Core features of Antisocial Personality Disorder

(Tunç, 2019) describes individuals with ASPD as individuals that “display behaviors that do not fit the social norms or criminal behavior such as deceitfulness, running away from home or school, theft, violence or substance use. They do not feel remorse about such behavior. They can exploit others for their benefit and cause physical, sexual, or financial damage. They might seem normal, smart, friendly, charming, or nice. They are described as egocentric, having a low threshold of tolerance toward stressors, unable to bond or show empathy, impulsive, exploitive, unable to maintain relationships, and irresponsible” 

According to the DSM-5 (APA, 2013), the essential features of a personality disorder are impairments in personality (self and interpersonal), functioning, and the presence of pathological personality traits. When it comes to ASPD, the significant impairment in personality functioning manifests by impairment in self-functioning (identity or self-direction) and interpersonal functioning (empathy or intimacy). 

The psychological personality traits manifest in two domains: Antagonism (Manipulativeness, deceitfulness, callousness, and hostility) and Disinhibition (Irresponsibility, Impulsivity, and Risk-taking). The functioning impairment and the personality trait expression are relatively permanent in time and stable in all situations. And they are not better explained by the individual’s development or culture.

Moreover, they are not solely explained by the effect of substance use or any medical condition. For an individual to be diagnosed with ASPD, they have to be at least age 18 years, with a previous diagnosis of symptoms of conduct disorder before the age of 15 years. (APA, 2013). 

The essential feature of antisocial personality disorder is “a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood” (APA, 2013, p. 659). When assessing an antisocial personality disorder, it may be essential to integrate information from a systematic clinical assessment and collect information from collateral sources to avoid the individual’s deceitfulness and manipulation (APA, 2013). 

The pattern of antisocial behavior continues into adulthood. Individuals with antisocial personality disorder cannot conform to social norms, are more likely than others to engage in unlawful conduct, and consequently be subject to arrest (APA, 2013). When it comes to their relationship with others, they exhibit a pattern of deceitfulness and manipulation to get what they want. They lack empathy and disregard others’ wishes, rights, and feelings (APA, 2013). 

Impulsivity is one of the main characteristics of antisocial personality disorder. According to the DSM-5 (APA, 2013), a failure to plan defines the pattern of impulsivity. Individuals with antisocial personality disorder become easily irritated and aggressive, may engage in physical fights, and even commit physical assaults (APA, 2013). 

This behavioral pattern may affect many areas of their lives, including vocational functioning, social and family relationships, and even day-to-day functioning. Consequently, in addition to causing problems with the law, these individuals are prone to harm others. For example, they may engage in harmful sexual behavior, neglect their children, or put them in danger (APA, 2013). 

Another prominent characteristic of individuals with antisocial personality disorder is their extreme irresponsibility and lack of remorse (APA, 2013). They tend to be indifferent and provide a rational explanation of their acts that externalize the blame and put it on others. They may blame the victims and make them believe that what is happening to them results from their own mistakes and that they deserve it (APA, 2013). In the meantime, they tend to minimize their harm to others (APA, 2013). 

When treating individuals with antisocial personality disorder, the situation is challenging in clinical settings, and some strategies need to be used to deal with them. In their article about managing the healthcare relationship with ASPD, (Dean, et al., 2015) mention strategies to assess patients with ASPD. They suggest that clinicians need to be aware that self-reports may not be accurate and consequently not reliable. Therefore, clinicians need to consider their observations of patients with antisocial personality disorder, along with the objective history of these individuals provided by them or by others (e.g., criminal and civil charges, employment history, interpersonal relationships, risk-taking behavior) (Dean, et al., 2015). Clinicians may need to use collateral information and self-reflection to help them make the correct diagnosis (Dean, et al., 2015).

Mona Gebrael El Hachem, Psy.D., LMHC

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References

Association, A. P. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.

Dean, Kimberlie, Korobanova, & Daria. . (2015, August 1). Antisocial personality disorder: managing the healthcare relationship. Retrieved from Medicine today: https://medicinetoday.com.au/2015/august/feature-article/antisocial-personality-disorder-managing-healthcare-relationship

Tunç, P. (2019). Dynamic formulation of antisocial personality disorder: a case study. Anadolu Psikiyatri Dergisi, 20(2), 211-216. doi: 10.5455/apd.302642618

Disclaimer: The content presented in this article is extracted 

From the March 2022 of the dissertation titled "Executive 

Functioning and Antisocial Personality Disorder", authored 

By Mona Gebrael El Hachem, Psy.D., LMHC.