Antisocial Personality Disorder alternately: Psychopathic personality Sociopathic personality

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Antisocial Personality Disorder(alternately
Psychopathic personality Sociopathic personality)

• DSM-IV

Axis II, Cluster B
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History of this Disorder

• Evans Pritchard (1835)
• Koch (1949)
• DSM-I (1953)
• DSM-III (1987)

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Facts Factors

• Estimated affected percentage of the population
• Cause is unknown
• Genetic factors
• Environmental factors (abuse, neglect)
• This condition is commonly seen in prisons

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Requirements for Diagnosis

• The individuals behavior must differ
  significantly from the norms dictated by their
  society, in all or most situation.
• The condition must be traceable to early
  adolescence
• The condition cannot be the result of chemical
  impairment

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Red-Light Behaviors

• Disregard for the safety of self or others
• Manipulation of others emotions for personal
  gain, especially manifested in unfounded claims
  of victimization.
• Extreme anger and arrogance

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Criteria for Diagnosis

• Patient must be at least 18 years old
• Time limitations
• At least four of the following behaviors must
  have occurred since age 18
• Poor job performance
• 1 felony conviction OR 3 arrests
• 2 separations from partners, or 2 divorces
• Persistent participation in physical fights
• Failure to honor financial obligations
• Transient traveling
• Extreme recklessness
• Repeated deception of others
• Failure to conform to social norms
• Lack of remorse

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Criteria / Diagnosis

• All symptomatic behaviors are graded on a five
  point Likert scale
• 1 absent
• 2 subthreshold
• 3 threshold
• 4 above threshold
• 5 prototypic

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Concurrent Disorders

• Anxiety disorders
• Depressive Disorders
• Substance Related disorders
• Pathological gambling/any impulse disorders

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Precursor Diagnosis

• Oppositional Defiant Disorder
• Present prior to age 15
• Characterized by
• Persistent truancy
• Expulsion or suspension from school as a result
  of poor behavior
• Delinquency (defined as arrested or referred to
  juvenile court because of behavior Diag. Crit.)
• Running away at least twice from parental or
  parental surrogate home
• Persistent lying
• Promiscuity (casual sexual relationships)
• Repeated alcohol or substance abuse problems
• Stealing
• Vandalizing
• School performance dramatically inconsistent with
  IQ
• Chronic violations of rules at home and/or at
  school
• Initiation of fights

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Precursor/Differential Diagnosis

• Conduct Disorder
• Past age 18
• Characterized
• Non-aggressive/aggressive
• Physical violence
• Confrontive theft
• Violating major appropriate social norms
• Persistent runaway behavior
• Lying
• Nonconfrontational stealing
• Substance abuse
• Undersocialized/socialized
• One friendship that has lasted 6 months
• Shows consideration for someone else- not for
  personal gain
• Refuses to tell on friends
• Shows guilt that is not prompted for
• Shows concern for others

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Treatment

• First priority- getting the client into therapy,
  and meaningfully involved
• Institutionalization has proven effective, but
  without the structure of an institution it is
  difficult to manage APD
• The goal of therapy is to work with APD clients
  to redirect behavior in less self-destructive
  ways activities with high levels of activity and
  simulation are helpful

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Prognosis

• Symptoms often peak in the clients 20s
• Impact on parenting behavior
• Symptoms tend to fade by the 40s

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References