ICD-10 defines dissocial personality disorders (also known as antisocial personality disorders) as a pattern of behavior dominated by contempt for the rights of others and frequent violation of them, occurring after the age of 15. A lack of empathy, irritability, aggressiveness, impulsivity, and deceit characterize this disorder. Individuals with antisocial personality disorders tend to break the law by engaging in activities such as theft, burglary, and drug dealing. They may also abuse psychoactive substances, engage in self-harm, and even commit suicide.
How Common Is It?
It is estimated that up to 3.6% of the population meets the criteria for antisocial personality disorder. This information makes it one of the most typical personality disorders. The group in which this prevalence is particularly high are men who abuse alcohol, especially those undergoing addiction treatment and serving sentences in prisons.
Causes
The causes of antisocial personality disorders have not yet been clearly and unambiguously determined. However, it is recognized that they are affected by internal (biological) and external (environmental) aspects. The most common biological factors include the malfunction of neural networks. Those are:
- Decreased reactivity of the autonomic nervous system
- Disturbed regulation of neurotransmitters
- Specific hormonal disorders (related to the secretion of cortisol and testosterone)
Moreover, environmental factors also play a role in the development of antisocial personality disorders. For example:
- Lack of security and failure to meet love needs during childhood
- Instrumentalism is present in family relationships
- Violence in the family
- The problem of addiction in the family and immediate environment
Symptoms
Personality disorders are persistent and pervasive patterns in how one thinks, perceives, responds, and relates that cause a person significant distress or impair their functional capacity. To better understand the causes and treatment of antisocial personality disorder, you must first understand some aspects of this specific disorder. After all, many people confuse them with psychopathy (psychopathic personality disorders) or character disorders.
However, this is not the same diagnosis, although there are likenesses between them. For example, psychopathy can be understood as a condition in which an individual is calculating, cold, and manipulative. On the other hand, antisocial people may even exhibit similar behaviors, but they are more related to impulsivity than to emotional coldness.
Symptoms of antisocial personality disorder can vary in level and intensity for each person. They occur more often in men than in women. It is estimated that 1 to 4% of the general population has an antisocial personality disorder. The incidence of the disorder decreases with age, suggesting that patients can learn to change their behaviors over time and try to work towards a better quality of life.
It can be said that antisocial personality disorder is a type of chronic mental condition in which thinking, perceiving, feeling, and relating to others may become dysfunctional and destructive. An antisocial person does not distinguish between what is good and what is bad. They completely disregard the desires, rights, and feelings of others, which means a complete lack of empathy.
ICD-10 Classification
In the International Statistical Classification of Diseases and Related Health Problems (ICD-10), dissocial personality disorder is in a category that includes asocial personality, antisocial personality, psychopathic personality, amoral personality, and sociopathic personality. In the case of antisocial personality disorder, the first symptoms may appear already in adolescence after the age of 11 and may be more noticeable after the age of 15. They mainly manifest themselves through aggressive behavior and lack of empathy.
Dissocial personality traits in young people include:
- Incapacity to adapt to social norms
- Impulsivity or inability to follow through on plans
- Aggression and irritability
- The ability to lie and deceive others for personal gain
- Behavioral disorders
- No responsibility for your own or others’ safety
Characteristics Behaviours of a Person With Antisocial Personality Disorder
An individual with antisocial personality disorder lacks empathy for others and maybe dismissive or unconcerned about the feelings, rights, and suffering of others. They are also characterized by impulsivity and antisocial behavior and have difficulty planning and thinking about consequences for themselves or others. Therefore, they may exhibit behaviors such as:
- A sudden change of residence, relationship, or job (without plans to get another one)
- Driving at high speed or under the influence of alcohol, sometimes leading to road collisions
- Consuming excessive amounts of alcoholic beverages or using drugs and other substances that may have harmful social, economic, and health effects
- Committing crimes
Additionally, people with this personality disorder become easily irritated and may show physical aggression. They have serious difficulty controlling their impulses and do not consider their actions’ impact on others. They may also be socially and financially irresponsible, which manifests itself in the following:
- They don’t look for work when they need it
- They don’t pay their bills
- They do not repay their loans and credits
- They do not cover private financial obligations
- They tend to be very stubborn, self-confident, or arrogant people
Interestingly, you can easily fall for their lies because when you first meet them, they are charming and convincing in their efforts to get what they want.
What To Pay Attention To
To sum up, antisocial personality disorders are characterized by:
- Lack of understanding of what is good and what is bad
- Constant lies for personal gain
- Insensitivity to the feelings of others
- Disregarding and violating the rights of others
- Manipulation
- Arrogance and a sense of superiority
- Constant problems with the law
- Dishonesty
- Impulsiveness
- Inability to implement plans
- Lack of empathy and remorse
- Irritability and violent behavior
- Superficial relationships
- Taking unnecessary risks
- Inability to consider negative consequences before taking action or learning from mistakes
- lack of financial responsibility and inability to hold a job
The presence of the above behaviors may indicate serious personality problems that a psychotherapist should address.
Diagnosis
To make a diagnosis of antisocial personality disorders, the psychiatrist first assesses whether a given patient meets the criteria for specific personality disorders, i.e., states that they exhibit behaviors and models of internal experience that are different from those acceptable by the environment in at least two areas: cognitive processes, that is, ways of perceiving and interpreting reality, emotionality, controlling impulses and rewarding needs, as well as the way of relating to others and acting in interpersonal situations.
In addition, the disorder must manifest itself as inflexibility, maladjustment, or other dysfunction and cover a wide range of individual and social situations. The person suffering from the disorder is negatively impacted, or both. It is also necessary for the symptoms to be stable and long-lasting and for their onset to be observed in late childhood or adolescence.
The condition that excludes the diagnosis is that the symptoms are considered to be symptoms of another mental disorder. Still, the co-occurrence of other mental disorders does not exclude the diagnosis.
Before making a diagnosis, the doctor also excludes organic disease, trauma, or brain dysfunction.
Diagnostic Criteria
Adolescents exhibiting this behavior are more likely to develop the disorder in adulthood. It does not mean that you will necessarily develop the disease, but you need to be aware of the risk. However, to be diagnosed by a psychologist, a person with the disorder must be over 18 years of age and meet at least three of the following criteria according to ICD-10:
- Absolute disregard for the feelings of others
- A strong and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations
- Inability to maintain lasting relationships with others, although there is no difficulty in establishing them
- Very low tolerance for frustration and low threshold for triggering aggression, including violent behavior
- Inability to experience guilt and benefit from experiences, especially from experienced punishments
- A marked tendency to blame others or provide seemingly acceptable rationalizations for behavior that is a source of conflict with the environment
Treatment
The standard method and the only one with proven long-term effectiveness in the case of all personality disorders is psychotherapy, in which the patient-therapist relationship and conversation are considered to be the key therapeutic elements.
Long-term individual dynamic psychotherapy (psychoanalytically oriented) is considered the most effective and most frequently used in general in the case of personality disorders. Still, it is not recommended for people with dissocial personalities because they are not able to change through insight.
However, you can try therapy using cognitive-behavioral assumptions.
Pharmacotherapy
Pharmacotherapy, i.e., the use of drugs, is of secondary importance in the case of personality disorders. The need for its use most often results from the co-occurrence of other mental disorders, which is, as previously mentioned, a common phenomenon in the case of dissociative personality disorder. Then, medications are used appropriately for the coexisting disease – e.g., antidepressants in the treatment of depressive disorders or anxiolytics in the case of anxiety disorders.
Undertaking psychotherapy by people with dissocial personalities is most often the result of a real threat, e.g., loss of job, expulsion from school, divorce, or imprisonment. Due to the lack of internal motivation to undertake treatment and lack of reflection and insight into one’s actions, therapy is usually treated as another game, thanks to which a person can ultimately achieve something for themselves.
Treatment Effectiveness
Taking into account the fact that we are dealing with a personality disorder, i.e., the sphere of humanity that is very difficult to influence and, at a certain age, changing it becomes practically impossible. Psychotherapeutic activities are only effective to a limited extent.
They allow a given person to observe their reaction styles and behaviors, analyze them, find solutions that allow for better social functioning, and improve the quality of life not only of the patient but also, and perhaps above all, of those around them.
However, due to the lack of insight into the symptoms, in the case of dissocial personality, the effects of treatment are usually small. Finally, it should be emphasized that what is optimistic is the fact that the severity of the symptoms of the disorder decreases with age.
How to Live With a Person with Mental Disorders?
Remember that you are not the psychotherapist of the person experiencing the illness. No matter how much you want to help your partner, you cannot replace the help of professionals. Know that no diagnosis of your partner can be used to explain unacceptable behavior towards you or other people. Lack of respect, frequent aggression, use of blackmail, insults, or other behaviors that bear the hallmarks of psychological violence cannot be explained by the disease.
The Sense of Responsibility
One such influence may concern the basic balance in the relationship, where the problems that the sufferer is struggling with within a certain area receive more attention than the mere presence of a partner who is not struggling with any difficulty. This arrangement may make it difficult for a healthy person to remember to take care of themselves in terms of mental health and not to blame themselves for their partner’s recovery.
The impulse to take on such a duty is, on the one hand, something natural and, in a sense, good, because it shows the strength of determination and willingness to help. However, if it is not noticed in time and replaced with a more solid form of help, it may lead to too much strain and, as a result, even the relationship breakdown.
Communication Problems
The second area where a relationship may experience difficulties is related to emotions. People in a relationship experiencing an illness or disorder may have difficulty experiencing and expressing emotions. Therefore, problems with understanding the partner and emotional states, such as a sense of shame or regret, may exist. Of course, a lot depends on the phase in which the relationship is, but also on the stage of recognizing the difficulties – whether it has been diagnosed and taken care of psychotherapeutically and possibly psychiatrically or not yet.
Give Space
People suffering from any serious disorders must not be relieved of their duties. Help is recommended, but doing so will only result in greater isolation. The patient will be deprived of all activities, which will also result in them losing motivation to function. The patient should have work and tasks. Do not overwhelm the patient with your care and support; give them space.
Sources
- Antisocial Personality Disorder: Often Overlooked and Untreated. APA.
https://www.psychiatry.org/news-room/apa-blogs/antisocial-personality-disorder-often-overlooked - Antisocial personality disorder. NHS.
https://www.nhs.uk/mental-health/conditions/antisocial-personality-disorder/ - Antisocial Personality Disorder. NIH.
https://www.ncbi.nlm.nih.gov/books/NBK546673/ - Antisocial personality disorder. NICE.
https://www.elft.nhs.uk/sites/default/files/antisocial%20personality%20disorder%20-%20information%20for%20the%20public.pdf - ICD-10. WHO.
https://icd.who.int/browse10/2016/en#F60.2 - Personality Disorder. NIH.
https://www.ncbi.nlm.nih.gov/books/NBK556058/ - Psychological interventions for antisocial personality disorder. NIH.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094166/ - Pharmacological interventions for antisocial personality disorder. NIH.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8094881/ - Antisocial personality disorder: prevention and management. NIH.
https://www.ncbi.nlm.nih.gov/books/NBK555205/
