antisocial personality disorder profiling psychopathology dr. kline fsu-pc summer 2004

Antisocial Personality DisorderAntisocial Personality Disorder

Profiling PsychopathologyProfiling Psychopathology

Dr. Kline Dr. Kline

FSU-PCFSU-PC

Summer 2004Summer 2004

What is a personality Disorder?What is a personality Disorder? Is a Is a long-standinglong-standing, , pervasivepervasive, & , & inflexibleinflexible pattern of pattern of

behavior.behavior.

Usually impairs social & occupational functioning.Usually impairs social & occupational functioning. Personality disorders comprise all disorders in the Personality disorders comprise all disorders in the

Axis II of the DSM & these are often comorbid with Axis II of the DSM & these are often comorbid with other Axis I disorders (substance use, depression, other Axis I disorders (substance use, depression, etc.) etc.)

   Presence of personality disorders complicate Presence of personality disorders complicate

treatment of other Axis Itreatment of other Axis I disorders disorders

What is an Antisocial Personality What is an Antisocial Personality Disorder (APD)?Disorder (APD)?

Two major criteria:Two major criteria:

1. The presence of a conduct disorder before 1. The presence of a conduct disorder before the age of 15. Symptoms includethe age of 15. Symptoms include: t: truancy; ruancy; running away from home, theft, compulsive running away from home, theft, compulsive lying, arlying, arson, & vandalism.son, & vandalism.

2. The continuation of this pattern of 2. The continuation of this pattern of antisocial behavior into adulthood.antisocial behavior into adulthood.

DSM-IV-TR Diagnostic Criteria for APD:DSM-IV-TR Diagnostic Criteria for APD: Pervasive pattern of disregard for the rights of others since age 15 & Pervasive pattern of disregard for the rights of others since age 15 &

at least 3 of the characteristics 1 through 7 . Eight through 10 must be at least 3 of the characteristics 1 through 7 . Eight through 10 must be present for diagnosis. present for diagnosis.

1. 1. Repeated law-breaking**Core symptom**Repeated law-breaking**Core symptom** 2. Deceitfulness; lying2. Deceitfulness; lying 3. Impulsivity3. Impulsivity 4. Irritableness & aggressiveness 4. Irritableness & aggressiveness 5. Reckless disregard for own safety & that of others.5. Reckless disregard for own safety & that of others. 6. Irresponsibility as seen in unreliable employment history or not 6. Irresponsibility as seen in unreliable employment history or not

meeting financial obligations.meeting financial obligations. 7. 7. Lack of remorseLack of remorse******not necessary for diagnosisnot necessary for diagnosis****** 8. Age at least 188. Age at least 18 9. Evidence of conduct disorder before age 15.9. Evidence of conduct disorder before age 15. 10. Antisocial behavior not occurring exclusively during episodes of 10. Antisocial behavior not occurring exclusively during episodes of

schizophrenia or mania.schizophrenia or mania.

What % of conduct disordered youth What % of conduct disordered youth become Antisocial Personality Disorders in become Antisocial Personality Disorders in adulthood?adulthood?

Roughly Roughly 60%60% of children with conduct of children with conduct disorder develop APD into adulthood disorder develop APD into adulthood (Myers, Stewart, & Brown, 1998). (Myers, Stewart, & Brown, 1998).

What is general profile of person with What is general profile of person with Antisocial Personality Disorder?Antisocial Personality Disorder? Individual:Individual: IrresponsibleIrresponsible CriminalityCriminality Displays antisocial behavior (sketchy work history, Displays antisocial behavior (sketchy work history,

illegal activities, irritability)illegal activities, irritability) Physically aggressive and violentPhysically aggressive and violent Has financial problems (defaults on debts)Has financial problems (defaults on debts) Reckless & impulsive behaviorReckless & impulsive behavior May be promiscuous May be promiscuous May lack remorse or show little regard for truthMay lack remorse or show little regard for truth

Prevalence of APDPrevalence of APD

Effects 3% of males; 1% of females in U.S.Effects 3% of males; 1% of females in U.S.

Rates may be higher among younger adults than Rates may be higher among younger adults than older adults. older adults.

Disorder is more common in people of low SES.Disorder is more common in people of low SES.

Comorbidity is high with other personality Comorbidity is high with other personality disorders (e.g., narcissistic PD) as well as other disorders (e.g., narcissistic PD) as well as other Axis I disorders (substance use).Axis I disorders (substance use).

What is the difference between APD What is the difference between APD and psychopathy?and psychopathy?

Major distinction appears to be in symptomatology.Major distinction appears to be in symptomatology.

““Lack of remorse,”Lack of remorse,” a core symptom of a core symptom of psychopathy, is not required for diagnosis of APD. psychopathy, is not required for diagnosis of APD.

In one study, 75 to 80% of convicted felons met In one study, 75 to 80% of convicted felons met criteria for APD, but failed to meet criteria for criteria for APD, but failed to meet criteria for psychopathy. psychopathy.

Problems with diagnosing APD:Problems with diagnosing APD: 1. One major criticism centers around method by which 1. One major criticism centers around method by which

diagnosis is made.diagnosis is made.

An APD diagnosis relies on reports of patient’s past life An APD diagnosis relies on reports of patient’s past life events. Since these people are often pathological liars, events. Since these people are often pathological liars, how can we verify their claims???how can we verify their claims???

**This is especially problematic—when family **This is especially problematic—when family members are deceased.***members are deceased.***

2. Many psychologists argue that a diagnostic concept 2. Many psychologists argue that a diagnostic concept in the field of psychopathology shouldn’t be linked with in the field of psychopathology shouldn’t be linked with criminality. criminality.

What is Psychopathy?What is Psychopathy?Core features-Core features-

– Psychopaths lack remorsePsychopaths lack remorse– Poverty of emotions (positive & negative)Poverty of emotions (positive & negative)

Psychopaths are:Psychopaths are:Superficially charmingSuperficially charmingPathological liars & cheaters Pathological liars & cheaters Impulsive; sensations seekersImpulsive; sensations seekersManipulative, will change story to fit factsManipulative, will change story to fit factsLess responsive to fear/anxietyLess responsive to fear/anxietyImmoral Immoral Occurs predominantly in men!!!Occurs predominantly in men!!!

Psychopaths identified by Hare checklistPsychopaths identified by Hare checklist

Two clusters:Two clusters:

1. 1. Emotional detachment clusterEmotional detachment cluster (a (a selfish remorseless individual with inflated selfish remorseless individual with inflated self-esteem who exploits others.)self-esteem who exploits others.)

2. 2. Antisocial lifestyle clusterAntisocial lifestyle cluster- marked by - marked by impulsivity & irresponsibility.impulsivity & irresponsibility.

Are psychopaths born or made?Are psychopaths born or made?

Most likely there are components of both Most likely there are components of both that account for the development of full that account for the development of full fledged psychopathy.fledged psychopathy.

Putative causes of APD & Putative causes of APD & psychopathy?psychopathy?

1. 1. FamilyFamily McCord & McCord (1964) concluded that McCord & McCord (1964) concluded that lack lack

of affection & severe parental rejectionof affection & severe parental rejection may be may be primary causes of psychopathic behavior. primary causes of psychopathic behavior.

Other suspected family related factors are:Other suspected family related factors are: Inconsistencies in discipline or no discipline at all, Inconsistencies in discipline or no discipline at all,

physical abuse, marital discord, & substance use.physical abuse, marital discord, & substance use.

2. Both antisocial personalities & 2. Both antisocial personalities & criminal behavior have heritable criminal behavior have heritable components.components. Twin Studies:Twin Studies: 1. Higher concordance rate for MZ twins 1. Higher concordance rate for MZ twins

than for DZ twins in APD (Lyons et al., than for DZ twins in APD (Lyons et al., 1995).1995).

Adoption Studies:Adoption Studies: 2. Higher rate of antisocial behavior in 2. Higher rate of antisocial behavior in

adopted children of biological parents with adopted children of biological parents with APD.APD.

3. Father’s behavior3. Father’s behavior

Fathers of psychopaths are likely to be Fathers of psychopaths are likely to be antisocial personalities themselves!!!!!!antisocial personalities themselves!!!!!!

4. Environmental Factors4. Environmental Factors Environment seems to play an important role in Environment seems to play an important role in

APD. APD.

It has been shown that environmental factors such It has been shown that environmental factors such as marital problems and substance abuse) are as marital problems and substance abuse) are related to the development of APD. related to the development of APD.

Also high levels of conflict & negativity and low Also high levels of conflict & negativity and low levels of parental warmth predict APD. levels of parental warmth predict APD.

What’s likely to be going on?What’s likely to be going on?

Child with diathesis for antisocial behavior Child with diathesis for antisocial behavior may be difficult to deal with & produce may be difficult to deal with & produce environmental changes that result in harsh environmental changes that result in harsh conditions (treatment) by family members.conditions (treatment) by family members.

This may fuel development of full blown This may fuel development of full blown antisocial behavior.antisocial behavior.

Are psychopaths less prone to anxiety Are psychopaths less prone to anxiety than normal people?than normal people?

Yes!!!Yes!!!

Lykken (1957) studied the ability of Lykken (1957) studied the ability of psychopaths & controls to avoid shock. psychopaths & controls to avoid shock.

Psychopaths were poorer than controls at Psychopaths were poorer than controls at avoiding the shocks, suggesting they are avoiding the shocks, suggesting they are low in anxiety compared to controls.low in anxiety compared to controls.

Do psychopaths show less autonomic Do psychopaths show less autonomic arousal to fear eliciting stimuli than arousal to fear eliciting stimuli than controls?controls? Psychopaths show a pattern of autonomic activity

that suggests they “tune out” aversive stimuli.

Their hearts beat faster than normals when anticipating stress, but their skin conductance levels are lower than controls in response to aversive stimuli.

This makes them appear underaroused when they are not.