Cure for Antisocial Personality Disorder

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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Antisocial Personality Disorder

As the term antisocial implies, individuals with this disorder are against society. Indeed, the hallmark feature is a pervasive pattern of disregard for, and failure to comply with, societal norms. Among people with Antisocial Personality Disorder, the rights of others are never a consideration, and when individuals with this disorder hurt, deceive, manipulate, abuse, or victimize others, they fail to experience remorse, guilt, or shame. When caught, antisocial types may weep crocodile tears but real feelings of remorse are notably absent, and they appear to lack a conscience. People with Antisocial Personality Disorder are often aggressive, ruthless, and interpersonally exploitative with a poor sense of responsibility. They take what they want, when they want it, with no regard for the impact that their actions have on others. They lack empathy and can be dangerously indifferent to the rights of others. Lying, cheating, stealing, and fighting appear to be part of their nature....

The Case of Mickey Antisocial Personality Disorder

When asked about his parents' health history, Mickey snorted loudly and then looked away. The only procedure he would cooperate with was the start of an IV to prevent the DTs, a condition he knew enough about to want to avoid, and the promise of a drug infusion that he liked. He was verbally abusive to the pulmonary resident, a gentle young fellow trying to explore possible shortness of breath episodes. When the sedating drug would start to wear off, Mickey would scream and become especially abusive to the staff. It was a tough hour's wait before the next drug dose could be administered. Terms and phrases entered in his chart by the nursing staff included obnoxious, demanding , unreasonable expectations, will not obey rules, and nasty to anyone trying to help. The institutional and individual countertransference to this horrendously difficult patient was frustration, then anger, and fantasies of how to get rid of him. It took all their collective and individual will not...

Cluster B personality disorders Antisocial personality disorder DLT

Antisocial personality disorder is characterized by continuous disregard for the safety of oneself and others and violation of the rights of others, without feeling remorse. Individuals with this disorder are unreliable, manipulative, incapable of lasting relationships, and unable to conform to social norms. The disorder starts early (before the age of 15), is pervasive, and manifests in variety of contexts. Although social deviance is one of the core features of antisocial personality disorder, it is not synonymous with criminality. Antisocial personality disorder uncomplicated by other disorders is not often met in clinical settings, except forensic psychiatry. However, owing to its impact on family and social environment, it has major public health significance and has been extensively studied in academic psychiatry, psychoanalysis, law, sociology, theology, and literature. Cleckley's seminal work The Mask of San 'ty(l2) is considered to be the basic text on antisocial personality...

Passiveaggressive negativistic personality disorder DLT Definition

Passive-aggressive disorder was not included in DSM-IV because of the many unsolved problems related to its concept in previous classifications. Instead, it is placed in Appendix B of DSM-IV where it is alternatively called negativistic personality disorder. Research criteria are proposed which are expected to be empirically evaluated and to determine the validity and reliability of this diagnosis ( Table 15). Table 15 DSM-IV research criteria for passive-aggressive personality disorder Resistance to demands for adequate social and occupational performance and negativistic attitude are considered to be central features of passive-aggressive personality disorder. A pervasive pattern of argumentativeness, oppositional behaviour, and defeatist attitudes are typical, and are thought to be a covert manifestation of underlying aggression which is expressed passively and indirectly. Passive-aggressive personalities have interpersonal and cognitive dysfunction and severe impairment in terms...

The Minimizing Antisocial Personality and Frame of Reference

Still studying the art of psychotherapy that she would begin to practice in her second year, Jenna sat in with an experienced clinician conducting therapy with a group of prisoners, most of whom had been diagnosed as antisocial personalities. Gradually, their cognitive core beliefs and distortions became evident. Defending his actions in the outside world, one convict protested, Look, you're either a goody-goody or you're out for yourself in this world, and everyone I've ever known has been out for themselves. Taking advantage from those kind of people ain't so bad. Many of the others nodded in agreement. Jenna, however, was immediately able to recognize two self-serving cognitive distortions dichotomous thinking and minimization. Moreover, by constructing the world so that everyone was out for themselves, the speaker was essentially able to justify taking advantage of anyone.

The Difficult Roommate Personality and Interpersonal Conflict

A quiet, easygoing sophomore presented to the university counseling center complaining about her roommate, who, she stated, was literally driving her crazy. She frequently came back from classes to find that her favorite dress had somehow fallen off its hanger, her phone messages had been accidentally erased, and even bookmarks had been pulled out and reinserted in the wrong pages. Her roommate denied everything, asserting, You're just a paranoid, get over it. But what really disturbed her was that, despite every attempt to get along, her roommate seemed to work hard at taking offense, resented her academic success and social skills, and would sometimes sigh in annoyance whenever she made the slightest noise. Such irritable temperament is frequently associated with the negativistic (passive-aggressive) personality.

Personality variables and the genetics of addiction

The genetics of drug abuse are beginning to be unravelled and already these studies have thrown up some important insights in relation to personality. The best studied dependence is that on alcohol, where the Scandinavian adoption studies have found the risk of alcoholism in male children of male alcoholics is the same regardless of whether the child is reared with the alcoholic father or by a non-drinking adoptive family. Building on these data, Cloninger (27) has identified two main forms of alcoholism. Type I is the late-onset form that has low inheritance and is associated with anxiety and stress which drinking is used to relieve, often in binges. In contrast, type II alcoholism starts at a younger age with a heavy regular intake and is associated with antisocial personality traits and criminality. This form is male limited, is associated with impulsivity, and may be related to underfunctioning of brain 5-hydroxytryptamine systems, as genetic polymorphisms of 5-hydroxytryptamine...

Individual vulnerability Genetic influences

The offspring of alcoholic parents are unquestionably exposed to an excess risk, but the understanding of the exact pathway of familial transmission is still limited. A more detailed analysis of the adoption data shows that the biological parents of alcoholic adoptees, when compared to the controls, are not only more likely to present alcoholism but also antisocial behaviour.(25) Antisocial personality is also significantly more prevalent in alcohol-abusing adoptees than in controls. The evidence indicates that the alcoholism-antisocial personality tandem is much more 'inheritable' than alcoholism alone. In decreasing order of significance, alcohol abuse in adoptees is predicted by their own antisocial personality, biological parents's alcoholism, biological parents's antisocial history, and, to a much lesser degree, history of alcoholism or psychopathology in the adoptive parents.

Special Risk Factor

Much of this research is plagued with methodological issues that make clear interpretations of the findings difficult. You can imagine the problems that arise in developmental research. One is an issue of longitudinal versus cross-sectional samples. If you are trying to determine the developmental nature of a disorder (i.e., Does a child with ADHD and CD develop into an adult with antisocial personality disorder ), it makes sense to follow the same people from childhood, through adolescence, and into adulthood. Research of this sort is very costly and is confounded by ever-evolving diagnostic criteria. Throughout the various incarnations of the DSM, criteria for all of these diagnoses have changed considerably with an accompanying change in the prevalence of each disorder. So, a child with a set of symptoms may meet criteria for ODD one year, but because criteria changed with a new edition of the DSM, three years later, with the same constellation of symptoms, he or she no longer...

Psychiatric comorbidity

Several studies have found that 70 per cent of addicts meet diagnostic criteria for a current psychiatric disorder, frequently depression, antisocial personality, and alcohol dependency 5,1.6) Such diagnoses may be primary or secondary to opiate abuse, and a careful assessment of mental state and social functioning when opiate free should be performed. Many will have had childhood behavioural problems such as conduct disorder, and studies suggest that attention-deficit hyperactivity disorder, truanting, and juvenile offending are markers for subsequent use. (1D Clearly, comorbid psychiatric disorders should be treated in their own right especially if it is felt that they are important in maintaining opiate use. (18) Opiate dependence is also a strong risk factor for suicide, which accounts for up to a third of all deaths among intravenous drug users.(,19)

Rarely Is a Woman Wicked

We have already presented the argument that there are possibly different pathways for the development of antisocial behavior and personality disorder in men and women, but what are some of the other differences that distinguish male and female antisocials For one, the rate of antisocial personality disorder is usually considered to be higher for men than women. In the community at large, the DSM-IV indicates that about 3 of men and 1 of women warrant such a diagnosis with rates of antisocial personality disorder increasing and the rate for women increasing faster than for men. The rates for conduct disorder (CD) in adolescents are considerably higher. One large epidemiologic study of 15-year-olds found that 7.5 to 9.5 of girls and 8.6 to 12.2 of boys met criteria for CD (Fergusson, Horwood, & Lynskey, 1993). Despite the high prevalence rate of females with CD and antisocial personality disorder, few empirical studies include females in their samples. A few notable exceptions include...

Personality change due to cerebral disease

Brain injury can produce an exaggeration of premorbid personality traits so that a person with an obsessional personality becomes even more meticulous and preoccupied with detail, whereas someone with an antisocial personality becomes more impulsive, irresponsible, and aggressive. Among a group of patients with Wilson's disease, psychopathic personality traits were significantly related to the severity of neurological symptoms, particularly dysarthria, bradykinesia, and rigidity.57 If the damage is localised to particular parts of the brain, the personality changes tend to be more specific.58,59 Frontal lobe damage is associated with apathy, lack of initiative, tactlessness, irritability, euphoria, and disinhibition. Although the patient's demeanour is predominantly listless there may be unpredictable outbursts of aggression or sexually disinhibited behaviour. Social skills tend to be lost with a failure to consider the feelings of other people and the impact of tactless remarks. The...

Interpersonal relations

Antisocial personality disorder is frequently comorbid with depression, which usually has atypical features. Bipolar disorder (manic phase) and mental retardation (learning difficulties) should be excluded. Substance abuse may be comorbid from childhood, and antisocial behaviour may be secondary to premorbid alcoholism type 2. Atypical schizophrenic disorder (pseudopsychopathic schizophrenia), temporal-lobe epilepsy, or a limbic-lobe syndrome should also be excluded. 1. antisocial personality disorder

Developmental issues

Histrionic individuals, especially those at the sicker end of the continuum, have often had deprived and traumatic childhoods, similar to those of antisocial personalities. Zetzel(79 pointed out that the developmental history of hysterical individuals reveals significant separations in the first four years of life, serious parental psychopathology, much physical illness during childhood, and absence of meaningful sustained relations with either sex.

Interpersonal relationships

Narcissistic personality disorder is often comorbid with major depression, dysthymic disorder, substance abuse, and anorexia nervosa. Patients meeting criteria for narcissistic disorder have a high overlap with histrionic, borderline, and antisocial personality disorders, and also with schizotypal, paranoid, and passive-aggressive personality disorders.

Contemporary concepts

Passive-aggressive personality survived though DSM-II and DSM-III, despite resistance towards its inclusion in these classifications. The original descriptions were relatively narrow yet descriptively clear and clinically relevant. According to Kernberg (62) this diagnosis has been a useful grab-bag for personality disorders that do not fit easily into any other major category. There has been much debate as to whether passive aggression constitutes a personality disorder, a defence mechanism, or a specific maladaptive personality trait (coping style).(19Z) Surprisingly, empirical literature on the subject is scarce, although passive-aggressive behaviour has been widely recognized by clinicians. An overlap with other personalities has been shown, and it has never been included as a separate category in the International Classification of Diseases. The passive-aggressive dimension, as assessed by self-reports, is always high in depressed patients and is state-dependent. ( 08) Perhaps it...

Avoidant anxious personality disorder

In eight studies in which the frequency of dependent PD was assessed, the median prevalence rate was 0.7 per cent. Passive-aggressive personality disorder The median prevalence rate of passive-aggressive PD, obtained from seven studies, was found to be quite high (1.7 per cent) interestingly, this type of PD has not been included either in DSM-IV or in ICD-10.

Community supervision

Many people with personality disorder are reluctant to change and will only take part in a treatment programme under duress. This is a particular concern with personality disorders that lead to antisocial behaviour. Because of this there have been moves to introduce community supervision of those with antisocial personality disorder or judged to have a serious risk of reoffending. Although the procedure has not been evaluated formally, it has been suggested that people with these disorders who are discharged under some form of community supervision are less likely to reoffend than those who do not receive such supervision. (38) These results are difficult to interpret as the patients were not randomized to type of care.

Other personality disorders

Low dosage of antipsychotic drugs has been recommended for the treatment of antisocial (now called dissocial) personality disorder for many years, (46) and these recommendations have included treatment by depot injection. Most of these reports are anecdotal and no control comparisons have been made. Mood stabilizers have also been considered for the treatment of personality disorder. Carbamazepine was one of the comparison drugs used in the study by Cowdry and Gardner (45) and lithium has been shown to reduce anger and impulsiveness in those with antisocial personality disorder(47) but this study has never been replicated. Similar benefits for lithium were shown in the treatment of alcohol dependence, probably because this condition is often associated with personality disorder (although

Associated psychopathology and comorbidity

Intermittent explosive disorder often co-occurs with other psychiatric disorders. For example, of 46 impulsive violent offenders ( n 24) and fire-setters (n 22) in one study,(8) 33 (72 per cent) of whom met the DSM-III criteria for intermittent explosive disorder, 44 (96 per cent) had a lifetime diagnosis of alcohol abuse, 41 (89 per cent) had borderline personality disorder, 24 (52 per cent) had a mood disorder, and nine (20 per cent) had antisocial personality disorder. Of 27 subjects with DSM-IV intermittent explosive disorder evaluated with the Structured Clinical Interview for DSM-IV, (6) 25 (93 per cent) met lifetime criteria for a mood disorder (with 15 (55 per cent) meeting criteria for a bipolar disorder), 13 (48 per cent) for a substance use disorder, 13 (48 per cent) for an anxiety disorder (with six (22 per cent) meeting criteria for obsessive-compulsive disorder), six (22 per cent) for an eating disorder, and 12 (44 per cent) for an impulse control disorder other than...

Definition and clinical features

Pyromania is defined in DSM-IV as follows deliberate and purposeful fire-setting on more than one occasion (criterion A) that is associated with tension or affective arousal before the act (criterion B), fascination with, interest in, curiosity about, or attraction to fire and its situational contexts (criterion C), and pleasure, gratification, or relief when setting fires, or when witnessing or participating in their aftermath (criterion D). Also, the fire-setting is not done for monetary gain, as an expression of sociopolitical ideology, to conceal criminal activity, to express anger or vengeance, to improve one's living circumstances, in response to a delusion or hallucination, or as a result of impaired judgement (criterion E), and is not better accounted for by conduct disorder, a manic episode, or antisocial personality disorder (criterion F). In ICD-10, pyromania (or pathological fire-setting) is defined as multiple acts of, or attempts at, setting fire to property or other...

Familial transmission of suicidal behaviour

There is an accumulating consensus that suicidal behaviour has a significant genetic component independent of the inheritance of psychiatric illness. First-degree relatives of people who attempt suicide have a higher rate of suicide attempts, antisocial personality disorder, assaultive behaviour, and substance abuse. (28) Half of the mothers of suicidal adolescents report a personal history of a suicide attempt. On the other hand, mood disorders in first-degree relatives are not associated with suicidality in the proband.

Psychological symptoms and comorbidity

The way the patient presents is inextricably linked to personal style and possible personality disorder. As a broad spectrum of personality disorders or traits ( 14) is associated with somatization disorder, the presenting style varies greatly from one patient to another. Characteristically, three broad patterns of personality style may be found in these patients, especially in chronic cases dramatic-emotional type, paranoid-hostile type, and passive-aggressive-dependent type. The same patient may show all three patterns. The passive-aggressive-dependent type presents personality traits of the dependent personality disorder combined with passive-aggressive traits. These patients live in close symbiotic relationships with others, feeling uncomfortable or helpless when alone. They are passive, having difficulty in expressing disagreement with others directly, but in an indirect and subtle way they control their surroundings through their illness. They may display an almost sublime...

Variations of the Compulsive Personality

The bedeviled compulsive is blended with the negativistic personality. For average compulsives, the strategy of self-denial works reasonably well, allowing them to submerge their oppositional desires and put forth a proper and correct front. The bedeviled variety, however, appears on the surface to be maintaining a controlled and austere front but struggles incessantly with a desire to conform to the wishes or agendas of others one minute and the desire to subvert others and assert their own interests the next. When expected to act decisively, they vacillate and procrastinate, feel tormented and confused, become cautious and timid, and use complex rationales to delay making decisions as long as possible. Unable to crystallize their own identity and feeling wave upon wave of ambivalence, they may express their dissatisfaction by becoming exhausted, grumpy, and discontent. Many feel caught between heart and head, between what one part of them sees as reasonable and another part as...

Conclusion Empathy As A Complex Social Behavior

Finally, empathy in the present model is a motivated behavior that more often than commonly believed is triggered voluntarily. This makes empathy a psychological capacity prone to social-cognitive intervention such as through training or enhancement programs for the sake of various goals (e.g., reeducation of antisocial personalities early consultation with at-risk children and training of psychotherapists or physicians).

Psychiatric disorders and accidents occurrence

The rate of accidental death is higher among people with schizophrenia, affective illness, and post-traumatic stress disorder ( PTSD) than in the general population, but psychiatric disorders contribute little to the overall prevalence of accidents, with the notable exception of drug and alcohol abuse and severe personality disorders 2) However, the prevalence of psychiatric disorders is higher among adults with accidental injuries (40-50 per cent) than among patients admitted to a surgical department (25-30 per cent), and is even higher if the injuries are intentional. (3) Approximately 15 to 25 per cent of persons presenting in hospital emergency rooms because of accidental injury have clinically significant blood concentrations of alcohol. In some subgroups of injuries (e.g. burn injuries at home), the prevalence rates have been reported to be over 50 per cent. There are twice as many people with antisocial personality disorders in trauma units than in psychiatric out- and...

Personality Disorder InterviewIV

The Personality Disorder Interview-IV (PDI-IV Widiger, Mangine, Corbitt, Ellis, & Thomas, 1995) is a semi-structured interview for the assessment of the 10 standard personality disorders in the DSM-IV as well as the two proposed personality disorders (Passive-Aggressive and Depressive) presented in the DSM-IV appendix. The PDI-IV is appropriate for respondents ages 18 years and older and administration time is about 90 to 120 minutes.

The Mesolimbic Dopaminergic Reward Circuitry

There are to date, no investigations specifically into the reward circuitry in antisocial populations but we could postulate that such groups would show functional abnormalities in this system. Soderstrom et al (2001) found that elevated levels of CSF homovanillic acid (HVA), an index of dopaminergic function, predicted to high scores on the PCL-R. Furthermore, robust evidence of the high comorbidity of substance abuse and antisocial personality disorder adds support to this hypothesis (Fu et al, 2002).

Affective Interpersonal Aspects of Antisociality

In DSM-IV and the Hare Psychopathy Checklist, a core feature of the diagnosis of antisocial personality disorder is the lack of empathy and the absence of committed, intimate relationships. Relationships are shallow, opportunistic, and exploitative. Central to this is the notion of altered emotional processing and there is consistent evidence of abnormalities in this area in antisocial groups. A number of studies have demonstrated reduced ability to recognize and discriminate emotional facial expressions (Blair et al, 2001), and vocal tone (Blair et al, 2002). Moreover, there are robust findings of lowered somatic markers of CNS arousal in response to emotional stimuli. For example, subjects with ASPD show reduced electro dermal skin response, event related potentials, and other physiological response in response to aversive conditioning (Flor et al, 2002). Although psychopaths show reduced reactivity to many emotions, they are particularly insensitive to distress and, most...

Clinical features

Clinical features of personality disorders and details of their classification are reviewed in Chapte ,.4,12,2. and Ch.a.pteI,4., 2.,3. However, there is difficulty in simply relating these criteria, which were developed for younger individuals, to the elderly. Typical diagnostic behaviours that clinicians associate with personality disorders in younger adults may present as different behaviours in the elderly. This may lead clinicians to overlook personality traits and disorders in older individuals. For example, a criterion of antisocial personality disorder is the repeated failure to sustain consistent work, a behaviour not applicable to the older retired individual. Yet it is possible that the personality trait of irresponsibility, which may have led to the loss of jobs earlier in life, continues, now appearing as a behaviour such as medicine non-compliance. Some authors have thus argued that the clinical features for some personality disorders are age-biased since certain...

Genes and environment

Genetic influences play a stronger role in the development of adult antisocial personality and criminality than in adolescent antisocial behaviour, due in part to the greater proportion of early-onset types in this group. Cytogenetic and molecular genetic studies have not yet identified specific conditions associated with antisocial behaviour, except for the XYY karyotype where affected individuals show about three times the rate of criminal behaviour than controls or individuals with other chromosomal anomalies such as XxY, even allowing for their reduced IQ.

Behayiour disorderschallenging behayiour

Aggressive behaviour is a common problem among the mentally retarded. The symptom of aggression is often a feature of the psychosis, depression, or antisocial personality disorder and is often described in genetic disorders such as the fragile X, Prader-Willi, and Klinefelter syndromes. Learned aggression through the imitation of aggressive models or as a function of communication is also found relatively frequently among people with mental retardation.

Introduction Scope of this chapter

Offending is part of a larger syndrome of antisocial behaviour that arises in childhood and tends to persist into adulthood. There seems to be continuity over time, since the antisocial child tends to become the antisocial teenager and then the antisocial adult, just as the antisocial adult then tends to produce another antisocial child. The main focus of this chapter is on types of antisocial behaviour classified as criminal offences, rather than on other types classified for example as conduct disorder or antisocial personality disorder.

Individual factors Hyperactivity and impulsivity

In the Cambridge Study, a combined measure of hyperactivity- impulsivity-attention deficit was developed at the age of 8 to 10 years, and it significantly predicted juvenile convictions independently of conduct problems at the age of 8 to 10 years. Hence, hyperactivity- impulsivity-attention deficit is not merely another measure of antisocial personality, but it is a possible cause, or an earlier stage in a developmental sequence leading to offending. Similar constructs to hyperactivity, such as sensation seeking, are also related to delinquency. In the Cambridge Study, the extent to which a boy was daring or took risks at the age of 8 to 10 years, as rated by parents and peers, significantly predicted his convictions up to the age of 32 years independently of all other factors 57 per cent of daring boys were later convicted. Also, poor concentration or restlessness of boys was the most important predictor of convictions for violence.

Social factors Socioeconomic deprivation

Socio-economic deprivation of parents is usually compared with offending by children. However, when the children grow up, their own socio-economic deprivation can be related to their own offending. In the Cambridge Study, an unstable job record of the boy at the age of 18 years was one of the best independent predictors of his later convictions between the ages of 21 and 25 years. Also, having an unskilled manual job at the age of 18 years was an important independent predictor of adult social dysfunction and antisocial personality at the age of 32 years.

Evidence for biological determinants of offending behaviour

Genetically mediated, abnormal neurotransmission in the central nervous system of offenders has been explored, principally by Virkkunen in Finland. He found low turnover of brain serotonin in alcoholic violent offenders, together with an abnormality in the gene thought to control serotonin breakdown. (28) Evidence of low cholesterol levels in American army veterans with antisocial personality disorder has been reported, but was not replicated in a Scottish study that found no association between serum cholesterol and aggressive personality traits.(2 30) The significance of these biochemical findings in relation to criminal behaviour is uncertain.

Comorbidity of substance misuse and antisocial personal disorder

Comorbidity of both substance misuse and antisocial personality disorder is common in mentally ill people who offend. Whether acting to predispose, precipitate, or perpetuate violence the combination of mental illness with substance misuse, or mental illness with antisocial personality disorder, is likely to lead to criminal behaviour. Hiday(6r also cites the evidence supporting neurobiological pathology as providing a common basis for mental illness, substance misuse, and antisocial personality disorder.

Uncertainty about the status of personality disorder and the distinction between its subcategories

Surveys of offender populations invariably report high rates of personality disorders because repeated offending is a defining component of the disorder. A discrete personality disorder associated with offending but that does not have offending as a definer has not been found. Personality-disordered offender patients in English high-security hospitals show a range of personality disorders together with other psychiatric disorders (most commonly substance misuse), and sometimes neurological impairments 90' Thus, in practice, antisocial personality disorder as the sole diagnosis in offender populations is uncommon. There is also evidence that the personality characteristics of mentally ill patients in secure hospitals are similar to those designated 'personality disordered'. (9 )

Assessing response to treatment

The treatability in general terms of antisocial personality disorder has not been demonstrated. (96) But even if it had, there are major problems in applying treatment to offender patients and particularly in secure settings. Measuring change in personality-disordered patients while they are detained in secure settings, and making decisions about discharge based on such change, is highly problematic. (9 98 Of the 400 personality-disordered offenders detained in secure hospitals, 50 per cent have been there for longer than 0 years.(99) Secure settings protect patients from those risk factors known to be associated with further offending, for example dysfunctional relationships, substance misuse, and opportunities to exploit others and be exploited, all of which are likely to be encountered in the community.

Coolidge Axis II Inventory

The Coolidge Axis II Inventory (CATI Coolidge, 2000 Coolidge & Merwin, 1992) is a 225-item, self-report inventory designed and revised to assess personality disorders and many clinical disorders according to the specific diagnostic criteria of DSM-IV-TR. Items are answered on a 4-point Likert scale ranging from strongly false to strongly true. The CATI measures all 10 personality disorders in the main text of the DSM-IV-TR but it also covers the Passive-Aggressive and Depressive Personality Disorders in the appendix of the DSM-IV-TR and the Sadistic and Self-Defeating Personality Disorders from the appendix of DSM-III-R.

Structured Interview for Dsmiv Personality

The Structured Interview for DSM-IV Personality (SIDP-IV Pfohl, Blum, & Zimmerman, 1997) covers 14 DSM-IV Axis II diagnoses, including the 10 standard personality disorders, Mixed Personality Disorder, as well as Self-Defeating, Depressive, and Negativistic Personality Disorders. Pfohl et al. (1997) recommend that prior to administering the SIDP-IV, a full evaluation of episodic clinical disorders is required. Interestingly, the SIDP-IV does not cover personality problems on a disorder-by-disorder basis. Rather, DSM-IV personality disorder criteria

From Normality to Abnormality

Many readers will be surprised that some of their best and most admired qualities express characteristics associated with the antisocial personality, though certainly in a muted form. Adaptive traits of the more normal style include a capacity for self-sufficiency, ambition, competitiveness, and a constructive pursuit of individuality and self-determination. Oldham and Morris (1995, p. 217) describe adventurers, intrepid individuals who pushed the frontiers by crossing oceans, breaking records, and even walking on the moon. Adventurers live on the edge, these authors state, challenging boundaries and restrictions. Risk and discovery are their rewards. Real-life examples likely include famous explorers such as Christopher Columbus, as well as John Glenn and other test pilots. For such persons, adventure provides a route to freedom that is socially acceptable, even admired as stereotypically masculine. According to Oldham and Morris, they are nonconformers with their own internal value...

Sadistic Personality Disorder Dsmiiir Appendix A

Sadistic individuals take pleasure in the suffering of others, including animals. Like the antisocial personality, lying is frequent, but the sadistic personality lies with the intent of inflicting pain on others and not merely to achieve some other goal. Although the DSM-III-R indicated that the pattern must be evident by adulthood, numerous studies have found the onset of sadistic behavior as early as childhood.

Personality change due to a general medical condition JLC

An adoption study of antisocial personality. Archives of General Psychiatry, 31, 785-91. 72. Lilienfeld, S., Van Valkenburg, C., Larntz, K., and Akiskal, H. (1986). The relationship of histrionic personality disorder to antisocial personality and somatisation disorders. American Journal of Psychiatry, 143, 718-22. 106. Millon, T. (1993). Negativistic (passive-aggressive) personality disorder. Journal of Personality Disorders, 7, 78-85. 107. Perry, J.C. and Flannery, R.B. (1982). Passive-aggressive personality disorder treatment implications of a clinical typology. Journal of Nervous and Mental Diseases, 170, 164-73. 111. McCann, J.T. (1988). Passive-aggressive personality disorder a review. Journal of Personality Disorders, 2, 170-9.

Specialized prison units

Very disruptive and violent prisoners, many of whom have antisocial personality disorders, are currently held in segregation units in a number of prison locations around the country. They are subject to continuous assessment in a number of close supervision centres with regimes varying between the highly restricted to more open regimes. Prisoners may graduate back to mainstream prisons depending upon behaviour.

The Evolutionary Neurodevelopmental Perspective

Disdain for shared standards of social living often leads to confusion between the narcissistic and antisocial personalities. Both exploit others to their own advantage. Narcissists, however, are passive in so doing and largely unaware of the relevance of manipulating others. Theirs is not the scheming, promise-breaking exploits of the antisocial. Instead, their self-centered convictions of entitlement lead them to believe that others simply owe them, whereas the antisocial is deliberately deceptive and ruthless. Moreover, the two disorders differ markedly in their daily worldview. The narcissist manifests an attitude of insouciant calm, being above the stresses of everyday life. In contrast, the antisocial sees the world as an intrinsically hostile place where everyone is a potential aggressor and impulsive anger serves a functional purpose The best Narcissistic traits are frequently associated with abuse of alcohol, opiates (Calsyn, Fleming, Wells, & Saxon, 1996), cocaine and...

The Debate about Stability versus Change for the Personality Disorders

In another early cross-sectional study, Coolidge et al. (1992) examined age differences in personality disorders between a sample of community-dwelling older adults (age range 61 to 78 years) and younger adults (age range 16 to 58 years) with the self-report form of the CATI (Coolidge & Mer-win, 1992). Results showed that the older adults were significantly higher on the schizoid and obsessive-compulsive scales than the younger adults there were no age differences on the dependent and avoidant scales and younger adults were higher on the remaining scales (antisocial, borderline, histrionic, narcissistic, paranoid, passive-aggressive, schizotypal, sadistic, and self-defeating). These results of age-related elevations for obsessive-compulsive and schizoid scales were replicated with larger samples (Segal et al., 2001). In a similar cross-sectional study using the self-report Millon Clinical Multiaxial Inventory (MCMI Millon, 1981b), Molinari et al. (1999) also reported a higher rate of...

Cluster A personality disorders Paranoid personality disorder JLC

Personailty Disorder Table

People with schizotypal personality disorder are suspicious, have paranoid ideas, and keep their distance from others. However, they also experience perceptual distortions and magical thinking, and are usually odd and eccentric. Schizoid personality disorder is characterized by aloofness, coldness, and eccentricity, but these individuals usually lack prominent suspiciousness or paranoid ideation. Individuals with avoidant personality disorder are hypersensitive and do not confide in others. However, their lack of confidence is based on fear of being embarrassed or found inadequate rather than fear of other people's malicious intentions. Some antisocial behaviour by paranoid individuals originates in a wish for revenge or counter-attack, rather a desire for personal gain as in antisocial personality disorder. Paranoid features are often present in narcissistic individuals who fear that their imperfections could be revealed. The differential diagnosis should be based on the predominance...

Passive Aggressive Personality Disorder Dsmivtr Appendix B

The Passive-Aggressive Personality Disorder has been in the DSM since its inception in 1952. Only in 1994 with the advent of DSM-IV was the Passive-Aggressive Personality Disorder removed from Axis II and placed in an appendix. The reasons for its drop in diagnostic status are uncertain however, Appendix B of DSM-IV-TR is intended to foster research that may result in a refinement of the diagnosis and its criteria, so it is possible the type may reappear in revised form in future versions of the DSM. A major problem is immediately evident from an examination of the criteria for the two personality disorders in the appendix of DSM-IV-TR (depressive and passive-aggressive). The Passive-Aggressive Personality Disorder's alternate label is Neg-ativistic Personality Disorder yet none of the 7 criteria lists negativism as a symptom. Negativism, however, is listed as Criterion 5 for the Depressive Personality Disorder. This anomaly is certain to cause some confusion in the minds of...

Variations of the Avoidant Personality

Avoidant Personality Subtypes

A defining feature of avoidant personality disorder is the conflict of longing for intimacy versus the fear of vulnerability that naturally ensues in a close relationship with another. In a similar manner, those with a negativistic personality (formerly referred to as passive-aggressive ) are basically ambivalent about themselves and others. They idealize their close friends and companions, but should their sense of autonomy be threatened, they seek to undermine or humiliate them. What we are terming the conflicted avoidant is an avoidant pattern that combines features of the negativistic personality. Here, we may expect to see basic withdrawal tendencies of the avoidant pattern but expressed in a manner akin to the negativist's penchant for interpersonal guerilla warfare.

Carl G Jung Jungs Contribution to Personality Theory

Histronie Wut

Although these additional dimensions do not translate directly into contemporary Axis II constructs, certain personality disorders nevertheless seem stuck in one of Jung's four modes. Compulsive personalities, for example, are famous for a paralysis of analysis, a heroic effort to get all of life into a rational mode, though mainly because they fear making a mistake and being condemned for it. Histrionic and antisocial personalities are famously sensation seeking, so much so that they fail to anticipate the consequences of their actions in favor of momentary pleasures. Because Jung is now mainly a historical figure, the study of the thinking-feeling and sensing-intuiting polarities in connection with pathological personality has not yet come to fruition.

The Negativistic Passive Aggressive Personality

Passive Aggressive Personality Disorder

Such individuals are often called passive-aggressive personalities. In this chapter, negativistic is the preferred designation, a newer label that captures the broader elements of the total pattern. The pattern is perhaps best understood as being both similar and opposite to the compulsive. In terms of the evolutionary model, both are ambivalent patterns that struggle mightily with issues of obedience and defiance (Rado, 1959). The negativistic pattern, however, is actively ambivalent, whereas the compulsive is passively ambivalent. As such, compulsives follow a strategy of containment, suppressing their conflicts to appear self-controlled, perfectionistic, orderly, and morally scrupulous. In contrast, negativists work out their resentments on the surrounding world, but only in indirect ways, thus symbolizing their inability to break free of ambivalence and pursue a strategy of overt opposition. Negativistic Personality Disorder DSM-IV Criteria Given the portrait of Kim, we are now in...

The relationship between offending behaviour and mental disorder

The mental disorder and the offending behaviours are intimately linked both in their origins and in their expression (e.g. antisocial personality disorder and the paraphilias). Perhaps most complex of all is the relationship between the disordered state of mind and disordered behaviour to be found in psychopathy, or its virtual equivalents antisocial personality disorder and severe personality disorder. These disorders are often characterized by varying mixtures of affective instability, impulsivity, suspiciousness, narcissism, difficulties with intimacy, and ready resort to anger. The psychopathic disorders arguably often have their roots in large part in an interaction between a pre-existing vulnerability and developmental disadvantages such as inadequate parenting, child abuse, educational failure, and social disruption. Similarly antisocial behaviour emerges most frequently against the same background of family and social deprivation. The problems of the definition and management...

Gender Bias in the Diagnosis of Personality Disorders Do Clinicians Have Gender Expectations

Cloninger Model

Calmly understanding the issues on all sides, the odds are stacked against it. Similarly, a child whose personal tempo is slower than average is unlikely to develop a histrionic style, and an unusually agreeable infant is unlikely to develop an antisocial personality. Thus, biology does not determine our adult personality, but it does constrain development, channeling it down certain pathways rather than others, in interaction with social and family factors. Research psychiatrist Cloninger (1986, 1987b) proposed an elegant theory based on hypothesized relationships of three genetic-neurobiologic trait dispositions, each of which is associated with a particular neurotransmitter system. Specifically, novelty seeking is associated with low basal activity in the dopaminergic system, harm avoidance with high activity in the serotonergic system, and reward dependence with low basal noradrenergic system activity. Novelty seeking is hypothesized to dispose the individual toward exhilaration...

Characteristics of the subchapters of Chapter V F

Specific personality disorders are coded in this subchapter. Cyclothymic personality is not included, but an equivalent appears in F3 as cyclothymia. Also, schizotypal disorders could have been assigned to this subchapter but appears instead in F2 (as F21). As in DSM-IV, the emotionally unstable personality disorder is found in this subchapter, where it is subdivided into an impulsive type (F60.30) and a borderline type (F60.31). A new entity is the factitious disorder, i.e. the intentional production or feigning of symptoms or disabilities, either physical or psychological (F68.1). If desired, narcissistic personality disorder and passive-aggressive personality disorder may be coded by using the criteria in Annex 1 of DCR.

Application to Antisocial Histrionic Narcissistic Dependent and Avoidant Personality Disorders

Evolutionary psychologists propose that individuals with either Antisocial Personality Disorder or Histrionic Personality Disorder cheat their way into the status hierarchy. For example, the antisocial person disregards and violates the rights of others with chronic patterns of aggression, deceitfulness, irresponsibility, and a lack of remorse. The DSM-IV-TR states that its prevalence rate is 3 in males and 1 in females, and these rates are relatively invariant across the world. Evolutionary psychologists suspect that antisocial persons often steal the resources of others rather than earn them by their place in the status hierarchy. Antisocial men may fake their parental investment so as to fool women into thinking they will be stable fathers when they will not be. Antisocial women may fool men who are actually high in parental investment to impregnate them despite the women's lack of commitment to the relationship or the children. In both cases, antisocial genes are passed on. With...

Genetics Of Sensation Seeking

The heritabilities for the three subscales Dis, TAS, and ES were fairly similar across the five groups in the three studies, averaging .50 to .57. That for BS was lower, probably because of the lower reliability of this subscale. None of the studies showed effects of shared environment and the remaining variance was due to the non-shared environment and error. Eysenck found specific genetic factors accounted for the predominance of the genetic variance for the subscales, except for ES which was almost entirely accounted for by the general genetic factor found in all of the scales. Koopmans et al. could not find one genetic factor underlying all 4 subscales, but did find genetic coveriance between Dis and BS, and another genetic factor underlying TAS and ES. Dis and BS are the most elevated scales of sensation seeking found in antisocial personalities of the primary type (Emmons & Webb, 1974).

Sadistic personality disorder DLT

The major distinction for the diagnosis of sadistic personality disorder is from antisocial personality disorder. Widiger et al.(U2) note that the sadistic person may simply represent an aggressive (antagonistic) subtype of psychopathy. Intimidation and sadistic control of others, as well as a fascination with weapons, martial arts, and torture, may be manifested by both antisocial and sadistic individuals. Moreover, both disorders may display 'malignant narcissism', (3 with an admixture of narcissistic, antisocial, sadistic, and paranoid features. Such a characterological constellation is frequent among murderers and therefore is considered to be of great forensic significance. (H8) Widiger et al.(UD state that making a distinction between antisocial personality disorder and the sadistic personality disorder may be as meaningless as trying to determine whether a person is psychopathic or antisocial. Existing data(H9) suggest that sadistic personality disorder is relatively uncommon,...

The Psychodynamic Perspective

Because the borderline, by this argument, defines a level of organization among intrapsychic structures, there is naturally a question of its relation to the character styles of classical psychoanalysis as well as to the DSM personality disorders. Rather than dump all of these into a single level called borderline, Kernberg (1994) provides additional differentiation by subdividing the borderline into two sublevels, one of which has more in common with psychosis and the other with neurosis. The more neuroticlike borderline organization includes the sadomasochistic, cyclothymic, dependent, histrionic, and those narcissistic personalities compensated by grandiosity. The lower level includes the paranoid, hypochondriacal, schizotypal, hypomanic, and antisocial personalities, as well as what Kernberg calls malignant narcissism. All the personalities at the higher and lower levels express the borderline personality organization but in different ways, depending on the particulars of their...

Neurotransmitters and their Enzymes

Antisocial Personality Disorder All of the above studies have used MAO-B from blood platelets. Recent data have implicated MAO type A in antisocial behavior and aggression, and studies on mice have shown a relationship between aggression and the absence of the gene. Caspi et al. (2002) have shown an interaction between childhood maltreatment and alleles of the gene encoding MAO-A. This is a longtudinal study so that the records of childhood maltreatment do not depend on retrospective accounts. Among those with the form of the gene that results in low MAO-A activity those children who also experienced severe maltreatment had a high incidence of conduct disorder during childhood, and antisocial personality disorder with violence at age 26. But among those with the form of the gene producing high MAO-A activity there was no difference in incidence of either of these disorders or in violence between those maltreated and those not maltreated during childhood. Neither the form of the gene...

Structured Clinical Interview for Dsmiv Axis II Personality Disorders

The Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II First, Gibbon, Spitzer, Williams, & Benjamin, 1997) was developed to complement the widely used Axis I version of the SCID (First, Spitzer, Gibbon, & Williams, 1997). The SCID-II has semi-structured format (like the Axis I version) but it covers the 10 standard DSM-IV Axis II personality disorders, as well as Personality Disorder Not Otherwise Specified, and Depressive Personality Disorder and Passive-Aggressive Personality Disorder from DSM-IV Appendix B (see Table 9.2). The Axis I SCID is commonly administered prior to personality disorder assessment so that the patient's mental state can be considered.

The stigma of personality disorder

Cusack and Malaney(9) posed the question as to whether patients with antisocial personality disorders are 'bad' or 'mad'. They attempted to establish differential criteria in order to show that if patients with an antisocial personality disorder are not 'mad', then they must be considered as 'bad' and therefore must be delivered to the judicial system, after diagnosis and treatment for any secondary symptomatology.

Diagnostic Interview for Dsmiv Personality Disorders

The Diagnostic Interview for DSM-IV Personality Disorders (DIPD-IV Zanarini, Frankenburg, Sickel, & Yong, 1996) is a semi-structured interview designed to assess the presence or absence of the 10 standard DSM-IV personality disorders as well as Passive-Aggressive Personality Disorder and Depressive Personality Disorder in the DSM-IV appendix. Before personality assessment, a full screening for Axis I disorders is recommended. Additionally, an assessment of the respondent's general functioning (e.g., in the areas of work, school, and social life) is advised before administration of the DIPD-IV (Zanarini et al., 1996).

Course and Prognosis for the Personality Disorders

One of the first outcome studies of Antisocial Personality Disorder was performed by Robins (1966). In a 5-year follow-up of 82 adults diagnosed with Antisocial Personality Disorder, she found that 61 showed no improvement and 5 had committed suicide. In another study with a 5-year follow-up interval, Maddocks (1970) found that 80 of 59 antisocial men had not improved. Black, Baumgard, Bell, and Kao (1995) further demonstrated the morbidity associated with the Antisocial Personality Disorder diagnosis, as nearly 24 were found to be dead after varying follow-up intervals of 16 to 45 years. Of course, some of these deaths might have been expected over a period as long as 45 years however, the study also points to the dangers of interpreting course, outcome, or prognosis from cross-sectional studies. We noted earlier in several cross-sectional studies that the mean level of antisocial behavior is significantly diminished in older groups. As just noted, a contributing factor is selective...

Variations of the Narcissistic Personality

Compensatory Narcissist

Unprincipled narcissists combine the self-confidence of the narcissist with the recurrent aberrant behavior of antisocial personality patterns. Many of these individuals achieve success in society by exploiting legal boundaries to the verge of unlawfulness. Others may inhabit drug rehabilitation programs, centers for youth offenders, and jails and prisons. Still others are opportunists and con men, who take advantage of others for personal gain. Most people who demonstrate a pattern combining these styles are vindictive and contemptuous of their victims. Whereas many narcissists have normal superego development, unprincipled narcissists are skilled in the ways of social influence but have few internalized moral prohibitions. They are experienced by others as unscrupulous, amoral, and deceptive. More than merely disloyal and exploitive, these narcissists show a flagrant indifference to the welfare of others, a willingness to risk harm, and fearlessness in the face of threats and...

The Interpersonal Perspective

Of being special and unique, or to avoid defeat (Gunderson & Ronningstam, 1990). After all, only someone special can go unpunished. Some even flaunt their transgressions to competitors, and fellow narcissists may even compete to determine who can successfully take the most shortcuts the most flagrant rule-breaker wins. Such individuals hug the boundaries between the narcissistic and antisocial personalities. In extreme cases, their self-centered exploitiveness may take on an almost diabolical quality. M. Scot Peck's (1983) portrayals of evil have been seen by some as mixing narcissism and moral corruption (Klose, 1995). Not all narcissists are like this. There are certainly those with good superego development this alternate variant of the personality pattern often incorporates moral values into an exaggerated sense of superiority. Here, moral laxity is seen as evidence of inferiority, and it is those who are unable to remain morally pure who are looked on with contempt.

Differential diagnosis

Dissocial antisocial personality disorder In ICD-10 it is suggested that a person should be 17 years of age or older before dissocial personality is considered. Since at age 18 most diagnoses specific to childhood and adolescence no longer apply, in practice there is seldom difficulty. In DSM-IV conduct disorder can be diagnosed at over 18 years of age and so there is potential overlap. A difference in emphasis is the severity and pervasiveness of the symptoms of those with personality disorder, whereby all the individual's relationships are affected by the behaviour pattern, and the individual's beliefs about his antisocial behaviour are characterized by callousness and lack of remorse.

Millon Clinical Multiaxial InventoryIn

The MCMI-III includes 11 Clinical Personality Patterns scales Schizoid, Avoidant, Depressive, Dependent, Histrionic, Narcissistic, Antisocial, Aggressive Sadistic, Compulsive, Nega-tivistic (Passive-Aggressive), and Self-Defeating Personality Disorder. Three Severe Personality Pathology scales are also included and these are Schizotypal, Borderline, and Paranoid Personality Disorder. Each represent more advanced stages of personality pathology with episodes of psychosis. Additionally, 7 Clinical Syndromes scales (Axis I related) are provided, covering moderate clinical presentations (e.g., Anxiety, Somatoform, Dysthymia, Alcohol Dependence) whereas 3 Severe Syndromes scales denote more serious clinical disorders (Thought Disorder, Major Depression, and Delusional Disorder). The MCMI-III has a Validity Index (3 items of an improbable nature) and 3 Modifying Indices (Disclosure, Desirability, and Debasement) designed to detect deviant test-tasking attitudes defensiveness or exaggeration...

Self Report Inventories

A rating scale can be completed by anyone who knows the subject well, perhaps a spouse, teacher, parent, coworker, priest, or even parole officer. Such persons are in a position to offer a unique perspective on the problem, its severity, and its causes. Rating scales and checklists may also be completed by the clinician, who makes a series of judgments on the basis of all available information, including the clinical interview. Here, rating scales and checklists often serve as a memory aid, ensuring that everything relevant to the disorder is included in developing a treatment plan. Rating scales usually have more items than the DSM-IV diagnostic criteria for the same syndrome and are usually held to a higher standard of scientific rigor. Because they have more items, they provide more fine-grained measurements, but they also take more time to complete. For example, the revised Psychopathy Checklist (PCL-R Hare, 1991) consists of 20 items, whereas the DSM-IV offers only seven criteria...

Disorders of lipid metabolism

The relationship between lipid levels and psychopathology is complex and controversial. Several studies suggest that low cholesterol levels are associated with violence. Freedman et al.,(57) in a study of 3490 male veterans, found that men diagnosed with generalized anxiety disorder had higher cholesterol levels whereas men with antisocial personality disorder had significantly lower cholesterol levels than normal. These associations were independent of other factors that could influence lipid levels, but precise cause-and-effect relationships are unclear.

Psychological factors Personality

It is now widely accepted that alcoholics do not present a homogeneous premorbid personality profile. However, some distinctive trait clusters have been identified which seem to characterize different types of alcoholics.(35) One such group (type 1) tend to score low in novelty seeking and high in harm avoidance and reward dependence. Another group (type 2) is formed by the natural thrill seekers, who appear to ignore harmful consequences and punitive responses. This latter cluster, which prevails mostly in males with early-onset alcoholism, is also typical of antisocial personalities. Of all personality features, conduct disorder and antisocial behaviour are the strongest predictors of alcohol misuse.(36) However, more than half the alcoholic population do not have such a personality background, presenting rather with a non-specific mixture of the different personality types described in clusters A, B, and C of the DSM-IV classification. (37)

Alpf Medical Research Personality Disorders

There are several variations of the depressive personality that mix with other personality traits. The ill-humored depressive is a mixture with the negativistic personality that complains endlessly and is chronically irritable. The voguish depressive is a mixture with histrionic or narcissistic features that sees suffering as noble. Self-derogating depressives possess some dependent features where they feel guilt and must discharge it though self-punishment. The morbid depressive shares features with the masochistic personality and frequently blends into an Axis I clinical depression. The restive depressive has avoidant features, expressing anguish and agitation. Depressives may share many traits also with the schizoid, compulsive, and borderline personalities. They are also often diagnosed with dysthymia, major depressive episodes, as well as with anxiety syndromes. Several variations on the negativistic personality exist. The circuitous negativist is a mixture with dependent traits...

Psychoanalytic Theories of Personality Disorders

Freud can also be credited with developing some of the earliest theoretical foundations of personality disorders such as the Dependent, Passive-Aggressive, Borderline, Narcissistic, Histrionic, and Obsessive-Compulsive Personality Disorders. Besides their instinctual bases, he viewed these personality disorders as emerging from unsuccessful resolutions of the psycho-sexual stages of development he posited. We now examine the psychoanalytic concepts relevant to the formation and maintenance of these and other personality disorders.

Early Historical Forerunners

The antisocial personality has been known since at least the ancient Greeks. In the 1800s, the origins of antisocial behavior were associated with the philosophical debate between free will and determinism. Given such a context, the physicians of the 1800s naturally wondered whether antisocial persons could understand the consequences of their own actions. Philippe Pinel (1801, 1806) referred to a form of madness known as la folie raisonnante, a tendency toward impulsive and self-damaging acts in the presence of unimpaired intelligence and full awareness of actions. Pinel's observation was intended to be descriptive, not value-laden. The idea that psychopathology could occur in the absence of mental confusion then spread throughout Europe but was still hotly debated. Toward the end of the nineteenth century, psychiatry began to turn away from moral classification and toward observational research. Koch (1891) proposed that the term moral insanity be replaced by psychopathic...

Domestic Violence Who Commits Domestic Violence

A 26-year-old male was arrested following the multiple stabbing death of his wife. Intoxicated during the incident, he positioned the corpse so that he could perform vaginal intercourse while he watched pornographic films on television. Psychological testing performed after his arrest revealed diagnoses of antisocial personality disorder and major depression (Meloy, 1996). The psychopath's apparent inability to inhibit aggression has implications for the area of domestic violence. Exactly who will become abusive is difficult to determine. Although domestic violence occurs at all levels of society, sociodemographic variables indicate that younger, lower income, less educated men with a history of parental violence and current diagnoses of antisocial personality disorder, depression, and alcohol or drug abuse are more likely to be perpetrators (L. E. Keller, 1996). In this text, psychopaths are more clearly depicted as the malevolent antisocial subtype.

Application to Personality Disorders

Pretzer and Beck (1996) believe that cognitive therapy has particular value in the treatment of personality disorders. Interestingly, Beck is one of the very few theorists to offer an ultimate explanation for personality disorders from an evolutionary perspective and also to offer specific therapeutic interventions for their amelioration. Beck's theorizing follows the traditional evolutionary explanations (which are expanded on in Chapter 8). Simply put, Beck (1992) theorizes that the origins of many modern personality disorders developed from specific conditions in the ancestral environment that are now maladaptive in the present environment. He labeled these behaviors, which were successful in the ancestral environment, primeval strategies. For example, persons with Antisocial Personality Disorder exhibit the primeval strategy of predation. Persons with the Histrionic Personality Disorder exhibit the primeval strategy of exhibitionism. Obsessive -compulsive persons exhibit the...

The Biological Perspective

Some research has been directed toward the role of genetics, a distal influence on immediate behavior that comes down to us across millions of years of evolutionary time. The heritability of certain personality disorders is clearer, though the exact pathways remain speculative. Pedigree studies have shown that antisocial and criminal behavior is much more frequent in the fathers of antisocial children, even when the child is adopted away at birth so that the psychological influence of coping with an antisocial parent is eliminated (Cadoret, Troughton, Bagford, & Woodworth, 1990). Antisocial behavior in a fraternal or identical twin also raises the possibility that the other twin will also be antisocial, whether raised together or separately. If histrionic personality disorder is considered a dramatic caricature of what is female, just as the antisocial personality may be considered a dramatic caricature of what is male, we might expect that both disorders represent the same underlying...

HIV and Personality Disorders High Risk Behavior and Disease Susceptibility

Why would HIV and personality disorder go together Personality disorders are often linked to impulsivity, and impulsivity is linked to high-risk behaviors. By definition, impulsive individuals fail to think through the consequences of their actions. Borderlines, for example, are famous for sudden shifts of emotion and impulsive actions, including spending sprees and heavy alcohol and substance abuse. Moreover, impulsivity is linked to unprotected sex and multiple sexual partners, a principal way through which HIV is spread. Likewise, a significantly greater proportion of subjects with antisocial personality disorder engage in needle sharing than those without antisocial personality disorder. The petulant borderline is mixed with the negativistic (passive-aggressive) personality. When even more dyscontrol is added to the active-ambivalence of the negativist, the result is someone who is even more unpredictable, restless, irritable, impatient, complaining, disgruntled, stubborn, sullen,...

Early Perspectives on the Personality Disorders

The social sciences, however, are fundamentally different. Whereas investigation in the natural sciences eventually comes to closure through the interplay of theory and research, the social sciences are fundamentally open. Here, advancement occurs when some new and interesting point of view suddenly surges to the center of scientific interest. Far from overturning established paradigms, the new perspective now exists alongside its predecessors, allowing the subject matter of the field to be studied from an additional angle. A perspective is, by definition, just one way of looking at things. Accordingly, paradigm experiments are either not possible or not necessary, because it is understood that no single perspective is able to contain the whole field. Tolerance thus becomes a scientific value, and eclecticism a scientific norm. In personality, the dominant perspectives are psychodynamic, biological, interpersonal, and cognitive. Other, more marginal conceptions could also be included,...

Epidemiology and Gender

Another important epidemiological issue concerns the extent to which gender differentially affects the prevalence of personality disorders among older adults. According to the DSM-IV-TR, three personality disorders (borderline, dependent, and histrionic) are more prevalent in females, and six personality disorders (antisocial, paranoid, schizoid, schizotypal, narcissistic, and obsessive-compulsive) are more prevalent in males. Sadistic Personality Disorder was also thought to be more common in males, whereas Self-Defeating Personality Disorder was thought to be more prevalent in females. No information was provided by the DSM for the Passive-Aggressive Personality Disorder regarding gender. Finally, the Depressive Personality Disorder was thought to occur with equal frequency in both genders.

Abnormal Behavior and Personality

Abnormal psychology has its own special vocabulary, or jargon. Many terms used in the discussion of abnormal behavior appear repeatedly in this book. Learn them now, for you will see them again and again. Diagnostic criteria are the defining characteristics used by clinicians to classify individuals within a clinical category. Essentially, diagnostic criteria constitute a checklist of features that must be present before a diagnosis can be made. Each disorder has its own unique list. Some lists are short others are longer. For example, seven criteria are used to diagnose the antisocial personality. One of these is deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure (DSM-IV 1994, p. 650). Eight criteria are used to diagnose the histrionic personality. One of the most interesting is interaction with others is often characterized by inappropriate sexually seductive or provocative behavior (p. 657). Real persons, however, seldom...

Minnesota Multiphasic Personality Inventory2

Because the MMPI-2 is a measure of symptom profiles, Axis I disorders, and personality traits, it is not intended as a formal measure of DSM-based personality disorders. As can be seen from the standard scales, only 1 of the 10 scales (Psychopathic Deviate) is an overt measure of personality pathology (Antisocial Personality Disorder). Although researchers have derived personality disorder scales (Morey, Waugh, & Blash-field, 1985) from the original MMPI items, use of these derived scales in clinical practice is uncommon they have not been updated since their initial creation nor validated with older adults

Basic Concepts of Evolutionary Theory

To explain further the development of ESS, British biologist John Maynard Smith coined the term frequency-dependent selection. Frequency-dependent selection states that the value of a trait will decrease as its frequency in the population increases. In practice, this means that natural selection places an upper limit on the predominance of any trait, which allows for an alternative and usually dissimilar behavioral trait. To relate this concept to personality disorders, evolutionary psychologists would posit that people with Antisocial Personality Disorder traits could persist in the gene pool as an alternative pattern to the predominant pattern of a culture's members practicing kin altruism and reciprocal altruism. However, it could not be a predominant pattern because not everyone, nor even a majority of societal members, could practice cheating and neglectful parenting and have that culture survive. From this basic foundation of evolutionary theory, we now examine clusters of...

Course and prognosis

Antisocial personality disorder may be used as an example. The ECA study revealed that antisocial personality disorder declined from a 1-month prevalence of 0.9 per cent for individuals between 25 and 44 years of age to 0 per cent for those over the age of 65. When considering men only, the rate fell from 1.5 per cent in those aged 22 to 44 to 0.1 per cent in those over 65. (2,9 Supporting this decline in antisocial personality disorder with ageing is a study revealing the decline in lifetime prevalence in antisocial personality disorder from between 2.1 and 3.3 per cent to between 0.2 and 0.8 per cent in those aged 65 and older. (21) In addition, antisocial traits, as measured by the Minnesota Multiphasic Personality Index, reveal a decline with ageing. (22 Similarly, a study in a forensic psychiatric centre revealed that, although antisocial personality disorder declined after the age of 27, one-third remained criminally active throughout their lives. There have been several...

Adoption studies

Although adoption studies allow us to examine the effects of both genes and environment, there are several potential drawbacks to the method. First, adoption is in itself an unusual event and there is a tendency for higher rates of some psychiatric difficulties such as antisocial personality traits amongst adoptees. Second, adoptive placements are not random in that adoption agencies are likely to attempt to match adoptive and biological parents for physical, social, and other characteristics. Nevertheless, despite these difficulties, adoption evidence has given much support to the role of both genes and environment for traits and behaviours such as cognitive ability and criminality.

Social issues

Social disintegration can cause episodic antisocial behaviour, reflecting a normal adaptation to an abnormal social environment. (31 Severe and chronic criminality can also be facilitated by social influences. However, the multifactorial origin of the antisocial personality disorder and its early onset and manifestations indicate that it cannot be attributed to cultural conflicts and social determinants. Patients with antisocial personality disorder often wear 'a mask of sanity' and may appear quite normal, charming, and understanding. However, their history reveals disturbed functioning in the domains of behaviour and self-concept, love and sexuality, interpersonal relations, and cognitive style. (32)

Biological issues

Family studies of borderline personality disorder support the constitutional psychobiological role. There is increasing evidence that parents of borderline patients have a high incidence of affective disorder and borderline-type behaviours, alcoholism, antisocial personality disorder, and other cluster B personality disorders. (50)


DSM-IV suggests that malingering should be 'strongly suspected' when two or more of the following factors apply medicolegal context, antisocial personality disorder, discrepancy between complaints and objective findings, and lack of co-operation with the assessment (although this may be considered too broad for clinical utility).

Violent offenders

Therapeutic communities have been established in prisons to deal with disruptive, violent prisoners and also with the underlying problems of psychopathy and antisocial personality disorder. Results at Barlinnie Special Unit in Scotland demonstrated dramatic reductions in violent incidents within prison. (29 Results at Grendon, England's only prison run entirely on therapeutic community lines, show significant reduction in re-offending in those who stayed longer than 18 months, a result enhanced when prisoners were discharged straight into the community rather than via transfer to other prisons. (2 The United Kingdom's government's Review of Services for Mentally Disordered Offenders has concluded that 'studies of the therapeutic community approach to treatment have shown the most encouraging results of any form of treatment'.(22.'

Genetic factors

Family, twin, adoption, and molecular studies offer strong evidence of a genetic component to AD-HKD. Studies of community (88 and clinic samples*89,9 and 91.) show that relatives of AD-HKD probands have an increased risk for AD-HKD. Moreover, they are also at increased risk for antisocial personality disorder, conduct disorder, and other conditions such as anxiety, mood, and reading disabilities. (52 Twin studies find a markedly higher concordance of AD-HKD for monozygotic (79 per cent) than dizygotic (32 per cent) twins that is consistent with a genetic origin of AD-HKD. (85) Adoption studies(92 provide further evidence of a genetic component to AD-HKD biological parents of AD-HKD probands are more likely to exhibit AD-HKD or related disorders than adoptive parents. Siblings of children with AD-HKD have two to three times the risk of having AD-HKD than siblings of normal controls. (93 Furthermore, the basic characteristics that comprise the syndrome of AD-HKD are highly heritable...

Family environment

Physical and sexual abuse can lead to the emergence of conduct problems in girls or boys who were previously free of such problems. Kessler et al. (26 found that physical aggression from the father was associated with a more than doubling of the rates of conduct disorder and quadrupling of the rates of antisocial personality disorder. Trickett and McBride-Chang(27 found sexual and physical abuse associated with a wide range of poor outcomes. The difficulty in ascertaining their effect arises, as they are usually associated with multiple other risk factors such as poor parenting and rejection, in addition to a genetic predisposition. Widom, (28 however, found that early childhood victimization only raised later criminality by 50 per cent.


Official statistics (arrests, persons convicted or cautioned), self-reported offending, and studies of self-reported conduct disorders or antisocial personality all show much higher rates among males than among females. Zoccollillo et al.(62) stress the need to look more specifically at future research criteria for conduct disorder in girls to create criteria to identify girls who are developing life-course persistent antisocial behaviour before adolescence, and to raise the possibility that criteria used for girls may need to be different from those used for boys. If current criteria are too gender biased, we are not serving 'at-risk' girls well. Girls reaching the current diagnostic criteria for conduct disorder have a poor outcome including early and violent death, arrest, substance abuse and dependence, antisocial personality disorder, failing to finish school, and teenage pregnancy. Current intervention models for delinquency do not make distinctions between males and females....

Ethical problems

The history of forensic psychiatry emphasizes the complex ethical problems that are confronted by practitioners and patients. They include the abuse and misuse of psychiatry, the conflicting demands of confidentiality and the duty to the court and third parties, consent to treatment and incapacity, the civil rights of patients and mental health law relating to detention, and the dual responsibilities of practitioners to the court and the patient client. Other continuing problems are dangerousness and risk assessment, the nature of antisocial personality disorder, and the contrasting roles of prison and hospital.

Specialized services

Although inevitably all forensic psychiatrists have patients under their care with personality disorders there is a wide lack of agreement about the diagnosis and treatability of this group, and in many instances an absence of conviction about the value of treatment. At the time of writing (early 1999) psychopathy and severe personality disorder are popular topics for debate in the United Kingdom, with an emphasis on the problems of management of those classified as having antisocial personality disorder or dissocial personality disorder.

The Item Level

Ideally, every scale item should tap some aspects of the construct the scale is intended to assess. When all the important aspects of a construct have been anchored to different items, the scale is said to possess content validity. The narcissistic personality, for example, consists largely of the traits of grandiosity, exploitiveness, and lack of empathy. As such, any scale lacking items that assess grandiosity cannot be a valid measure of the narcissistic construct, as content essential to the construct is missing. Careful consideration of the different facets of every construct is, therefore, essential to scale development. Scales that perform in accordance with the expectations of psychological theory are said to possess the additional property of construct validity (Cronbach & Meehl, 1955). If a new antisocial personality scale fails to correlate highly with an established measure of substance abuse, for example, this calls the validity of the antisocial scale into question....

Personality change

In acquired antisocial personality disorder(36) the person is often self-centred and relatively oblivious to the needs of others. They are likely to be tactless and, on occasion, offensively rude. Irritability and aggression and impulsive behaviour are seen. They may show a lack of remorse for the violent behaviour. These personality traits often are accompanied by the dysexecutive syndrome. Thus not only does the person show disturbed social decision-making, resulting in antisocial behaviours, but also disruption of the planning and organizational skills needed for cognitive tasks. For example, helpful and supportive friends may be alienated in favour of disreputable acquaintances, at the same time as money is impulsively spent, and lost, on risky projects without any attempt to weigh up the options.

Focus on Research

One of the reasons alcoholism resists treatment is that every alcoholic is different. Recognizing that people drink for different reasons, researchers have turned to personality to better understand the variety of forces that drive the disease. Cloninger (1987a) proposed two types of alcoholism based on his model of neurobiological personality dimensions. His Type 1 alcoholic is high in harm avoidance and reward dependence and low in novelty seeking, a combination of traits similar to the dependent and avoidant personalities. His Type 2 alcoholic is high in novelty seeking but low in harm avoidance and reward dependence, a combination of traits similar to the antisocial personality. Cloninger's speculations are interesting, if only because two personality types identified as being at risk fall at opposite corners in the space defined by his conceptual model (see Figure 1.5 in Chapter 1). The avoidant-dependent type appears to drink as a retreat from the stresses of life, and the...


Davis describes the use of cognitive therapy with the antisocial personality. Rather than attempt to induce shame and anxiety, these authors advocate a strategy that helps move the subject from a primitive to a more abstract level of moral reasoning. Most antisocials function at the lowest level, constructing the world in terms of their own immediate self-interest. The goal of therapy is the next level, which features a longer term, more enlightened self-interest that includes limited recognition of the effects of the individual's own actions on others. Specific problem areas can be identified through a thorough review of the subject's life. Following this, the use of cognitive distortions relevant to each problem is identified. An-tisocials may believe that just wanting something justifies any subsequent behavior, thoughts and feelings are always accurate, their actions are right because they feel right about what they are about to do, and the views...

Predisposing factors

Pathological gambling may occur in any mental disorder. However, it is most commonly associated with depression. More usually, a neurotic type of depression occurs after a bout of heavy gambling with large losses. In symptomatic pathological gambling, the depression is primary and a response to the tension and feelings of guilt that occur in depression. This latter situation is similar to alcohol misuse and shoplifting, as part of the depressive syndrome. Pathological gambling may also be a manifestation of antisocial personality disorder.

Chart Records Review

In some clinical contexts in which older patients may be evaluated (e.g., nursing homes and rehabilitation hospitals), charts or records may be available. In long-term care settings in which patients have had lengthy stays, these charts may be voluminous. In cases where records are accessible, it behooves the clinician to thoroughly examine them as part of the assessment process. A review of such records may show important behavioral patterns of the patient that are observed by members of the treatment team. Such patterns may give clues to personality disorder features shown by the patient, especially if the same traits are seen by different professionals. For example, passive and helpless behaviors might be noted by nursing staff and activity directors, suggesting a dependent personality style. Aggressive, haughty, and indignant behaviors in another resident may point to the presence of narcissistic, borderline, or paranoid features. Noncompliance with treatment may be due to several...