, psychopaths are very impulsive and erratic where as sociopaths have more impulse control and are able to control their behavior. Psychopaths will act on impulse and have a habit of leaving clues while sociopaths have a habit of getting involved in schemes and taking calculated risks to decrease the risk of being exposed. Psychopaths are also unable to maintain normal relationships while sociopaths will appear normal in relationships and are frequently considered social predators. also psychopaths have a much high predisposition to violence than sociopaths.
Though the prognosis for people diagnosed with psychopathy or sociopathy is poor there are treatment options available. There are a variety of types if psychotherapy that can be used in the treatment both psychopathy and sociopathy including cognitive behavior therapy which helps uncover negative beliefs and unhealthy behaviors and replacing them with healthy and positive behaviors. Psycho dynamic psychotherapy raises an awareness to unconscious behaviors and thoughts and changing their negative impact and psycho education teaches a person about the condition as well as coping strategies and problem solving skills and treatment. Frequently psychotherapy is used in combination with medications depending on the individual needs of the patient. Most doctors find that using a combination of treatments is the most effective when treating either psychopaths or sociopaths.
Kimberly Allen is a registered nurse with an AND in nursing. She has worked in ACF, LCF and psychiatric facilities, although she spent most of her career as a home health expert. She is now a regular contributor to HealthAndFitnessTalk.com, dispensing advice and knowledge about medical issues and questions. You can reach her with any comments or questions at firstname.lastname@example.org.