Canadian University Dubai

Dr. Martin Kramar

November 22nd, 2022
PSY 230 - Personality
ANTISOCIAL PERSONALITY DISORDER
Dhrashti Vagnani 20220001883
Hamdan Aziz 20210001127
Anum Shakeel 20210001450
Ahmed Mukhtar 20210001892
Amrita Unnikrishnan 20210001154
 ABSTRACT

Antisocial Personality disorder on ASPD is a commonly debated topic among many

psychologists. Those who suffer from this disorder usually display impulsive and reckless

behavior and often show no remorse for. Diagnostic tests such as the Psychopathy Checklist

Revised as well as the Triarchic Psychopathy Measure are used to determine whether a

patient with symptoms of ASPD can be diagnosed with the disorder. ASPD is likely to be

caused by genetic factors as well as environmental factors which means it can be passed on

through family generations as well as can be developed from a young age. Research also

suggests that ASPD is a lot more common in men than women with the prevalence rates

being 3% and 1% respectively. This disorder is often talked about and related to psychopathy

due to its high comorbidity with psychopathic behavior.  Antisocial Personality Disorder can

also be compared to other personality disorders such as BPD as well as BP. However they

can be differentiated based on the 4 factors of impulsivity. While in-depth research of the

disorder has been conducted, a lot about it remains to be learnt, including different and more

effective methods of treatment. At the moment CBT as well as Mentalization based

treatments are used which have worked in certain cases but not all. This paper covers all

points mentioned above in detail as well as more in regards to ASPD. For our research we

used secondary resources such as studies and experiments that were available to us through

scholarly sites such as google scholar. 

 INTRODUCTION

Antisocial personality disorder is a type of personality disorder that is defined by a prolonged

tendency involving disdain for the rights of others as well as a challenge maintaining close

friendships. The disorder usually involves a history of breaking rules, which might also

occasionally include abusing the law, a propensity for drug dependence, a lack of compassion

and impulsivity. Individuals diagnosed with the disorder usually start showing signs of

symptoms by the age of 11. The intensity and prevalence of the disorder peaks during early

adulthood, and decreases by age sixty (Black, 2015). Further, the DSM-5 requires that a

person be at least 18 years old, have conduct disorder symptoms that began before the age of

15, and have antisocial behavior that cannot be attributed to schizophrenia or bipolar

disorder.

It is believed that an interaction of environmental and genetic factors contribute to the

development of personality disorders. Environmentally, it refers to a person's societal and

cultural interactions in adolescence and childhood which include their family life, peer

relationships, and social attitudes. Genetically, it refers to a person's inherent dispositional

characteristics determined by their genetically determined biology. Research within the

genetic origins of ASPD has strong roots, suggesting that the development of the disorder can

largely be based on a person’s biology. Twin studies are the best ways to discern genetic

influences on personality. Many such studies have reported a strong influence of genetics on

the development of ASPD (Baker et al., 2009). In addition to this, gender plays an essential

role in the manifestation of the disorder. More men than women are diagnosed, wherein their

manifestations of the disorder are also respectively distinct. 

On the other hand, many studies have attempted to discern the influence of home and

social environment on the origin of ASPD. The families of these children are known to
showcase anti-social behavior that may reflect on them. Moreover, due to the lack of

affection and love in these families, the individuals display a lack of balancing hormones

such as oxytocin. This may lead to underdevelopment in the part of the brain that deals with

emotion and empathy (Black, 2006). 

Moreover, ASPD is one of the most difficult disorders to treat. Not only is it under-

researched, but it's over-lap with psychopathy makes it increasingly difficult to differentiate

between and diagnose. In addition to this, people diagnosed with ASPD commonly show lack

of remorse and hence lack the motivation to start any forms of therapy. 

Antisocial personality disorder along with psychopathy are the most prevalent in the

justice system. Further research within the subject of symptomatology, causes, and treatments

are essential in the functioning of society. This paper attempts to do that by answering

questions that appear crucial in the advancement of the subject. 

 THEORECTICAL FRAMEWORK

Personality consists of stable patterns of perception and cognition about oneself and the
environment. Personality traits are the essential building blocks of personality, and these
traits are stable in time and varied situations. Severe impairments in the functioning and
expression of personality traits indicate the possibility of a personality disorder. The ten types
of personality disorders are grouped into three clusters(Venter, 2016). 

Cluster A includes-
 Paranoid personality disorder
 Schizoid personality disorder
 Schizotypal personality disorder 
Cluster B includes-
 Antisocial personality disorder
 Borderline personality disorder
 Histrionic personality disorder
 Narcissistic personality disorder
Cluster C includes-
 Avoidant personality disorder
 Dependent personality disorder
 Obsessive-compulsive personality disorder

 The DSM-5 explains antisocial personality disorder as a general pattern of indifference and
violation of other people's rights. The early signs of this pattern can start early in childhood,
and the behaviour displayed by such individuals is deviant from societal norms. Originally
antisocial personality disorder was under the categories of psychopathy and sociopathy. The
term antisocial personality disorder did not exist in the psychiatric dominion until DSM-III
was published in 1980. The Diagnostic and Statistical Manual of Mental Disorders-fifth
edition witnessed major modifications of personality disorders. The DSM-5 states the
following conditions are required for diagnosing antisocial personality disorder. These
criteria include significant impairments in self-regulation and interpersonal relationships; the
presence of seven specific pathological personality traits (manipulativeness, dishonesty,
callousness, aggression, negligence, impulsivity, and risk-taking); the personality defects
must be stable across time and situations, not possible to be better interpreted as caused due
to other variables such as developmental or culturally normative (Venter, 2016). They cannot
be due to the physiological side effects of any substance or medication. Criticisms include the
lack of objective criteria for diagnosing antisocial personality disorder. The clinicians
positively interpreted the changes made to DSM-5, in which antisocial personality disorder
includes using personality traits as an instrument for measuring antisocial personality
disorder. Psychopathy and sociopathy are extreme forms of antisocial personality disorder
that share many common affective and behavioural characteristics. Psychopathy gained
public interest in the mid-20th century. Researchers used the time between the publication of
the DSM-I and DSM-III to investigate the differences between people diagnosed with
psychopathy and ordinary people without a psychiatric diagnosis. Studies before 1968,
indicate impaired autonomic functioning in people with psychopathy and exclusive
physiological changes when individuals with psychopathy were exposed to fear imagery.
Robert Hare developed the Psychopathy Checklist-Revised (PCL-R), which was used as a
screening tool to enable clinicians to determine the abnormalities in a psychopath's brain. The
Hare PCL-R recognises two domains, one concentrating on affective and interpersonal
factors and the other on behaviours and impulse control. Studies indicate that they have
reduced grey matter in the frontal lobe, abnormal symmetry in the hippocampus region, a
bigger corpus callosum and distortions within the amygdala. The abnormalities in the brain
areas influence the hormonal and thus start disturbing the normal functioning of the body.
Present studies indicate that psychopathic individuals are driven by impulse and desire. One
possible explanation for this is the imbalance of neurotransmitters. Serotonin, dopamine and
norepinephrine are widely studied, and the results suggest that individuals with psychopathy
display a shortage of the neurotransmitters mentioned above. 

This paper provides a comprehensive understanding of Antisocial personality disorder,

diagnosis and treatment. Through this research, we aim to answer the following questions –
1. How do you identify someone with ASPD? 
2. How does it affect behaviour, and how does this compare to other personality disorders? 
3. How are ASPD and psychopathy interrelated?
4. How does gender influence the development of ASPD? 
5. How does living with ASPD affect relationships/workplaces? 
6. How does childhood trauma lead to the development of ASPD?
7. What type of treatment can we offer to those with ASPD? 

METHODOLOGY

This research includes information gathered from sources of secondary data. Peer-reviewed
journal articles on Antisocial personality disorder were retrieved from search engines such as
google scholar and the Learning Resource Centre at Canadian University Dubai. The
credibility of all the sources was considered in this research. The resources used in this paper
were selected based on the following criteria-
1. How current is the source?
2. Do the sources align with the research questions on ASPD?

The relevant keywords for literature search included ‘ASPD’, ‘Psychopathy’, ‘gender’,
‘relationships’, ‘behavior’, ‘trauma’, ‘genetic’, alone and in combinations. Most of the cited
references were within the last five years. A few pieces of research information are included
from previous decades to establish foundational concepts that remain relevant to this date.
1. How do you identify someone with ASPD? 

Antisocial personality disorder is mainly characterized with certain difficult kind of

behaviour such as irresponsibility, criminal tendencies and impulsiveness. The attributes of
ASPD develops usually in late youth or early teenage. Prior to the age of 18, the disease was
determined to have conduct disorders. Individuals with this personality disorder have issues
with telling the truth; this means that they can lie, disregard laws, steal, and bully different
kids. Guardians and medical care providers might overlook indications of social disorders.
Side effects can overlap with different issues. Assuming the individual is diagnosed and
treated early, the condition may not enter into adulthood. Assuming the behaviour continues,
the conclusion will be antisocial personality disorder for such a person by the age of 18
(Brazil et al, 2018).Grown-ups with antisocial personality disorder for most part show it
symptoms prior the age of 15. Signs of this disorder involve serious and constant behavioural
issues. Individuals with ASPD frequently give symptoms of social problems in their youthful
age or early puberty. This disorder is thought to last a lifetime but for certain people,
symptoms like having certain destructive behaviour can reduce overtime. Also, it is not
evident whether this decline is because of maturity or expanded consciousness of the
outcomes of solitary way of behaving. Like different kinds of behavioral condition, antisocial
personality disorder is on a spectrum, and this implies that, it can range in seriousness from
periodic unpleasant way of behaving to repeatedly violating the law and committing out
serious crimes.

Below are also ways through which individuals with ASPD can be identified:

● They disregard good and bad.

● They tell constant lies or deceive to take advantage of others.

● Be pessimistic and inconsiderate to other people.

● Lack concern or regret about other people’s distress.

● Act irresponsibly and show negligence for normal social way of behaving.

● Experience issues or difficulty in sustaining long term relationships.

● They are also physically aggressive.

● They consistently blame others for their problems.

2. How does it affect behaviour, and how does this compare to other personality

disorders?

According to the DSM-5, Individuals with Antisocial Personality Disorder consistently

disregard and violate the rights of others (Johnson, 2019) as well as repeatedly engage in
irresponsible, delinquent, and criminal behavior (Glenn et al., 2013). Antisocial personalities
have a tendency to manipulate, provoke, or treat people cruelly. They don't display any regret
or guilt for their actions. People with antisocial personality disorder frequently break the law
and turn into criminals. They might be dishonest, act angrily or rashly, and struggle with drug
and alcohol abuse. Due to these traits, individuals with this disorder frequently fail to fulfill
obligations to their families, employers, or educational institutions (Antisocial Personality
Disorder - Symptoms and Causes, 2019). 
A person suffering from antisocial personality disorder, may feel disconnected from 
family, friends, and coworkers. The stress of living with someone struggling with the disorder
can be a lot more difficult to deal with, even if they do not actively damage those around
them. One study found that compared to carers of people with other mental diseases, those of
people with antisocial personality disorder experienced higher levels of sorrow and
caregiving strain. These caregivers suffered a decline in their wellbeing and reported
symptoms of Post traumatic stress disorder (PTSD), depression, as well as anxiety (Antisocial
Personality Disorder - Symptoms and Causes, 2019). 
ASPD has an extremely high rate of comorbidity with other disorders such as: drug
addiction, psychopathy, depression, bipolar disorder, anxiety, and borderline personality
disorder (Glenn et al., 2013). Below are more details on how Antisocial personality disorder
is associated, and how it is different from psychopathy. 
Psychopathy shares many features with ASPD, as well as features such as
manipulativeness and callousness. While some people with ASPD may exhibit psychopathic
symptoms, others might not. Although psychopathology and ASPD share many
characteristics, some claim that there may be differences in the underlying psychobiological
processes. Research on fear Response of those who suffer from psychopathy and ASPD
showed the differences between them. The selective attention that prioritized goal-relevant
information and filtered out unimportant information, such as information about risks, was a
trait of psychopathy. On the other hand, those with ASPD showed a more pronounced anxiety
deficit as well as potential executive functioning abnormalities (Glenn et al., 2013). 

Mood disorders/other personality disorders 

ASPD shares many characteristics with mood disorders such as impulsivity, reactivity and
more. Focusing on Impulsivity as a common characteristic, it makes it difficult to
differentiate between ASPD as well as BPD (Borderline Personality Disorder). However,
evidence shows that by using the four factor model of impulsivity, the two disorders can
easily be differentiated (Glenn et al., 2013). These 4 factors include (Zald, 2015):
 lack of premeditation
 sensation seeking
 lack of perseverance
 Urgency
Borderline Personality Disorder was associated with the attributes of urgency and a shortage
of perseverance, and Antisocial Personality Disorder was associated with sensation seeking
and a need for premeditation.
This feature is also quite common in Bipolar disorder. However research conducted
on those who suffered from one of the disorders only as well as those who suffered from
both, suggests that the mechanisms driving impulsivity in the two disorders may differ
slightly, or perhaps the ability to control impulsivity is lessened when the disorders are
combined (Glenn et al., 2013). Another study conducted on those who suffered from Bipolar
disorder as well as ASPD had (Glenn et al., 2013):
  greater functional impairment. 
  more strain on family connections.  
 higher drug usage rates. 
 more severe depression. 
It is important to remember that all disorders mentioned have differences, but a person may
even suffer from multiple disorders at the same time.
3. How are ASPD and psychopathy interrelated?

The classic definition of psychopathy is a condition primarily referred to in relation to

personality (especially affective deficiencies) and, to a lesser degree, of behavior. On the
other hand, particularly for antisocial personality disorder, the DSM-V criteria are heavily
reliant on behavior. The diagnostic concepts of psychopathy and antisocial personality
disorder are separate, despite being frequently used interchangeably. 
Four major categories of personality traits—Interpersonal, affective, antisocial, and lifestyle
characteristics—are connected to psychopathy. Antisocial traits associated with the condition
include involvement in criminal activities, teen or preteen misconduct, and behavioral
problems in childhood. Furthermore, the interpersonal characteristics involve an exaggerated
sense of self-importance, a propensity for manipulation or deception, an entrenched tendency
to lie, and a sociable approach that appears attractive on the surface. 
Moreover, lack of compassion toward others, a lack of emotional receptivity, a deep seated
propensity to avoiding personal responsibility, and a lack of remorse for one's behavior are
affective characteristics linked to psychopathy. And lastly, a pattern of excessive life
expectations, frequent rash behavior, pursuit of highly stimulating events, and dependence on
others for material or financial assistance are all lifestyle characteristics linked to
psychopathy (Promises Behavioral Health, 2022). The aforementioned traits are all part of the
twenty-item symptom rating scale in the Hare Psychopathy Checklist-Revised (PCL-R). It is
noted to be one of the most accurate ways of diagnosing someone with psychopathy. 
However, even though most characteristics mentioned in the PCl-R match the criteria for
ASPD as described by the DSM-V, they can be very distinct. Many of the traditional
characteristics of psychopathy were difficult to measure with objectivity, which led to the
development of ASPD. Later, Canadian psychologist Robert D. Hare developed the
Psychopathy Checklist—Revised (PCL-R) which was used to identify psychopathy rather
than making a clinical diagnosis of it in a medical setting, unlike ASPD (Skeem et al., 2011).
Psychopathy, as a concept,  was primarily applied in criminal justice contexts to aid in the
classification of offenders.. For instance, it is noteworthy that most criminals who meet the
requirements for psychopathy also meet the requirements for ASPD, but only one-third of
those with ASPD, according to study, fit the criteria for psychopathy (Abdalla-Filho &
Völlm, 2020). 
There has been a growing number of research within the realm of psychopathy in recent
years, especially in the criminal setting. It is increasingly seen as a condition that only affects
the individual, but also the society. A notable author, recently, theorized that psychopathy
was similar to narcissistic and histrionic personality disorders as well as antisocial ones.
Some psychopathy criteria, according to Blackburn, are evident in ASPD (poor impulse
control, dishonesty, recklessness, lack of emotion), whereas others are seen in other Cluster B
personality disorders, most notably narcissistic (grandiosity, lack of compassion), histrionic
(overly dramatic expression of emotion), and borderline (impulsivity) (Blackburn, 2007). 
Another study discovered that antisocial personality disorder diagnoses far too many persons
as fitting the criteria for the diagnosis, especially those with criminal history. For instance,
studies reveal that between 50% and 80% of criminals match the criterion for an antisocial
personality disorder, but that only 15% of inmates would be predicted to meet the PCL-R's
for psychopathic behavior (Ogloff, 2006). As such, treatment options or research done within
psychopathy may not apply to ASPD, which is why it is an important distinction that
increases the scope of greater findings and research within the realm of psychopathy. 

4. How does gender influence the development of ASPD? 

ASPD is more common in men than in women, with prevalence rates in community settings
estimated to be 3% for men and 1% for women, with significantly higher estimates in drug
abuse and prison settings. The plethora of research that has been done within psychopathy
and ASPD, has primarily focused on men. Only in the last decade or so, has the focus shifted
to women with the disorder. Hence, the huge gap between the two may be based on
genetic/environmental factors as well as some measurement bias. Nonetheless, differences
between the two undeniably exist. 
It has been evident through previous research that men with ASPD can sometimes be
overdiagnosed due to their aggressive manifestations of anti-social motivations. For instance,
men with ASPD are more likely to engage in criminal and violent activity, but women with
ASPD are more likely to engage in non-violent antisocial behavior (such as skipping work or
school). Moreover, another study discovered that women with ASPD displayed fewer
symptoms than men with ASPD. This is supported by the discovery that, in comparison to
their male counterparts, antisocial girls experience childhood conduct issues at a later age and
are less likely to commit violent crimes (Silverthorn & Frick, 1999). The relatively non-
violent nature of the antisocial behaviors advocated by women with ASPD may cause clinical
settings to misdiagnose ASPD in women. The DSM-5's emphasis on subjective distinctions
in symptom manifestation may aid doctors in the identification of ASPD, particularly among
women (Alegria et al., 2013). 
Researchers Forouzan and Cooke (2005) suggest that behavioral and interpersonal
expressions differ by gender. For instance, in interpersonal situations, deceitful males are
more likely to be cunning whereas women are more likely to behave coquettishly. On the
other hand, in terms of behavior, male psychopaths frequently exhibit impulsivity and
conduct issues like violence, whereas female psychopaths typically engage in behaviors like
escaping, self-harming, manipulating others, and stealing. 
Furthermore, the two researchers assert that classic characteristics of psychopathy have
different motivations in the two distinct genders. For instance, women may engage in
reckless sexual activity because of their drive to manipulate their partners. Whereas, men
may engage in the same behavior as a consequence of their need for pleasure seeking
activities. Finally, it was discovered that contrary to men, women with ASPD are more likely
to have high prevalence of marital conflict, persistent unemployment, and dependence on
welfare programs. Additionally, they experience greater rates of coexisting mental illnesses
such drug abuse, depression, anxiety, and suicidal behavior (Rogstad & Rogers, 2008). 
In contexts where alcohol and other drugs are abused, many studies have looked at sex
variations in ASPD diagnoses. Hesselbrock, Meyer, and Keener (1985) found that 49% of
men and 20% of women fit the ASPD criteria in a sample of 231 male and 90 female
alcoholics. Furthermore, it was noted that men were twice as likely as women to be given an
ASPD diagnosis in samples of alcohol and drug abusers. 
In an effort to identify the origins of the gender differences, researchers investigated the
effects of biological/genetic, environmental, and developmental factors. However, the
mechanisms that lead to the gender differences have not been definitively discovered by
researchers, prompting the need for additional research. 

5. How does living with ASPD affect relationships/workplaces? 

Psychopathy and sociopathy are extremes of Antisocial Personality Disorder that share
similar characteristics. 3-15% of individuals with ASPD have Psychopathy. In contrast,
approximately 30% of individuals with ASPD have sociopathy. Psychopathy is primarily
caused due to neurological abnormalities, and sociopathy is caused due to environmental
factors such as abuse and lack of parental attention. Individuals with sociopathy may have
lower-level psychopathic traits that may emerge due to adverse environmental conditions
(Johnson, 2019).

The core of an Antisocial personality disorder diagnosis is an egocentric ideology. These

individuals make decisions that benefit their selfish motives and desires. They are not
bothered about how their decisions and actions can harm other people. Individuals with
Antisocial Personality Disorder are primarily intelligent, charismatic and reasonably
successful. They are skilled at manipulative behaviours and use them to fulfill their selfish
needs. They like to control every situation, and their partners often need to be submissive and
agree with their opinions to satisfy their demands. The beginning of a romantic relationship is
characterized by extreme flattery, intimacy and undivided attention to the partner. They have
poor impulse and anger control, which can cause them to be involved in criminal behaviour,
self-destructive behaviours, and violence in relationships (Love & Holder, 2015).

A psychopath can create a good impression in the workplace due to their charisma and
ability to manipulate and persuade people despite their inability to be team players.
Sociopaths can form relationships with people who resonate with their thought processes.
Their relationships are often problematic. They often face difficulties in maintaining stable
employment. Sociopaths have a slight conscience but are limited to the individuals and
groups identifying with their beliefs. Both psychopaths and sociopaths meet the criteria for
Antisocial Personality Disorder (Johnson, 2019).

Neurobiological data indicates the presence of abnormal neural processing in psychopathic

individuals. The ventromedial prefrontal cortex (vmPFC) controls features of self-processing,
such as self-reflection and rumination, that impacts guilt and embarrassment. The prefrontal
cortex's anterior cingulate cortex (ACC) is the primary area related to cognitive and affective
mechanisms of motivation, such as reward, punishment, negative emotions and empathy. The
reciprocal connection between the ventromedial prefrontal cortex (vmPFC) and the anterior
cingulate cortex (ACC) influence social and emotional behaviours. The reduced size and
functioning of the Amygdala cause poor fear conditioning and impaired recognition of
emotion. Psychopaths experience hyperactivity in the left hemisphere (impulsivity) and
hypoactivity in the right hemisphere (controls urges and impulse behaviours) (Johnson,
2019).The dysfunctional neural processes in psychopaths cause difficulty in the ability to
recognize, differentiate, and analyze affective information. These impairments cause
difficulties in understanding affective states leading to dire and negative consequences, such
as the inability to take another person's perspective, which affects an individual's
relationships (Gawda, 2012).

The Attachment theory suggests a negative relationship between Psychopathy and romantic
relationships. A secure attachment style aids both women and men build good romantic
relationships with greater trust, commitment and satisfaction. However, Psychopathy is
generally related to an avoidant/anxious attachment style. Psychopathy and avoidant
attachment are similar but have different mechanisms that explain specific behaviours. The
mechanism underlying avoidant attachment is the dimension of avoidance which is likely to
be developed because an individual may have experienced rejection in their attachment
relationships during infancy and childhood and are conditioned to avoid forming attachment
needs to prevent future rejection. How an individual with avoidant attachment behaves is like
psychopathic and antisocial behaviour. Although the behavioural pattern seems like
Psychopathy, the factors underlying psychopathic behaviour differ— Deficient mechanisms
of inhibition influence psychopathic behaviour. The Arousal model suggests that those high
in Psychopathy have an abnormally impulsive approach behaviour in the presence of a
reward. These individuals will not avoid relationships that are rewarding to them because
their disinhibition would prevent them. A critical distinction between avoidant attachment
and Psychopathy is that avoidant attachment is associated with higher levels of inhibition
rather than impulsiveness (Love & Holder, 2015).

This distinction between the two can be further explained using an example of a breakup.
When people start receiving signs that their partner's commitment to the relationship is
reducing, they generally become concerned and try to save the relationship. However,
individuals high in Psychopathy and those with an avoidant attachment would appear
unaffected and unbothered by the end of a relationship. A person high in Psychopathy is
primarily unaware of signs that his/her partner is losing commitment to a relationship. These
individuals hardly experience pain and distress in such a situation due to an underactive
Behavioural inhibition system (BIS). This neuropsychological system predicts a person's
response to anxiety signals in a specific environment. This neuropsychological system is
activated when aversive or adverse events occur. However, suppose the relationship was
gratifying, and the loss of the relationship implies the loss of the reward. In that case, we
notice the individual attempting to confront the partner, express feelings, and manipulate the
partner to change their decision. This approach behaviour is due to an overactive Behavioural
approach system (BAS) which controls appetitive motives, in which the goal is to move
toward something desired. They are so focused on the rewards and benefits of the
relationship and, therefore, would actively attempt to keep the relationship. Whereas when
individuals with an avoidant attachment notice signs of distress in relationships and would
respond to the situation with indifference due to the withdrawal of their attachment needs.
The notable difference between Psychopathy and avoidant attachment is in Behavioural
approach system (BAS) activity. Individuals high in Psychopathy have an overactive BAS
and, as a result, would approach and maintain rewarding relationships. Those with an
avoidant attachment have an underactive BAS and would avoid any situation or person that
makes them feel rejected. Furthermore, this indicates that people high in Psychopathy do not
necessarily perceive others as hostile or threatening compared to those with avoidant
attachment. Psychopathic individuals maintain a positive perception of others as long as their
relationships are rewarding (Outcalt, 2007). Impulsiveness and avoidance are critical
characteristics in the romantic relationship style of psychopathic individuals. These people
are more likely to commit/perform social errors such as cheating and violating the boundaries
of a romantic partner because they are so fixed on the rewards that they are unable to
recognize and analyze cues indicating punishment or memories of the past consequence of
negative behaviour. The improper function of the Behavioural inhibition system (BIS) causes
the person to not experience anxiety in a social interaction which promotes them to pursue a
reward without any inhibition. An impaired Behavioural approach system (BAS) causes a
person to be so focused on the reward that they cannot modulate their response behaviour
according to punishing stimuli. The integrated effect would bring out impulsiveness in social
situations that result in the commission of social errors (Outcalt, 2007).

True love is not an egocentric is. A healthy relationship is built on the foundation of trust,
self-confidence and awareness that helps us grow and understand our own needs and the
needs of our partner. Emotions are essential for an individual to interpret a stimulus as
rewarding, neutral, or threatening. The psychopathic reward-seeking behaviour impairs the
individual's ability to attend to guilt, anxiety or empathy. Those high in Psychopathy have an
overactive Behavioural approach system which makes them unaware of negative emotions
while pursuing something rewarding. This blocks the person's ability to create mutual
relationships and prevents the emotional resonance required for deep empathy. Cultivating
cognitive and emotional resources to improve a person's ability to delay gratification can
change the relational behaviours of psychopathic individuals. Understanding the
psychobiological basis of the affective dysfunctions in psychopaths is of great value to
diagnosing the disorder and providing effective treatment (Gawda, 2012).

6. How does childhood trauma lead to the development of ASPD?

Although ASPD can primarily be due to genetic reasons, environmental factors also come
into play significantly. Children can show traits of ASPD in their childhood, such as
aggressive behavior, disregard for others, lack of empathy, annoyance, and dishonesty
(DeLisi et al., 2019). Through research, we can elaborate on how children can develop these
traits that later lead to the diagnosis of ASPD due to adverse childhood experiences and
childhood. Building secure attachment in infants is crucial for their development.
According to research, ASPD can form in the first 18 months of a child's life if parents
neglect primary needs, such as the need to be fed, to be responded to, and using self to soothe
the child. Due to neglect and a disorganized attachment style between the early stages and the
age of eight, we can predict that the child will more likely develop ASPD (Glenn et al.,
2013). The child loses their sense of security because their attachment needs are not only not
satisfied, damage and fear are imposed onto the children through this (Ling et al., 2022). To
further support this, in research from Ling et al., this type of neglect from the primary
caregiver is considered mental abuse and is positively associated with ASPD. Individuals
who experience abuse tend to victimize themselves and others who have been through a
similar experience. They often also wish their or an experience on others if they feel someone
is taking advantage of their trauma (2022). This can be related to the developing traits of
ASPD. Verbal and sexual abuse from the caregiver is strongly associated with developing
ASPD (DeLisi et al., 2019). Moreover, childhood social deprivation, neglect, and abuse are
primarily responsible factors in predicting the resulting ASPD in individuals (Glenn et al.,
2013).
Childhood abuse and environmental experience affects the individual's biological
system. Although the genes cannot be altered through this, they are changed in terms of
expression and can adjust hormone and neurotransmitter levels, directly affecting the brain.
Individuals with antisocial personality disorder have decreased volume and functioning in the
prefrontal cortex. Neuropsychological test results of irregularities in brain functioning in
children as low as three years old suggest that they are more likely to develop ASPD (Glenn
et al., 2013).
Through longitudinal studies, it was proven that individuals who were abused
physically or sexually have ASPD on a far larger scale than those who had not been abused
(Rhee et al., 2021). Research further suggests that children who have antisocial parents/
parental figures in the house may result in mistreatment towards the child. Moreover,
children who witness abuse between their parents are more likely to carry that out within
their relationships in adulthood. Furthermore, children and adolescents who spend most of
their time watching TV are more likely to develop ASPD. Children become accustomed to
violence shown on TV and lose sensitivity towards the content as it becomes normalized to
them. Due to this, children also tend to imitate the violence they observe on television (Glenn
et al., 2013).
According to research, one of the main predictors of an adult having ASPD would be
if they had CD (Conduct disorder) in their childhood (Hutchings et al., 2007). Conduct
Disorder is typically defined by children who behave in misconduct, have disregard for
others, and display aggressive behavior (Fairchild et al., 2019). CD is most likely to develop
in children who have to deal with constant shifts in their parental figures, have single parents,
have parents who indulge in substance abuse, or have a mental disorder. These factors cause
a sense of neglect and mental abuse toward the child. Children with CD tend to behave
aggressively and not do as they are told. This is a high predictor of the individual
participating in criminal acts, brutality, and other sources of criminality (Hutchings et al.,
2007)

7. What type of treatment can we offer to those with ASPD? 

Treatment for Antisocial Personality Disorder proves quite difficult, as many people with
ASPD do not seek intervention and many services refuse to provide support for these
individuals (Glenn et al., 2013). 
Cognitive Behavioural Therapy is a type of psychotherapy that can be used to treat many
different disorders. It serves to help a person identify ways to control their emotions as well
as learn new effective ways of communication and help build stronger relationships with
others. The process is much more efficient than other forms of treatment as well. The steps
include (Cognitive Behavioral Therapy - Mayo Clinic, 2019):
  Identifying the problem
 Becoming more aware of your thoughts
 Identifying the negative thoughts and emotions
 Reshaping these thoughts or emotions 
Although CBT has resulted in improvement in regards to social functioning and physical
aggression, These improvements were insignificant and there were no improvements
recorded in other areas in regards to Antisocial personality disorder (Glenn et al., 2013). 
However, Mentalization based treatment has emerged as a possible form of treatment for
those suffering from ASPD (Glenn et al., 2013). This refers to the ability to think about one’s
mental state as well as that of others. This treatment form was originally developed for BPD,
but research suggests it could be effective in treating ASPD patients with moderate levels of
psychopathic traits (Glenn et al., 2013). During MBT, the patient's ability to understand their
own thoughts is improved, as well as the ability to understand others. In the therapy sessions,
you are asked to reflect on your current issues rather than that of the past allowing you to
focus on your thoughts at the moment as well as what others think. By doing so you are able
to control your impulses and emotions better as well as improve your relationship with other
individuals (Mentalization-based Therapy (MBT) —, n.d.)
Regarding Pharmacological treatment, Evidence shows that antimanic drugs inhibitors and
selective serotonin reuptakes for impulsive dyscontrol, as well as  low amount of
antipsychotics for cognitive-perceptual abnormalities and antidepressants for emotional
dysregulation can be used to treat ASPD (National Collaborating Centre for Mental Health
(section of the Colleges Research Unit), 2009). However, this evidence comes from research
conducted on Borderline Personality Disorder. 
The lack of compliance from patients reported by therapists makes it hard to establish a
therapeutic alliance. This is why no treatment so far can be considered a standard form of
intervention when treating ASPD patients. 
 DISCUSSION

The world is seen more personally than interpersonally by antisocial people. They are unable
to put another person's viewpoint ahead of their own. They are unable to assume another's
role as a result. Due to this cognitive restriction, their acts are not based on socially conscious
decisions. They have a very poor opinion of other people and believe that since they are
exploitative, they should also be exploited in return. 

The improper function of the Behavioral inhibition system (BIS) causes the person to not
experience anxiety in a social interaction which promotes them to pursue a reward without
any inhibition. An impaired Behavioral approach system (BAS) causes a person to be so
focused on the reward that they cannot modulate their response behavior according to
punishing stimuli. This increases the chances of committing social errors which negatively
impact social relationships.
 In terms of environmental factors, trauma faced in childhood can lead to ASPD. Mental
abuse in childhood is caused by a disorganized attachment style and can lead to ASPD.
Sexual abuse victims tend to have a higher impact of ASPD. This trauma leads to changes in
the prefrontal cortex of the brain.
Based on current research, an effective treatment plan for ASPD is yet to be standardized.
However CBT as well as Mentalisation based treatments are currently being used and are
proving to be effective in certain ways.     After research, we also found that ASPD has an
extremely high rate of comorbidity with other disorders including BPD and BP. However
they could be differentiated through the factors of impulsivity as well as other methods.
 CONCLUSION

Individuals with ASPD usually display aggressive behavior, impulsiveness, and

deceitfulness. They are also not the most law-abiding citizens, and this trait usually results in
criminality, identifying these traits helps us differentiate those with ASPD.  Trauma in
childhood is one of the leading causes of the development of ASPD in the context of
environmental factors. A child can develop traits of ASPD when they do not have a secure
attachment with the caregiver, which is considered mental abuse. individuals who were
abused physically or sexually have ASPD on a far larger scale than those who had not been
abused. When comparing ASPD with BPD, one main characteristic that is similar between
the two happens to be impulsivity. However, it is also one trait that differentiates one from
the other. We can distinguish that individuals with BPD have a sense of urgency and less
space for perseverance. In contrast, with ASPD, individuals need premeditation and sensation
seeking.  When analyzing the relationship between ASPD and psychopathy, the four major
personality traits, including Antisocial characteristics, are related to psychopathy. There is an
exaggerated sense of self-importance, deceit, and lying abilities, and  lack empathy. 
Furthermore, not every individual with ASPD fits the criteria for psychopathy. Through our
research, we found that men are more likely to develop ASPD than women, and the presence
of substance abuse and being in prison further foster the development of ASPD. Our findings
suggest that men and women express ASPD differently and the cause of different experiences
and differences in the expressiveness of ASPD is yet to be determined through further
research. Impulsiveness and avoidance are critical characteristics in the romantic relationship
style of psychopathic individuals. The improper function of the Behavioral inhibition system
(BIS) causes the person to not experience anxiety in a social interaction. An impaired
Behavioral approach system (BAS) causes a person to be so focused on the compensation
that they cannot modulate their response behavior according to punishing stimuli.  Although
CBT has been proven to improve social functioning and aggression in the context of
treatments, the  improvements were limited to two areas only. However, mentalization
treatments refer to the ability to think about one’s mental state and that of others and have
been effective for individuals with moderate traits of ASPD. Moreover, the lack of
cooperation from the patients is what makes it challenging to create a standard form of
intervention and treatment dedicated to those with ASPD. 

RECCOMENDATION

As mentioned above, traits or characteristics of ASPD typically develop in childhood, where

the child usually develops a CD (Conduct Disorder) or generally displays high levels of
aggressive behavior, impulsivity, and disregard for others. Due to the root of the development
of these traits being genetic, parents should seek training intervention strategies as soon as
they experience improper behavior from the child. Even though the disorder is genetic, the
environment can continue to foster it if not controlled. Although we cannot alter the
biological composition, we can reduce the impact that it has on the brain by controlling the
individual's environmental factors, and stop it from altering the biological
composition.Research for women with ASPD has only surfaced in the last decade. The
material out there proves to be scarce and does not allow psychologists to understand the
gender differences within ASPD. Many women have also gone undiagnosed due to the lack
of research and ambiguity. Further probing is necessary in order to correctly diagnose each
individual and accurately understand the extent of the disorder. Research within ASPD and
psychopathy have been limited. The two disorders are often used interchangeably due to their
similarities. However, many individuals and criminals are often misdiagnosed due to the
ambiguous nature of the diagnostic criteria. Within the field of criminal justice, research
within the diagnostic criteria of both ASPD and psychopathy can help with the categorization
of criminals and aid in their treatment. Psychologists could also guide parents on how they
express ASPD traits, which can foster the same characteristics in their children, leading them
to become diagnosed with ASPD in adulthood. Once the caregiver understands what
attributes to not display in their lives to disable any fostering of the traits for their children,
they may be able to eliminate CD and other displays of ASPD. Furthermore, caregivers must
ensure to have a secure attachment with the infant in their early stages. A secure attachment
provides the child with safety and the confidence that the caregiver will meet their needs,
which eliminates any retaliation. Due to the lack of a specific intervention for ASPD, more
resources need to be invested into this research and the cooperation of all therapists would be
required as some of them opt not to treat those with ASPD as it can be understandably
difficult. Current data focuses on attempting to use treatments for other similar personality
disorders to treat ASPD which resulted in CBT and mentalization based treatment to be used.
However, this was not always effective. It may be more beneficial to use a combination of
different talk therapies as well as psychiatric interventions to produce an effective treatment
plan. It may also require it to be engineered differently for each person. 
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