Developing and Overcoming Antisocial Personality Disorder
Developing and Overcoming Antisocial Personality Disorder
Personality disorders are among the most difficult disorders to be diagnosed and treated in psychology. The highly ingrained behaviors of the disorders, the difficulty in differentiating between normalcy and illness, and the patients lack of understanding and excepting their symptoms as abnormal, are all contributing obstacles of the disorder.
Personality is shaped by experiences during childhood and adolescence as well as genetics. Therefore, children that develop mental disorders are more likely to develop personality disorders as adults. Conduct disorder in children has been highly linked to the development of antisocial personality disorder in adults. The DSM (Diagnostic and Statistical Manual) suggests, but does not require, a history of conduct disorder when making an antisocial personality diagnosis (1). Not only is there a high correlation between people having the disorders, but conduct disorder seems to be a preliminary childhood manifestation of the same underlying malfunctions that are characteristic of the adult disorder, antisocial personality disorder. When looking at the development and causes of antisocial personality disorder it is important to note the symptoms, characteristics, and circumstance of conduct disorder as well.
Conduct disorder, a childhood behavior disorder described by the DSM, is characterized by chronic misbehavior. The children and adolescence often participate in serious physical fighting, alcohol and drug abuse, violation of parental and school rules, vandalizing and setting fires, and many other antisocial behaviors. These children, unless adequately treated, have a 50% rate of becoming involved with drugs and criminal behavior during adolescence. They also have a 75%-85% rate of being chronically unemployed as adults. Many of these children, about 40%, grow up to have antisocial personality disorder (2).
Antisocial personality disorder is a Axis II DSM recognized disorder under the personality disorder category that has earned separation from the acute psychological disorders of Axis I. This is the most common disorder among the personality disorders: between 2.3%-3.3% of the population is diagnosed some time in their lives, it crosses all ethnicity's, and is five times more commonly diagnosed in males than in females. The main symptoms of this disorder are, a tendency to develop maladaptive behaviors that diverge or violate from societal norms, and they have a severe difficulty developing and keeping positive relationships. The characterization of antisocial personality disorder is very similar to that of conduct disorder, but the symptoms are manifested in different ways. These people tend to be cold, uncaring, and can be maliciously cruel at times. They feel very little guilt for their actions, believing they are always faultless. They will often pretend to care and be pleasant until they succeed in getting what they want. They often have extreme personality traits of arrogance, impatient, low tolerance of frustration, and poor impulse control. These characteristics are transient and chronic, often effecting the individual, their family, and the community negatively (3).
The poor impulse control, lack of patience, and uncaring attitude, cause the people with the disorder to have trouble staying in relationships such as marriage. They have difficulty staying employed and doing anything that requires a routine. This extreme personality characteristics is related to criminal activity, violent death due to extreme daring behavior, and suicide attempts (3).
When analyzing this disorder one is likely to wonder, what causes the symptoms of the disorder to develop and how, if at all, the disorder can be overcome? What factors are responsible for 2.3%-3.3% of the population developing these abnormal characteristics and personality extremities to the point of being "disordered?" After much thought and consideration of argumentative suggestions for different causes of the disorder, I have come to the conclusion that it is due to a variation of three main influential factors.
The first influential factor to be discussed that is important in the development of personality disorders, such as conduct disorder and antisocial disorder, is genetic and biological contributions and characteristics that make certain people more likely to develop this disorder than others. There have been many studies done that show ample support for genetic influence in the development of antipersonality disorder. These studies show that criminals with antisocial personality have criminal records more like their biological fathers than their adopted fathers, which supports that the disorder runs in families. Also twins that are identical have a 50% concordance rate of the development of the disorder, as opposed to only a 20% concordance with twins that are not identical (4).
Hormones and neurotransmitters also play a vital role in supporting the biological connection with the disorder. The disordered displaying symptoms of impulsivity and aggression have naturally lower levels of adrenaline in their blood when calm and excited. Adrenaline is a hormone released in higher amounts when the sympathetic system responds to excitable stimuli, such as anxiety, pressure, danger, and joy. Possibly, the variance of this hormone attributes to some symptoms showed by the disordered. The lack of adrenaline, stimulation, might cause the disordered to becomes easily bored and attempt to seek thrills by more dangerous and extreme measures in order to obtain arousal and excitement. This lower hormone concentration also supports reasoning for antisocial and dangerous behavior, because one who is not as stimulated in dangerous situations with fear and anxiety, would feel less aversion to initiating and participating in these situations (5).
Neurotransmitters such as serotonin have been targeted in connection with the disorder. Higher levels of serotonin in the blood have been found in correlation with antisocial personality types. Newborns with a family history of antisocial personality disorder have lower levels of serotonin in the brain at birth than normal infants (AJP CSF). Other findings have also shown that there is decreased serotonin functioning in those with antisocial disorder and those who have high susceptibility to the disorder, but further studies are being done to try and understand the dysfunction (6).
About 60% of children with ADHD (Attention Deficit Hyperactivity Disorder) also develop conduct disorder, and then many of these people go on to develop antisocial personality disorder (1). There are neurological differences in the brains of those with ADHD, deficits in executive functioning. The high comorbidity suggests that there are also differences in the brains of those who develop the personality disorders. Both those diagnosed with ADHD and the personality disorders have a primary deficit in the ability to control impulsiveness and behaviors, which also suggests that the neurological problem may be the same for all of the disorders.
Although, personality disorders are the most difficult of the psychological disorders to treat, there are certain methods used and others in progress by the scientific world today. To treat the biological symptoms, such as low levels of serotonin and the high comorbidity found with ADHD, medications are often prescribed. The most effective drug so far for the disorder is lithium, which decreases the impulsively and hyperactivity of the disordered. Stimulants such as Adderall can be given to treat similar symptoms, and they also increase concentration levels. These drugs have only been approved for treating those with ADHD diagnosis. Antidepressive drugs, such as MAOIs and SSRIs that influence serotonin levels, are starting to be used in the treatment of the disorder. Their efficacy has not been proven to be sufficiently so far by scientific studies (3).
A second influential factor in the development of conduct disorder and antisocial disorder is environmental factors. Psychosocial contributions to the development of these disorders have been supported in numerous studies. Children are heavily influenced from birth and are products of their environment. They learn social skills and coping mechanisms from parental example. Children who have uninvolved parents and that already have genetic predisposition's for the disorders, are more likely to develop antisocial characteristics. Children who have parents that are alcoholic or drug abusers are more likely to be substance abusers themselves. The families with substance abuse have also been found to have poor functioning compared to normal families, and therefore, more children who become disordered. The highest rate of disordered children comes from families that have an antisocial parent that is also a substance abuser (7).
Other environmental contributors to the development of the disorders are teacher and peer groups of the child (3). ADHD is also a good example of supporting environmental influence as well as biological influence. Children with ADHD often have trouble in school because of lack of impulse control and attention span. They are loud and get into trouble, which leads to punishment by the teachers and unpopularity among the other students. This environmental factor furthers the development of even more extreme antisocial behavior, fighting and skipping school, and eventually many of these children are diagnosed with conduct disorder.
Treatment of environmental factors involves attempting to reverse maladaptive cognitive thought developed due to experience. These maladaptive thought processes are very hard to tackle for the antisocial disorder, because a common symptom is the inability of those with the disorder to see their behavior as abnormal. Regardless, it has been found more helpful than not in improving some people with antisocial personality disorder. Treating children through these processes has been proven essential to overcoming the disorder and decreasing the prevalence of antisocial disorder developing later in life. Family counseling and intervention is very helpful as well for children. The maladaptive psychosocial environment can be changed so that the child experiences and learns positive social skills (8).
The third and final contributing factor to whether or not a person develops conduct and antisocial personality disorder, and whether they are able to overcome the disorders, is best described as the unique "I-function" of each individual (9). My comprehension of the I-function is fairly new and incomplete. I can best describe it as the manifestation of consciousness in each individual that is continuously and uniquely effected by the unconscious and unique connectivity's in the brain. The I-function is how one consciously makes decisions and solves problems, but it also is an outlet for all the unconscious products of the brain. I learned in, Dr. Grobstein's, neurobiology class at Bryn Mawr College about the existence of the I-function and about the uniqueness of every individual brain. If the differences in our brains allow for unique ideas and outlooks that make our experiences and ways of thinking unique as well, then I believe some brains can and do develop determination and a will to overcome the antisocial personality disorder, consciously implementing the decisions through the I-function.
Now one may ask how I plan to support the integrity of this rather alternative influential factor for these disorders. Although, I found many theories and studies supporting the importance of psychosocial and biological contributing factors in the development of conduct and antisocial disorder, I found little that answered my initial questions that made me take interest in researching this topic in the first place. These questions included, who overcomes these disorders when the odds are against them, and how do they overcome these other predisposition to antisocial disorders. The foundations of the disorders create a dim outlook because a primary characteristic of the disorder is the person's inability to realize or admit the abnormality of their behaviors. Therefore, it is often difficult to give the person adequate treatment, drugs or psychotherapy, for their symptoms.
I have decided to primarily support the third factor with the very case that struck my interest in the topic. There is a person that I have known all my life who developed conduct disorder by the age eight, worsening in severity of the disorder as he grew into adolescence. He was constantly in trouble and demonstrated nearly every characteristic of conduct disorder including, severe physical fighting, theft and vandalizing property, skipping school, lying, and violation of rules and law for thrills. He eventually did some drugs and became an alcoholic in his adolescence. He was nearly killed several times due to lack of fear and extreme thrill seeking. For instance, he sped at the highest possible speed down a road in the rain at night on a motorcycle. Losing control he hit a telephone pole, which caused him to break many bones in his body, almost killing himself. After several less severe offenses, he was playing with a gun and shot a girl in the head accidentally. The girl lived, stated it was an accident, so he went to jail for a minimal period still believing he just had "bad luck" as opposed to a disorder.
This person has a environmental history of being diagnosed with ADHD, and later antisocial disorder. He was also assumed to have had conduct disorder, although he was not diagnosed during childhood. He comes from a divorced family, with a paternal alcoholic and ADHD history, and had extremely low parental supervision. He was never physically abused in any way. His brain has not been tested for specific abnormalities, but he has many similarities to those that have abnormalities. He refused medication for ADHD, because he did not want to take it. He had severe inability to control impulse and hyperactivity, could not hold a job, and showed extreme low arousal during very disturbing situations.
During the time spent in jail, he somehow made a conscious decision to
except the dysfunction of his actions. He then began taking a
medication known as Effexor that decreases the re-uptake of serotonin,
and is usually prescribed to depressed patients. Even though he was not
diagnosed with depression, he claims the medication has been an
incredible help to over coming certain symptoms of the disorder. It has
decreased his impulsivity, severe temper, and aggression incredibly. He
has reformed his way of thinking, treating others, and living life. He
is now socially normal can hold a job, and has productive
From the understanding of antisocial personality disorder so far it seems to be primarily influenced by genetic and environmental causes. The various extremities of the influences highly determine if the third influence, which we will call the I-function, can save the person from the disorder. The genetic, is the most influential and permanent factor, while environment factors run a close second in importance during the development of the disorders. Finally, the I-function demonstrating every human's innate differences is influential if the other two factors are not extreme beyond repair.
If the person is so genetically prone to developing the disorders, with no biological capacity to understand or feel guilt, anxiety, or compassion, then there is little hope that drugs, or any amount of therapy will make the person normal or even safe to live among society. There is also little hope of the brain willing itself to heal if it cannot understand the problem. If there is genetic hope, but the person has consistent negative psychosocial experience due to extremely antisocial environments, then the person will probably not have much hope of overcoming the disorder, but probably more than the former example. I believe the unique I-function, and other differences in the brain that make one different, can possibly bring about determination, a conscious effort to overcome the disorder and predisposition's of genetics and environment influence. However, in cases such as conduct and antisocial personality disorder, the extremities of the other two contributing factors are key to the influence of the I-function.
In order to decrease the chance of a child with conduct disorder or a predisposition for personality disorders from developing antisocial disorder later in life, it is imperative that interventions be made to improve the quality of family functioning and reduce dysfunctional behavior. In order for the child to overcome genetic predisposition's and to learn to behave socially and successfully, the child must be set in a nurturing psychosocial environment and be given any medications that increase that child's ability to develop and function normally. Humans do have a degree of free choice because we are all genetically unique, but chances of escaping the disorders will increase with increased psychosocial and medical help.
The person I referred to earlier had neither early diagnosis of conduct disorder and refused medication for the treatment ADHD. He grew up in a environment that increased the chances of developing antisocial disorder and then did develop the disorder. He showed many symptoms of biological abnormalities. However, somehow he willed himself to change his outlook and began taking the initiative to heal himself. Through these attempts he has been successful at obtaining normalcy. I have learned that some brains have the capacity to heal themselves, but I still do not know what determines which brains make a conscious and unconscious effort to help themselves. This suggests that personal choice has a significant influence on one's ability to correct personality disorders. Along with psychosocial and medical help, these chances can only increase.
The further implications of the brain's ability to overcome genetic and
environmental predispositions to disorders are much more important than
the scope of this paper. This ability reinforces the idea that even
though brain is behavior, brain is also uniquely powerful and creative.
The man with antisocial personality disorder had a brain with the
ability to overcome all it was accustomed to, in order to help itself
adapt and survive.
1) "ADHD" , ADHD comorbidity with conduct and antisocial personality disorder
2) "Antecedents of Personality Disorders in Young Adults.", symptoms of personality disorders
3) "Treatment.", Different treatments for personality disorders
4) " Reworking Antisocial Personality Disorder.", biological characteristics of antisocial personality disorder
5) "The Neurobiology of Stress and Emotions.", hormone contributors to antisocial personality
6) "CSF 5-HIAA and Family History of Antisocial Personality Disorder in Newborns", article concerning the connection between serotonin and antisocial disorders
7) "Family Functioning and Peer Affiliation in Children of Fathers With Antisocial Personality Disorder and Substance Dependence: Associations With Problem Behaviors.", environmental factors related to the development of antipersonality disorders
8) " Aggression and Transference in Severe Personality Disorders.", characteristics of antisocial personality disorder
9) Serendip Website, I-function
Comments made prior to 2007
I liked reading about the thought that people with antisocail disorder can be helped in some way. My child has this problem and I was told that it was lost cause in someways to help him at all to be able to funtion in the world as he grew older. Thanks for the reading ... Jenny, 8 April 2006
I found your form to be very helpful. I see many of the symptoms in myself and have been diagnosed with APD in the past. I have not been on medication, but I am very withdrawn, I cant understand other peoples viewpoints, its hard for me to express how I feel, I dont care what other people think about me, and I'm so tired of being scared all the time. I do so many things so I wont have to be scared, I lift weights, I box, I dont even talk to anybody. I'm tired of this, and I want to be better. Can somebody please help me? ... Kevin Wright, 12 May 2006
I agree with genetic predisposition. I also believe that serotonin and thyroid, study in Sweden, play a role in antisocial. I have loved-ones, family, who suffer with this. I am about to research more indepth. Thyroid precipitates metabolism. The norepinephrine (adrenaline) is low, and the serotonin is low as well? That sounds very feasible, although adrenaline and serotonin could be imbalanced without the adrenaline being too high. There are so many ways to go with this. Please study study study. This is pervasive in society. Needs to be eradicated or at least some of symptoms allevaited to end suffering of those who cannot help the way their hormones/nerrotransmission goes. sry so sloppy ... Reader on the web, 17 February 2007