Antisocial personality disorder  

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Antisocial personality disorder (abbreviated APD or ASPD), is a psychiatric diagnosis in the DSM-IV-TR recognizable by the disordered individual's disregard for social rules and norms, impulsive behavior, and indifference to the rights and feelings of others.

In common language, sufferers of this condition are referred to as sociopaths or psychopaths.

The World Health Organization's ICD-10 diagnostic manual uses dissocial personality disorder instead. The concept psychopathy (not to be confused with psychosis) generally denotes a related but more severe personality disorder.

Sociopathy is sometimes claimed to be a less formal synonym for this disorder based on terminology from an older edition of the DSM. Various experts have co-opted the terms psychopathy and sociopathy inconsistently to mark differences in meaning they believe are theoretically important although there is a consensus that both terms refer to personality disorders with prominent norm-breaking and socially disruptive behavior.

Diagnostic criteria (DSM-IV-TR)

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV, currently DSM-IV-TR), a widely used manual for diagnosing mental and behavioral disorders, defines antisocial personality disorder as a pervasive pattern of disregard for and violation of the rights of others occurring since age 15vc, as indicated by three (or more) of the following:

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

The manual lists the following additional necessary criteria:

• The individual is at least 18 years of age.
• There is evidence of conduct disorder with onset before age 15 years.
• The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or a manic episode.

History

The first version of the DSM in 1952 listed sociopathic personality disturbance. Individuals to be placed in this category were said to be "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals". There were four subtypes, referred to as 'reactions'; antisocial, dyssocial, sexual and addiction. The antisocial reaction was said to include people who were 'always in trouble' and not learning from it, maintaining 'no loyalties', frequently callous and lacking responsibility, with an ability to 'rationalise' their behaviour. The category was described as more specific and limited than the existing concepts of 'constitutional psychopathic state' or 'psychopathic personality' which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge.

The DSM-II in 1968 rearranged the categories and 'antisocial personality' was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalise. The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a 'group delinquent reaction' of childhood or adolescence or 'social maladjustment without manifest psychiatric disorder' should be ruled out first. The dyssocial personality type was relegated in the DSM-II to 'dyssocial behavior' for individuals 'who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.

The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviours to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as 'Deviant Children Grown Up'. However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.

The DSM-IV maintained the trend for behavioural antisocial symptoms while noting "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. In an 'alternative model' section for personality disorders, for ASPD it lists an optional specifier for "psychopathic features" where there is a lack of anxiety/fear accompanied by a bold and efficacious interpersonal style.

See also

• Fictional portrayals of psychopaths
• Psychopathy and psychopathology
• Antisocial behavior
• Anti-Social Behaviour Order
• Conduct disorder
• Oppositional defiant disorder
• The Dark Core of Personality (2018), a study Ingo Zettler