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Antisocial Personality Disorder

In everyday speak, people often use the term “antisocial” when referring to someone who prefers not to socialize much.  However, the clinical term “antisocial” has a very different meaning.   In the clinical sense, it has more to do with not following accepted social norms.  Even if you’re not familiar with Antisocial Personality Disorder, popular culture terms like “psychopath” and “sociopath” offer a general idea of how the disorder works. To be clear, “psychopath” and “sociopath” do not have concrete medical definitions and are not used in making diagnoses. Some people insist they mean the same thing, while others argue that those terms indicate people whose symptoms are either more or less severe. The most important common thread is that these people – “psychopaths”, “sociopaths”, or anyone with Antisocial Personality Disorder – ignore the rights of others and prioritize their own desires over everything else.

From an early age, these people have frequent conflicts with authority figures and break rules and laws on a routine basis. They do what they want, when they want with little regard for those they hurt, and almost half end up with criminal histories. Those who manage to avoid repeatedly breaking the law still harm themselves and others in numerous ways. They cheat, deceive, and manipulate others for their own pleasure and profit. Although they can act friendly and pleasant sometimes, this is usually just to get something they want. When this fails, they can turn aggressive quickly. Relationships mean little to them, and connecting emotionally with another person is a truly foreign concept because they believe they are better than everyone around them. They look out for themselves and no one else, always trying to prove they are superior, but a lifetime of burning bridges ultimately hurts them the most.

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Causes and Risk Factors

Rates

Antisocial Personality Disorder is several times more common in men than in women, appearing in 4.5% to 6.8% of men but in fewer than 1% of women. However, in prisons and the rest of the justice system, these rates are much higher. Almost half of these men and 21% of these women have the disorder.

Chaotic youth

People with this personality disorder frequently suffered through chaotic home environments as they grew up. They commonly have parents who had combative, violent relationships and abused drugs and alcohol. Having a parent with a personality disorder, especially Antisocial Personality Disorder, also puts children at risk. Parenting style plays a big role, too. When parents give inconsistent punishments and praise, children are more likely to develop this personality disorder.

Brain biology

The frontal lobes of the brain in people with Antisocial Personality Disorder are physically different from those of healthy people. This area dominates what scientists call “executive functioning”, which is controls planning, forethought, self-restraint, and the ability to weigh the consequences of one’s own actions. Though it is difficult to determine whether these brain differences are the cause or result of a lifetime of antisocial behavior, there is undoubtedly a connection.

Coexisting disorders

Nine out of 10 people with Antisocial Personality Disorder also have at least one other mental illness. Substance use problems are the most common additional disorder that these people suffer. Alcohol abuse is at least three times more common than average, and other drug use is five times more common than average. Anxiety disorders also appear frequently in these people, striking half of them, and a quarter also deal with depressive disorders.

Diagnosing Antisocial Personality Disorder

The criteria

By age 15, these people begin to show a consistent pattern where they ignore the rights of others for their own personal gain. Before this, these people likely showed signs of or were diagnosed with Conduct Disorder as children. Their behavior normally includes breaking the law and leads to a criminal record beginning at an early age. They are often aggressive and violent, getting into frequent confrontations and fights. They have no concern for their own physical safety or that of others either. Little, if any, planning comes before their actions as well. In this same way, they are very irresponsible and have trouble holding jobs or keeping to obligations. These people repeatedly lie and deceive others to get what they want, and they don’t feel bad about doing it. The last key piece about this disorder is that people with Bipolar Disorder or Schizophrenia can behave in similar ways because of their illnesses, but that does not mean they also have Antisocial Personality Disorder.

Other important factors

People with this disorder cannot empathize with others. They feel nothing for people who are suffering and often blame victims for their predicaments. This is one way that they avoid feeling bad for the people they hurt. These people are also characteristically arrogant, carrying an air of superiority and a know-it-all nature. When they absolutely need to, they can put on a charming, but shallow, front for a short period of time. This helps them deceive people into believing they are well-meaning when they really only want to get their way.

Because of their self-centered nature, people with this disorder are terrible in relationships. They have trouble committing to a monogamous partnership and cheat frequently. When they become parents, they see their kids as a burden instead of a blessing. Their children are often abused or neglected, and child protective services often needs to step in.

Treating Antisocial Personality Disorder

Reducing symptoms

People with Antisocial Personality Disorder rarely seek treatment for that disorder because the nature of most personality disorders prevents them from acknowledging any issue with their behavior. When these people do come in for treatment, it is usually for other disorders like anxiety, depression, and substance use. Managing these issues is one of the most accessible ways to make antisocial symptoms less severe. This is especially true for alcohol and drugs, which are often a factor in aggression and violence. Treatment for these conditions is similar for people who do not also have a personality disorder, except that it may have to last longer and be more intense or frequent.

Controlled environments

The best opportunities for directly treating the core issues of Antisocial Personality Disorder occur in controlled environments, such as mental health hospitals, prisons, or court-mandated probation. The main treatment in these situations is based in Cognitive-Behavioral Therapy, especially when it is done in groups. It works best for people whose symptoms are not extreme and who have the potential to see the negative effects of their actions. Therapy programs focus on changing behavior by teaching social skills, anger management, non-violent problem solving, and relaxation techniques. These interventions reliably reduce future criminal behavior in these people.

Prevention with family therapy

One of the newer approaches to Antisocial Personality Disorder is to catch it early in childhood before it fully develops. Teachers and counselors work to identify children with developing antisocial symptoms as early as preschool all the way up through high school. Once they identify these children, the best treatment is family therapy that teaches parents skills to manage and change their child’s behavior. Parents learn how appropriately to punish antisocial actions and encourage more functional social abilities.

Medication options

Although there are no medications that directly treat Antisocial Personality Disorder, there are a few that may help manage symptoms if people are willing to take them. Antidepressants like Prozac (fluoxetine) and Zoloft (sertraline) can help soften aggressive impulses and treat depression and anxiety that these people may also have. Lithium helps reduce these same types of symptoms as well.

Managing Antisocial Personality Disorder

Getting a loved one to treatment

Having a family member with Antisocial Personality Disorder is exhausting and frustrating to say the least. The best general strategy is to establish rules and stick to them, like dealing with someone who is addicted to drugs or alcohol. Families need to present firm consequences for lies and destructive behavior because these people will take advantage of any lenience. This often proves difficult, as families empathize with the affected person and feel guilty for imposing these rules. However, a hard-line stance from a big group of family members is the most promising way to get these people to the treatment that they would never seek on their own.

Resources for family members

People with Antisocial Personality Disorder deceive and manipulate those around them constantly, and family members and loved ones catch the brunt of this. People get so wrapped up in dealing with the emotions of a family member with this personality disorder that they neglect their own mental health. They become the main victims of the affected person’s aggressive and angry nature. Family therapy and support groups are a great resource and can help people learn techniques to shield themselves from the chaos and violence of Antisocial Personality Disorder.

Types of Personality Disorders

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References
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