Antisocial Personality Disorder - Research Paper Example

?Running head: ANTISOCIAL PERSONALITY DISORDER Antisocial Personality Disorder (school) Antisocial personality disorder is defined bythe DSM-IV based on a variety of criteria, including the failure to conform with social norms, deceitfulness, reckless disregard for the safety of others, repeated physical fights, and similar other qualities. The cause of this disease has not been definitively established, nevertheless, conduct disorder, as well as other childhood and adolescent mental disorders have been credited as predisposing factors to the development of antisocial personality disorder. Its treatment and prevention therefore have been based on the prevention of the onset of such childhood and adolescent disorders. Its treatment includes cognitive behavioral therapy, risperidone, home visiting programs, and skill based programs. In applying the religious and spiritual applications of this disorder, it is possible to apply a more holistic assessment of the disorder, especially for those who consider spiritual and religious beliefs as essential elements to their full recovery. Anti-Social Personality Disorder I. Introduction Antisocial personality disorder is one of the disorders diagnosed by the DSM-IV or the Diagnostic and Statistical Manual of Disorders as personality disorders. This disorder is largely based on manifestations of personality – personalities which deviate from the normal physiological and mental functions of individuals. The DSM-IV discusses the following criteria for qualifying antisocial personality disorder: evidence of conduct disorder before the age of 15; pervasive pattern of disregard for and violation of rights of others since the age of 15, manifesting with atleast three of the following behavior: failure to conform to social norms in relation to social norms with respect to lawful behaviors, indicated by repeated acts meriting arrest; deceitfulness, marked by repeated lying, use of aliases, tricking others to gain profit or pleasure; impulsiveness; irritability and aggressiveness, with repeated physical fights; reckless disregard for safety of others and of self; consistent irresponsibility, marked by repeated failure to sustain work behavior or honor financial responsibilities; lack of remorse marked by indifference, rationalizing being hurt or mistreated by another (Ogloff, 2006). They are also likely to use aggression and deception to promote their personal interests and to basically get what they want (Porter and Woodworth, 2007). This paper shall discuss the disease in its historical context, as well as current research on its causes. It shall discuss the treatment approaches for this disorder, including the benefits of such treatment. It shall also consider research as to the prevention of this illness as well as cross cultural issues pertaining to the topic. Finally, it shall discuss the topic from a Christian worldview perspective, including the disorder’s cause, treatment, and prevention. This topic is being considered with the hope of establishing a clear and comprehensive assessment of the subject matter. II. Historical context In a discussion by Million, et.al., (as cited by Ogloff, 2006), the author set forth that psychopathy is one of the first personality disorders to be recognized in the field of psychiatry. Psychopathy originally referred to personality disorders seen as extreme forms of normal personalities. Practitioners have debated conditions characterized by antisocial behavior with the term manie sans delire coined in the 1700s to specify behavior from humans whose affective faculties have been discredited; critics point out however that it is a term which was useful only in court (Ogloff, 2006). Throughout the years, various labels have been considered for the condition which has now been known simply as psychopathy. These labels included moral insanity, moral imbecility, degenerative constitution, and psychopathic taint. In the current context, antisocial personality disorder is applied in a much broader context than psychopathy; it is also based on behavioral qualities, not so much on the traditional personality characteristics implied in psychopathy (Ogloff, 2006). American psychiatrist Cleckley described psychopathy in his book “Mask of Sanity” where he specified 16 qualities to characterize the disorder, including superficial charm and good intelligence; absences of delusions; absence of nervousness; unreliability; insincerity; lack of remorse or shame; and similar qualities (Ogloff, 2006). In 1932, the American Psychiatric Association described various personality disorders and labeling them as psychopathic illnesses. Then, in 1968, such disorders were relabeled by the DSM-II as personality disorder, antisocial type. Those who were labeled as such were described as ‘unsocialized,’ or having patterns of behavior which brought them in constant conflict with society (Ogloff, 2006). They were said to be incapable of developing loyalties to other people, groups, or even social values; and they were also grossly selfish and incapable of feeling guilt (Ogloff, 2006). Much criticism resulted from the DSM-II characterization due to its unreliability. Consequently, more specific qualities were then developed. The DSM-IV sets forth the current accepted qualities of antisocial personality disorder as described in the introductory portion of this paper. III. Current research as to the cause of the illness There are various factors associated with the development of APD, and these factors include a diagnosis of a mental disorder during childhood or adolescent years. Conduct disorder (CD) during adolescent and childhood years is the most common factor associated with the development of APD (Hemphala and Tengstrom, 2010). Other disruptive behavior disorders like oppositional defiant disorder and attention deficit/hyperactivity disorder are also predisposing factors to the development of this disease. Based on the hierarchical development model, ODD and ADHD impact on the development APD by increasing the early appearance and persistence of conduct disorder (Diamantopoulou, van der Ende, and Verhulst, 2010). Other authors further claim that among individuals with ADHD and CD, the development of severe APD during their adult years is also a significant possibility (Washburn, et.al., 2007). Other mental disorders and disruptive behavioral disorders also contribute to the development of this disorder. Moreover, substance abuse increases the risk for APD among deviant peers who would often resort to various illegal activities (lying and stealing) in order to acquire money to support their unhealthy habits (Washburn, et.al., 2007). Marijuana use has also emerged as a factor in the development of APD, even manifesting a stronger impact, as compared to CD, in the development of APD (Diamantopoulou, van der Ende, and Verhulst, 2010). Some studies have also suggested that depression is a factor which increases the risk for APD with its symptoms like irritability, hopelessness being primary factors impacting on the development of APD (Washburn, et.al., 2007). Loeber, et.al., (2002, p. 31) also discusses that callous or unemotional behavior can also add to the risk of APD development. These behaviors when taken together alongside other co-morbid factors impact on the development of APD. IV. Various treatment approaches There are various treatment approaches for antisocial personality disorder, one of them being cognitive behavioral therapy. When applied to violent individuals with antisocial disorder results revealed that at 12 months, the respondents manifested a decrease in the occurrence of verbal and physical aggression (Davidson, et.al., 2009). This type of therapy is meant to manage the antisocial patient’s aggressive, impulse, and aggressive tendencies, gradually easing them towards more socially accepted behavior (Meloy, 2007). It is important to note however that there are no definite treatments available for antisocial personality disorder or psychopathy (Ogloff, 2006). However, various studies have presented viable options for the treatment of this condition. The most useful treatments seem to be on skill-based and behavioral therapies which target higher-risk offenders in the community (Rice and Harris, 1997). Among adult patients, well-designed implementation programs seem to assist in preventing repeated offenses among individuals suffering from the disorder (Losel, 1995). Farrington (2005) also discusses that in preventing conduct disorder and delinquency, it is possible to eventually prevent the occurrence of APD. Some of the interventions for conduct disorder include home visiting programs wherein visitors would advice mothers on their child’s care, nutrition, rearing, and preschool intellectual enrichment programs (Farrington, 2005). Interventions on parent management training are also meant to assist parents in managing their children’s CD. Interventions which target chronic delinquents, including multisystemic therapy and treatment foster care are meant to treat CD and in turn, prevent the incidence of APD. Not much is known about the treatment of childhood and adolescent psychopathy, but authors Frick, et.al. (2005) point out that it is important to implement an early and extensive intervention for such patients in order to ensure the adequate management of the disorder. While psychopaths can be difficult to treat because their symptoms can persist throughout their life, antisocial personality disorder can be easier to manage, especially at younger ages and with the application of preventive measures (Farrington, 2005). Hirose (2001) set forth his discussion on the treatment of antisocial personality disorder to include risperidone. This drug targets the antisocial patient’s impulsivity and in its application on antisocial patients, this drug was known to reduce the antisocial patient’s anger, aggressive, and antagonistic behavior. In combination with other drugs which help manage akathisia (a side-effect of risperidone), risperidone has shown much promise in managing the antisocial patient’s aggressive behavior (Hirose, 2001). Most of the above interventions do not directly target the causes of the disorder and all the symptoms associated with the disease, however based on the specific applications of the treatments on patients, the disease has now become more manageable. V. Research as to the prevention of the illness The main preventive measure for antisocial personality disorder is on preventing the initial onset of conduct disorder (Loeber, Burke, and Lahey, 2002). As was mentioned previously, conduct disorders during childhood and adolescent years often eventually lead to antisocial personality disorders during adult years. This is very much in line with the claims of Loeber and other authors as they point out that the best means of preventing antisocial disorder is to prevent the onset of conduct disorder. And one of the ways of preventing conduct disorder is through cognitive behavioral therapy (Fountoulakis, Leucht, and Kaprinis, 2008). This type of therapy is meant to make adjustments in a patient’s behavior – teaching him how to deal better with situations he is faced with. This type of therapy is meant to adjust a person’s behavior towards less destructive, aggressive, or impulsive actions; in short teaching the person to behave in ways which are more acceptable to the general population. By preventing the onset of conduct disorder, the adolescent would learn how to properly deal with his emotions and be less impulsive, aggressive, thrill-seeking, hyperactive, and instead be more socially conforming (Frances, Miller, & Mack, 2005). In effect, the end goal which can hopefully be gained is a more socially adjusted adult – one which is not manifesting antisocial behavior. Universal preventive measures as discussed by Harrington and Bailey (2003) are interventions which cover the entire population. These measures include school-based programs which provide an essential standard for preventive activities. These programs emphasize on the management of: physically aggressive behavior of students (bullying), academic failure, and low commitment to school (Harrington and Bailey, 2003). These programs can be implemented in combination with other activities which are meant to adjust the ways in which schools are managed. Some of these programs may include the reduction of class size and on the implementation of better class organization, behavior management strategies, and skills which support proper citizenship (Harrington and Bailey, 2003). These programs are also meant to manage the behavior of students, especially those who are at risk of developing conduct behavior. Selective prevention is also another means of preventing antisocial behavior. This strategy focuses on high-risk groups. It applies two preventive interventions means, first is the vulnerability-focused intervention which target groups which have a high risk based on their individual qualities, and second is the situation-focused interventions which focuses on individuals whose risks come from extraneous circumstances (Harrington and Bailey, 2003). The management of child mental disorders is also considered a main preventive intervention for antisocial disorder. One such disorder is attention deficit/hyperactivity disorder (ADHD). Studies reveal that there is a link between ADHD and antisocial personality disorder with hyperactivity leading to early offending, as well as an increased likelihood for such behavior persisting throughout the person’s adult life (Harrington and Bailey, 2003). Situation-based interventions are those which are founded on individual circumstances. For the most part, these situations often involve child abuse and parenting issues. Child abuse and poor parental supervision can impact negatively on children causing them to develop aggressive tendencies, as well as to manifest thrill-seeking behavior, alongside low commitment tendencies in their school activities (Harrington and Bailey, 2003). By implementing these interventions, antisocial personality disorders can be prevented; moreover, conduct disorders among children and adolescents can be prevented from their initial onset. VI. Cross-cultural issues pertaining to the topic Anti-social personality disorder is largely associated with masculine behavior, hence, adolescent males are often labeled as bullies or are credited for conduct disorders whenever they manifest any socially unacceptable behavior (Schaeffer, et.al., 2003). Even when they do not actually possess the clinical symptoms which would qualify their disorder as CD or antisocial, they are still viewed by society as individuals afflicted with personality disorders. This expectation of antisocial behavior often impacts negatively on male adolescents and young adults who are already labeled as antisocial or disorderly even when they are just going through the normal stages of human development (Schaeffer, et.al., 2003). This gender bias is a form of labeling which also dictates the behavior of individuals themselves. For those who may grow up with habits of unruly and bullying behavior, they may see the label as something they cannot get away from; and they often end up accepting such a label instead of growing or getting away from it. The racial and cultural bias on diagnosing personality disorders is also considered an issue. In a study by Mikton and Grounds (2007), the authors set forth how previous studies suggest a cross-cultural bias in the diagnosis of personality disorders and this partly accounts for the smaller proportion of Black, relative to White patients with personality disorders in psychiatric hospitals. However, their research revealed how Caucasians were actually 2.8 times more likely to be diagnosed with personality disorders as compared to African-Caribbeans. There was no cultural bias seen in their study, however, its methods (case vignette) may have caused limitations on the conduct of the study and its subsequent results (Mikton and Grounds, 2007). Iwamasa, Larrabee, and Merritt (2000) discussed ethnicity criterion bias in personality disorders as defined by the DSM; the authors also included an examination of sex as well as ethnicity. A card-sort analysis using undergraduate college students as sorters was carried out. This analysis set forth that the criteria were disproportionately biased according to ethnicity resulting to some ethnic groups being for specific personality disorders. The criteria were assessed systematically and the diagnoses of antisocial and paranoid personality disorders were often assigned to African Americans, schizoid personality disorders were assigned to Asian Americans, and schizotypal personality disorders were assigned to Native Americans (Iwamasa, Larrabee, and Merritt, 2000). Other personality disorders were assigned to European Americans and no personality disorder was applied to Latinos. These preconceived notions by student sorters reflect the, often prejudiced, perspectives which the general population can have about personality disorders, including antisocial disorder. VII. Antisocial personality disorder Christian worldview perspective Christianity, and by association, the Bible has a perspective about antisocial personality disorder which is different from the clinical perspective on the disease. First of all, the Bible labels the behavior manifested by an antisocial person as a sin (Martens, 2003). The Bible sees the following symptoms as sins, and not symptoms of a sickness: failure to conform to social norm, deceitfulness, impulsivity, irritability, aggressiveness, reckless disregard for the safety of others, and lack of remorse. These are the symptoms which make up antisocial personality disorder (Grady, 2002). The Bible also emphasizes that Christians are tested by God by tempting them to do things which violate His teachings. Those with antisocial disorders may have a fascination with immoral and occult activities (Kazenga, n.d). These are against the teachings of God. The more prudent move to treat and prevent these activities would be for us to be “…strong in the Lord and in his mighty power. Put on the full armor of God, so that you can take your stand against the devil’s schemes. For our struggle is not against flesh and blood, but against the rulers, against the authorities, against the powers of this dark world and against the spiritual forces of evil in the heavenly realms” (Ephesians 6:10-12). The blending of spirituality and psychotherapy has been considered an effective means of addressing psychological issues for antisocial patients. For it to work however, the following requirements for spirituality have to be fulfilled: it must be seen as one aspect of the total human being; it must be seen as compatible with the other dimensions of the total person; it must apply a practical approach to living; be applicable to theistic and nontheistic practices; and be applicable to any school of psychotherapy (Martens, 2003). It is important to distinguish between behavior which is guided by the lack of morals and behavior guided by psychological incapacities. The religious and spiritual themes are meant to imply behavior based on moral deficiencies; whereas, antisocial personality disorder in its clinical capacity implies breaks in the patterns of behavior founded on clinical and physiological issues. VIII. Closing Summary Based on the above discussion, antisocial personality disorder is a disorder which is largely characterized by behavior which is outside the norms of society, including irritability, deceitfulness, and lack of remorse. Its manifestation during adult years is often traced back to conduct disorder and hyperactivity disorder during adolescent years. Its treatment includes the prevention of the onset of conduct disorder and hyperactivity disorder. Other treatment measures include cognitive behavioral therapy and risperidone. Cross-cultural issues in relation to this disorder are based on gender and racial biases which often affect its diagnosis and eventual treatment. The Bible has a different view of personality disorder, labeling it as a sin, and disbelieving its manifestations as a sickness. Based on this discussion, more studies on cross-cultural barriers in the treatment and management of the disease can be undertaken. These studies would help establish whether or not these barriers and issues impact on the efficacy of the treatment methods. References Davidson, K., Tyrer, P., Tata, P., Cooke, D., Gumley, A., Ford, I., Walker, A., Bezlyak, V., Seivewright, H., Robertson, H., Crawford, M. (2009). Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychological Medicine, 39: pp. 569-577 Diamantopoulou, S. Verhulst, F., & van der Ende, J. (2010). Testing Developmental Pathways to Antisocial Personality Problems. J Abnorm Child Psychol, 38: pp. 91–103. Farrington, D. (2005). The Importance of Child and Adolescent Psychopathy. Journal of Abnormal Child Psychology, 33(4), pp. 489–497. Fountoulakisa, K., Leucht, S. & Kaprinisa, G. (2008). Personality disorders and violence. Current Opinion in Psychiatry, 21: pp. 84–92. Frances, R., Miller, S., & Mack, A. (2005). Clinical textbook of addictive behaviors. London: The Guilford Press Frick, P. Stickle, T., Dandreaux, D., Farrell, J., & Kimonis, E. (2005). Callous-unemotional traits in predicting the severity and stability of conduct problems and delinquency. Journal of Abnormal Child Psychology, 33, pp. 471–487. Grady, K. (2002). Turning sin into sickness: how clinical psychology and psychiatry usurp the word of God. Christianity and Pharmacy, 5(2), pp. 16-23. Harrington, R. & Bailey, S. (2003). The Scope for Preventing Antisocial Personality Disorder by Intervening in Adolescence. University of Central Lancashire. Retrieved 15 June 2011 from http://www.personalitydisorder.org.uk/news/wp-content/uploads/ASPD_Adolescence.pdf Hemphala, M. & Tengstrom, A. (2010). Associations between psychopathic traits and mental disorders among adolescents with substance use problems. British Journal of Clinical Psychology, 49, pp. 109–122. Hirose, S. (2001). Effective treatment of aggression and impulsivity in antisocial personality disorder with risperidone. Psychiatry and Clinical Neurosciences, 55(2), pp.161–162. Iwamasa, G., Larrabee, A., & Merritt, R. (2000). Are personality disorder criteria ethnically biased? A card-sort analysis. Cultur Divers Ethnic Minor Psychol, 6(3): pp. 284-96. Kazenga, E. (n.d). Understanding Personality disorders. eChristian Counseling. Retrieved 15 June 2011 from http://www.echristiancounseling.org/content/UnderstandingPersonalityDisorders.pdf Loeber, R., Burke, J., & Lahey, B. (2002). What are adolescent antecedents to antisocial personality disorder? Criminal Behaviour and Mental Health, 2, pp. 24–36. Losel F. (1995). The efficacy of correctional treatment: A review and synthesis of meta- evaluations, in McGuire J. editor (1995). What Works? Reducing Reoffending: Guidelines from Research and Practice, pp. 79-111. Chichester, UK: Wiley and Sons. Martens, W. (2003). Spiritual psychotherapy for antisocial and psychopathic personalities: some theoretical building blocks. Journal of Contemporary Psychotherapy, 33 (3), pp. 205-218. Meloy, J. (2007). Antisocial personality disorder. Forensis. Retrieved 15 June 2011 from http://forensis.org/PDF/published/2007_AntisocialPerso.pdf Mikton, C. & Grounds, A. (2007). Cross-cultural clinical judgment bias in personality disorder diagnosis by forensic psychiatrists in the UK: a case-vignette study. J Pers Disord, 21(4): pp. 400-17. New International Version. Colorado Springs: Biblica, 2011. BibleGateway.com. Retrieved 15 June 2011 from http://www.biblegateway.com/passage/?search=Ephesians+6%3A10-18&version=NIV Ogloff, J. (2006). Psychopathy/antisocial personality disorder conundrum. Australian and New Zealand Journal of Psychiatry, 40: pp. 519–528. Porter, S. & Woodworth, M. (2007). I'm Sorry I Did It... but He Started It": A Comparison of The Official and Self-Reported Homicide Descriptions of Psychopaths and Non Psychopaths. Law and Human Behavior, 31(1), pp. 91-107 Rice M. & Harris G (1997). The treatment of adult offenders, in Handbook of Antisocial Behavior, edited by Stoff D, Breiling J, Maser J. (1997). New York: Wiley, pp 425–435 Schaeffer, C., Petras, H., Ialongo, N., Poduska, J., & Kellam, K. (2003). Modeling Growth in Boys’ Aggressive Behavior Across Elementary School: Links to Later Criminal Involvement, Conduct Disorder, and Antisocial Personality Disorder. Developmental Psychology, 39(6), pp. 1020–1035 Washburn, J., Romero, E., Welty, L., Abram, K., Teplin, L., McClelland, G., & Paskar, L. (2007). Development of Antisocial Personality Disorder in Detained Youth: The Predictive Value of Mental Disorders. J Consult Clin Psychol., 75(2): pp. 221–231. Read More