Antisocial Personality Disorder

Do you remember the last time you had labelled and made judgements about someone not getting along well with other people at social gatherings or on a day to day basis? There must have been times you spent hours talking about someone behaving in a way that you did not like or was not socially appropriate. But have you ever considered that their behaviour could be a manifestation of an outcome of a Personality disorder (a type of mental disorder where there is a rigid and unhealthy pattern of thinking, functioning and behaving which generally deviates from the expectations of the culture, causing distress and problems in functioning)?

Antisocial Personality disorder (ASPD) also known as Dissocial Personality disorder [ICD-10], a mental health disorder that is characterised by a consistent disregard for others rights and feelings. Antagonize, manipulate, ill-treat others and show no guilt or remorse for their behaviour. Often violate law, lie, and act impulsively, often becoming criminals. Unable to fulfil responsibilities related to professional life, family or school. Usually comes to focus because of a gross disparity between behaviour and the prevailing social norms.

Symptoms and Signs

Individuals with ASPD may do the following;

• Have low empathy, unconcern for the feelings of others
• Persistent attitude of irresponsibility, disregard for the social norms, rules and obligations
• Can establish relationships but have difficulty in maintaining enduring relationships
• Very low tolerance to frustration, significant irritability
• Low threshold for discharge of aggression ( including violence), fight and assault others easily, Impulsive
• Do not experience guilt, remorse after hurting someone else
• Failure to learn from the negative consequences of behaviour
• Not care for the safety of self or others Persistent lying; deceitful, callous, manipulative behaviour to exploit others
• Arrogance; a sense of superiority being extremely opinionated
• Failure to plan ahead Poor or abusive relationships

These people may also have issues of boredom, irritability, psychosomatic symptoms, alcohol and substance abuse, a variety of mood or anxiety disorders. A significant number of people may have had behavioural problems and attention- deficit hyperactive disorder as children. A diagnosis for ASPD cannot be made before the age of 18 years. An adult to be diagnosed with ASPD will have to show signs and symptoms of Conduct disorder before the age of 15, during their childhood and adolescence years. A few signs of conduct disorder include;

• Deceitfulness
• Serious violation of social rules
• Theft
• Destruction of property
• Aggression towards people and animals

Diagnosis

The diagnosis of ASPD is made based on the following;

• Personal and medical history
• Conducting a psychological evaluation to analyse and explore thoughts, feelings, relationships, beliefs n behaviour pattern and family history.
• Ruling out the other medical and psychological conditions
• Based on the symptoms and the diagnostic criteria on the Diagnostic and Statistical Manual of Mental disorders (DSM-5) and the (ICD)Classification of mental and behavioural disorders.
• Typically ASPD cannot be diagnosed before the age of 18 years.

Treatment

There is no definite way to prevent antisocial personality disorder from developing in individuals who are at risk. Since it is the interplay of various factors of an individual’s life since childhood, it is helpful if the risk factors are identified and early intervention is provided. However, it is difficult to change the long-rooted patterns of thinking and behaviour. The disorder is hard to treat in adults, people with ADPS rarely seek help on their own, and often think they don’t need help. Research has shown that there is no specific current treatment for personality disorders itself but various psychotherapies and medications such as mood stabilisers, antidepressants, anti-anxiety drugs can be prescribed for treating some symptoms. Choice of treatment method is usually based on an individual’s needs. Commonly used psychotherapies are;

• PSYCHODYNAMIC/ PSYCHOANLYTICAL therapy
• COGNITIVE behavioural therapy and DIALECTIC behaviour therapy can help change one’s ways of thinking.
• BEHAVIOUR therapy uses reward and punishment to promote desirable behaviour.
• GROUP therapy and FAMILY therapy can be helpful in Psychoeducation; teaching the family members and the individual about the illness, treatment and the ways of coping. Teaching new vocational and relationship skills.

Psychotherapy can be helpful as it helps one to gain insight and understand their disorder, the factors contributing to the symptoms (the risk factors), factors maintaining the disorder, the complications and can talk about their thoughts, feelings and behaviour.

Conclusion

Personality disorders are generally a lifelong- enduring pattern. In most cases cannot be treated to its fullest. It is most common in men than in women. Psychotherapies and medications can help in managing the disorder and helping the individual with their normal functioning. It is therefore important for the individual and the family members to work together in an individual’s recovery for the most effective results. You may not be able to change the behaviour of a loved one but, can definitely learn coping skills to help set boundaries and protect yourself and them from harm. The prognosis for the disorder varies.