Analytical Essay on Antisocial Personality Disorder: Literature Review, Criteria and Diagnosis

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Abstract

Antisocial Personality Disorder (ASPD) is a major and challenging mental health condition. Anyone suffering from ASPD shows a long-term pattern of deceitfulness, manipulating, exploiting, or violating the rights of others without any remorse. It has been quite challenging for scientists and researchers to identify the primary source of antisocial personality disorder and is yet to be identified. However, through many studies, some methods have been developed that can help with the treatment of this awful disease. With the help of researchers and scientists, methods such as. Cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), schema-focused therapy (SFT), and person-centered psychotherapy were found to be potentially helpful.

Antisocial Personality Disorder

A personality disorder is a type of mental disorder in which an individual has a rigid and defective pattern of thinking, working, and behaving. A person with a personality disorder has trouble perceiving situations and people. Antisocial personality disorder (ASPD) is a particularly challenging type of personality disorder, characterized by impulsive, irresponsible, and often unlawful behavior. Individuals with an antisocial personality disorder will typically be manipulative, deceitful, reckless, and don’t care for other people’s feelings. ASPD has several symptoms that fall under different criteria, some of the major symptoms include hostility, severe irritability, anger, aggression, or violence. The long-term effects of this disorder can be agonizing and can lead to physical violence and criminal activities. An antisocial personality disorder is not the correct classification associated with long-term lasting behavior patterns of ASPD. It does not mean shy, introverted, loner, or quiet. The “social” in antisocial refers to social norms and regulations. Individuals diagnosed with ASPD have no regard for the rules, norms, and laws of their society. This disorder is one of the most socially destructive personality disorders given its mutuality with serious conduct problems, violence, and crime. It is important to mention that psychopathy, sociopathy, and dissocial personality disorder are formally categorized as an antisocial personality disorders in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). The precise source of antisocial personality disorder is yet to be discovered. However, through different research methods, it can be treated to some degree. Researchers have found team therapy to be one of the most effective treatment options.

Literature Review

According to the American Psychiatric Association and diagnostic and statistical manual of disorders, fifth edition (DSM-5). An individual must be at least 18 years of age and have proof of conduct disorder (CD) with onset before the age of 15 to satisfy diagnosis criteria. However, Matt DeLisi from Iowa State University along with Alan J.Drury and Michael J. Elbert from U.S. Probation and Pretrial Services, United States of America analyzed archival data from the total population of 865 active correctional clients in a federal jurisdiction in the Midwestern United States. They discovered that mental or physical abuse in childhood life can start the development of ASPD in individuals from an early age. They manually collected additional data from presentence reports (PSR), offender documents from the Bureau of Prisons, local, state, national criminal histories, psychological and psychiatric reports. They discovered that greater adverse childhood experiences were linked with ASPD diagnosis and physical abuse showing associations with ASPD symptoms and sexual abuse with lifetime diagnosis for ASPD. What is even more interesting is that symptoms were not significantly associated with traumatic childhood experiences. In contrast, adverse childhood experiences were significantly associated with a formal diagnosis for ASPD (DeLisi, Drury, & Elbert 2019). An antisocial personality disorder is a severe disorder with robust associations with crime and violence and in order to diagnose and find a cure, it is crucial to get to the root of the problem.

Researchers and scientists have found similar symptoms in conduct disorder (CD), sociopathy, and psychopathy, and ASPD. This explains why individuals must have proof of conduct disorder (CD) before the age of 15 to get diagnosed with ASPD. The primary source of ASPD has been very challenging and has not been identified. The diagnosis itself is very controversial, evidence for treatment is rare; and, in contrast to other personality disorders, patients with ASPD reject rather than seek treatment. However, experts unanimously argued against the judgment that treatment is not possible. Fortunately, the International Journal of Law and Psychiatry searching for a solution for this problem, through literature search and a Delphi-study method, they discovered effective treatment methods for ASPD. Cognitive-behavioral therapy (CBT), dialectical behavioral therapy (DBT), schema-focused therapy (SFT), person-centered psychotherapy, client-centered psychotherapy, psychodynamic psychotherapy, and mentalization-based treatment (MBT) was found to be potentially effective treatment options. CBT is one of the effective methods, compared to Treatment as Usual (TAU). The group treated with CBT showed a small, non-significant improvement in social functioning and physical aggression reduction relative to TAU, but there were no changes in anger or verbal aggression (Bosch, Rijckmans, Decoene, Chapman, 2018). Although these treatment methods are not a complete cure for ASPD, they still help with reducing symptoms of ASPD, partially cure the individual. And more importantly, help with the development of new treatment methods in the future.

Criteria and Diagnosis

The essential features of antisocial personality disorder are failure to social norms, deceitfulness, impulsive, reckless, lack of remorse, and violating the law that begins in childhood or early adolescence and continues into adulthood. Patterns of antisocial personality disorder have also been referred to as psychopathy, sociopathy, or dissocial personality disorder. ASPD falls under a wide spectrum and has many criteria. Age and past experiences are a major criterion in diagnosis with ASPD, an individual must be 18 years of age (Criterion B) with symptoms of conduct disorder prior to the age of 15 (Criterion C). It is difficult to identify individuals with APD and at the same time they can turn someone’s world upside down based on what they want. They can display innocence and may even try to impress someone by displaying a glib, superficial charm, and can be verbally facile (DSM5 2013). There is a total of 10 criteria to be met in order to get diagnosed with an antisocial personality disorder.

Criterion B individuals must be 18 years of age.
Criterion C symptoms of conduct disorder before the age of 15.
Criterion A1 failure to conform to social norms with respect to lawful behavior.
Criterion A2 frequently deceitful and manipulative in order to gain personal profit or pleasure.
Criterion A3 impulsivity may be manifested by failure to plan ahead.
Criterion A4 repeatedly getting into fights or committing acts of physical assault.
Criterion A5 displaying a reckless disregard for the safety of themselves or others.
Criterion A6 consistently and extremely irresponsible.
Criterion A7 financial irresponsibility.
Criterion D antisocial behavior must not occur exclusively during the course of schizophrenia or bipolar disorder.

Related Disorders

Antisocial personality disorder symptoms show a correlation with other disorders and conditions. ASPD falls into 10 criteria and all of the criteria should meet in order to get diagnosed. Anything that fails to meet any of the criteria of ASPD, falls under some other related disorder along the borderline of antisocial personality disorder. ASPD may be confused with other personality disorders because of certain similarities. For example, when both, antisocial behavior and substance use disorder began in childhood and continued into adulthood, both a substance use disorder and antisocial personality disorder should be diagnosed if the criteria for both are met, even though some antisocial acts may be a consequence of the substance use disorder (DSM-5 2013). As has been previously mentioned, an antisocial personality disorder is not the correct classification associated with long-term lasting behavior patterns of ASPD. Therefore, it is very important to distinguish among these disorders based on differences in their characteristic features. Some related disorders to ASPD could be substance use disorder, schizophrenia and bipolar disorders, and other personality disorders.

Prevalence

According to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, twelve-month prevalence rates of antisocial personality are between 0.2% and 3.3%. The highest prevalence of ASPD is amongst severe samples of males with alcohol use disorder and from substance abuse clinics, prisons, or other forensic settings. Males are more prone to ASPD than females, but there is some concern that ASPD may be underdiagnosed in females. The prevalence of ASPD is also higher in those affected by adverse socioeconomic and sociocultural settings (DSM-5 2019). This puts nations that are poor and those who flee their country or forced out of their land are at a higher risk for developing ASPD. As per the assessment of DeLisi, Drury, & Elbert on ASPD concluded that greater adverse childhood experiences were linked with ASPD diagnosis and physical abuse showing associations with ASPD symptoms and sexual abuse with lifetime diagnosis for ASPD (DeLisi, Drury, & Elbert 2019). Children who had a tough childhood experience, who underwent physical or mental abuse are prone to suffer from ASPD.

Treatment Options

Antisocial personality disorder has been a particularly challenging type of personality disorder. For anyone to be diagnosed with ASPD must be at least 18 years of age and has previously shown signs of conduct disorder before the age of 15. Treatment options vary depending on the individual’s condition. Researchers found behavioral therapy more effective rather than the use of medical interventions. It is important to be aware that ASPD patients often see the environment as their enemy and avoid being vulnerable to therapists, thus, it takes time to form a working alliance with them (Bosch, Rijckmans, Decoene, Chapman, 2018). Even though there is a lack of empirical evidence for the effective treatment of ASPD, literature and practice-based data generated in the Delphi study provided a sufficient basis for the development of coherent mental healthcare resources for patients suffering from ASPD. With the help of Delphi study, experts concluded that treatment by a team is more useful and also necessary from a safety perspective. They also highlighted another benefit of the team approach; namely, that a team can help fill essential interdisciplinary roles in therapy. These roles have to be clear, especially in a team in which all boundaries are put to the test. It can also enable split treatment, such as delivering different treatment methods such as individual vs. group therapy, which has proven effective in the treatment of other disorders such as SFT, DBT, and MBT (Bosch, Rijckmans, Decoene, Chapman, 2018).

Conclusion

The antisocial personality disorder is a high-risk and serious disorder that can start from childhood and continue through adulthood. Individuals affected by this mental disorder are classified as dangerous, impulsive, irresponsible, and deceitful. They constantly engage in unlawful activities and show a lack of remorse. Antisocial personality is more common in males than in females and falls on a large spectrum from easy, mild to severe and serious symptoms. It also has shown a correlation with other related disorders and conditions such as psychopathy, sociopathy, and dissocial personality. Two main criteria for ASPD diagnosis are at least 18 years of age and proof of conduct disorder before the age of 15. Although the precise source of this disorder remains unknown, despite its difficulty, researchers from around the world have discovered effective methods of decreasing symptoms of ASPD that will help individuals suffering to some degree.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Association.
Apeldoorn, Deventer, Breda, Tilburg, Brussel, Fraser (2018). Treatment of antisocial personality disorder: Development of a practice-focused framework, Science Direct, 58, 72-78 DOI: 10.1016/j.ijlp.2018.03.002
DeLisi, Matt, Drury, Alan J., & Elbert, Micheal J. (2019). The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Science Direct, 92, 1-6. DOI: 10.1016/j.comppsych.2019.04.001

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