|
According to the DSM-IV, essential features include a consistent
pattern of total disregard for, and the violation of, rights of
others. For purposes of diagnosis, individuals must be at least
18 years of age. Symptoms begin in childhood and early adolescence,
continuing into adulthood. Children often have histories of conduct
disorder, socialized aggressive, non-socialized non-aggressive.
They show aggression towards people, as well as animals. It is not
uncommon for children to maim animals, specifically cats. They violate
rules, are deceitful, and often steal. There is a complete disregard
for others.
As adults, these individuals are manipulative and will obtain money
in any way possible. They may pursue illegal activities and if caught,
often show minimal, if any, remorse for their behavior, and may
indicate, “I was dealt a bad hand of cards at birth, subsequently,
I deserve whatever I get, obtaining it in any way I can, and others
deserve to lose.” These individuals are excessively opinionated
and very “cocky.” They can be very charming and engaging.
Within the first 15-30 minutes of a therapy session, these individuals
may compliment you on how you’ve decorated your office, or
regarding a certain painting on the wall, which can be viewed as
a red flag for antisocial personality disorder.
These individuals are often grossly sexually promiscuous, with
numerous sexual partners. They rarely sustain a long-term, monogamous
relationship.
Associated disorders may include substance abuse or gambling addiction,
as well as features of narcissistic personality disorder.
Again, as with all personality disorders, there are gradations
of severity. However, full-blown antisocial personality disorder
in western society occurs in approximately 3% of males and 1% of
females, according to the DSM-IV.
Causes of Antisocial Personality Disorder
Theories abound, but causes for antisocial personality are unknown.
Many have tried to draw a physiological link between smoking or
drinking during pregnancy, or other teratogenic during the gestation,
or a hereditary link; if a father is antisocial, then perhaps there
is a greater likelihood that the son will also be antisocial. However
these studies have no significant P-values, and none have been proven.
Another theory has to do with an extra Y-chromosome, the “supermale.”
However many diagnosed with antisocial personality disorder do not
have this extra chromosome. The bottom line? W don’t know
for sure what causes antisocial personality disorder. It is this
author’s opinion that a combination of many ingredients causes
an antisocial outcome, i.e., a dysfunctional family component, inadequate
parenting, inconsistent discipline or lack thereof, and perhaps
a lesser ingredient will be the social environment including the
media.
Some individuals who have been diagnosed with antisocial personality
disorder have a history of traumatic abuse in their youth. However
as with sexual abuse, abused individuals do not necessarily grow
up to be perpetrators, or antisocial. Research studies have shown
that of the many individuals who were sexually abused, only approximately
13-28% will go on to sexually abuse in their adult lives. Subsequently,
a large percentage of individuals who were sexually abused do not
in fact go on to sexually abuse others. A father with an antisocial
personality disorder will not necessarily have a child with the
disorder. However, the child will observe poor role modeling, and
children growing up often want to be like their parents. This type
of role modeling definitely lends itself towards a higher incidence
of crime. We do know that parenting plays an enormous role in the
development of many personality disorders. However with our development
and the walk of life, we find that many factors impact the individual.
When performing a history we take as many factors as we can into
consideration before a diagnosis is made.
Treatment of Antisocial Personality Disorder
It is very difficult to successfully treat individuals diagnosed
with antisocial personality disorder. Most of these individuals
are ordered by the court system to seek treatment. However treatment
options in our prison systems are poor to nonexistent. If individuals
have used malingering techniques and have had a good attorney, chances
are they will be placed in forensic mental health facilities, having
slipped through some loophole and found to be not guilty by reason
of insanity (NGRI), unfit to stand trial (UST), or guilty but mentally
ill (GMI). In these settings patients have a better opportunity
to receive appropriate treatment with individual and group therapy.
Incarceration in our typical jail system in western society has
not proved effective in terms of decreasing the recidivism rate
of antisocial personality disorder. The recidivism rate remains
quite high. These individuals frequently learn new techniques in
the prison system, as well as continued substance abuse.
This author spent 9 years doing forensic psychology assessing,
diagnosing and treating antisocial personality disorder from adolescents
to adults, and in that period of time, found a variety of techniques
that have been somewhat helpful. Needless to say, recovery is very
slow, and patience needs to be great and expectations minimal in
the beginning. Behavior programs combined with individual therapy
is very helpful. There needs to be strict limits and consistent
positive and negative reinforcement. The team approach is very helpful,
and everyone needs to be on the same page on the inpatient unit.
Group therapy is also effective. However in group therapy, one must
be careful in choosing the groups, and psychological testing for
all participants is help so IQ can be assessed and individuals grouped
for higher effectiveness. There are different modalities that can
be used for group therapy with antisocial personality disorders.
Certain movies can be viewed and discussed, bringing about very
interesting responses. For example, the movie “Weeds”
with Nick Nolte, a true life event of a prisoner who was diagnosed
with sociopathy, and went on to find a passion in his life that
made his life worthwhile. The protagonist went around to prisons
presenting plays about prison life. Other movies may target certain
behaviors, such as “The Accused” with Jodi Foster, a
true life account of a woman who was raped, and the mob action leading
up to the event, is an excellent movie showing when individuals
have reached a certain level of growth in treatment. Other topics
that may be targeted for discussion include guilt, victim vs. perpetrator,
and discussions of mob action. Processing these movies for 1-2 hours
in group has proven to be very effective in getting these individuals
to think about morality, and where their morality is compared to
others in the group, as well as society. Creativity is the key in
treating antisocial personality disorder. To deviate from traditional
treatment is a must, and one cannot be rigid in group therapy. More
traditional modalities are helpful with the behavioral programs.
Once again, as with all treatments, it is a combination of all of
the above. This author has even used music therapy, with specific
lyrics from certain songs, as discussion motivators, to pull groups
into conversation. If a therapist is lucky enough, and the individual
is motivated enough to get in touch with some guilt regarding their
behavior, it is not uncommon for these individuals to fall into
a depression. It is excellent progress if an individual can actually
become depressed in the process of therapy, since these individuals
rarely acknowledge any feelings or emotions. Should this occur,
and it is a true depression and you are not being manipulated, then
an anti-depressant is not the treatment of choice initially. You
can actually work with these feelings and emotions, and work with
the depression in sessions. However, at
some point, an anti-depressant may be helpful. Close watch for suicidal
ideation with strong intent is important. Antisocial personality
disorders, unlike narcissistic personality disorders, may potentially
commit suicide, and when they do attempt suicide, since they are
impulsive, their suicide lethality is very high. This is in contrast
to a narcissistic personality disorder, who lives himself so much,
would never attempt suicide. Narcissists DO NOT try to commit suicide.
When you love yourself as much as a narcissist does, suicide is
not an option.
The use of prediction in paradoxical intervention can also be helpful
in treating antisocial personality disorder. Prediction of failure
will cause extreme anger, but can be helpful. Paradoxical interventions
only work with individuals with an average IQ or above.
Medication for the most part is not helpful, and only comes into
play when the individual is depressed or displays severe aggression.
Some medications that have been beneficial for anger are Lithium
Carbonate, and Valproic acid. These medications have been helpful
in the treatment of aggression.
If you are in a forensic facility and you have worked there for
awhile, don’t be surprised of the recidivism rates. Be prepared
to have your patients come back in after another arrest. Do not
get discouraged, and have someone available that you, the therapist,
can talk to. This is a very stressful area to work, and is met with
a cascade of disappointment. However the successes that do come
through are extremely powerful and long lasting.
|
