301.7 Antisocial Personality Disorder
Patients with Antisocial Personality Disorder chronically disregard and
violate the rights of other people; they cannot or will not conform to the norms
of society. This said, there are a number of ways in which people can be
antisocial. Some are engaging con artists; others may be graceless thugs. Women
with the disorder are often involved in prostitution. The more traditional
aspects of antisociality in others may be obscured by the heavy use (and,
generally, purveyance) of illicit drugs.
Although these people often seem superficially charming, many are
aggressive and irritable. Their irresponsible behavior affects nearly every life
area. Besides substance use, there may be fighting, lying, and criminal behavior
of every conceivable sort: theft, violence, confidence schemes, and child and
spouse abuse. These people may claim to have guilt feelings, but they do not
appear to feel genuine remorse for their behavior. Although they may complain of
multiple somatic problems and will occasionally make suicide attempts, their
manipulative interactions with others make it difficult to decide whether or not
their complaints are genuine.
DSM-IV criteria for Antisocial Personality Disorder specify that the
patient must have (1) a history of three or more Conduct Disorder symptoms as
juvenile, and (2) at least four antisocial symptoms as an adult. For
convenience-,- the juvenile symptoms are listed in their entirely in the
accompanying criteria.
About 3% of men, but only about 1% of women, have this disorder; it
accounts for about three-quarters of penitentiary prisoners. It is more common
among lower-class populations and runs in families; it probably has both a
genetic and an environmental basis. Male relatives have Antisocial Personality
Disorder and substance-related disorders; female relatives have Somatization
Disorder and substance-related disorders. Attention-Deficit/Hyperactivity
Disorder in childhood is a common precursor.
Although treatment seems to make little difference to antisocial
patients, there is some evidence that the disorder decreases with advancing age.
Many such people mellow out after the age of 30 or more, to become
"only" sub- stance users. Death by suicide or homicide is the lot of
others.
Generally, the diagnosis of Antisocial Personality Disorder will not be
warranted if antisocial behavior occurs only in the context of substance abuse.
Individuals who misuse substances sometimes engage in criminal behavior, but
only when in pursuit of drugs. It is crucial to learn whether
patients with possible Antisocial Personality Disorder have engaged in
illicit acts when not using substances.
Although these patients often have a childhood marked by incorrigibility
delinquency, and school problems such as truancy, fewer than half the children
with such a background eventually develop the full adult syndrome. Therefore,
this diagnosis should never be made before age 18.
Source
DSM-IV Made Easy: The Clinician's Guide to Diagnosis. James Morrison.