Personality Disorders
TREATMENT SYNOPSIS
Individuals with this disorder have persistent rule-breaking, deceitfulness, antagonistic behavior, irresponsibility, lack of remorse and failure to plan ahead. In childhood, they usually have oppositional defiant disorder which develops into conduct disorder in adolescence. Fire-setting and cruelty to animals in childhood/adolescence is common. In adulthood, they often are divorced, have alcohol/drug abuse, anxiety, depression, unemployment, homelessness, and criminal behavior.
Ineffective Therapy: There is no evidence that any psychological or pharmaceutical treatment is effective in improving the core features of this disorder. Psychological treatment in prison often makes this disorder worse. Fortunately, this disorder often slowly improves after age 40.
Diagnostic Features:
Antisocial Personality Disorder is a condition characterized by persistent disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Deceit and manipulation are central features of this disorder. For this diagnosis to be given, the individual must be at least 18, and must have had some symptoms of Conduct Disorder (i.e., delinquency) before age 15. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing.
Diagnostic Criteria:
Three or more of the following are required:
In the new, soon to be released, DSM-V diagnostic criteria for Antisocial Personality Disorder; the requirement for having a Conduct Disorder before age 15 is dropped. Thus the new DSM-V diagnostic criteria for Antisocial Personality Disorder will become almost identical to that of "psychopathy" as proposed by Dr. Robert D. Hare.
Psychopaths:
A diagnosis of Antisocial Personality Disorder (using DSM-IV criteria) has limited utility for making differential predictions of institutional adjustment, response to treatment, and behavior following release from prison. In contrast, the diagnosis of being a psychopath has considerable predictive validity with respect to treatment outcome, institutional adjustment, recidivism and violence (Hare 1991). Dr. Robert D. Hare's "Psychopathy Checklist-Revised (PCL-R)" is the psycho-diagnostic tool most commonly used to assess psychopaths. On this checklist, psychopaths have the majority of the following traits:
Prevalence:
The prevalence of Antisocial Personality Disorder in the general population is about 3% in males and 1% in females. It is seen in 3% to 30% of psychiatric outpatients.
Course:
The course of this disorder is chronic. This disorder is usually worse in young adulthood and often improves in middle age.
Familial Pattern:
This disorder is more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders and Somatization Disorder. Complications:
Individuals with this disorder have an increased risk of dying prematurely by violent means (e.g., suicide, accidents, and homicide). Prolonged unemployment, interrupted education, broken marriages, irresponsible parenting, homelessness, and frequent incarceration are common with this disorder.
Comorbidity:
Anxiety Disorders, Depressive Disorders, Substance-Related Disorders, Somatization Disorder, Pathological Gambling (and other impulse control disorders), and other Personality Disorders (especially Borderline, Histrionic, and Narcissistic) frequently co-occur with this disorder.
Associated Laboratory Findings:
No laboratory test has been found to be diagnostic of this disorder.
Drug Addiction
Substance dependence is a drug user's compulsive need to use controlled substances in order to function normally. When such substances are unobtainable, the user suffers from substance withdrawal. In the American Psychological Association (APA) Dictionary of Psychology, psychological dependence is defined as "dependence on a psychoactive substance for the reinforcement it provides." Most times, psychological dependence is classified under addiction. While addictions often include a physiological need or craving for a substance, a psychological dependence is not based on physiology. Rather, it is a "need" for a particular substance based on the mental and psychological affects it creates.
The reward system is partly responsible for the psychological part of drugtolerance. People will often turn to a substance (such as alcohol) or behavior (such as sex) to help alleviate certain negative emotions or increase positive emotions. Psychological dependence begins after the first use, when these emotions are regulated by the substance or behavior, but the result is not sustainable. The "high" of the substance or behavior always fades, often leaving the user feeling generally depressed and dissatisfied, and unable to find pleasure in previously enjoyable activities. This leads to a return to the drug for an additional "fix;" because the person falls back to their initial emotional state after the effects of the substance or behavior wears off, they come to crave the substance or behavioragain. This constant feeling leads to psychological reinforcement,which eventually leads to psychological (and sometimes physiological) dependence. In chronic drug users, gradual tolerance of the substance forces a larger dose to be taken to reach the same effect.
Of the various things that a person can be psychologically dependent on, the most common are nicotine, alcohol, opiates, barbituates, and benzodiazepines. Along with substances, people can also become dependent on activities or behaviors, such as shopping, sex, self-harm, eating, or restricting food. Psychologicaldependence can be equally or more difficult to overcome than physiologicaldependence on a substance, and many choose to enter into a behavioral orsubstance abuse program while attempting to recover.
TREATMENT SYNOPSIS
Individuals with this disorder have persistent rule-breaking, deceitfulness, antagonistic behavior, irresponsibility, lack of remorse and failure to plan ahead. In childhood, they usually have oppositional defiant disorder which develops into conduct disorder in adolescence. Fire-setting and cruelty to animals in childhood/adolescence is common. In adulthood, they often are divorced, have alcohol/drug abuse, anxiety, depression, unemployment, homelessness, and criminal behavior.
Ineffective Therapy: There is no evidence that any psychological or pharmaceutical treatment is effective in improving the core features of this disorder. Psychological treatment in prison often makes this disorder worse. Fortunately, this disorder often slowly improves after age 40.
Diagnostic Features:
Antisocial Personality Disorder is a condition characterized by persistent disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. Deceit and manipulation are central features of this disorder. For this diagnosis to be given, the individual must be at least 18, and must have had some symptoms of Conduct Disorder (i.e., delinquency) before age 15. This disorder is only diagnosed when these behaviors become persistent and very disabling or distressing.
Diagnostic Criteria:
Three or more of the following are required:
- Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
- Deceitfulness, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults
- Reckless disregard for safety of self or others
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
In the new, soon to be released, DSM-V diagnostic criteria for Antisocial Personality Disorder; the requirement for having a Conduct Disorder before age 15 is dropped. Thus the new DSM-V diagnostic criteria for Antisocial Personality Disorder will become almost identical to that of "psychopathy" as proposed by Dr. Robert D. Hare.
Psychopaths:
A diagnosis of Antisocial Personality Disorder (using DSM-IV criteria) has limited utility for making differential predictions of institutional adjustment, response to treatment, and behavior following release from prison. In contrast, the diagnosis of being a psychopath has considerable predictive validity with respect to treatment outcome, institutional adjustment, recidivism and violence (Hare 1991). Dr. Robert D. Hare's "Psychopathy Checklist-Revised (PCL-R)" is the psycho-diagnostic tool most commonly used to assess psychopaths. On this checklist, psychopaths have the majority of the following traits:
- Selfish, callous and remorseless use of others:
- Glibness/superficial charm (smooth-talking, engaging and slick)
- Grandiose sense of self-worth (greatly inflated idea of one's abilities and self-esteem, arrogance and a sense of superiority)
- Pathological lying
- Conning/manipulative (uses deceit to cheat others for personal gain)
- Lack of remorse or guilt (no feelings or concern for losses, pain and suffering of others)
- Emotional poverty (limited range or depth of feelings)
- Callous/lack of empathy (a lack of feelings toward others; cold, contemptuous and inconsiderate)
- Failure to accept responsibility for own actions
- Chronically unstable, antisocial and socially deviant lifestyle:
- Need for stimulation/proneness to boredom (an excessive need for new, exciting stimulation and risk-taking)
- Parasitic lifestyle (exploitative financial dependence on others)
- Poor behavioral control (frequent verbal abuse and inappropriate expressions of anger)
- Promiscuity (numerous brief, superficial sexual affairs)
- Lack of realistic, long-term goals
- Impulsivity
- Irresponsibility (repeated failure to fulfill or honor commitments and obligations)
- Juvenile delinquency (criminal behavioral problems between the ages of 13-18)
- Early behavior problems (before age 13)
- Revocation of conditional release (violating parole or other conditional release)
- Many short-term marital relationships (lack of commitment to a long-term relationship)
- Criminal versatility (diversity of criminal offenses, whether or not the individual has been arrested or convicted)
Prevalence:
The prevalence of Antisocial Personality Disorder in the general population is about 3% in males and 1% in females. It is seen in 3% to 30% of psychiatric outpatients.
Course:
The course of this disorder is chronic. This disorder is usually worse in young adulthood and often improves in middle age.
Familial Pattern:
This disorder is more common among first-degree biological relatives of those with the disorder than in the general population. There is also an increased familial risk for Substance-Related Disorders and Somatization Disorder. Complications:
Individuals with this disorder have an increased risk of dying prematurely by violent means (e.g., suicide, accidents, and homicide). Prolonged unemployment, interrupted education, broken marriages, irresponsible parenting, homelessness, and frequent incarceration are common with this disorder.
Comorbidity:
Anxiety Disorders, Depressive Disorders, Substance-Related Disorders, Somatization Disorder, Pathological Gambling (and other impulse control disorders), and other Personality Disorders (especially Borderline, Histrionic, and Narcissistic) frequently co-occur with this disorder.
Associated Laboratory Findings:
No laboratory test has been found to be diagnostic of this disorder.
Drug Addiction
Substance dependence is a drug user's compulsive need to use controlled substances in order to function normally. When such substances are unobtainable, the user suffers from substance withdrawal. In the American Psychological Association (APA) Dictionary of Psychology, psychological dependence is defined as "dependence on a psychoactive substance for the reinforcement it provides." Most times, psychological dependence is classified under addiction. While addictions often include a physiological need or craving for a substance, a psychological dependence is not based on physiology. Rather, it is a "need" for a particular substance based on the mental and psychological affects it creates.
The reward system is partly responsible for the psychological part of drugtolerance. People will often turn to a substance (such as alcohol) or behavior (such as sex) to help alleviate certain negative emotions or increase positive emotions. Psychological dependence begins after the first use, when these emotions are regulated by the substance or behavior, but the result is not sustainable. The "high" of the substance or behavior always fades, often leaving the user feeling generally depressed and dissatisfied, and unable to find pleasure in previously enjoyable activities. This leads to a return to the drug for an additional "fix;" because the person falls back to their initial emotional state after the effects of the substance or behavior wears off, they come to crave the substance or behavioragain. This constant feeling leads to psychological reinforcement,which eventually leads to psychological (and sometimes physiological) dependence. In chronic drug users, gradual tolerance of the substance forces a larger dose to be taken to reach the same effect.
Of the various things that a person can be psychologically dependent on, the most common are nicotine, alcohol, opiates, barbituates, and benzodiazepines. Along with substances, people can also become dependent on activities or behaviors, such as shopping, sex, self-harm, eating, or restricting food. Psychologicaldependence can be equally or more difficult to overcome than physiologicaldependence on a substance, and many choose to enter into a behavioral orsubstance abuse program while attempting to recover.