Perspectives on Antisocial

Personality disorder
By
Dhruv Shenk
4 BHMS
Personality disorder
• A personality disorder is an enduring pattern of inner experience and
behavior that deviates markedly from the expectations of the
individual’s culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood,is stable over time, and leads to
distress or impairment.
Normal
• Personality refers to an individual’s characteristic way of behaving,
experiencing life, and of perceiving and interpreting themselves, other
people, events, and situations.
• Characteristic feature of a non-disordered personality is sufficient
flexibility to react appropriately and adapt to other people’s
behaviours, life events, and changes in the environment.
Definition:
• Or psychopathy, sociopathy, or dyssocial personality disorder.

Antisocial behavior is generally defined as behavior that violates the

basic rights of others.
• antisocial behavior is often associated with criminal behaviors such as
stealing or physical assault, but it also includes other more insidious
behaviors such as lying, duplicity, and manipulating others for
personal gain.
The Development
• Childhood behavior problems are two , those characterized by aggression
and acting-out behaviors (externalizing problems), and those characterized
by anxiety, withdrawal, and depression (internalizing problems );
• Disruptive behaviors such as aggression, defiance, and temper tantrums are
some of the most common behavioral problems seen in children .
• History of conduct disorder in childhood and adolescence, though not
invariably present, may further support the diagnosis.
• origins in childhood behavior problems, particularly those characterized by
aggressive and destructive behavior
• low socioeconomic status and urban settings.
Every addiction disorder every personality disorder has antisocial
personality disorder as a risk factor ,prognostic factor, and as a co
morbidity.
Prevalence

More seen in males than females.

Age group after 18 only it can be diagnosed

Low socio-economic groups

• The highest prevalence of antisocial personality disorder (greater than 70%)
is among most severe samples of males with alcohol use disorder and from
substance abuse clinics, prisons, or other forensic settings. Prevalence is
higher in samples affected by adverse socioeconomic (i.e., poverty) or
sociocultural (i.e.,migration) factors.
Cloninger model of personality
This model of personality is based on the idea that different
responses to punishing, rewarding, and novel stimuli the main
characteristics of the human mind is caused by an interaction
of the three dimensions below:
• Novelty Seeking (NS) – degree to which people are impulsive,
correlated with low dopamine activity.
• Harm Avoidance (HA) – degree to which people are anxious,
correlated with high serotonin activity.
• Reward Dependence (RD) – degree to which people are approval
seeking, correlated with low norepinephrine activity.
The Why
• Testosterone
• Serotonin
(ICD-10) the diagnostic guidelines for
dissocial (antisocial) personality disorder
• (presence of at least three of six traits or behaviours )
• These traits include callous unconcern for the feelings of others,
• gross and persistent attitude of irresponsibility and disregard for social
norms, rules and obligations,
• incapacity to maintain enduring relation ships,
• very low tolerance to frustration and a low threshold for discharge of
aggression,
• incapacity to experience guilt and to profit from experience,
• particularly punishment, and marked proneness to blame others.
• There may also be persistent irritability as an associated feature.
 Diagnostic Criteria 301.7 (F60.2) acc. To
DSM5
A. A pervasive pattern of disregard for and violation of the rights of others, occurring sinceage 15 years, as
indicated by three (or more) of the following:
1. Failure to conform to social norms with respect to lawful behaviors, as indicated by
repeatedly performing acts that are grounds for arrest.
2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for safety of self or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent
work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt,
mistreated, or stolen from another.
B. The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia
or bipolar disorder.
Differential diagnosis
• Substance use disorders
• Schizophrenia and bipolar disorders.
• narcissistic personality disorder
• Histrionic personality disorder
“The 16
1. Intelligent
characteristics of psychopaths:
2. Rational
3. Calm
4. Unreliable
5. Insincere
6. Without shame or remorse
7. Having poor judgment
8. Without capacity for love
9. Unemotional
10. Poor insight
11. Indifferent to the trust or kindness of others
12. Overreactive to alcohol
13. Suicidal
14. Impersonal sex life
15. Lacking long-term goals
16. Inadequately motivated antisocial behavior”
― Hervey M. Cleckley, The Mask of Sanity
•Psychopaths know intellectually
what is immoral, they just don’t
have a feeling of immorality about
it. ―Barbara Oakley
• Belladonna: Belladonna is a solution for delusions and should be
given where there is restlessness, anxiety, and a desire to tear their
own clothes. Such patients tend to spring out of bed and hurt people
around him. They seem to be scared and see objects when they shut
their eyes. The speech and actions of the patients are hasty.
• Hyoscyamus: This is a cure for intense insanity with a lot of excitation
of the senses and abnormal impulses. Hyoscyamus is for patients
who mostly imagine that they are being followed by some evil
presence or that somebody is attempting to kill him. The patient
keeps running from an imaginary enemy. They are very talkative and
usually jumpy.
• Stramonium: This cure is for patients who suffer from insanity and act
in the most alarming manner. They usually have pipe dreams and see
rats, mice, snakes and different creatures moving towards him or her.
• Sepia: Another cure is Sepia for the patients who have dull
premonitions about their ailment, powerless memory, and feeling of
weakness and vulnerability. They fear almost every situation, give up
easily, and fear separation.
• Aurum metallicum: This is a cure for those with mental depression
and sadness. They feel as if they have lost the companionship of their
friends and are destined to stay alone. Their memory is frail, they are
usually outraged, or feel the need to debate about everything.
• Ignatia: Most instances of depression at some time of the treatment
require Ignatia. It suits women better while Arsenicum and Nux
vomica are more appropriate for men. Ignatia is for patients who are
always gloomy and tend to murmur with an inclination to sob. They
conceal their sadness and are usually quiet.
• Sulfur: Sulfur is used as a cure for mental conditions that are broad
and usually related to religious depression. They turn out to be on
edge about their own life. They are additionally distracted and these
patients will stop for quite a while to think about how words are
spelled.
• Cannabis indica: This cure is for those who have heavenly vivid
dreams and fantasies that cannot possibly exist in reality; however,
they seem real to the patient. A moment appears to be a great many
years, and a thing might seem to appear yards away
Bibliography

• The ICD-lO classification of mental and behavioral disorders. Clinical

Descriptions and Diagnostic Guidelines. Geneva: World Health
Organization; 1992. World Health Organization
• Antisocial Personality Disorder". National Library of Medicine.
Retrieved 16 May 2018.
• American Psychiatric Association (2013), Diagnostic and Statistical
Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric
Publishing, pp. 661, ISBN 978-0-89042-555-8
• Diagnostic and Statistical Manual of Mental Disorders (Fifth ed.).
Arlington, Virginia: American Psychiatric Association. 2013. pp. 646–49.
ISBN 978-0-89042-555-8.
Thank
You