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An overview of the antisocial personality disorder

Iskander, in Handbook of Clinical Neurology2012 Antisocial personality disorder Antisocial personality disorder ASPD is characterized by a longstanding pattern of disregard for violating the rights of others. Although the diagnosis is not applied until a person is 18 years of age, to warrant the diagnosis one must have evidence of conduct disorder with onset before the age of 15.

Antisocial Personality Disorder Symptoms

The prevalence of ASPD is probably between 1. An important epidemiological feature is that the disorder is far more likely to be diagnosed in men than in women. The male-to-female ratio for ASPD varies from around 4: ASPD is extensively linked to criminal activity and substance abuse, although all people with this diagnosis have not been arrested nor have they necessarily served time in prison.

These patients appear to have substantial neurobiological differences compared with patients who do not meet criteria for psychopathy. They are both more ruthless and more incapable of any type of emotional attachment to others.

The genetics of antisocial personality disorder Research has consistently shown a greater prevalence of ASPD in monozygotic than dizygotic twins, suggesting genetic influences in the disorder, but adverse environmental factors appear to be involved in a complex interaction with the genetic diathesis Cadoret et al. The investigators determined that a functional polymorphism in the gene responsible for the neurotransmitter-metabolizing enzyme monoamine oxidase-A MAO-A was found to moderate the effect an overview of the antisocial personality disorder childhood maltreatment.

Males with the low MAO-A activity genotype who were also maltreated in childhood had elevated antisocial scores. Males with high MAO-A activity did not have elevated antisocial scores, even when they had experienced childhood maltreatment. Eighty-five percent of males with both low MAO-A activity genotype and severe maltreatment developed antisocial behavior.

  • ASPD is extensively linked to criminal activity and substance abuse, although all people with this diagnosis have not been arrested nor have they necessarily served time in prison;
  • Print Overview Antisocial personality disorder, sometimes called sociopathy, is a mental condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others;
  • They show no guilt or remorse for their behavior;
  • A " psychopath " is someone whose hurtful actions toward others tend to reflect calculation, manipulation and cunning; they also tend not to feel emotion and mimic rather than experience empathy for others.

Their findings replicated those of Caspi et al. A Swedish study Nilsson et al.

Antisocial personality disorder

The MAO-A genotype appeared to have no effect on adolescent criminal activity if the genotype was considered alone, without the adverse environmental factors.

Hence the three studies together offer strong support for a specific interaction between a genotype and traumatic events early in life.

  • By contrast, "sociopaths" are somewhat more able to form attachments to others but still disregard social rules; they tend to be more impulsive, haphazard, and easily agitated than people with psychopathy;
  • Recently, an antipsychotic medication called clozapine has shown promising results in improving symptoms among men with antisocial personality disorder.

In one study Young et al. Heritable characteristics of children may influence parental behavior and thus contribute to the gene—environment interaction. Ninety-three families had monozygotic twins, 99 had dizygotic twins, 95 had ordinary siblings, 181 had full siblings in stepfamilies, 110 had half-siblings in stepfamilies, and 130 were characterized by genetically unrelated siblings in stepfamilies.

Data on parenting styles were collected by video recordings and by questionnaire. The investigators suggested that certain heritable characteristics of the children evoke harsh and inconsistent parenting.

By contrast, siblings without those heritable characteristics did not evoke negative parental behavior, and these siblings seemed to experience a protective effect when harsh parental behavior was directed at the other sibling. In a subsequent report from the Caspi group, Kim-Cohen et al. Parental history of ASPD symptoms accounted for approximately one-third of the observed association between maternal depression and children's antisocial behavior. Neurobiological findings In addition to the genetic findings reported above, evidence is accumulating that there may be particular biological substrates for ASPD and psychopathy.

Levels of 5-hydroxyindole acetic acid are significantly lower in families with histories of ASPD than in those without such family histories Constantino et al. In addition, a good deal of research has linked the risk of criminal behavior to lowered autonomic nervous system responsiveness Raine et al.

In fact, heightened autonomic nervous system responsiveness appears to be protective against criminal behavior in prospective follow-along studies of teenagers.

Antisocial personality disorder: a current review.

Neuropsychological deficits may also play a role in the development of ASPD. The brain volume of antisocial subjects may actually be different from that in normal controls. These investigators concluded that this structural deficit may relate to the low autonomic arousal, lack of conscience, and problematic decision-making typical of antisocial and psychopathic individuals. A subgroup of studies has begun to differentiate the neurobiology of psychopathy from that of ASPD. The subjects with psychopathy were characterized by decreased electrodermal responsiveness, the absence of a startle reflex, and less facial expression.

The researchers noted that the psychopathic individuals had a pronounced lack of fear in response to events and a general deficit in processing emotional information. They noted that the emotional hyporesponsiveness was highly specific to the individuals with psychopathy.

Those with psychopathy had a statistically significant increase in callosal white-matter volume, as well as in callosal length. The researchers suggested that atypical neural development processes involving an arrest of early axonal pruning or increased white-matter myelination may be responsible for these corpus callosum abnormalities in psychopathy.

Treatment and prevention There are no controlled studies suggesting that there are effective treatments for patients with ASPD. No medication or psychotherapeutic strategies have been an overview of the antisocial personality disorder to be efficacious. The understanding of early environmental factors that influence the expression of genes has the potential to lead to preventive treatment at an early age. Family therapy or individual psychotherapy with parents may lead to alterations in parental behavior that could decrease the likelihood of subsequent antisocial behavior in the children.