Transcript Antisocial Personality Disorder

Antisocial Personality Disorder
Profiling Psychopathology
Dr. Kline
FSU-PC
Summer 2004
What is a personality Disorder?
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Is a long-standing, pervasive, & inflexible pattern of
behavior.
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Usually impairs social & occupational functioning.
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Personality disorders comprise all disorders in the
Axis II of the DSM & these are often comorbid with
other Axis I disorders (substance use, depression,
etc.)
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Presence of personality disorders complicate
treatment of other Axis I disorders
What is an Antisocial Personality
Disorder (APD)?
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Two major criteria:
1. The presence of a conduct disorder before
the age of 15. Symptoms include: truancy;
running away from home, theft, compulsive
lying, arson, & vandalism.
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2. The continuation of this pattern of
antisocial behavior into adulthood.
DSM-IV-TR Diagnostic Criteria for APD:
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Pervasive pattern of disregard for the rights of others since age 15
& at least 3 of the characteristics 1 through 7 . Eight through 10
must be present for diagnosis.
1. Repeated law-breaking**Core symptom**
2. Deceitfulness; lying
3. Impulsivity
4. Irritableness & aggressiveness
5. Reckless disregard for own safety & that of others.
6. Irresponsibility as seen in unreliable employment history or
not meeting financial obligations.
7. Lack of remorse***not necessary for diagnosis***
8. Age at least 18
9. Evidence of conduct disorder before age 15.
10. Antisocial behavior not occurring exclusively during episodes
of schizophrenia or mania.
What % of conduct disordered youth
become Antisocial Personality Disorders in
adulthood?
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Roughly 60% of children with conduct
disorder develop APD into adulthood
(Myers, Stewart, & Brown, 1998).
What is general profile of person with
Antisocial Personality Disorder?
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Individual:
Irresponsible
Criminality
Displays antisocial behavior (sketchy work
history, illegal activities, irritability)
Physically aggressive and violent
Has financial problems (defaults on debts)
Reckless & impulsive behavior
May be promiscuous
May lack remorse or show little regard for truth
Prevalence of APD
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Effects 3% of males; 1% of females in U.S.
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Rates may be higher among younger adults than
older adults.
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Disorder is more common in people of low SES.
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Comorbidity is high with other personality
disorders (e.g., narcissistic PD) as well as other
Axis I disorders (substance use).
What is the difference between APD
and psychopathy?
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Major distinction appears to be in
symptomatology.
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“Lack of remorse,” a core symptom of
psychopathy, is not required for diagnosis of APD.
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In one study, 75 to 80% of convicted felons met
criteria for APD, but failed to meet criteria for
psychopathy.
Problems with diagnosing APD:
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1. One major criticism centers around method by
which diagnosis is made.
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An APD diagnosis relies on reports of patient’s past
life events. Since these people are often pathological
liars, how can we verify their claims???
**This is especially problematic—when family
members are deceased.***
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2. Many psychologists argue that a diagnostic
concept in the field of psychopathology shouldn’t be
linked with criminality.
What is Psychopathy?
Core features– Psychopaths lack remorse
– Poverty of emotions (positive & negative)
Psychopaths are:
Superficially charming
Pathological liars & cheaters
Impulsive; sensations seekers
Manipulative, will change story to fit facts
Less responsive to fear/anxiety
Immoral
Occurs predominantly in men!!!
Psychopaths identified by Hare checklist
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Two clusters:
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1. Emotional detachment cluster (a
selfish remorseless individual with inflated
self-esteem who exploits others.)
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2. Antisocial lifestyle cluster- marked by
impulsivity & irresponsibility.
Are psychopaths born or made?
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Most likely there are components of both
that account for the development of full
fledged psychopathy.
Putative causes of APD &
psychopathy?
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1. Family
McCord & McCord (1964) concluded that lack
of affection & severe parental rejection may be
primary causes of psychopathic behavior.
Other suspected family related factors are:
Inconsistencies in discipline or no discipline at all,
physical abuse, marital discord, & substance use.
2. Both antisocial personalities &
criminal behavior have heritable
components.
Twin Studies:
 1. Higher concordance rate for MZ twins
than for DZ twins in APD (Lyons et al.,
1995).
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Adoption Studies:
 2. Higher rate of antisocial behavior in
adopted children of biological parents with
APD.
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3. Father’s behavior
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Fathers of psychopaths are likely to be
antisocial personalities themselves!!!!!!
4. Environmental Factors
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Environment seems to play an important role in
APD.
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It has been shown that environmental factors such
as marital problems and substance abuse) are
related to the development of APD.
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Also high levels of conflict & negativity and low
levels of parental warmth predict APD.
What’s likely to be going on?
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Child with diathesis for antisocial behavior
may be difficult to deal with & produce
environmental changes that result in harsh
conditions (treatment) by family members.
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This may fuel development of full blown
antisocial behavior.
Are psychopaths less prone to anxiety
than normal people?
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Yes!!!
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Lykken (1957) studied the ability of
psychopaths & controls to avoid shock.
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Psychopaths were poorer than controls at
avoiding the shocks, suggesting they are
low in anxiety compared to controls.
Do psychopaths show less autonomic
arousal to fear eliciting stimuli than
controls?
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Psychopaths show a pattern of autonomic activity
that suggests they “tune out” aversive stimuli.
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Their hearts beat faster than normals when
anticipating stress, but their skin conductance
levels are lower than controls in response to
aversive stimuli.
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This makes them appear underaroused when they
are not.