Antisocial Personality Disorder: Deagnosis and Treatment

Abstract

This paper is designed to provide a comprehensive knowledge about a particular field of study in personality psychology. Here, the introduction of the general features of personality and personality psychology will be given to facilitate the understanding of the further selected topic. The area of personality psychology that will be discussed under the main topic is; personality disorder. To make it more specific the discussion will be made mainly on Antisocial Personality Disorder (APD) its effects, after effects, reasons and different other aspects through peer study of journal reviews. The ways of possible general treatments for all type of personality disorder will also be discussed here along with all the diagnostic criteria approved by diagnostic and statistical manual of personality disorder IV (DSM-IV). At first a small account of different categories of personality disorder will be given to facilitate the understanding of its relation with personality psychology and than we will try to find out the key factors and traits discovered by the modern research about the APD. Moreover, a brief account of the major techniques and methods; used for the treatment of personality disorder will also be discussed here. To navigate the different aspects of the main topic, basic information will be collected from the journals of psychological studies. This study will be focused on the general features of the personality psychology specifically on APD to keep the study more compact and comprehensive.

Introduction

Personality is a term used in psychology to define an individual’s thought activities and reasons for performing a distinctive act in different kind of situations. The word personality had been derived from a Latin word “persona” which means; a mask to depict the nature of an individual. The branch of psychology which deals with the differences of individuals and the characteristics of their nature is called personality psychology. The field of personality psychology is so vast; it builds a consistent view of a person’s whole psychological activities. This study reveals that every man is different in many ways with the other; it not only presents a picture of differences among people on the basis of psychological processes but also paves a path for studying the similarities among the people of same thoughts. Personality psychology describes the individual’s feeling, thoughts and works according to their mental approach. The personality theory presented by Walter Mischel states that it is the study of the differences of individuals as well as the effects of certain events on the overall behavior of them. (Ehrenreich, 1997)

Personality disorder

Personality disorder is basically a disorder of behavior; the people that come under this category are those deviated by the hopes of the people around them in the same society. Personality disorders create many difficulties for a suffering person and the people he interacts with. These problems originate with the unsatisfied expectations of an individual towards society. The unfulfilled fantasies a person lives in, most of the time, leads them towards psychological or personality disorders. Personality disorders arise in a person when their own expectations from society deceive them, the behavioral disorder a person exhibits due to this reason is almost universal and of the same extent in many people around the globe. The term ego-syntonic is used for the behavior which arouse due to the unexpected attack on someone’s ego. These disorders sometimes show changes from a single aspect, but when the vivid changes reveal in the multi aspects of the behavior it is studied under multiple personality disorder. (Putnam, 1992)

Personality disorder is divided into three main groups or clusters where ten personality disorders are placed under these clusters. The three clusters are named as; the odd cluster, the impulsive cluster and the anxious cluster. Out of these clusters the odd cluster has further divided into three sub categories these are; paranoid personality disorders, schizoid personality disorder and schizotypal personality disorder while the impulsive cluster is divided into four sub categories; antisocial personality disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder. The anxious cluster is divided into three sub categories; avoidant personality disorder, dependant personality disorder and obsessive-compulsive personality disorder. (Paris, 1996)

Anti social personality disorder (APD)

The antisocial personality disorder (APD) is a natural disorder, people with anti social nature like to violate the laws and they show disregard with the other people rights. These hostile natured people show aggression among their family too; abusing their own children and spouse keep them away from family life. The patients with antisocial personality disorder are called psychopaths while the same abnormality in the patients under eighteen years of age is referred as conduct disorder. Due to the uncontrolled aggressive emotions of most of the untreated patients, a large number of psychopaths lead their lives in jails; many detailed studies were conducted in jails on the patients of antisocial personality disorders. Unlike the other personality disorders the psychopaths not only create problems for themselves but they also become threat for the law and order situations. Antisocial personality disorder is the most prevailing type of psychological disorder. A study conducted by Dr Robert has confirmed many hypothesise about this disorder. It reveals that psychopathy is basically a genetic abnormality and the psychopaths born with such type of personality disorder become naturally fearless and aggressive while sociopathy enhances the nature of the anti social personality disorder.(Port, 2007)

According to the” Diagnostic and Statistical manual of Mental disorder IV” (DSM-IV) the least age for the diagnosis of antisocial personality should be 18 and seven types of diagnostic features should be apparent in him. These diagnostic features include; presence of the unlawful behavior and disregard for the law, swindling and lying for self pleasure, lack of decision making for the future, aggressive behavior and involvement in frequent quarrels, inattentive behavior towards the safety of others as well as self protection; and the last one is the merciless behavior. A person who meets all these criteria will be diagnosed with antisocial personality disorder. The rate of prevalence of APD in the general population of America is relatively more stable than the other countries which is 2%; in men it is slightly higher (3%) than women (1-2%). No evidence has proved the effect of ethnic difference on the prevalence of APD but it is observed that the rate of APD prevalence in urban areas is higher than the rural areas of United States. 50 to 60% of jail population is comprised of the people with Anti social personality disorder. It is difficult to say whether the number of people with APD is increased or decreased within last fifty years due to the changes brought in diagnostic patterns. By the statistical outcomes, the reasons for stability in the rate of APD patients is; the reforms in the laws for the antisocial people and their consideration for proper treatment. (Colman, 1997)

A study conducted by collecting data from different countries uncovered many facts about the antisocial personality disorder and its relationship with the childhood behavioral symptoms for the disease. According to the study, childhood conduct can help to predict the antisocial personality in adulthood. By the rise of the antisocial behavior among the adults, the prediction of which child will not be antisocial is more complicated than the prediction of the children with antisocial behavior. Although the adults with the antisocial behavior show a history of childhood conduct problems, even then it is not necessary that all the children with severe conduct problem will be the victim of antisocial personality disorder in their adulthood. The conduct behavior among the children could be listed as; behavior problem, psychopathic characteristics, consequences related with behavior problem and the behavior that is not considered as serious problem. These all types of problems may show varying degree of behavior and characteristics in children like; leaving home, lying, fighting, rape, use of aliases, absence of guilt, drug abuse, promiscuous sexual act, bad academic performance and other bad school experiences, but some of the bad characteristics like masturbation are not considered as much problematic. (Lahet, 2005)

Several physiological conditions also play an important role by helping in the diagnosis of certain psychological disorders. Stress is one of the factors that could become the reason of any psychological disorder specially the APD. The stress dependent hormonal regulation by hypothalamus-pituitary and adrenal can give significant account of stress level among children. The studies show that the children living in good home environment show the lesser cortisol secretion by the adrenal gland. Cortisol is the hormone which is secreted more profoundly during stress. The estimation of hormone level in the blood can help to study the stress level under certain conditions. (Brotman, 2007)

Antisocial personality disorder is also can also be related with drug dependency but not all drug dependent people show the symptoms of APD. A study conducted on prisoners showed that the rate of antisocial personality disorder is six times higher in the prisoners with the history of drug dependency than the non drug dependent prisoners. Moreover, the type of drug also shows different effects on the patients; alcoholic patients show lesser signs of APD than the other substance dependants. Though there is no general medication for the treatment of antisocial personality disorder, medication can be given for the control of some factors involved in the prevalence of APD. In pharmacological approach of APD, due to substance misuse, drugs like methadone are used. These pharmacotherapies help the patient to maintain its improved condition by the use of such medications for controlling relapse and abstinence from the misused substance. Many patients show poor will power to abstain from the forbidden substance and they start reusing the substance with any break in medication which is a big challenge to be handled for the treatment of such patients. Methadone is highly effective in opioid dependants and maintains many other symptoms related with criminal behavior, it is also very helpful to control the behaviors that can cause HIV. Methadone can also reduce the suicide death rates due to an over dose of misused drugs. (Welch, 2002)

The recommended treatment for the patient of all type of personality disorder is mainly comprised of psychotherapy along with the symptom targeted pharmacotherapy. There are certain types of therapies that are given to the patients with different personality disorders according to the nature of the problem, these psychotherapies are the basic steps taken by the psychiatrist to normalize and rehabilitate the patients. Some of these therapies are; cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), comprehensive validation therapy (CVT), cognitive analytic therapy (CAT), transference-focused psychotherapy (TFP). The relation of neurobiological and psychosocial causes of the disorder with heredity is still under research and the genetic relation with the disorder is still unknown. (Oldham, 2005)

In an article written by Professor Madison; clinical Director at Broadmoor Hospital; a concept of biological treatment for the patients of dangerous and sever personality disorder (DSPD), is given. In his article; he emphasized on the treatment of the detained patients at the hospital who are resistant for the treatment. The patients especially with the antisocial personality disorder should consider for the said treatment.The biological treatment in the form of hormone therapy for its stress controlling effect and gene therapy could bring commendable effects in the life of such patients. The patients with antisocial personality disorder should be considered for psychological treatment by law and during treatment should be supported by the law enforcement agencies, these patients should be kept monitoring to prevent from any relapse otherwise the patients with dangerous and sever personality disorder ; specially related with APD could become serious threat for the society. Many researchers think that treatment for such patients is mere waste of time and money due to their vulnerability of relapse but the researches on the biological advancement for the treatment of the disease will definitely bring some change.(Lock, 2008)

The antipsychotic medication is given to the patients of personality disorder with the combination of cognitive behavioral therapy (CBT) along with social skill training; which gives very good result in certain disorders, the same practice can be apply for the treatment of the patients with APD. This treatment showed marked difference in the targeted symptoms by cognitive behavioral therapy. The effect of this therapy is more durable with the short-term follow ups. The people taking care of patients at home can help the therapists to continue the therapy at home for the patient. Nurses of the psychiatry division can also supervise the CAT process more effectively. CBT is given with the combination of antipsychotic medication but the CBT alone, plays a major role in the improvement of the general condition of the patient. CBT therapy mostly involves the techniques used for developing trust and other normal behavioral traits in the patient by strengthening the bond between family or community and the patient. This therapy also helps in normalizing the patient by enhancing the positive change with planned strategy of symptom management. The use of addictive drugs like heroin can reduce the chance of adherence to the ongoing strategy of the cognitive therapy and thus can increase the chances of relapse. (Turkington, 2006)

Psychopathic patients and the patients with antisocial personality disorder, started to get medically treated according to the mental act ruled in 1983. The patients of antisocial personality disorder can be treated by using any of the general therapy available for the personality disorders.The basic treatment for the patient is included; their rehabilitation, nursing, caring, medication, and related psychotherapies available for the particular type of disorder of personality. The thing to be remember here is that the APD has no specific medication available by now but the medication to control the aggressive behavior in these patients , can be used as apart of treatment. Many clinical methods were set to treat such patients that sometimes worked singly. However, many times, more than one method was needed to treat the patients of different forms of diseases. These methods are; pharmacological method which includes all the medication of the patient. Most common drugs given to the patient are anti depressant, neuroleptic and anticonvulsant. The medication is only one aspect of the treatment method which supports the other psychological methods of treatment. A patient of APD can be treated physically by electroconvulsive therapy. Electroconvulsive therapy is given to the patient by placing electrodes on the temples and a minor shock of 80 to 110 volts is given to the patient. This therapy is quite helpful to treat extremely depressed patients. For abnormally aggressive patients psychosurgery is suggested in which a small tissue of the brain from a minute location is destroyed. This type of surgery is most of the time performed when all the other ways to control aggression fail. The most common type of psychopathological therapies is behavior therapy which is made to alter the behavior of the patient. In this therapy the reasons of the antisocial behavior of the patient is tried to be found and is measured on the basis of environmental factors. Aversion therapy is used to create a sensation of disliking for a particular object or behavior that is unnecessary and potentially harmful for the patient. This technique is used among the patients with unusual sexual arousal. In this technique a weak stimulus is tried to develop through mild electric shock, a foul smell sensation is created by using some particular chemicals and sometimes drugs that cause nausea against the targeted object are used for this purpose. Cognitive techniques are used to change the cognitive approach of the patient by asking questions and inculcate the new perception of negatively considered things in the mind of patient. The cognitive therapy is based upon the principle that our behavior is ruled by our thoughts. In group therapy, patients are given a concept of learning within the group of people of same kind, it particularly helps those patients who display less vocal characteristic among the people, the interaction with other people helps them to become vocal with the other people and build confidence in themselves. This therapy supports and encourages the members of the same group and facilitates the rehabilitation process of the patients. (Lee, 1999)

Conclusion

The whole study of personality disorders reveals that all types of personality disorders of cluster A, B and C have few common points, though we have discussed only antisocial personality disorders to keep our study narrow and limited. One thing is pervasive for all type of such disorders that is that all the personality disorders evolve due to genetic or social cause but environment of the person basically plays an important role in the evolution of these disorders. The treatment of these diseases again comprises of two basic modes – medicated therapy and social or behavioral therapy. In all type of personality disorders behavioral or social therapies give more positive results than the medicated therapies; even then the need of medication cannot be neglected because these medications really help some times to control the extremely aggressive behavior of the patients. Unlike the treatment for other personality disorders there is no particular medication for antisocial personality disorder. This constricted study about antisocial personality disorder particularly concludes that the childhood conduct is more important to trace the antisocial personality disorder; the only way to treat these patients is environmental and behavioral therapy. Research is still being done to find out new ways and techniques for the treatment of this personality disorders to improve the cognitive abilities of the people and to make them useful for the society.

References

Bernstein.P.D, Useda.D.J, (2007) Paranoid personality disorder.

Brotman.L.M, Gouley.K.K, Huang.K.Y, Kambuokos.D, Fratto.C, Pine.D.S (2007)

Effects of a Psychosocial Family-Based Preventive Intervention on Cortisol Response to a Social Challenge in Preschoolers at High Risk for Antisocial Behavior. Arch Gen Psychiatry. 2007;64(10):1172-1179.

Colman.A.M & Wilson.J.C (1997) Antisocial personality disorder: An evolutionary game theory analysis. Web.

Ehrereich, Jhon.H (1997), Personality theory: A case of intellectual and social Isolation?, The journal of psychology.

Lahet.B.B, Applegate.B, Loeber.R, Burke.D.J(2005) Predicting future antisocial personality disorder in males from clinical assessment in childhood, journal of consulting and clinical psychology 2005, vol. 73, no. 3, 389-399. Web.

Lee.H.J, (1999) the treatment of psychopathic and anti social personality disorder. A review. Web.

Lock.M.P (2008), Treatment of antisocial personality disorder,The British Journal of Psychiatry 193: 426. doi: 10.1192/bjp.193.5.426

Oldham.M.J,(2005) Guideline Watch: Practice Guideline for the Treatment of Patients With Borderline personality disorder. Web.

Paris.J (1996), A biopsychosocial approach to etiology and treatment, Social Factors in the personality disorder. Published by Cambridge University Press, 1996. Web.

Port.T (2007) Psychopath, Sociopath or Antisocial Personality

Are These All the Same Psychological Disorder?

Putnam.F.W (1992) – The British Journal of Psychiatry, Putnam 161 (3).

Turkington.D, Dudley.R, Warman.M.D, Beck.T.A, (2006) Cognitive-Behavioral Therapy for Schizophrenia: A Review.Web.

Welch.S (2002), personality disorder and substance misuse. Journal of. Nervous and Mental Disease 187 478-486. Web.

Lock.M.P (2008), Treatment of antisocial personality disorder,The British Journal of psychiatry 193: 426. doi: 10.1192/bjp.193.5.426