Antisocial Personality Disorder

Antisocial personality disorder (APD) is a diagnostic category of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV), which is characterized by a “pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues through adulthood.” Behaviors and characteristics associated with the disorder include irresponsibility, unstable interpersonal relationships, deceitfulness, manipulations, erratic work histories, unlawful behaviors, disregard for the safety of self or others, conning others for profit or pleasure, failure to conform to societal norms, superficiality, a lack of remorse for harmful behavior, and/or an indifference to the harm caused to others. These characteristics are not uncommon in other personality disorders. Furthermore, one or more of these characteristics can be displayed in an individual who would not fit the diagnostic criteria of APD. Due to these issues and others, the diagnosis of APD must be made by a qualified clinician using the specifics of the disorder and collateral information.

By virtue of being a personality disorder, APD indicates an inflexible, maladaptive, and persistent pattern of behavior that causes significant impairments in functioning or subjective distress; this excludes criminal, aggressive, or antisocial behaviors engaged in by an individual who does not match the diagnostic criteria for APD. Not everyone who commits a crime, takes advantage of others, or harms others suffers from APD. In addition to the above criteria, APD can be diagnosed only in someone over the age of 18 and in someone with a history of being diagnosed with a conduct disorder. However, the diagnosis cannot be made if the behaviors occur during the course of schizophrenia or a manic episode. It is important to note that not everyone with a conduct disorder will develop APD.

Individuals diagnosed with APD may suffer from other disorders, such as substance abuse, mood disorders, paraphilia, or a number of psychiatric disorders. The causes of APD are not yet fully understood, although it appears that both genetic and environmental variables are involved. Individuals diagnosed with APD have in some studies been shown to have unique [Page 26]neurological functioning and/or physiology such as slow frontal lobe activities and low serotonin levels. There is evidence for a familiar pattern indicating a genetic base. Children and adolescents diagnosed with a conduct disorder are at greater risk for developing APD if they experience abuse or neglect, unstable parental attachments, and/or inconsistent parental discipline. Research in this area must be read with a critical eye, given that most participants are institutionalized, involved in the criminal justice system, and/or in some sort of mental health treatment. The results are not always generalizable beyond the participants of the study.

Concerns have been expressed regarding this disorder. Some believe APD is overdiagnosed in certain populations (such as in minorities), whereas others believe it is underdiagnosed in certain populations (such as in females). The DSM-IV provides the following warning: “[APD] appears to be associated with lower socioeconomic status and urban settings. Concerns have been raised that the diagnosis may at times be misapplied to individuals in settings in which seemingly antisocial behaviors may be part of a protective survival strategy.” Although this statement appears to apply to those living in urban areas, it could also pertain to prison settings. The DSM-IV goes on to warn that “Neither deviant behaviors (e.g., political, religious, or sexual) nor conflicts that are primarily between the individual and society are mental disorders unless the deviance or conflict is a symptom of a dysfunction in the individual.”

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