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Antisocial Personality Disorder Criteria

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 18 years, as indicated by three (or more) of the following:

Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.

Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
impulsivity or failure to plan ahead.

Irritability and aggressiveness, as indicated by repeated physical fights or assaults
reckless disregard for safety of self or others.

Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

DSM-IV Code: 304.7

The individual is at least 18 years old (under 18 see Conduct Disorder ). There is evidence of Conduct Disorder with onset before age 15 years and the
occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode


Associated Features:

Depressed Mood.
Addiction.
Dramatic or Erratic or Antisocial Personality.

Differential Diagnosis:

Some disorders have similar symptoms. The clinician, therefore, in his diagnostic attempt has to differentiate against the following disorders which need to be ruled out to establish a precise diagnosis.

Substance-Related Disorder;
Schizophrenia
Manic Episode
Narcissistic Personality Disorder
Histrionic Personality Disorder
Borderline Personality Disorders
Paranoid Personality Disorder
Adult Antisocial Behavior.

Cause:

The cause of this disorder is unknown, but biological or genetic factors may play a role. The incidence of antisocial personality is higher in people who have an antisocial biological parents. Although the diagnosis is limited to those over 18 years of age, there is usually a history of similar behaviors before age 15, such as repetitive lying, truancy, delinquency, and substance abuse. This disorder tends to occur more often in men and in people whose predominant role model had antisocial features.

Twin studies have confirmed the hereditability of antisocial behaviour in adults and shown that genetic factors are more important in adults than in antisocial children or adolescents where shared environmental factors are more important. (Lyons et a11995)

Cadoret et al (1995) studied the family environment as well as the parentage of adoptees separated at birth from parents. Antisocial Personality Disorder in the biological parents predicted antisocial disorder in the adopted away children. However, adverse factors in the adoptive environment (for example, "marital problems or substance abuse) independently predicted adult antisocial behaviours.

Treatment:

Counseling and Psychotherapy [ See Therapy Section ]:

Effective treatment of antisocial behavior and personality is limited. Group psychotherapy can be helpful. If the person can develop a sense of trust, individual psychotherapy or cognitive behavioral therapy can also be beneficial. There is no research that supports the use of medications for direct treatment of antisocial personality disorder, though.

Effective psychotherapy treatment for this disorder is limited. It is likely, though, that intensive, psychoanalytic approaches are inappropriate for this population. Approaches the reinforce appropriate behaviors and attempting to make connections between the person's actions and their feelings may be more beneficial. Emotions are usually a key aspect of treatment of this disorder. Patients often have had little or no significant emotionally-rewarding relationships in their lives. The therapeutic relationship, therefore, can be one of the first ones. This can be very scary for the client, initially, and it may become intolerable. A close therapeutic relationship can only occur when a good and solid rapport has been established with the client and he or she can trust the therapist implicitly.

Pharmacotherapy [ See Psychopharmacology Section ] :

Medications should only be utilized to treat clear, acute and serious Axis I concurrent diagnoses. No research has suggested that any medication is effective in the treatment of this disorder.

Self-Help [ See Self-Help Section ]

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Groups can be especially helpful for people with this disorder, if they are tailored specifically for antisocial personality disorder. Individuals with this disorder typically feel more at ease in discussing their feelings and behaviors in front of their peers in this type of supportive modalit.