Antisocial personality disorder
Antisocial personality disorder (APD) is a personality disorder which is often characterised by antisocial and impulsive behaviour. APD is generally (if controversially) considered to be the same as, or similar to, the disorder that was previously known as psychopathic or sociopathic personality disorder. Approximately 3% of men and 1% of women have some form of antisocial personality disorder (source: DSM-IV).
Although criminal activity is not a necessary requirement for the diagnosis, these individuals often encounter legal difficulties due to their disregard for societal standards and the rights of others. Therefore, many of these individuals can be found in prisons. However, it should be noted that criminal activity does not automatically warrant a diagnosis of APD, nor does a diagnosis of APD imply that a person is a criminal. It is hypothesized that many high achievers exhibit APD characteristics.
Research has shown that individuals with APD are indifferent to the possibility of physical pain or many punishments, and show no indications that they experience fear when so threatened; this may explain their apparent disregard for the consequences of their actions, and their lack of empathy when others are suffering.
The recent, controversial science of sociobiology attempts to explain animal and human behavior and social structures, largely in terms of evolutionarily stable strategies. For example, in one well-known 1995 paper by Linda Mealey, chronic antisocial/criminal behavior is explained as a combination of two such strategies.
According to the psychoanalysis of Freud, a sociopath has a strong Id and ego that overpowers the Superego. The theory proposes that internalized morals of our unconscious mind are restricted from surfacing to the ego and consciousness.
Diagnostic criteria (DSM-IV-TR)
The DSM-IV-TR, a widely used manual for diagnosing mental disorders (see also:DSM cautionary statement), defines anti-social personality disorder as a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
The manual lists the following additional necessary criteria:
* The individual is at least age 18 years.
* There is evidence of Conduct Disorder with onset before age 15 years.
* The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.
Criticism of the DSM-IV criteria
The DSM-IV confound: some argue that an important differential has been lost by including both sociopathy and psychopathy together under APD. As Hare et al write in their abstract, "The Axis II Work Group of the Task Force on DSMIV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions", concluding, "... conceptual and empirical arguments exist for evaluating alternative approaches to the assessment of psychopathy. . . . our hope is that the information presented here will stimulate further research on the comparative validity of diagnostic criteria for psychopathy; although too late to influence DSMIV".
Diagnostic criteria (PCL-R test)
In contemporary research and clinical practice, APD is most commonly assessed with the Hare Psychopathy Checklist- Revised (PCL-R), which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point scale according to specific criteria through file information and a semi-structured interview. The items are as follows:
* Glibness/superficial charm
* Grandiose sense of self-worth
* Pathological lying
* Lack of remorse or guilt
* Shallow affect
* Callous/lack of empathy
* Failure to accept responsibility for own actions
* Need for stimulation/-proneness to boredom
* Parasitic lifestyle
* Poor behavioral controls
* Early behavioral problems
* Lack of realistic, long-term goals
* Juvenile delinquency
* Revocation of conditional release
* Promiscuous sexual behavior
* Many short-term marital relationships
* Criminal versatility
Score 0 if the trait is absent, 1 if it is possibly or partially present and 2 if it is present. The item scores are summed to yield a total score ranging from 0 to 40 which is then considered to reflect the degree to which they resemble the prototypical psychopath. A score higher than 30 supports a diagnosis of psychopathy. Forensic studies of prison populations have reported average scores of around 22 on PCL-R; control "normal" populations show an average score of around 5.
A note of caution: the test must be administered by a trained mental health practitioner under controlled conditions for it to have any validity.
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