Antisocial personality disorder

Short description: Personality disorder characterized by a long-term pattern of disregard for, or violation of, the rights of others

Antisocial personality disorder

Other names| Dissocial personality disorder (DPD), sociopathy
Specialty| Psychiatry
Symptoms| Pervasive deviance, deception, impulsivity, irritability, aggression, recklessness, and callous and unemotional traits
Usual onset| Childhood or early adolescence[1]
Duration| Long term[2]
Risk factors| Family history, poverty[2]
Differential diagnosis| Conduct disorder, Narcissistic personality disorder, Substance use disorder, bipolar disorder, borderline personality disorder, schizophrenia, criminal behavior[2]
Frequency| 1.8% during a year[2]
Personality disorders

Cluster A (odd)

* Paranoid
* Schizoid
* Schizotypal

Cluster B (dramatic)

* Antisocial
* Borderline
* Histrionic
* Narcissistic

Cluster C (anxious)

* Avoidant
* Dependent
* Obsessive–compulsive

Not specified

* Depressive
* Haltlose
* Passive–aggressive
* Sadistic
* Self-defeating
* Psychopathic

* v
* t
* e

Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterized by a long-term pattern of disregard for, or violation of, the rights of others. A weak or nonexistent conscience is often apparent, as well as a history of legal problems or impulsive and aggressive behaviour.[3][4]

Antisocial personality disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), while the equivalent concept of dissocial personality disorder (DPD) is defined in the International Statistical Classification of Diseases and Related Health Problems (ICD); the primary theoretical distinction between the two is that antisocial personality disorder focuses on observable behaviours, while dissocial personality disorder focuses on affective deficits.[5] Otherwise, both manuals provide similar criteria for diagnosing the disorder.[6] Both have also stated that their diagnoses have been referred to, or include what is referred to, as psychopathy or sociopathy. However, some researchers have drawn distinctions between the concepts of antisocial personality disorder and psychopathy, with many researchers arguing that psychopathy is a disorder that overlaps with but is distinguishable from ASPD.[7][8][9][10][11]

## Contents

* 1 Signs and symptoms
* 1.1 Conduct disorder
* 1.2 Comorbidity
* 2 Causes
* 2.1 Genetic
* 2.2 Physiological
* 2.2.1 Hormones and neurotransmitters
* 2.2.2 Neurological
* 2.3 Environmental
* 2.3.1 Family environment
* 2.3.2 Cultural influences
* 2.4 ICD-10
* 2.5 Psychopathy
* 2.6 Other
* 3 Treatment
* 4 Prognosis
* 5 Epidemiology
* 6 History
* 7 See also
* 8 References
* 9 Further reading
* 10 External links

## Signs and symptoms

Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others.[3] Individuals with this personality disorder will typically have no compunction in exploiting others in harmful ways for their own gain or pleasure and frequently manipulate and deceive other people. While some do so through a facade of superficial charm, others do so through intimidation and violence.[12] They may display arrogance, think lowly and negatively of others, and lack remorse for their harmful actions and have a callous attitude to those they have harmed.[3][4] Irresponsibility is a core characteristic of this disorder; most have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations, and people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.[3][4][13][14]

Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardize their own safety and the safety of others, which can place both themselves and other people in danger.[3][4][15] They are often aggressive and hostile, with poorly regulated tempers, and can lash out violently with provocation or frustration.[3][14] Individuals are prone to substance use disorders and addiction, and the non-medical use of various psychoactive substances is common in this population. These behaviors lead such individuals into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behavior and criminal infractions stemming back to adolescence or childhood.[3][4][13][14]

Serious problems with interpersonal relationships are often seen in those with the disorder. People with antisocial personality disorder usually form poor attachments and emotional bonds, and interpersonal relationships often revolve around the exploitation and abuse of others.[3] They may have difficulties in sustaining and maintaining relationships, and some have difficulty entering them.[13]

### Conduct disorder

Main page: Medicine:Conduct disorder

While antisocial personality disorder is a mental disorder diagnosed in adulthood, it has its precedent in childhood.[16] The DSM-5's criteria for ASPD require that the individual have conduct problems evident by the age of 15.[12] Persistent antisocial behavior, as well as a lack of regard for others in childhood and adolescence, is known as conduct disorder and is the precursor of ASPD.[17] About 25–40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.[18]

Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD and is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. Children with the disorder often display impulsive and aggressive behavior, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism or get into fights with other children and adults.[19] This behavior is typically persistent and may be difficult to deter with threat or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population, and children with the disorder may also engage in substance use.[20][21] CD is differentiated from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, and property, though many children diagnosed with ODD are subsequently rediagnosed with CD.[22]

Two developmental courses for CD have been identified based on the age at which the symptoms become present. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of aggression and violence.[23] The second is known as the "adolescent-onset type" and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood.[24] In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood-onset subtype, especially if callous and unemotional traits are present, tends to have a worse treatment outcome.[25]

### Comorbidity

ASPD commonly coexists with the following conditions:[26]

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[27] Alcohol Use Disorder is likely caused by lack of impulse and behavioral control exhibited by Antisocial Personality Disorder patients.[28] The rates of ASPD tends to be around 40-50% in male alcohol and opiate addicts.[29] However, it is important to remember this is not a causal relationship, but rather a plausible consequence of cognitive deficits as a result of ASPD.

## Causes

Personality disorders are seen to be caused by a combination and interaction of genetic and environmental influences.[30] Genetically, it is the intrinsic temperamental tendencies as determined by their genetically influenced physiology, and environmentally, it is the social and cultural experiences of a person in childhood and adolescence encompassing their family dynamics, peer influences, and social values.[3] People with an antisocial or alcoholic parent are considered to be at higher risk. Fire-setting and cruelty to animals during childhood are also linked to the development of antisocial personality. The condition is more common in males than in females, and among people who are in prison.[30][12]

### Genetic

Research into genetic associations in antisocial personality disorder suggests that ASPD has some or even a strong genetic basis. Prevalence of ASPD is higher in people related to someone afflicted by the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behavior and conduct disorder.[31]

In the specific genes that may be involved, one gene that has seen particular interest in its correlation with antisocial behavior is the gene that encodes for Monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norephinephrine. Various studies examining the genes' relationship to behavior have suggested that variants of the gene that results in less MAO-A being produced, such as the 2R and 3R alleles of the promoter region, have associations with aggressive behavior in men.[32][33] The association is also influenced by negative experience in early life, with children possessing a low-activity variant (MAOA-L) who experience such maltreatment being more likely to develop antisocial behavior than those with the high-activity variant (MAOA-H).[34][35] Even when environmental interactions (e.g. emotional abuse) are controlled for, a small association between MAOA-L and aggressive and antisocial behavior remains.[36]

The gene that encodes for the serotonin transporter (SCL6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behavior and personality traits. Genetic associations studies have suggested that the short "S" allele is associated with impulsive antisocial behavior and ASPD in the inmate population.[37] However, research into psychopathy find that the long "L" allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e.g. lack of empathy, fearlessness) and interpersonal (e.g. grandiosity, manipulativeness) personality disturbances.[38] This is suggestive of two different forms, one associated more with impulsive behavior and emotional dysregulation, and the other with predatory aggression and affective disturbance, of the disorder.[39]

Various other gene candidates for ASPD have been identified by a genome-wide association study published in 2016. Several of these gene candidates are shared with attention-deficit hyperactivity disorder, with which ASPD is comorbid. Furthermore, the study found that those who carry 4 mutations on chromosome 6 are 1.5 times more likely to develop antisocial personality disorder than those who do not.[40]

### Physiological

#### Hormones and neurotransmitters

Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development.[41] Aggressiveness and impulsivity are among the possible symptoms of ASPD. Testosterone is a hormone that plays an important role in aggressiveness in the brain.[42] For instance, criminals who have committed violent crimes tend to have higher levels of testosterone than the average person.[43][citation needed] The effect of testosterone is counteracted by cortisol which facilitates the cognitive control of impulsive tendencies.[44]

One of the neurotransmitters that has been discussed in individuals with ASPD is serotonin, also known as 5HT.[41] A meta-analysis of 20 studies found significantly lower 5-HIAA levels (indicating lower serotonin levels), especially in those who are younger than 30 years of age.[45]

While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5HT metabolism, but may be the most essential psychopathological aspect linked with such dysfunction.[46] Correspondingly, the DSM classifies "impulsivity or failure to plan ahead" and "irritability and aggressiveness" as two of seven sub-criteria in category A of the diagnostic criteria of ASPD.[47][12]

Some studies have found a relationship between monoamine oxidase A and antisocial behavior, including conduct disorder and symptoms of adult ASPD, in maltreated children.[48]

#### Neurological

Antisocial behavior may be related to head trauma.[49] Antisocial behavior is associated with decreased grey matter in the right lentiform nucleus, left insula, and frontopolar cortex. Increased volumes have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post central cortex.[50]

Intellectual and cognitive ability is consistently found to be impaired or reduced in the ASPD population.[51] Contrary to stereotypes in popular culture of the "psychopathic genius", antisocial personality disorder is associated with both reduced overall intelligence and specific reductions in individual aspects of cognitive ability.[51][52] These deficits also occur in general-population samples of people with antisocial traits[53] and in children with the precursors to antisocial personality disorder.[54]

People that exhibit antisocial behavior demonstrate decreased activity in the prefrontal cortex. The association is more apparent in functional neuroimaging as opposed to structural neuroimaging.[55] The prefrontal cortex is involved in many executive functions, including behavior inhibitions, planning ahead, determining consequences of action, and differentiating between right and wrong. However, some investigators have questioned whether the reduced volume in prefrontal regions is associated with antisocial personality disorder, or whether they result from co-morbid disorders, such as substance use disorder or childhood maltreatment.[56] Moreover, it remains an open question whether the relationship is causal, i.e., whether the anatomical abnormality causes the psychological and behavioral abnormality, or vice versa.[56]

Cavum septi pellucidi (CSP) is a marker for limbic neural maldevelopment, and its presence has been loosely associated with certain mental disorders, such as schizophrenia and post-traumatic stress disorder.[57][58][59] One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.[59]

### Environmental

#### Family environment

Many studies suggest that the social and home environment has contributed to the development of antisocial behavior.[41] The parents of these children have been shown to display antisocial behavior, which could be adopted by their children.[41] A lack of parental stimulation and affection during early development leads to high levels of cortisol with the absence of balancing hormones such as oxytocin which disrupts and overloads the child's stress response systems, which is thought to lead to underdevelopment of the child's brain that deals with emotion, empathy and ability to connect to other humans on an emotional level. According to Dr. Bruce Perry in his book The Boy Who Was Raised as a Dog, "the [infant's developing] brain needs patterned, repetitive stimuli to develop properly. Spastic, unpredictable relief from fear, loneliness, discomfort, and hunger keeps a baby's stress system on high alert. An environment of intermittent care punctuated by total abandonment may be the worst of all worlds for a child."[60]

#### Cultural influences

The sociocultural perspective of clinical psychology views disorders as influenced by cultural aspects; since cultural norms differ significantly, mental disorders such as ASPD are viewed differently.[61] Robert D. Hare has suggested that the rise in ASPD that has been reported in the United States may be linked to changes in cultural mores, the latter serving to validate the behavioral tendencies of many individuals with ASPD.[62]:136 While the rise reported may be in part merely a byproduct of the widening use (and abuse) of diagnostic techniques,[63] given Eric Berne's division between individuals with active and latent ASPD – the latter keeping themselves in check by attachment to an external source of control like the law, traditional standards, or religion[64] – it has been suggested that the erosion of collective standards may indeed serve to release the individual with latent ASPD from their previously prosocial behavior.[62]:136–7

There is also a continuous debate as to the extent to which the legal system should be involved in the identification and admittance of patients with preliminary symptoms of ASPD.[65] Controversial clinical psychiatrist Pierre-Édouard Carbonneau suggested that the problem with legal forced admittance is the rate of failure when diagnosing ASPD. He states that the possibility of diagnosing and coercing a patient into prescribing medication to someone without ASPD, but is diagnosed with it could be potentially disastrous, but the possibility of not diagnosing it and seeing a patient go untreated because of a lack of sufficient evidence of cultural or environmental influences is something a psychiatrist must ignore, and in his words, "play it safe".[66]

### ICD-10

The WHO's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), has a diagnosis called dissocial personality disorder (F60.2):[67][68]

It is characterized by at least 3 of the following:

1. Callous unconcern for the feelings of others;
2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
5. Incapacity to experience guilt or to profit from experience, particularly punishment;
6. Marked readiness to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.

The ICD states that this diagnosis includes "amoral, antisocial, asocial, psychopathic, and sociopathic personality". Although the disorder is not synonymous with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature.[68][69]

It is a requirement of the ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.[68]

### Psychopathy

Main page: Medicine:Psychopathy

Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls.[11][70][71][72] Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL-R).[73] "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy.[11][67][72][74][75]

American psychiatrist Hervey Cleckley's work[76] on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy.[7][11] However, critics argue ASPD is not synonymous with psychopathy as the diagnostic criteria are not the same, since criteria relating to personality traits are emphasized relatively less in the former. These differences exist in part because it was believed such traits were difficult to measure reliably and it was "easier to agree on the behaviors that typify a disorder than on the reasons why they occur".[7][8][9][10][11]

Although the diagnosis of ASPD covers two to three times as many prisoners than the diagnosis of psychopathy, Robert Hare believes the PCL-R is better able to predict future criminality, violence, and recidivism than a diagnosis of ASPD.[7][8] He suggests there are differences between PCL-R-diagnosed psychopaths and non-psychopaths on "processing and use of linguistic and emotional information", while such differences are potentially smaller between those diagnosed with ASPD and without.[8][9] Additionally, Hare argued confusion regarding how to diagnose ASPD, confusion regarding the difference between ASPD and psychopathy, as well as the differing future prognoses regarding recidivism and treatability, may have serious consequences in settings such as court cases where psychopathy is often seen as aggravating the crime.[8][9]

Nonetheless, psychopathy has been proposed as a specifier under an alternative model for ASPD. In the DSM-5, under "Alternative DSM-5 Model for Personality Disorders", ASPD with psychopathic features is described as characterized by "a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviors (e.g., fraudulence)." Low levels of withdrawal and high levels of attention-seeking combined with low anxiety are associated with "social potency" and "stress immunity" in psychopathy.[19]:765 Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components.[77]

### Other

Theodore Millon suggested 5 subtypes of ASPD.[78][79] However, these constructs are not recognized in the DSM and ICD.

Subtype  | Features

|

Nomadic antisocial (including schizoid and avoidant features)  | Drifters; roamers, vagrants; adventurer, itinerant vagabonds, tramps, wanderers; they typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility.
Malevolent antisocial (including sadistic and paranoid features)  | Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals, including serial killers.
Covetous antisocial (including negativistic features)  | Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having.
Risk-taking antisocial (including histrionic features)  | Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures.
Reputation-defending antisocial (including narcissistic features)  | Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights.

Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk-taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special ... Taxonomies may be put forward at levels that are more coarse or more fine-grained."[62]:223

## Treatment

ASPD is considered to be among the most difficult personality disorders to treat.[80][81][verification needed][82] Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community.[83] Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.[80] They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment.[84][verification needed] Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.[85]

Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment.[86] Those with ASPD may stay in treatment only as required by an external source, such as parole conditions.[82][verification needed] Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended.[80] There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.[87] Psychotherapy also known as talk therapy is found to help treat patients with ASPD.[88]Schema therapy is also being investigated as a treatment for ASPD.[89] A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However, this treatment requires complete cooperation and participation of all family members.[90] Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use,[91] although others have reported contradictory findings.[92]

Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors.[80] Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of even this form of therapy.[93]

The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD.[94] A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD.[95] Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.[citation needed][96][97]

## Prognosis

According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores and reading problems.[98] The strongest relationship between these variables and ASPD are childhood hyperactivity and conduct disorder. Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD.[99][100] Like many disorders, genetics play a role in this disorder but the environment holds an undeniable role in its development.

Boys are twice as likely to meet all of the diagnostic criteria for ASPD than girls (40% versus 25%) and they will often start showing symptoms of the disorder much earlier in life.[101] Children that do not show symptoms of the disease through age 15 will not develop ASPD later in life.[101] If adults exhibit milder symptoms of ASPD, it is likely that they never met the criteria for the disorder in their childhood and were consequently never diagnosed. Overall, symptoms of ASPD tend to peak in late-teens and early twenties, but can often reduce or improve through age 40.[4]

ASPD is ultimately a lifelong disorder that has chronic consequences, though some of these can be moderated over time.[101] There may be a high variability of the long-term outlook of antisocial personality disorder. The treatment of this disorder can be successful, but it entails unique difficulties. It is unlikely to see rapid change especially when the condition is severe. In fact, past studies revealed that remission rates were small, with up to only 31% rates of improvement instead of remittance.[101] As a result of the characteristics of ASPD (e.g., displaying charm in effort of personal gain, manipulation), patients seeking treatment (mandated or otherwise) may appear to be "cured" in order to get out of treatment. According to definitions found in the DSM-5, people with ASPD can be deceitful and intimidating in their relationships.[102] When they are caught doing something wrong, they often appear to be unaffected and unemotional about the consequences.[102] Over time, continual behavior that lacks empathy and concern may lead to someone with ASPD taking advantage of the kindness of others, including his or her therapist.[102]

Without proper treatment, individuals suffering with ASPD could lead a life that brings about harm to themselves or others. This can be detrimental to their families and careers. ASPD victims suffer from lack of interpersonal skills (e.g., lack of remorse, lack of empathy, lack of emotional-processing skills).[103][104] As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide.[105][106] They also see higher rates of committed crime, reaching peaks in their late teens and often committing higher-severity crimes in their younger ages of diagnoses.[101] Comorbidity of other mental illnesses such as Depression or substance use disorder is prevalent among ASPD victims. People with ASPD are also more likely to commit homicides and other crimes.[101] Those who are imprisoned longer often see higher rates of improvement with symptoms of ASPD than others who have been imprisoned for a shorter amount of time.[101]

According to one study, aggressive tendencies show in about 72% of all male patients diagnosed with ASPD. About 29% of the men studied with ASPD also showed a prevalence of pre-meditated aggression.[107] Based on the evidence in the study, the researchers concluded that aggression in patients with ASPD is mostly impulsive, though there are some long-term evidences of pre-meditated aggressions.[107] It often occurs that those with higher psychopathic traits will exhibit the pre-meditated aggressions to those around them.[107] Over the course of a patient's life with ASPD, he or she can exhibit this aggressive behavior and harm those close to him or her.

Additionally, many people (especially adults) who have been diagnosed with ASPD become burdens to their close relatives, peers, and caretakers. Harvard Medical School recommends that time and resources be spent treating victims who have been affected by someone with ASPD, because the patient with ASPD may not respond to the administered therapies.[102] In fact, a patient with ASPD may only accept treatment when ordered by a court, which will make their course of treatment difficult and severe. Because of the challenges in treatment, the patient's family and close friends must take an active role in decisions about therapies that are offered to the patient. Ultimately, there must be a group effort to aid the long-term effects of the disorder.[108]

## Epidemiology

As seen in two North American studies and two European studies, ASPD is more commonly seen in men than in women, with men three to five times more likely to be diagnosed with ASPD than women.[109][101] The prevalence of ASPD is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. It has been found that the prevalence of ASPD among prisoners is just under 50%.[109] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) use treatment programs than in the general population, suggesting a link between ASPD and AOD use and dependence.[109][105] As part of the Epidemiological Catchment Area (ECA) study, men with ASPD were found to be three to five times more likely to excessively use alcohol and illicit substances than those men without ASPD. While ASPD occurs more often in men than women, there was found to be increased severity of this substance use in women with ASPD. In a study conducted with both men and women with ASPD, women were more likely to misuse substances compared to their male counterparts.[110][111]

Individuals with ASPD are at an elevated risk for suicide.[106] Some studies suggest this increase in suicidality is in part due to the association between suicide and symptoms or trends within ASPD, such as criminality and substance use.[112] Offspring of ASPD victims are also at risk.[113] Some research suggests that negative or traumatic experiences in childhood, perhaps as a result of the choices a parent with ASPD might make, can be a predictor of delinquency later on in the child's life.[100] Additionally, with variability between situations, children of a parent with ASPD may suffer consequences of delinquency if they're raised in an environment in which crime and violence is common.[99] Suicide is a leading cause of death among youth who display antisocial behavior, especially when mixed with delinquency. Incarceration, which could come as a consequence of actions from a victim of ASPD, is a predictor for suicide ideation in youth.[113][114]

## History

The first version of the DSM in 1952 listed sociopathic personality disturbance. This category was for individuals who were considered "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals".[115][verification needed] There were four subtypes, referred to as "reactions": antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.[116]

The DSM-II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize.[117] The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM-II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.[118]

The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up".[119] However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.[120]

The DSM-IV maintained the trend for behavioral antisocial symptoms while noting "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".[77]

## See also

## References

1. ↑ "Antisocial Personality Disorder" (in en). https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0024893/.
2. ↑ 2.0 2.1 2.2 2.3 American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 661, ISBN 978-0890425558, https://archive.org/details/diagnosticstatis0005unse/page/661
3. ↑ 3.0 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8 Mayo Clinic Staff (2 April 2016). "Overview- Antisocial personality disorder". http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/home/ovc-20198975.
4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 "Antisocial personality disorder: MedlinePlus Medical Encyclopedia". 29 July 2016. https://medlineplus.gov/ency/article/000921.htm.
5. ↑ Handbook of Psychology. John Wiley and Sons. 2003. p. 88.
6. ↑ Farrington, David P.; Coid, Jeremy (2004). Early Prevention of Adult Antisocial Behavior. Cambridge, England: Cambridge University Press. p. 82. ISBN 978-0-521-65194-3. https://books.google.com/books?id=KtXU8R8oZYwC&q=dissocial+personality+disorder&pg=PA82. Retrieved 12 January 2008.
7. ↑ 7.0 7.1 7.2 7.3 Patrick, Christopher J. (2005). Handbook of Psychopathy. Guilford Press. ISBN 9781606238042. https://books.google.com/books?id=OuNdrmHcJlgC.
8. ↑ 8.0 8.1 8.2 8.3 8.4 Hare, Robert D. (1 February 1996). "Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion". Psychiatric Times (New York City: UBM plc) 13 (2). http://www.psychiatrictimes.com/dsm-iv/content/article/10168/54831. Retrieved 19 May 2017.
9. ↑ 9.0 9.1 9.2 9.3 "Psychopathy and the DSM-IV criteria for antisocial personality disorder". Journal of Abnormal Psychology 100 (3): 391–8. August 1991. doi:10.1037/0021-843x.100.3.391. PMID 1918618. http://www.psych.utoronto.ca/~peterson/psy430s2001/Hare RD Psychopathy JAP 1991.pdf. Retrieved 19 May 2017.
10. ↑ 10.0 10.1 Semple, David; Smyth, Roger; Burns, Jonathan; Darjee, Rajan; McIntosh, Andrew (2005). The Oxford Handbook of Psychiatry. Oxford, England: Oxford University Press. pp. 448–449. ISBN 978-0-19-852783-1. https://books.google.com/books?id=1MeRuoTs0loC.
11. ↑ 11.0 11.1 11.2 11.3 11.4 "Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy". Psychological Science in the Public Interest 12 (3): 95–162. December 2011. doi:10.1177/1529100611426706. PMID 26167886. http://www.psychologicalscience.org/index.php/publications/journals/pspi/psychopathy.html.
12. ↑ 12.0 12.1 12.2 12.3 "Antisocial Personality Disorder" (in en). New York City: Sussex Publishers. https://www.psychologytoday.com/conditions/antisocial-personality-disorder.
13. ↑ 13.0 13.1 13.2 "Antisocial personality disorder". http://www.nhs.uk/conditions/antisocial-personality-disorder/Pages/Introduction.aspx.
14. ↑ 14.0 14.1 14.2 "Antisocial personality disorder: prevention and management". March 2013. https://www.nice.org.uk/guidance/cg77/chapter/Introduction.
15. ↑ "Differences Between a Psychopath vs Sociopath" (in en-US). World of Psychology. 12 February 2015. https://psychcentral.com/blog/differences-between-a-psychopath-vs-sociopath/.
16. ↑ Personality and dangerousness : genealogies of antisocial personality disorder. Cambridge, England: Cambridge University Press. 2001. ISBN 978-0521008754. OCLC 52493285.
17. ↑ Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association. 2000.
18. ↑ "The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder". Psychological Medicine (Cambridge University Press) 22 (4): 971–86. November 1992. doi:10.1017/s003329170003854x. PMID 1488492.
19. ↑ 19.0 19.1 Kupfer, David; Regier, Darrell, eds (2013). Diagnostic and Statistical Manual of Mental Disorders (5 ed.). Washington, DC: American Psychiatric Association. ISBN 978-0890425558. https://archive.org/details/diagnosticstatis0005unse.
20. ↑ Hinshaw, Stephen P.; Lee, Steve S. (2003). "Conduct and Oppositional Defiant Disorders". Child Psychopathology (2 ed.). New York City: Guilford Press. pp. 144–198. ISBN 978-1-57230-609-7. https://leelab.psych.ucla.edu/wp-content/uploads/sites/44/2015/10/Hinshaw-and-Lee-2003-ODD-CD-Chapter.pdf.
21. ↑ "Childhood conduct problems, attention deficit behaviors, and adolescent alcohol, tobacco, and illicit drug use". Journal of Abnormal Child Psychology (Springer Science+Business Media) 23 (3): 281–302. June 1995. doi:10.1007/bf01447558. PMID 7642838.
22. ↑ "Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder". Journal of Abnormal Child Psychology 21 (4): 377–410. August 1993. doi:10.1007/bf01261600. PMID 8408986.
23. ↑ "Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy". Psychological Review 100 (4): 674–701. October 1993. doi:10.1037/0033-295x.100.4.674. PMID 8255953.
24. ↑ "Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females". Development and Psychopathology 13 (2): 355–75. June 2001. doi:10.1017/s0954579401002097. PMID 11393651.
25. ↑ "[DSM-5--what has changed in therapy for and research on substance-related and addictive disorders?"]. Fortschritte der Neurologie-Psychiatrie 81 (11): 648–54. November 2013. doi:10.1159/000356537. PMID 24194058. https://www.karger.com/ProdukteDB/miscArchiv/000/356/537/000356537_sm_eversion.pdf. Retrieved 20 May 2017.
26. ↑ Internet Mental Health – antisocial personality disorder . Mentalhealth.com. Retrieved on 7 December 2011.
27. ↑ "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder". Neuropsychiatric Disease and Treatment 5: 309–26. April 2009. doi:10.2147/NDT.S4882. PMID 19557141.
28. ↑ "Alcohol Use Disorder and Antisocial and Borderline Personality Disorders". Alcohol Research 40 (1): 1. 2019. doi:10.35946/arcr.v40.1.05. PMID 31886107.
29. ↑ "Antisocial personality disorder in patients with substance abuse disorders: a problematic diagnosis?". The American Journal of Psychiatry 147 (2): 173–8. February 1990. doi:10.1176/ajp.147.2.173. PMID 2405719.
30. ↑ 30.0 30.1 "Antisocial Personality Disorder | MentalHealth.gov" (in en). https://www.mentalhealth.gov/what-to-look-for/personality-disorders/antisocial-personality-disorder.
31. ↑ "Behavioral Genetics: The Science of Antisocial Behavior". Law and Contemporary Problems 69 (1–2): 7–46. 1 January 2006. PMID 18176636.
32. ↑ "The VNTR 2 repeat in MAOA and delinquent behavior in adolescence and young adulthood: associations and MAOA promoter activity". European Journal of Human Genetics 16 (5): 626–34. May 2008. doi:10.1038/sj.ejhg.5201999. PMID 18212819.
33. ↑ "The integration of genetic propensities into social-control models of delinquency and violence among male youths". American Sociological Review 73 (4): 543–568. August 2008. doi:10.1177/000312240807300402. http://www.asanet.org/galleries/default-file/Aug08ASRFeature.pdf. Retrieved 20 November 2016. "Archived copy". http://www.asanet.org/galleries/default-file/Aug08ASRFeature.pdf.
34. ↑ "Role of genotype in the cycle of violence in maltreated children". Science 297 (5582): 851–4. August 2002. doi:10.1126/science.1072290. PMID 12161658. Bibcode: 2002Sci...297..851C.
35. ↑ "Early trauma and increased risk for physical aggression during adulthood: the moderating role of MAOA genotype". PLOS ONE 2 (5): e486. May 2007. doi:10.1371/journal.pone.0000486. PMID 17534436. Bibcode: 2007PLoSO...2..486F.
36. ↑ "Candidate genes for aggression and antisocial behavior: a meta-analysis of association studies of the 5HTTLPR and MAOA-uVNTR". Behavior Genetics 44 (5): 427–44. September 2014. doi:10.1007/s10519-014-9661-y. PMID 24902785.
37. ↑ "Impulsive-disinhibited personality and serotonin transporter gene polymorphisms: association study in an inmate's sample". Journal of Psychiatric Research 43 (10): 906–14. July 2009. doi:10.1016/j.jpsychires.2008.11.008. PMID 19121834.
38. ↑ "The other allele: exploring the long allele of the serotonin transporter gene as a potential risk factor for psychopathy: a review of the parallels in findings". Neuroscience and Biobehavioral Reviews 35 (3): 612–20. January 2011. doi:10.1016/j.neubiorev.2010.07.005. PMID 20674598.
39. ↑ "Systematic review, structural analysis, and new theoretical perspectives on the role of serotonin and associated genes in the etiology of psychopathy and sociopathy". Neuroscience and Biobehavioral Reviews 37 (7): 1254–96. August 2013. doi:10.1016/j.neubiorev.2013.04.009. PMID 23644029. https://www.researchgate.net/publication/236638079.
40. ↑ "Genome-wide association study of antisocial personality disorder". Translational Psychiatry 6 (9): e883. September 2016. doi:10.1038/tp.2016.155. PMID 27598967.
41. ↑ 41.0 41.1 41.2 41.3 "What Causes Antisocial Personality Disorder?". http://psychcentral.com/lib/2006/what-causes-antisocial-personality-disorder/.
42. ↑ "The influence of testosterone on human aggression". British Journal of Psychology 82 ( Pt 1) (1): 1–28. February 1991. doi:10.1111/j.2044-8295.1991.tb02379.x. PMID 2029601. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.2044-8295.1991.tb02379.x.
43. ↑ "Testosterone, aggressiveness, and antisocial personality. Hormone Sensitivity and Bone Mineral Metabolism". Aggressive Behavior 25 (2). 12 February 1999. doi:10.1002/(SICI)1098-2337(1999)25:2<113::AID-AB4>3.0.CO;2-4.
44. ↑ "Testosterone and cortisol jointly regulate dominance: evidence for a dual-hormone hypothesis". Hormones and Behavior 58 (5): 898–906. November 2010. doi:10.1016/j.yhbeh.2010.08.020. PMID 20816841. http://www.sciencedirect.com/science/article/pii/S0018506X10002412.
45. ↑ "A meta-analysis of serotonin metabolite 5-HIAA and antisocial behavior". Aggressive Behavior 28 (4): 299–316. 2002. doi:10.1002/ab.90027.
46. ↑ "Serotonin and aggression". Annals of the New York Academy of Sciences. 3–4 1036 (3): 382–92. December 2004. doi:10.1300/J076v21n03_03. PMID 15817750.
47. ↑ American Psychiatric Association (2000). "Diagnostic criteria for 301.7 Antisocial Personality Disorder". Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. http://behavenet.com/node/21650.
48. ↑ "Childhood maltreatment, subsequent antisocial behavior, and the role of monoamine oxidase A genotype". Biological Psychiatry 60 (7): 677–83. October 2006. doi:10.1016/j.biopsych.2005.12.022. PMID 17008143.
49. ↑ "Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account". Brain and Cognition 55 (1): 185–97. June 2004. doi:10.1016/S0278-2626(03)00273-2. PMID 15134852.
50. ↑ "Neural bases of antisocial behavior: a voxel-based meta-analysis". Social Cognitive and Affective Neuroscience 9 (8): 1223–31. August 2014. doi:10.1093/scan/nst104. PMID 23926170.
51. ↑ 51.0 51.1 "Untangling Intelligence, Psychopathy, Antisocial Personality Disorder, and Conduct Problems: A Meta–Analytic Review". European Journal of Personality 33 (5): 529–564. 1 September 2019. doi:10.1002/per.2207. https://journals.sagepub.com/doi/full/10.1002/per.2207.
52. ↑ "Executive–cognitive functioning in the development of antisocial personality disorder". Addictive Behaviors 28 (2): 285–300. March 2003. doi:10.1016/S0306-4603(01)00232-5. PMID 12573679. https://www.sciencedirect.com/science/article/abs/pii/S0306460301002325.
53. ↑ "Exploring the relations among executive functions, fluid intelligence, and personality". Journal of Individual Differences 30 (4): 194–200. 2009. doi:10.1027/1614-0001.30.4.194. https://psycnet.apa.org/record/2009-23196-003.
54. ↑ "Intelligence, Callous-Unemotional Traits, and Antisocial Behavior". Journal of Psychopathology and Behavioral Assessment 20 (1): 231–247. September 1998. doi:10.1023/A:1023015318156. https://link.springer.com/article/10.1023/A:1023015318156.
55. ↑ "Prefrontal structural and functional brain imaging findings in antisocial, violent, and psychopathic individuals: a meta-analysis". Psychiatry Research 174 (2): 81–8. November 2009. doi:10.1016/j.pscychresns.2009.03.012. PMID 19833485.
56. ↑ 56.0 56.1 "Antisocial personality disorder: a current review". Current Psychiatry Reports 15 (12): 427. December 2013. doi:10.1007/s11920-013-0427-7. PMID 24249521. http://link.springer.com/10.1007/s11920-013-0427-7.
57. ↑ "Cavum septum pellucidum and its increased prevalence in schizophrenia: a neuroembryological classification". The Journal of Neuropsychiatry and Clinical Neurosciences 16 (1): 41–6. 2004. doi:10.1176/appi.neuropsych.16.1.41. PMID 14990758.
58. ↑ "Cavum septum pellucidum in monozygotic twins discordant for combat exposure: relationship to posttraumatic stress disorder". Biological Psychiatry 55 (6): 656–8. March 2004. doi:10.1016/j.biopsych.2003.09.018. PMID 15013837.
59. ↑ 59.0 59.1 "Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy". The British Journal of Psychiatry 197 (3): 186–92. September 2010. doi:10.1192/bjp.bp.110.078485. PMID 20807962.
60. ↑ The Boy Who Was Raised as a Dog. New York: Basic Books. 2017. pp. 123. ISBN 978-0-465-09445-5.
61. ↑ "Treatment of antisocial personality disorder". The British Journal of Psychiatry 193 (5): 426; author reply 426. November 2008. doi:10.1192/bjp.193.5.426. PMID 18978330.
62. ↑ 62.0 62.1 62.2 The sociopath next door: the ruthless versus the rest of us (1st ed.). New York: Broadway Books. 2006. ISBN 978-0-7679-1582-3. https://archive.org/details/sociopathnextdoo00stou.
63. ↑ "Antisocial Personality Disorder". Comprehensive Handbook of Psychopathology (3rd ed.). Boston, MA: Springer. 2002. pp. 445–490. doi:10.1007/0-306-47377-1_16. ISBN 978-0-306-46490-4.
64. ↑ Berne, Eric (1976). A Layman's Guide to Psychiatry and Psychoanalysis (first ed.). New York, NY: Grove. pp. 241–2. ISBN 978-0-394-17833-2.
65. ↑ McCallum, David (2001). Personality and Dangerousness: Genealogies of Antisocial Personality Disorder. New York: Cambridge Univ. Press. p. 7. ISBN 978-0-521-00875-4.
66. ↑ Forensic Uses of Clinical Assessment Instruments. Routledge. 2006. pp. 247–250.
67. ↑ 67.0 67.1 "Dissocial personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)". http://www.mentalhealth.com/icd/p22-pe04.html.
68. ↑ 68.0 68.1 68.2 WHO (2010)ICD-10: Clinical descriptions and diagnostic guidelines: Disorders of adult personality and behavior
69. ↑ "F60.2 Dissocial personality disorder". World Health Organization. http://apps.who.int/classifications/icd10/browse/2010/en#/F60.2.
70. ↑ "Neurobiological basis of psychopathy". The British Journal of Psychiatry 182: 5–7. January 2003. doi:10.1192/bjp.182.1.5. PMID 12509310.
71. ↑ Merriam-Webster Dictionary. "Definition of psychopathy". http://www.merriam-webster.com/dictionary/psychopathy.
72. ↑ 72.0 72.1 Encyclopedia of Mental Disorders. "Hare Psychopathy Checklist". http://www.minddisorders.com/Flu-Inv/Hare-Psychopathy-Checklist.html.
73. ↑ Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems. 2003.
74. ↑ DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders (Fourth ed.). United States: American Psychiatric Association Press Inc.. 2000. ISBN 978-0-89042-025-6. https://archive.org/details/diagnosticcriter0000unse.
75. ↑ "International Statistical Classification of Diseases and Related Health Problems". World Health Organization. 2016. http://apps.who.int/classifications/icd10/browse/2016/en.
76. ↑ "The emergence and development of psychopathy". History of the Human Sciences 27 (5): 91–110. 2014. doi:10.1177/0952695114541864.
77. ↑ 77.0 77.1 Nussbaum, Abraham (2013). The Pocket Guide to the DSM-5 Diagnostic Exam. Arlington: American Psychiatric Association. ISBN 978-1-58562-466-9. https://books.google.com/books?id=rEPy72wKdswC. Retrieved 5 January 2014.
78. ↑ Millon, Theodore (2000). Personality Disorders in Modern Life (Second ed.). Hoboken, New Jersey: John Wiley & Sons, Inc.. pp. 158–161. ISBN 978-0-471-23734-1.
79. ↑ Millon, Theodore – Personality Subtypes. Millon.net. Retrieved on 7 December 2011.
80. ↑ 80.0 80.1 80.2 80.3 Psychotherapy for Personality Disorders. 9 (First ed.). American Psychiatric Publishing. 2000. 1–6. ISBN 978-0-88048-273-8.
81. ↑ Abnormalities of Personality. Within and Beyond the Realm of Treatment. Norton. 1993. ISBN 978-0-393-70127-2.
82. ↑ 82.0 82.1 Abnormal psychology (Sixth ed.). New York, NY. 2 December 2013. ISBN 9780078035388. OCLC 855264280.
83. ↑ Antisocial personality disorder. 2011.
84. ↑ The American Psychiatric Publishing Textbook of Personality Disorders. American Psychiatric Publishing. 2005. ISBN 978-1-58562-159-0.
85. ↑ "Psychopathy and therapeutic pessimism. Clinical lore or clinical reality?". Clinical Psychology Review 22 (1): 79–112. February 2002. doi:10.1016/S0272-7358(01)00083-6. PMID 11793579.
86. ↑ "Rehabilitating antisocial personalities: treatment through self-governance strategies". The Journal of Forensic Psychiatry & Psychology 24 (1): 48–70. February 2013. doi:10.1080/14789949.2012.752517. PMID 24009471.
87. ↑ Derefinko, Karen J.; Widiger, Thomas A. (2008). Antisocial Personality Disorder. 213–226. doi:10.1007/978-1-59745-252-6_13. ISBN 978-1-58829-917-8.
88. ↑ "Treatment – Mayo Clinic" (in en). Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/treatment/txc-20198986.
89. ↑ Bernstein, David P.; Arntz, Arnoud; Vos, Marije de (2007). "Schema Focused Therapy in Forensic Settings: Theoretical Model and Recommendations for Best Clinical Practice". International Journal of Forensic Mental Health 6 (2): 169–183. doi:10.1080/14999013.2007.10471261. http://www.iafmhs.org/files/Bernstein.pdf.
90. ↑ "Treatment and prevention implications of antisocial personality disorder". Current Psychiatry Reports 2 (1): 51–5. February 2000. doi:10.1007/s11920-000-0042-2. PMID 11122932.
91. ↑ "Anti-social personality disorder and response to methadone maintenance treatment". Drug and Alcohol Review 15 (3): 271–6. September 1996. doi:10.1080/09595239600186011. PMID 16203382.
92. ↑ "Prediction of 7 months methadone maintenance treatment response by four measures of antisociality". Drug and Alcohol Dependence 49 (3): 217–23. February 1998. doi:10.1016/S0376-8716(98)00015-5. PMID 9571386.
93. ↑ Beck, Aaron T.; Freeman, Arthur; Davis, Denise D. (2007). Cognitive Therapy of Personality Disorders (Second ed.). New York: Guilford Press. ISBN 978-1-59385-476-8. https://archive.org/details/cognitivetherapy0000beck.
94. ↑ Mayo Clinic staff (12 April 2013). "Antisocial personality disorder: Treatments and drugs". Mayo Foundation for Medical Education and Research. http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/treatment/txc-20198986.
95. ↑ "Pharmacological interventions for antisocial personality disorder". The Cochrane Database of Systematic Reviews 9: CD007667. September 2020. doi:10.1002/14651858.CD007667.pub3. PMID 32880105. PMC 8094881. https://pubmed.ncbi.nlm.nih.gov/32880105.
96. ↑ "Antisocial Personality Disorder". Encyclopedia of Drugs, Alcohol & Addictive Behavior. 1 (3rd ed.). Detroit, MI: Macmillan Reference USA. 2009. pp. 181–183.
97. ↑ "Treatment Guidelines for Clients with Antisocial Personality Disorder" (in en). Journal of Mental Health Counseling 37 (1): 15–27. 2015-01-01. doi:10.17744/mehc.37.1.52g325w385556315. ISSN 1040-2861. https://meridian.allenpress.com/jmhc/article/37/1/15/83299/Treatment-Guidelines-for-Clients-with-Antisocial.
98. ↑ "Predictors of antisocial personality. Continuities from childhood to adult life". The British Journal of Psychiatry: The Journal of Mental Science 184: 118–27. February 2004. doi:10.1192/bjp.184.2.118. PMID 14754823.
99. ↑ 99.0 99.1 "Delinquent Behavior: Systematic Review of Genetic and Environmental Risk Factors". Clinical Child and Family Psychology Review 22 (4): 502–526. December 2019. doi:10.1007/s10567-019-00298-w. PMID 31367800.
100. ↑ 100.0 100.1 "The relationship between adverse childhood experiences (ACE) and juvenile offending trajectories in a juvenile offender sample.". Journal of Criminal Justice 43 (3): 229–41. May 2015. doi:10.1016/j.jcrimjus.2015.04.012.
101. ↑ 101.0 101.1 101.2 101.3 101.4 101.5 101.6 101.7 "Antisocial Personality Disorder". StatPearls [Internet].. Treasure Island (FL): StatPearls Publishing. 23 November 2019. https://www.ncbi.nlm.nih.gov/books/NBK546673/.
102. ↑ 102.0 102.1 102.2 102.3 "Antisocial Personality Disorder". 13 March 2019. https://www.health.harvard.edu/a_to_z/antisocial-personality-disorder-a-to-z.
103. ↑ "A behavioral genetic analysis of callous-unemotional traits and Big Five personality in adolescence". Journal of Abnormal Psychology 124 (4): 982–993. November 2015. doi:10.1037/abn0000099. PMID 26595476.
104. ↑ "Emotional processing in psychopathic personality.". Aggressive Behavior 28 (5): 394–400. September 2002. doi:10.1002/ab.80015.
105. ↑ 105.0 105.1 "Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders". Schizophrenia Bulletin 32 (4): 626–36. October 2006. doi:10.1093/schbul/sbj068. PMID 16574783.
106. ↑ 106.0 106.1 "Antisocial personality and risks of cause-specific mortality: results from the Epidemiologic Catchment Area study with 27 years of follow-up". Social Psychiatry and Psychiatric Epidemiology 54 (5): 617–625. May 2019. doi:10.1007/s00127-018-1628-5. PMID 30506390.
107. ↑ 107.0 107.1 107.2 "Impulsive and premeditated aggression in male offenders with antisocial personality disorder". PLOS ONE 15 (3): e0229876. March 2020. doi:10.1371/journal.pone.0229876. PMID 32142531. Bibcode: 2020PLoSO..1529876A.
108. ↑ "Antisocial personality disorder" (in en). 2018-03-21. https://www.nhs.uk/conditions/antisocial-personality-disorder/.
109. ↑ 109.0 109.1 109.2 National Collaborating Centre for Mental Health (UK). (2010). Antisocial Personality Disorder: Treatment, Management and Prevention.. Leicester (UK): British Psychological Society. https://www.ncbi.nlm.nih.gov/books/NBK55333/.
110. ↑ "Antisocial personality". Psychiatric Disorders in America.. New York: Free Press. 1991. pp. 258–290.
111. ↑ "Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions". The Journal of Clinical Psychiatry 66 (6): 677–85. June 2005. doi:10.4088/jcp.v66n0602. PMID 15960559.
112. ↑ "Psychopathy, antisocial personality, and suicide risk". Journal of Abnormal Psychology 110 (3): 462–70. August 2001. doi:10.1037//0021-843x.110.3.462. PMID 11502089.
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114. ↑ "Suicidal ideation and behaviors among youths in juvenile detention". Journal of the American Academy of Child and Adolescent Psychiatry 47 (3): 291–300. March 2008. doi:10.1097/CHI.0b013e318160b3ce. PMID 18216737.
115. ↑ Diagnostic and Statistical Manual: Mental Disorders. American Psychiatric Association (APA). 1952. pp. 38. ISBN 978-0890420171.
116. ↑ Chemical dependency and antisocial personality disorder : psychotherapy and assessment strategies. New York: Haworth Press. 1994. ISBN 978-1560243083. OCLC 25246264. https://archive.org/details/chemicaldependen0000forr.
117. ↑ Diagnostic and Statistical Manual of Mental Disorders (DSM-II). Washington, D. C.: American Psychiatric Association. 1968. pp. 43. http://www.germantownschools.org/faculty/kkorek/Handouts/Abnormal_Psychology/dsm-ii.pdf.
118. ↑ International Handbook on Psychopathic Disorders and the Law, Volume 1, Alan Felthous, Henning Sass, 15 April 2008, e.g. Pgs 24 – 26
119. ↑ "The development of the Feighner criteria: a historical perspective". The American Journal of Psychiatry 167 (2): 134–42. February 2010. doi:10.1176/appi.ajp.2009.09081155. PMID 20008944.
120. ↑ The DSM-IV Personality Disorders W. John Livesley, Guilford Press, 1995, Page 135

## Further reading

* "Ten Subtypes of Psychopathy". Psychopathy: Antisocial, Criminal and Violent Behavior. New York, NY: Guilford Press. 1998. ISBN 978-1-57230-344-7.

## External links

* DSM-IV-TR Criteria for Antisocial personality disorder
* Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion

Classification|

* ICD-11: Script error: No such module "ICD11". 6D11.2
* ICD-10: F60.2
* ICD-9-CM: 301.7
* MeSH: D000987

|

External resources|

* MedlinePlus: 000921

* v
* t
* e

DSM personality disorders

DSM-III-R only|

* Sadistic
* Self-defeating (masochistic)

DSM-IV only|

Personality disorder not otherwise specified

| Appendix B (proposed)|

* Depressive
* Negativistic (passive–aggressive)

|

DSM-5
(Categorical
model)|

| Cluster A (odd)|

* Paranoid
* Schizoid
* Schizotypal

|

Cluster B (dramatic)|

* Antisocial
* Borderline
* Histrionic
* Narcissistic

Cluster C (anxious)|

* Avoidant
* Dependent
* Obsessive-compulsive

DSM-5|

Alternative hybrid categorical and dimensional model in Section III included to stimulate further research

|

* v
* t
* e

Psychopathy

Contexts|

* In fiction
* In the workplace

Characteristics|

* Anti-social behaviour
* Bold
* Callous
* Diminished empathy
* Disinhibited
* Grandiose
* Impulsive
* Lack of guilt
* Manipulative
* Pathological lying
* Remorseless
* Shallow affect
* Superficially charming

Related topics|

* Antisocial personality disorder
* Conduct disorder
* Dark triad
* Flying monkeys
* History of psychopathy
* Juvenile delinquency
* Machiavellianism
* Macdonald triad
* Narcissism
* Psychopathic Personality Inventory
* Psychopathy Checklist
* Sadistic personality disorder
* Sexual sadism disorder
* Sociopathy

Notable theorists|

* Hervey M. Cleckley
* George E. Partridge
* Robert D. Hare

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Original source: https://en.wikipedia.org/wiki/Antisocial personality disorder. Read more

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