Antisocial Personality Disorder

deceit and manipulation are central features heavy use of rationalization; may blame their victims for being stupid, weak looking out for #1 more likely to die prematurely

Criteria for Antisocial P D A.A pervasive pattern of disregard for and violation of the rights of others since the age of 15 as indicated by 3 or more: –Repeated unlawful acts (lying, using aliases, conning others) –Impulsivity or failure to plan ahead –Irritability and aggressiveness –Reckless disregard for the safety of self or others –Irresponsibility in work or finances –Lack of remorse B. At least 18 years old C.Evidence of Conduct Disorder before the age of 15 D.Antisocial behavior does not occur exclusively in schizophrenic or manic episode

Antisocial Personality Disorder Prevalence: 2.5% of general population (but see Lenzenweger et al, 2007) Much more common in males 3% of population, 1% of women Comorbidity with Axis I: Substance abuse disorders (esp. alcohol), Anxiety, Depression, somatization, pathological gambling, impulse control disorders Axis II: overlap with BPD, HistrionicPD, Narcissistic PD differential: BPD manipulates for attention; ASPD for personal gain NPD not impulsive

begins early in life and abates in midlife. starts in early childhood for boys, but in adolescence for girls. 40% of Conduct Disordered males become ASPD. rates of conviction decline steeply after 40 for ASPDs (psychopathic burnout) Course

Hare, McPherson, & Forth (1988) JCCP Rate of Prison Time for Psychopaths (Group P) And Non-psychopaths (Group NP)

Risk Factors low SES in urban setting male parent with ASPD combination of Conduct Disorder and ADHD (The Fledgling Psychopath (Lynman, 1996) childhood abuse or neglect unstable or erratic parenting individualist society

Protective Factors High ANS reactivity (Kagan) high IQ (Kandel et al, 1988) may lead to rewards in school that help child to orient to conventional social order higher SES less disturbed parent “sibling barricade” (Reiss et al, 1995)

Hare’s Psychopathy Checklist - R (1985) based on Cleckley’s (1941, 1976) description Mask of Sanity Interpersonal & Affective Traits Unstable & Antisocial Lifestyle 1. Glibness/superficial charm 9. Parasitic lifestyle 2. Grandiose sense of self-worth 10. Poor behavioral controls 3. Need for stimulation 11. Promiscuous sexual behavior 4. Pathological lying 12. Early behavioral problems 5. Cunning/manipulative 13. Lack of realistic long-term goals 6. Lack of remorse or guilt 14. Impulsivity 7. Shallow affect 15. Irresponsibility 8. Callous/lack of empathy 16. Doesn’t accept respons. actions 17. Many short-term relationships 18. Juvenile delinquency

Subtypes of Psychopathy Primary (based on personality and emotion) cold, remorseless, lack of empathy, but charming seems to lack emotion and anxiety predator mentality may be more intelligent than secondary may have larger genetic component Secondary (based on behavior and lifestyle) impulsive, irresponsible, aggressive, life of crime poor emotional control may be less intelligent than primary more environmental component

Etiology – Biological Factors Genetics Serotonin hypothesis Testosterone Hypothesis Low cortical arousal hypothesis Avoidance learning deficit hypothesis

Etiology – Environmental Factors Childhood abuse Harsh or erratic parenting Chaotic family life Mother who has been convicted of crime Farrington (2006)

Gene-Environment Interaction in Anti-Social Behavior Caspi et al (2002) Science

Treatment Insight oriented treatment generally not effective Empathy training may increase ability to manipulate others SSRIs for impulsiveness and aggressiveness Early treatment may be best bet at treatment (Caldwell et al, 2006) group setting may help to learn interdependence with others Vaillant (1975): sometimes the introspection of enforced incarceration is the best therapy. Conclusion: As of now, therapy is not effective. Prevention appears to be a better option.

Rates of Violent Recidivism for Psychopaths and Nonpsychopaths Who Were Treated in the Therapeutic Community or Who Went to Prison Rice (1997 ) American Psychologist

Question of the Week There is a clear biological element to psychopathy, and we have seen evidence that children as young as seven may display genetically- based psychopathic traits. Yet psychopathy and ASPD are not considered to be mitigating factors in criminal acts whereas psychotic disorders such as schizophrenia are. Should courts take psychopathy into account when sentencing criminals? Why or why not? Movie of the Week: The Dark Knight Starring: Christian Bale Heath Ledger