Not all antisocials are criminals, and not all criminals are antisocial. Quite the contrary, there are many normal-range antisocial traits that are admired and encouraged in our competitive society. In fact, most antisocials find comfortable places in society, often becoming business tycoons, politicians, and military professionals. Oldham and Morris's adventurer and Millon's dissenting personalities are examples of these normal variants, who are often the heroes and conquerors described in our history books.
Several subtypes of the antisocial personality have been identified using Millon's evolutionary theory: covetous antisocials, who feel that life has not given them their due; reputation-defending antisocials, who share traits with the narcissistic personality; risk-taking antisocials, who share qualities with the histrionic personality and seem un-fazed by brushes with death; nomadic antisocials, who share characteristics with the schizoid or avoidant personality; and malevolent antisocials, who, in their belligerent and vicious manners, share qualities with the paranoid and sadistic personalities.
The concept of an antisocial personality has been around for a long time. In the early 1800s, Philippe Pinel introduced the notion that the antisocial personality was a unique form of madness where the person was impulsive and destructive yet maintained all intellectual faculties, la folie raisonnante. Although Pinel's term was intended to be a value-free label, other physicians of the time began to argue that the antisocial possessed a character deficiency, and in 1835, Prichard coined the term moral insanity to describe these kinds of patients.
Of all of the personality disorders, the antisocial has the most extensive and persuasive biological evidence supporting it. It appears that there are some children who from birth are likely to explore the environment more assertively, resist control, and be undeterred by punishment or parental efforts at curbing acting-out behavior. Cleckley proposes what he calls semantic aphasia, or an inability for antisocials to understand and process emotional experiences, hence leading to their failure to develop a conscience and ability to empathize. Other researchers have found evidence that antisocials have additional specific language-processing deficiencies that all support Cleckley's original concept. Other biological research has found frontal lobe abnormalities in antisocials and lower levels of physiological arousal that may account for the antisocial's constant search for dangerous and novel experiences as well as a host of neurochemical differences that may contribute to the disorder.
Psychodynamics provides an easily understood model for comprehending the antisocial personality: a strong ego development with a failure to develop a superego. Instead, the id and the pleasure principle dominate the entire personality. With the id in control, the antisocial has no tolerance for frustration and seems able to delay action toward a reward only in the face of concrete punishment. Some antisocials have more developed reality principles that enable them to wear a "mask of sanity" that allows them to move in normal social circles. Although they are just as remorseless as other antisocials, they have relatively more control over their impulses and are better at manipulating others.
Interpersonally, antisocials can be characterized as hostile. Using SASB, Benjamin describes antisocials as also seeking to control others while vehemently trying to prevent others from controlling them. Developmentally, interpersonal theorists propose that antisocials are not exposed to models of empathic tenderness and never learn to control their aggression. Parental models that are also violent tend to produce violent children as well. Although neglect and abuse are rather nonspecific factors for many types of psychopathology, Benjamin predicts that a specific pattern of general parental neglect punctuated by sporadic outbursts of authoritarian rule and harsh discipline is what creates the anger and resentment seen in the antisocial.
Cognitively, antisocials are notorious for poor planning abilities and inability to foresee consequences to their actions. Their cognitive style is deviant, impulsive, and egocentric. One hypothesis that explains why they are such poor planners is that they are unable to generate mental models of consequences of actions or are too susceptible to their desire for instant rewards to process consequences. Beck et al. add that antisocials have a need to see themselves as strong and independent and often have core beliefs such as, "If I am not the aggressor, then I will be the victim."
From an evolutionary perspective, antisocials are actively oriented to satisfying themselves by manipulating the environment. Their behavior is driven by their basic mistrust of other people and often ends up violating even the most basic standards of social living.
Antisocials share many qualities with other personalities, namely paranoids, histrionics, borderlines, and sadists. They are not particularly vulnerable to anxiety disorders, although they often suffer from substance abuse disorders and occasionally from symptoms of depression.
Antisocials are a frustrating group to treat. They are often in therapy against their will and as a punishment for transgressions against society. Advancing age seems to increase the chances for progress in therapy, but in general, antisocials see therapy as a game where the goal is to con and to best the therapist by pretending to be contrite and redeemed but ultimately returning to their previous behaviors. For this reason, developing a therapeutic alliance has the best chance of enacting real change. Because anti-socials are most likely incapable of achieving change through insight, other strategies might include cognitive-behavioral techniques, becoming a parent to the patient using more effective parenting techniques from the position of a benevolent power, or placing the antisocial in a position requiring nurturing.
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