Antisocial ( Dissocial ) personality disorder (ASPD) is a personality disorder characterized by impulsivity, aggressiveness, antisocial behavior, and a violation of the ability to form attachments. Patients with this disorder are convinced of the legitimacy of their own needs, grossly disregard the feelings of others, do not feel guilt and shame, are well-oriented in the social environment and easily manipulate other people. The disorder is most pronounced in adolescence and persists throughout life. The diagnosis is established on the basis of anamnesis and conversation with the patient. Treatment – psychotherapy, pharmacotherapy.
Dissocial personality disorder (sociopathy, antisocial personality disorder, antisocial psychopathy according to Gannushkin, antisocial personality according to McWilliams) is a personality disorder that manifests itself in persistent antisocial behavior, lack of guilt and shame, impulsivity, aggressiveness and a violation of the ability to maintain close relationships. It is detected in 1% of women and 3% of men. It most often affects urban residents, children from large families and representatives of low-income segments of the population. Researchers say that patients with dissocial personality disorder make up up to 75% of the prison population. At the same time, not all sociopaths become criminals – some patients commit actions that are condemned by society, but not formally punishable. Treatment of this pathology is carried out by specialists in the field of psychiatry, clinical psychology and psychotherapy.
Causes of dissocial personality disorder
There are two opposing theories of the development of this disorder. Proponents of the biogenetic predisposition theory point out that in close male relatives, sociopathy is five times more common than the population average. In addition, in the families of patients with dissocial personality disorder, hysterical disorders are often detected. The researchers believe that this may indicate the presence of a hereditary disease or mutation that provokes the development of these two types of disorders.
Followers of psychological theory consider dissocial personality disorder as a result of the influence of the environment. They believe that this psychopathy develops with improper upbringing (neglect or excessive guardianship), lack of love and attention from significant adults. As factors contributing to the development of dissocial personality disorder, proponents of this theory consider the high criminal activity of family members, the presence of relatives suffering from alcoholism and drug addiction, poverty and unfavorable social conditions caused by a sudden move due to war or a difficult economic situation.
Most mental health professionals take an intermediate position, believing that dissocial personality disorder develops as a result of the interaction of internal (hereditary) and external (environmental) factors. Concomitant mental disorders (oligophrenia, schizophrenia), past illnesses and brain injuries have a certain significance. Patients often show mild neurological disorders and EEG abnormalities, which, according to experts, may indicate organic brain damage in childhood.
Symptoms of dissocial personality disorder
Manifestations of the disorder in boys usually become visible already at an early school age. In girls, symptoms appear a little later – during the prepubertal period. The characteristic features of sociopathy are impulsivity, promiscuity, stubbornness, cruelty, deceit, and selfishness. Children suffering from dissocial personality disorder often skip school, damage public property, engage in fights, bully weaker peers and younger children, torment animals, run away from home, and wander.
A distinctive feature of patients with dissocial personality disorder is early opposition to their parents. In social relations, depending on the individual characteristics of the patient, either open hostility or implicit, but persistent disregard for the interests of other people is possible. Children and adolescents with dissocial personality disorder do not feel remorse when caught committing an unseemly act. They immediately find excuses for their own behavior, shifting the blame and responsibility to others. Many patients start smoking, drinking alcohol and drugs early. There is a high level of sexual activity combined with promiscuity in choosing partners.
In adulthood, patients usually look adequate and socially adapted. There are no problems in communication in patients with dissocial personality disorder – due to their charm, peculiar charm and ability to win over others, they often make a pleasant impression with superficial contacts. Lack of deep attachments, selfishness, and inability to empathize provoke manipulative behavior. People with dissocial personality disorder can easily lie, often use other people to their advantage, threaten suicide, talk about a “hard fate” or imitate the symptoms of non-existent somatic diseases to achieve certain goals.
The main goal of patients suffering from dissocial personality disorder is to get pleasure, the opportunity to” snatch ” as much pleasure from life as possible, regardless of objective circumstances. Patients are confident in the legitimacy of their desires and their right to meet any needs. They never reproach themselves, they never feel guilty or ashamed. The threat of punishment, condemnation or rejection by society does not cause them anxiety and depression. If their misdeeds become known to others, patients with dissocial personality disorder easily find an explanation and justification for any of their actions. Patients are almost unable to learn from their own experience. They either do not work, or are late, play truant and shift their responsibilities to other employees and perceive any criticism as unfair.
Eric Bern identifies two types of patients with dissocial personality disorder: passive and active. Passive sociopaths do not have internal restrictions in the form of conscience, rules of decency or humanity, but are guided by norms established by some external authority (religion, current legislation). This behavior protects them from open conflicts with society and allows them to at least partially (or formally) meet the requirements of society.
Active patients with dissocial personality disorder are deprived of both internal and external restrictions. If necessary, they can at some time demonstrate to others their responsibility, decency and willingness to comply with the rules of society, but at the slightest opportunity they refuse any restrictions and return to their previous behavior. Active sociopaths are more likely to demonstrate openly criminal deviant behavior, passive – hidden, formally unpunished (lying, manipulation, neglect of duties).
Dissocial personality disorder persists throughout life. Some patients create isolated social groups, becoming leaders of sects or criminal groups. After 40 years, the criminal activity of patients usually decreases. With age, many patients develop concomitant affective and somatic disorders. Drug addiction and alcoholism often develop. Dependence on psychoactive substances in combination with antisocial behavior becomes the cause of aggravating social maladjustment.
Diagnosis of dissocial personality disorder
The diagnosis is made on the basis of a life history and a conversation with the patient. To make a diagnosis of “dissocial personality disorder”, you must have at least three criteria from the following list: inability to empathize and callousness towards others; irresponsibility, disregard for responsibility and social norms; inability to form stable attachments in the absence of problems in communication; low resistance to frustration and aggressive behavior; irritability; inability to take into account previous negative experiences; the tendency to shift the blame to other people.
Dissocial personality disorder is differentiated from chronic mania, heboid schizophrenia, and secondary personality changes that occur against the background of drug abuse, alcohol, and other psychoactive substances. In order to better assess the degree of neglect of duties and disregard for established rules, the diagnosis takes into account the social conditions and cultural norms characteristic of the patient’s region of residence.
Treatment of dissocial personality disorder
Treating sociopathy is not an easy task. Patients suffering from this disorder very rarely seek professional help, since they practically do not experience negative emotions. Even if a person with a dissocial personality disorder feels “out of place” with other people, feels that they are missing something important, and comes to an appointment with a psychologist or psychotherapist, the chances of improvement are low, since sociopaths are almost unable to establish stable empathic relationships necessary for productive psychotherapeutic work.
As a rule, the initiators of therapy for dissocial personality disorder are employees of educational institutions, employers or representatives of law enforcement agencies. The effectiveness of treatment in such cases is even lower than in self-treatment, since the lack of motivation and the inability to establish an alliance with the therapist is added to the pronounced internal resistance. The exception is sometimes self-help groups, in which a patient suffering from a dissocial personality disorder can open up without fear of judgment, and receive the support of well-meaning participants. For effective therapy, two conditions are necessary: the presence of an experienced leader who is not susceptible to manipulation of the patient, and the absence or minimum number of guided participants who can fall under the influence of the patient.
In case of dissocial personality disorder with pronounced impulsivity, as well as in case of concomitant somatized, anxiety and depressive disorders, drug therapy is used. Due to the high probability of developing addictions and a possible decrease in motivation for psychotherapeutic work, drugs are prescribed in small doses in short courses. With increased aggressiveness, lithium is used. The prognosis for a cure is unfavorable. In most cases, dissocial personality disorder is almost impossible to correct.