ANTISOCIAL PERSONALITY DISORDER

Symptoms

It is characterized by a persistent pattern of disregarding and violating social norms and the rights of other people. Pathological behavior is also often expressed in impulsivity, irresponsibility, limited empathy, a tendency to lie, or unstable relationships. These characteristics make people with a dissocial personality more likely to come into conflict with the law than the general public. This does not mean that everyone with the disorder will come into conflict with the law.

Causes

It should be noted that the basis of a dissocial personality consists of coexisting innate (biological) and external (environmental) factors. Among the biological factors, the most commonly mentioned are poor functioning of neural networks related to emotionality in the broad sense, which causes difficulties in controlling impulses and aggressive behavior, and an inability to feel empathy or remorse. It also points to reduced reactivity of the autonomic nervous system, which is associated with the tendency of dissocial people to seek stimulation and to engage in irresponsible but “exciting” behavior. At the same time, the role of possible environmental factors that may influence the emergence and development of a dissocial personality disorder is emphasized, such as insecurity and an unmet basic need for love in childhood—emotionally cold, instrumental family relationships, chaos and often violence, as well as problems with alcohol and other psychoactive substance addiction. These factors block the natural development of a child’s sense of omnipotence and the feeling that support is available in the environment. The absence of, or insufficiently developed, attachment patterns (bond with the parent/caregiver), and not showing emotions to the child, prevent them from learning to recognize, name, and use emotional states in daily life.

Diagnosis

Typical characteristics of antisocial personality disorder are: failure to comply with the law and ethical standards, and an egocentric, callous lack of concern for others, accompanied by deceit, irresponsibility, manipulation, and/or risk-taking.

According to the DSM classification, the following criteria apply to antisocial personality disorder:

A. Moderate or severe impairment in personality functioning, as manifested by characteristic problems in two or more of the following four areas:

1. Identity: egocentrism; self-esteem derived from personal gain, power, or pleasure.
2. Self-direction: goal-setting based on personal gratification; lack of prosocial internal standards associated with failure to conform to ethical principles consistent with the law or a given culture.
3. Empathy: lack of concern for the feelings, needs, or suffering of others; no remorse after hurting or mistreating others.
4. Intimacy: the inability to form mutually intimate relationships because the basic attitude in entering a relationship is a willingness to exploit the other person (including through deceit and coercion); use of dominance or intimidation to control others.

B. Six or more of the following seven pathological personality traits:

1. Manipulativeness (aspect of antagonism): frequent use of deceit to influence others; using seduction, charm, eloquence, or coercion to achieve one’s own goals.
2. Callousness (aspect of antagonism): disregard for the feelings or problems of others; lack of guilt or remorse over the negative or harmful impact of one’s own actions; aggression; sadism.
3. Deceitfulness (aspect of antagonism): lying and dishonesty; misrepresenting oneself or events in order to present oneself in a favorable light.
4. Hostility (aspect of antagonism): persistent or frequent angry feelings; anger or irritability in response to minor slights and insults; malicious, vindictive behavior.
5. Risk-taking (aspect of disinhibition): engaging in unsafe, risky, and potentially harmful activities unnecessarily and regardless of the consequences; proneness to boredom and mindless initiation of anti-boredom actions; disregard for one’s own limitations and ignoring danger.
6. Impulsivity (aspect of disinhibition): acting spontaneously in response to immediate stimuli; temporary action, without a plan or considering the results; difficulties in making and carrying out plans.
7. Irresponsibility (aspect of disinhibition): neglecting and failing to meet obligations (financial or otherwise); lack of respect for arrangements and promises.

Treatment

People with antisocial personality disorder rarely seek treatment of their own accord. Forming a therapeutic alliance and maintaining motivation for treatment are hindered by the following common patient characteristics: emotional insensitivity, deceitfulness, poor emotional and behavioral control, and impulsivity. Better and more pragmatic therapeutic programs are currently being developed. The focus is on reducing symptoms (antisocial behavior, maladaptive beliefs or cognitive distortions, and sometimes interpersonal problems) in attempts to treat personality. The programs are often based on group work and include techniques used in cognitive behavioral therapy. It is important that interventions also address comorbid problems (for example addiction, anxiety, mood disorders) and environmental factors that may be disruptive.