Antisocial Personality Style and Disorder
Millon and others have argued that the DSM only provides a checklist of "bad boy" behaviors, and skips over the inner workings of the disorder. Thus, the diagnostic criteria are very behaviorally based and it is possible to over-diagnose this disorder. The prevalence is about 3% of the general population for men, 1% for women. I have heard some say that Antisocial Personality Disorder is the "Borderline" for males; women with traumatic and dysfunctional histories are more likely to become Borderlines, while men Antisocials.
Below is info on the Antisocial Personality Style
and Antisocial Personality Disorder
. People with this Style show some of the characteristics. People with the Disorder show more or all of them, and show them in a more severe form.Examples:
the stereotypic successful but cutthroat businessman who is willing "to step on others to make it to the top," "buy and sell people" in the workplace, engage in unethical but generally legal business practices, and adopt a "work hard: play harder" lifestyle. Think Bill Gates.
Think of the good-looking and popular frat boy who says whatever is needed to get a girl drunk and alone, then slips the "date rape" drug into her drink to have sex with her. He feels no "remorse" until caught.
Think of the computer geek who writes viruses to destroy people's computer files and systems for the feeling of power, who argues no "thing" is destroyed so it isn't a crime, and rationalizes that by doing this is he doing the world a "favor" by exposing vulnerable computer system flaws.
Think of the "Investment Deal of a Lifetime" businessman who bilks old people out of their life savings and then disappears to another state to do the same when the law is about to close in.
Any of these example can represent a Style or a Disorder.
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Shows superficial charm and easily make friends. Decision making is externally oriented. They show poor judgment and sometimes impulsive behavior, and justify and rationalize, and have difficulty learning from mistakes. They resent authority, tend to be competitive, but are poor losers.
Charm develops into a tendency to lie and "conn" others for profit or enjoyment. Decision making is more rigid and inflexible, and can be motivated by "getting even" for real or perceived "slights." Impulsiveness can lead to spur of the moment decisions that result in joblessness and homelessness. They externalize responsibility for behavior, and blame all problems on others. They can easily default on debts and obligations, and leave others suffering with no concern. Resentment of authority can take on an aggressive quality.
Lacks a sense or empathy as well as responsibility for the consequences of their actions. Often have a feeling emptiness and seek excitement to relieve the boredom. Assume the worst in others so can be argumentative and easily irritated.
Lack of empathy develops into a lack of guilt, shame, or even basic remorse for the harm they cause to others. Impulsivity and emptiness can lead to recklessness with no appreciation for the danger, sexual acting out, and substance use in order to relieve the boredom. Can be assaultive and abusive when they feel frustrated.
Adept at reading social situations and cues; uses this information to persuade others into meeting their needs. Assume others are like them, so seldom honest and open.
Reads others to manipulate them because they see others as basically ways to gratify their desires. No real loyalty or accountability to "loved" ones. Assume others are like them, so highly distrustful; likely to see environment as a "dog-eat-dog world" and think it's best to "get" others before they "get" you. Sometimes they show a cold disregard for others, while at other times a contemptuous disdain. When told of someone being victimized, they may not care or may say the person deserved it for being stupid.
Irresponsible with money sometimes, but able to work and support themselves, may be quite successful sometimes
Spend money carelessly, fail to honor financial obligations, can't maintain stable work due to the discipline this requires; leave one job without another
There are several models for how Antisocial's develop. They aren't exclusive, so feel free to "mix and match" what you need to understand them.
Results of Evaluation
Meloy discussed the "stranger self-object." When the Antisocial was a child, he perceived his parents as being cold, uncaring, and likely to harm him. His introject, or basic template for people, does not include attachment, empathy, or trust. Without this, empathy can not develop, as well as shame or remorse.
Without an empathic and nurturing parent, they also don't develop an internalization for the rules of society, and instead follow their own more primitive rules of "what feels good is good" and "you know it is bad if you get caught."
A best-case scenario includes what Kernberg (I think) called "superego lacunae" or holes in their conscience; they may possess some moral reasoning in some areas but not in others. Think of the drug dealer who thinks it morally wrong for you to sell his drugs and keep some of the profit for yourself, but who has no qualms about the business of drug sales.
There is some evidence that Antisocials may develop from difficult temperament children or abused children. Both can show attachment difficulties and irregular arousal patterns. The child with attachment difficulties might follow the process above.
The children with irregular arousal patterns could become aggressive if the thresholds for stimulation are too low; thus they are quick to sense threat or danger. Alternately, the "cold criminal" mentality could results from thresholds for stimulation being too low; thus they lack the sense of danger or anxiety that gives others indication of mistakes or bad judgment.
Sociopathic behavior becomes reinforced, deficient parenting and modeling lead to the child taking care of himself and distrusting adults and authority, and efforts to become powerful over others to care for himself begin.
Cognitive Behavioral theorists say that Antisocials suffer from a number of mistaken cognitive beliefs. They learned these and they were reinforced somewhere. OK so that's not much on how they started, but it's worthwhile to look at the way they think:
1) wanting something or wanting to avoid something is sufficient justification for acting in any way needed to obtain it or avoid it
2) thinking or feeling is a fact, and so if you think it is then it is true; the result is that you are always right
3) undesirable consequences will not happen to you or won't matter
4) you're on your own in this world
5) why worry about tomorrow, focus on today
Antisocials often have histories of abuse, neglectful parenting, and emotional trauma. They experience unpredictable discipline, had parents who were inconsistent and modeled putting their own needs first, learned little about sharing and being interdependent with others, develop a heightened need to establish their own independence from "bad" parents, and control others rather than be controlled.
The emotional trauma they experience often leads to deep feelings of vulnerability and the rejection and lack of love they experience leads to shame. To avoid actually experiencing these feelings, they repress and deny their own feelings to the point that they can not longer empathize with other people because to do so would be to recognize their own painful past.
As long as you are pleasant and "go along" with their rationalizations, the interview can be nice. But, question them about their irresponsible behavior, and they turn rude. They are attention seeking, so they are willing to brag about their accomplishments, so long as they don't have to talk about their failures. (There was a story in the news recently about a criminal who made bond and left the state. He contacted a TV new program offering to sell his "story." Cops got the email from the TV program, set up a sting, and nailed him.)
While they will not admit to having made real mistakes or bad decisions, they may be able to admit that things are not going well for them, and that others are likely to continue to cause them problems until some goal is accomplished. Thus, it is possible to form some kind of alliance with them to work toward some therapeutic goal. However, they lack genuineness and real sincerity in their stated desire to change, so therapy is of little help.
The 4-9 codetype is the most typical. Sometimes you can get minor elevations on 6 and 8, since they are overlapping, as a result of the aggressiveness, distortion in thinking, and paranoid-ish view of the world. Elevations on 2 (depression) and 7 (Anxiety) are uncommon, since real, "core" sociopaths don't feel depression and anxiety like other people do. However, those with an Antisocial Style might. Keep in mind that if an Antisocial thinks it is worth the effort to fake on these, he will, and may be able to do a good job of it.
Low to average number of responses, sometimes reject cards, more Pure C (from their impulsiveness), as well as more Animal content and FM than M. You may also see more Popular responses, given their social perceptiveness, and few if any shading, since they don't feel much anxiety or depression.
Stories on the TAT are likely to include juvenile themes where the hero does as he pleases and punishment is absent or very minor. Explanations of the hero's reasoning for acting as he does are likely to be similar to those described above with regard to cognitive distortions. Other people are viewed as "bad" and as acting with malice toward others and the hero. They are caught and punished, however.
Therapy as noted above is most helpful if it is problem focused. Gently awakening the buried feelings in the client and connecting them to current actions is the basic goal and process. However, you won't get very far; experiences that have been repressed for too long aren't going to come to the surface in the limited therapy time you have.
Other modalities may help too to provide experiences that change the way the Antisocial sees themselves in the world. This basically amounts to teaching sublimation though.
Family therapy can be helpful. However, realize that you are basically working to coordinate the person's environment to work together to "gang up" on the client. If the entire family cooperates to make demands of the patient, and not give them any leeway to begin rationalizing and justifying their irresponsible behavior, the client can make some limited changes. Basically, this amounts to an it's easier to comply than fight" approach.
Medication to target specific behaviors like impulsivity and aggressiveness may help, but you can't medicate the underlying cause of the disorder.
The best treatment may be time. Antisocials don't come in for treatment much after age 35. They tend to have learned that some behaviors, while completely justified and reasonable for them of course (grin), end up causing more hassle than anything else. Thus, some antisocial behaviors are avoided to avoid the frustration and annoyance they cause.
Are All Gang Members Antisocial?
Narcissistic Personality Disorder: These two disorders are close, when you look at the disregard for social rules, distorted thinking, and limited empathy for others. Coupled with manipulativeness, they are very close.
However, a Narcissist has much more access to a variety of emotions than an Antisocial, but typically does not show the conduct disordered behavior in youth, or the impulsivity and aggressiveness of the Antisocial. Further, Narcissists tend to feel more unhappy, depressed, and empty as their life progresses. They also have a sense of entitlement that Antisocial's don't have (i.e., "I deserve this" or "Rules about not getting this don't apply to me" versus "I want it and I'll take it" or "I want it and if you are dumb enough to let me
" without any thought to deserving or having a right to it).
Histrionic Personality Disorder: While Histrionics may do Antisocial-seeming things, like maintaining affairs, being impulsive, or showing limited empathy for others, they don't engage in the conduct disordered behaviors or show the kind of coldness Antisocials do. Substance Abuse Disorders: Antisocials may have substance abuse or dependence, and you can diagnose both. Antisocial activities to support the drug habit can support both diagnosis.
Are All Abusive or Neglectful Parents Antisocial?
Well, not necessarily. A gang member that has some true remorse for his actions, that can admit to making a moral mistake in joining the gang, that can admit to real feelings of anxiety and fear at the idea of leaving the gang, and who can reach and re-experience the childhood history of trauma is not likely to be a "core" Antisocial. They may still have an Antisocial style, but therapy might be effective. On the other hand, real Antisocials are socially skilled, and can "talk a good game" but don't get it. Real Antisocials engaged in conduct disordered kinds of behaviors at a young age, often before any gang involvement was noted.
Well, not necessarily. Among all personality disorders, Antisocials are more likely to abuse and neglect than the rest; however, Antisocials are not represented that often in the population of abusive and neglectful parents. In other words, an Antisocial is at high risk to abuse and neglect, but the majority of those who abuse and neglect are not Antisocial.