Antisocial Personality Disorder Treatment

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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Table 192 Characteristics of Persons with Antisocial Personality Disorder

Typical Thoughts Associated with the Antisocial Personality refers to emotional and interpersonal traits, such as incapacity for fear , superficia charm, lack of empathy and care for others, being egocentric, and having callous social attitudes and shallow emotions. The second cluster assesses the social deviance associated with an antisocial lifestyle, such as being impulsive, displaying poor self-control, possessing a high need for excitement, and having early and chronic behavioral problems. The major distinction between psychopathy and antisocial personality disorder mainly lies in the first cluster of emotional and interpersonal traits that defi psychopathy. Consequently, most extreme psychopaths would meet criteria for a diagnosis of antisocial personality disorder , but not all people with antisocial personality disorder are psychopaths (if they don' t have the subjective characteristics of superfi cial charm, egocentricity, lack of empathy , and shallow emotions).

Antisocial Personality and Alcoholism A

Great deal is known regarding the relationship of antisocial personality disorder and alcoholism. This diagnostic combination is estimated to involve as many as 2 percent of the male population of the United States. Most studies of this combination of illnesses indicate that the antisocial alcoholic has an earlier onset of drinking difficulties, more family history of alcoholism, more social complications of alcoholism, and a greater number of symptoms of other psychiatric disturbances, e.g., drug abuse, depression, mania, schizophrenia, and psychotic symptoms. Antisocial alcoholics have also been reported to attempt suicide more frequently. In addition to these more severe symptoms at the time of initial evaluation, antisocial personality disorder influences the natural history of the substance use disorders and alcoholism. This change in course is demonstrated by the following studies. Schuckit (1985) utilized standardized research criteria to divide a group of 541 alcoholics into...

Review Of Efficacy Research

On a broader scale, Mueser et al. (2003) summarized a number of studies that seem to suggest an integrative treatment package for patients with dual disorders requires a long-term program with extended follow-up, which, the authors argue, is superior to a short-term intensive approach to care. Mueser and his colleagues went on to state that much more research is needed to study dually diagnosed patients on variables such as gender, trauma history, polysubstance use versus alcohol use alone, and the presence or absence of antisocial personality disorder.

Onset Make a Difference

In addition, BD comorbid with CD was associated with poorer functioning and an increased risk for psychiatric hospitalization 32 . Subjects with both CD and BD also had a higher familial and personal risk for mood disorders than other CD subjects, who had a higher personal risk for antisocial personality disorder 20 . These studies suggest that subjects who receive diagnoses of both CD and BD may have both disorders. Although more research is needed to clarify this issue, it raises the hope that some cases of delinquency may respond to mood stabilizers.

Risk Factors For Suicide Attempts

Although only about 10 percent of substance abusers who attempt suicide will die in a subsequent attempt, most substance abusers who commit suicide have attempted suicide at least once before. Thus, a review of the risks of suicide attempts may guide the identification of those substance abusers at risk of suicidal death. The risk of attempting suicide by an alcoholic or drug abuser is increased by coexisting depression, Antisocial Personality disorder (ASP), and a history of parental alcoholism. Several studies have found that alcoholism in a parent is associated with suicide attempts among alcoholics. In addition, antisocial personality disorder (ASP) and drug abuse, which commonly occur in genetically predisposed males who develop alcoholism early in life, are associated with suicide attempts. Many clinicians have noted the repetitive high-risk behaviors of intravenous drug addicts, who often are quite aware that they may acquire infection or die by overdose with each injection.

Causes of Personality Disorders

Antisocial Personality Antisocial personality disorder also has several explanatory theories. For example, many antisocial persons were themselves abused and victimized as children (Pollock et al., 1990), leading to social learning and psychoanalytic theories of the cause of this disorder . A high proportion of antisocial persons also abuse multiple illegal drugs or alcohol, leading some researchers to propose that biological changes associated with drug abuse are responsible for antisocial behavior. There are also clear familial trends suggesting that antisocial personality disorder is due, in part, to genetic causes (Lykken, 1995). Others have proposed learning theories of antisocial personality disorder, due mainly to research showing that such persons are deficient i learning through punishment (e.g., Newman, 1987).

The Erratic Cluster Ways of Being Unpredictable Violent or Emotional

Antisocial Personality Disorder Once childhood behavioral problems become an established pattern, the possibility of an antisocial personality disorder becomes more likely (American Psychiatric Association, 1994). As a child with behavioral problems grows up, the problems tend to worsen, as the child develops physical strength, cognitive power , and sexual maturity. Minor problems, such as lying, fighting, and shoplifting, evolve into mor serious ones, such as breaking and entering and vandalism. Severe aggression, such as rape or cruelty to a theft victim, might also follow. Some children with these behavioral problems rapidly develop to a level of dangerous and even sadistic behavior . For example, we sometimes hear in the news about preteen children (usually male) who murder other children in cold blood and without remorse. In one study , children who grew into severe delinquency as teenagers were already identifiable by kinde garten teachers' ratings of impulsiveness and...

Contraindica Tions

Based on our observations, the following exclusions are recommended (1) individuals with self-centered and aggressive disorders display strong resistance to group work, especially when assuming auxiliary roles. They tend to lack spontaneity and are rigid in their portrayals of significant others that is, they either insulate or attempt to dominate others in the group (2) it is better to rule out individuals with narcissistic, obsessive compulsive (severe), and antisocial personality disorders since individual therapy is more suitable for them and (3) individuals with Cluster A personality disorders and impulse control disorders, such as intermittent explosive disorders, have difficulty functioning in a group composed of individuals with different diagnoses.

The Adjustment Domain

Monster Kody

Monster, in Pelican Bay prison in 1993, photographed through Plexiglas. His autobiography, which he wrote while in solitary confinement, provides a real-life account of the mind of a person with antisocial personality disorder. Kody Scott, a.k.a. Monster, in Pelican Bay prison in 1993, photographed through Plexiglas. His autobiography, which he wrote while in solitary confinement, provides a real-life account of the mind of a person with antisocial personality disorder.

Family History of Alcoholism

Hesselbrock, V., Bauer, L., O'Connor, S. and Gillen, R., Reduced P300 amplitude in relation to family history of alcoholism and antisocial personality disorder among young men at risk for alcoholism. Alcohol Alcohol. Suppl. 2 95-100, 1993. Bauer, L. O., O'Connor, S. and Hesselbrock, V. M., Frontal P300 decrements in antisocial personality disorder. Alcohol. Clin. Exp. Res. 18 1300-1305, 1994. O'Connor, S., Bauer, L., Tasman, A. and Hesselbrock, V., Reduced P3 amplitudes are associated with both a family history of alcoholism and antisocial personality disorder. Prog. Neuropsychopharmacol. Biol. Psychiatry 18 1307-1321, 1994.

Prevalence of Personality Disorders

The total prevalence rate for having at least one personality disorder is about 13 percent. That is, at any given time, approximately 13 percent of the population is diagnosable with a personality disorder of one or more types. This brings up the issue of comorbidity, which we also mentioned in our A Closer Look on the Unabomber . A substantial proportion, between 25 and 50 percent, of the people who meet the criteria for a diagnosis on one personality disorder will also meet the criteria for diagnosis on another personality disorder (Oltmanns & Emery , 2004). Many of the personality disorders contain common features. For example, several disorders involve social isolation, including schizotypal, schizoid, avoidant, and, in many cases, obsessive-compulsive disorder. Uninhibited and irresponsible behavior is one of the criteria for a diagnosis of borderline, histrionic, and antisocial personality disorders. As such, dif ferential diagnoses are often challenging in personality...

Genotype Environment Interaction

Recent developments have begun to identify genotype-environment interactions. One study examined the ef fects of abusive parenting on whether children developed antisocial personalities (Caspi et al., 2002). Abused children who had a genotype that produced low levels of the brain neurotransmitter monoamine oxidase A (MAOA) frequently developed conduct disorders, antisocial personalities, and violent dispositions. In contrast, maltreated children who had high levels of MAOA were far less likely to develop aggressive antisocial personalities. This study provides an excellent example of genotype-environment interaction exposure to the same environment (abusive parenting) produces dif ferent effects on personality, depending on the dif ferences in genotype. Interestingly, this suggests that violent parents may create violent children only if the children have a genotype marked by low levels of MAOA. The empirical study of genotype-environment interactions represents one of the most...

Gender Differences in Personality Disorders

The overall prevalence rate for personality disorders is fairly equal in men and women. There are a few specific disorders, howeve , that show a tendency to be more prevalent in men or in women. The one disorder with the most disparate gender distribution is antisocial personality disorder, which occurs in men with a prevalence rate of about 4.5 percent and in women at only about a 0.8 prevalence rate. As such, about one out of every 20 adult men have antisocial personality disorder , whereas it is less than one in a hundred for women (Oltmanns & Emery , 2004).

Relation Of Adhd To Drug Abuse

Serious psychiatric disorder is common among adults with a history of ADHD. ANTISOCIAL PERSONALITY disorder, alcohol and substance abuse, depression, and anxiety are the most common associated disorders. These associated disorders should not be viewed as invariant outcomes of ADHD but rather as disturbances for which ADHD youth are at increased risk. Whether any of these psychiatric outcomes are manifested depends on a variety of factors besides ADHD, including the child's self-esteem, opportunity for normal socialization with peers, success in school, and level of social and family support (Tarter, 1988).

Specific Personality Disorders

The following sections describe specific personality disorders, including the criteri for diagnosing someone as possessing each disorder . We will focus this material on describing the characteristics of each personality disorder and by giving examples. A discussion of the causes of personality disorders is given in A Closer Look on the antisocial personality disorder, Theories of the Psychopathic Mind (pages 634-635), as well as in the last section of the chapter , Causes of Personality Disorders.

Antisocial Behavior

Antisocial behavior in children is associated with social impairment and psychological dysfunction, such as oppositional defiant disorders, conduct disorders, and antisocial personality disorders. These disorders often involve engaging in delinquent behavior, but they are far from synonymous with criminal activity. In preschoolers, antisocial behavior can include temper tantrums, quarreling with peers, and physical aggression (i.e., hitting, kicking, biting). Parents often report difficulties in handling and controlling the child. Comorbidity (visible problems that may not be the child's only problem) is often found because antisocial behavior is associated with hyperactivity, depression, and reading difficulties. Follow-up studies indicate that antisocial behavior in toddlers often decreases with age, as children learn to control their behavior or benefit from the intervention of professionals in the field. Individual differences dictate the tendency of children to engage in...

Mental Illness

No one has identified genes encoding morality. Nevertheless, character traits, such as conscientiousness and agreeableness, are found to be the same in identical twins separated at birth, and growing up in different environments. Some with antisocial personality disorder show signs of morality blindness as they grow up. They bully younger children, torture animals, lie, and are incapable of empathy or remorse, despite normal family surroundings. Some grow up to be criminals who try to talk elderly people out of their savings, rape women, or shoot convenience-store clerks lying on the floor during a robbery.

Etiology

The disorder runs in families and cosegregates with mood disorders, substance use disorders, learning disorders, and antisocial personality disorder. Families with a child diagnosed with ADHD are more likely than those without ADHD offspring to have family members with the above-mentioned disorders.

Lead Toxicity

In identical twins, genetic and environmental factors each account for 50 of the differences in memory (Dominique de Quervain. Nature Neuroscience, 2007). Monozygotic twins raised apart from an early age were examined for signs of antisocial personality disorder. In male twins, genes accounted for 47 of direct physical aggressiveness, 40 for indirect physical aggressiveness, and 28 for verbal aggression. Direct physical aggression is violence toward others indirect aggression is aggression toward objects verbal aggression is aggression expressed in speech.

Passive Aggression

Another means by which patients can defend against conflicted aggression is the mechanism of passive aggression. Patients express their anger indirectly through passively provocative behaviors, allowing them to deny how intensely angry they actually feel. Ms. II's and Ms. C's tardiness at work are examples of passive-aggressive behaviors. This mechanism is intended to reduce patients' imagined risk from more overt displays of aggression. It serves, too, to deny anger or to enact it in ways that patients consider less hurtful. As with other mechanisms used in depression, however, it tends to backfire. Patients do not experience the relief that a more effective expression of grievances would provide, and others are often provoked by their passivity, increasing the patients' awareness of interpersonal difficulties against which they feels helpless.

Assessment

By the time drug abusers seek treatment, they often have a number of problems that need to be solved, only the first of which is stopping drug use. Within any treatment setting, comprehensive assessment is essential to focus treatment on the areas where change is needed. It is first important to understand the types and amounts of drugs that are typically taken in order to assess the severity of the drug-abuse problem. Drug-use information is assessed through the patient s self-report and urinalysis testing. Urinalysis testing provides objective information about whether the individual has or has not used drugs recently and can also be used to verify the truthfulness of self-reports. An understanding of psychological and environmental factors that precede and follow drug use (e.g., when, where, and why drugs are taken where and how the drugs are acquired), known as a functional analysis, is also necessary for the development of strategies to initiate abstinence and prevent relapse....

Case Example

C would act in a passive-aggressive manner. For instance, she would come late to meetings at her job or become withdrawn or sullen in her relationships. Often she was unaware of the hostility behind her behavior or of the potential impact of her sullen stance. In response to this hostile behavior, the individual with whom she was disappointed would often withdraw, and Ms. C would feel slighted. She would see herself as unjustly treated and wish for someone to rescue her and right the injustice that had occurred. Over time, however, she would become increasingly depressed and self-critical as the longed-for redressing of grievances did not occur. Her rage would become increasingly self-directed.

Cluster B

Many patients with ASPD experience depression related to issues of rejection, abandonment, or remorse for past actions (Beck et al., 2004 Millon, 1999 Millon & Davis, 2000). Most times the depression manifests itself in hopelessness and triviality, in that patients with ASPD experience consequences of their actions and believe that there is no hope for change for the future. Depression becomes cyclical, in that the patient with ASPD is not able to see a way out. The perpetual cycle is manifested in the actions of the antisocial personality, followed by depression, which may spur on more antisocial activities. Depression co-occurring with ASPD perpetuates the cycle, which makes it difficult to motivate patients to change.

Alcohol Dependence

The etiology of alcohol dependence is unknown. Adoption studies and monozygotic twin studies demonstrate a partial genetic basis, particularly for men with alcoholism. Male alcoholics are more likely than female alcoholics to have a family history of alcoholism. Compared with control subjects, the relatives of alcoholics are more likely to have higher rates of depression and antisocial personality disorder (ASP). Adoption studies also reveal that alcoholism is multidetermined genetics and environment (family rearing) both play a role.

Natural History

Other psychiatric disorders frequently occur in conjunction with conduct disorder. The most prevalent comorbid (coexisting) psychiatric disorder is attention deficit disorder. By adolescence, the comorbid conditions of psychoactive substance use disorder with depressive disorders often emerge however, virtually any type of psychiatric disorder can be present concurrently with CD (Rutter, 1984). By adulthood, an ANTISOCIAL PERSONALITY disorder is the most common outcome of CD this CD in childhood is associated with an increased risk for antisocial personality disorder in adulthood. Compared to other psychiatric disorders of childhood, CD is the most likely to remain stable. Persistence of conduct problems into adulthood is most likely if the behavior problems are serious, are generalized across multiple environments or situations, have an early age onset, and lead the person into the criminal-justice system (Loeber, 1991).