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. Societal rules do not apply to them. In many cases, people with Antisocial Personality Disorder commit criminal acts (often habitually), and as a consequence, the disorder is overrepresented in prison populations (rates range from 30% to 70%; Widiger & Rogers, 1989) and is responsible for a markedly disproportionate amount of societal misery.
Other features of Antisocial Personality Disorder include a host of impulsive, reckless, and erratic behaviors. In some cases, the crimes these people commit seem aimless, random, or impulsive. They appear not to be motivated by any rational purpose, but rather are perversely impetuous. They typically show an inability to learn from experience and to avoid negative consequences. People with Antisocial Personality Disorder often present as charming and ingratiating, and they are well skilled at hiding their true intentions. As such, many victims are known to have been misled and conned by the superficial charm of antisocial criminals. Another feature is that they lack a capacity to genuinely care about others. Their relationships, therefore, tend to be superficial, shallow, and exploitative. Others are seen as objects to be manipulated and used for the antisocial individual's personal gain. They lack a capacity for love, intimacy, and sustained attachment and are generally unresponsive to trust, kindness, or affection. They lie shamelessly and can easily take advantage of those who have trusted them.
Whereas the inner lives of people with Antisocial Personality Disorder are flat and emotionally empty, and their personal suffering muted or nonexistent, contact with antisocial personalities may be dangerous because many of them are outright criminals. A saying we have used illustrates the deceptive nature of the antisocial: "The most dangerous criminals are not those who break down your backdoor but those whom you let in the front door." An important diagnostic feature of Antisocial Personality Disorder in the DSM-IV-TR is that it must have originated in childhood or early adolescence in the form of Conduct Disorder, which is diagnosed on Axis I. Antisocial Personality Disorder is diagnosed if the pattern continues into adulthood. Historically, one of the earliest views of people with Antisocial Personality Disorder was that they were morally insane. Other descriptions of the disorder have included the terms sociopath, psychopath, and dissocial personality. The term Antisocial Personality Disorder became the official diagnostic label in the DSM-I. Interestingly, the term psychopath still persists in popular media and is often used synonymously by the public with the term psychopathic killer (e.g., to describe notorious serial killers such as Ted Bundy, John Wayne Gacy, Gary Gilmore, and Charles Manson). Use of the term in these contexts gives the false impression that all psychopaths are murderers. Table 3.1 lists the DSM-IV-TR diagnostic criteria for Antisocial Personality Disorder.
Two Antisocial Personality Disorder criteria seem to be problematic for older adults. Criterion 4 (irritability and aggressiveness, as indicated by repeated physical fights or assaults)
Table 3.1 DSM-IV-TR Diagnostic Criteria for Antisocial Personality Disorder (Code: 301.7)
A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:
(1) failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
(2) deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
(3) impulsivity or failure to plan ahead
(4) irritability and aggressiveness, as indicated by repeated physical fights or assaults
(5) reckless disregard for safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
B. The individual is at least age 18 years.
C. There is evidence of Conduct Disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of
Source: From Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision, American Psychiatric Association, 2000, Washington, DC: Author. Copyright 2000 by American Psychiatric Association. Reprinted with permission.
and Criterion 5 (reckless disregard for safety of self or other) require physical strength and agility. It is likely that these aggressive, impetuous, uncontrolled, and reckless behaviors diminish as the person's stamina, impulsivity, and energy levels decline naturally with age (Kroessler, 1990; Zarit & Zarit, 1998). For many persons, however, even externally imposed limitations (e.g., jail) and age-related physical declines do not assure that antisocial behavior will remit since the underlying psychological processes are known to remain constant (a point that is discussed further in Chapter 6). There is no reason to think that empathy, genuine concern for the welfare of others, and a conscience will meaningfully develop in people with Antisocial Personality Disorder as a mere function of growing older.
Theorized Pattern in Later Life and Possible Impact of Aging An important issue in the study of aging individuals with Antisocial Personality Disorder is that some of them do not survive into old age because of a lifestyle of risky behaviors. Substance abuse often compounds the characteristic recklessness and im-pulsivity of the antisocial type and can lead to early mortality. Those who reach later life typically have poor social support systems in place, with the exception of those who have integrated into a "fellowship of thieves." A pattern among some aging individuals with Antisocial Personality Disorder is that they have been rejected and completely cut off by family members and peers who have had enough of the person's deceitful, manipulative, self-centered, and aggressive ways. In these cases, each of the specific stressors of aging is likely to be difficult for aging antisocial individuals because they lack appropriate supports. Perhaps most important, what one can expect to see in the aging antisocial type is a person who is unlikely to be acting out in the extreme and physical manner of his or her youth, but the underlying psychological processes (e.g., lack of concern for the welfare of others, deceitfulness, exploitative approach, emotional coldness, and irresponsibility) will likely remain (Harpur & Hare, 1994).
Physical disability, sensory decline, and cognitive impairment can be particularly problematic for incarcerated older individuals with Antisocial Personality Disorder because their limitations make them especially vulnerable to exploitation from other prisoners. The prognosis for treating individuals with this personality disorder is generally bleak across the life span largely due to their limited personal distress and limited awareness that something is wrong with their attitudes and behaviors. They tend to seek treatment only under duress from others (e.g., court mandated) or when it is in their best interest to do so (e.g., when applying for parole). Thus, should the aging antisocial type seek therapy, it is important to fully explore and understand the ulterior motives for seeking help. Because the antisocial type has difficulty forming meaningful relationships with others, it likely will be difficult to achieve any semblance of an honest, collaborative working relationship. Instead of helping the patient develop empathy or concern for others, the interventions might focus on helping the patient to think through the consequences of his or her actions, plan constructive behaviors (or minimize the extent of destructive behaviors), and discover strategies to stay out of trouble.
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