PERSONALITY DISORDERS

Antisocial Personality Disorder

What is Antisocial Personality Disorder?

Antisocial Personality Disorder (ASPD) refers to a pattern of disregard for, and violation of, the rights of others. This pattern is observable during childhood or early adolescence (specifically, occurring since 15 years of age) and continues into adulthood. An individual with ASPD may exhibit some the following symptoms:

Ψ A failure to conform to social norms with respect to lawful behaviors (e.g., repeatedly performing acts that are grounds for arrest)
Ψ Deceitfulness (e.g., repeated lying, use of aliases, or conning others for personal profit or pleasure)
Ψ Impulsivity or failure to plan ahead
Ψ Irritability and aggressiveness (e.g., repeated physical fights or assaults)
Ψ Reckless disregard for the the safety of self or others
Ψ Consistent irresponsibility (e.g., repeated failure to sustain consistent work behavior or honor financial obligations)
Ψ Lack of remorse (e.g., being indifferent to or rationalizing having hurt, mistreated or stolen from another)

What are some characteristics associated with ASPD?

With these symptoms in sight, people with ASPD often come across as having a lack of empathy. They tend to be callous, cynical, and contemptuous of the feelings, rights, and suffering of others. They may also appear arrogant, with this manifesting in the feeling that ordinary work is beneath them, or lacking realistic concerns about their current problems or future. They also tend to appear irresponsible and exploitative in their sexual relationships. That said, some may also display a glib, superficial charm and can appear to be good with words.

Causes of ASPD

Like many other disorders, there is no single, contributing cause to ASPD. However, what researchers can agree upon is that ASPD is brought about by a combination of genetic and environmental risk factors.

Genetic factors:

Ψ Inheritance of a risk MAOA allele, with the MAOA gene being responsible for regulating behavior. Inheriting the risk allele would imply a lowered ability for regulating behavior, hence making an individual more susceptible to expressing symptoms of ASPD. This gene was found to be moderately heritable.
Ψ Twin and adoption studies have shown a moderate heritability for antisocial and criminal behavior, though it is unclear what exactly is inherited.

Environmental factors:

Ψ One’s family plays a role in contributing to the presence of ASPD, with poor parental supervision, parental conflict, harsh parental discipline, and neglect increasing the risk of developing ASPD.
Ψ Association with delinquent peers and siblings are also known to contribute to the presence of ASPD.
Ψ Physical or sexual abuse and neglect are also associated with ASPD.

Addressing ASPD

Given the heavy consequences that ASPD brings onto one and the people around them, much research has been geared into investigating possible therapy options for individuals with ASPD. ASPD is generally challenging to address and prognosis can be poor. In addition, individuals with ASPD often do not voluntarily seek help for their condition, unless it is mandated. They often exhibit a low capacity for remorse and do not see the costs associated with their antisocial acts. As a result, they might find therapy unnecessary.  

This certainly does not mean that all hope is lost though! The success of therapy depends on a variety of factors, such as each person’s situation, their willingness to participate in therapy, and the severity of their symptoms. Therapy options include cognitive-behavioral therapy (CBT), schema therapy, and family therapy.

Cognitive-behavioral therapy (CBT) 

CBT is aimed at correcting an individual’s negative thoughts and behaviors, and replacing them with more positive/prosocial ones. In the case of ASPD, this therapy would be more effective if the individual is motivated to change and if therapy is used in a milieu setting. Therapy response tends to be most predictable in individuals who normatively respond to aversive consequences and who have felt the emotional and practical pain of their antisocial behaviors.

Schema therapy 

While it is similar to CBT, schema therapy focuses more on exploring the childhood origins of psychological problems, experiential techniques, building a therapist-client relationship, and correcting maladaptive coping styles. Individuals with ASPD tend to hold rigid, maladaptive schemas associated with aggression, mistrust/abuse, and emotional inhibition, with these arising as a result of unmet needs in early childhood. Therefore, therapy makes use of two strategies – limited reparenting and empathic confrontation – to build a therapeutic rapport with the client. Limited reparenting involves showing empathic attitudes and behaviors on the psychologist’s part, whereas empathic confrontation involves a balance between expressing empathy and getting the client to realize how their maladaptive schemas lead to negative consequences.

Family therapy  

Given the large role that family plays in contributing to the presence of ASPD, family therapy is a good complement to the individual therapy modalities mentioned above. Family therapy helps individuals with ASPD realize the consequences that their behaviors bring to their loved ones, hence improving understanding among family members of people with ASPD. Another key focus is on ensuring the physical, economic, and emotional safety of family members. This can be achieved by addressing the client’s difficulties in various facets of their lives - maintaining an enduring relationship with their spouse/partner, parenting and responsibility, as well as their anger and hostility that could lead to domestic violence.

Caring for someone with ASPD

Indeed, it is no easy feat taking care of a loved one with ASPD. In the process of doing so, don’t be afraid to seek help for yourself when the need arises. In such cases, therapies would be aimed at teaching you coping strategies and skills regarding boundary setting, as well as protecting yourself from the aggression, violence, and anger common to ASPD.