The abnormal antisocial personality

2021-07-17 04:35 PM

In the absence of specific diagnostic criteria for the DSM, people view antisociality and psychopathy as two different diseases

The terms antisocial personality and psychopathic personality are often used interchangeably. In fact, the DSM-IV-TR category for antisocial personality combined the diagnosis of this disorder with a psychopathic personality, which is different from the DSM III. Critics of the DSM-IV-TR argue that this attempt has failed and that the two diseases cannot be equated: they have different properties and have long-term consequences. According to Hare et al. (2000), the DSM-IV-TR still describes an antisocial individual as someone who commits delinquent acts. In contrast, the psychopathic personality is implicitly emotional (both negative and positive); an individual's behavior is derived from the need to seek thrills as well as any other benefit. Antisocial behavior tends to decrease with increasing age; disease personality is not.

This is what the therapist gets from working with a person with borderline personality disorder, using the interesting approach of “non-therapy therapy”.

Sarah is 31 years old, has just returned to live with her parents for a while. The psychiatrist who had treated her before did not diagnose her with a borderline personality disorder to avoid the potential harm of this disorder in the future. However, the hospital transfer note still states: "emotional instability", "deliberate manipulation", "potential tendencies to violence and aggression". She can be “self-harming”, has never volunteered for therapy, her case involves many different social disciplines such as psychiatry, clinical psychology, social work, housing, and police.

What do you expect? oh, the Sarah I met in my first session was so nervous that she could barely speak. She didn't look me in the eye once. During the whole session, we talked almost exclusively about daily trifles. At the end of the session, I asked her if she wanted to see us again next week.

“What do you think?” she asked.

“Oh, that depends on you.”

“Do you think that helps?”

"I don't really have an idea - it may or may not be."

That's how the deal between us began - the crux of our "non-therapeutic" approach. Sometimes we meet in the counseling room, sometimes we both go shopping, sometimes we go to an internet cafe - all of Sarah's choosing. We drank coffee, talked about whatever Sarah wanted, and during that time, I tried not to advise her to be responsible for her health and conduct anyway. One of the things Sarah decided to do in our therapy sessions was understood email and the internet. But she is a perfectionist, and when things go awry, she is engulfed by feelings of failure, anxiety, and blame (“D… fuck this damn computer”). At that time, the effective method is to control emotions,

“Oh, maybe it was just a little glitch - I still remember how I started using the internet… [story of incompetence]” …slowly but surely, these feelings of failure will get smaller and she starts to feel confident.

I understood that, to Sarah, the world seemed a plain black and white place - either good or bad, or a feat or a disaster. This manifests in her messy relationships - a world of angels and demons. Sarah will be completely drawn to her new friends, if they are always the embodiment of erudition and chivalry… this is maintained until the friend begins to withdraw from the disproportionate, burdensome position. and this "god-like" fatigue. And, facing her biggest fear - rejection, Sarah takes her revenge, sending several old friends to the hospital.

The goal of “no therapy” is this – to avoid letting the knowledgeable and shrewd look that captivated Sarah, with her already low self-esteem, make her see herself as “another person” - means incompetent and ignorant. Even as an “expert” who needs to define the job holistically, I invited Sarah to “work together to find a solution”. The goal of this approach is simply to try to have a stable relationship, free from the distractions of different roles - in other words, to focus on the process, not the content. Once this is achieved, perhaps - just maybe - we can consider the idea of ​​"therapy". The stability, of course, is a success in itself. Thus, at least in the early stages of therapy,

One of the most valuable methods I use is the different types of "I don't know." This does not mean avoiding petty annoyances, but it shows that you are neutral, ready to adapt to uncertainties and different shades of black and white confusion:

“So what do you think about the death penalty?”

"It's a complicated issue - I really don't know." “But what about child killers?”

“Oh, some people say they deserve the death penalty, others say don't make excuses - This is a very delicate subject. What do you think?”

One problem that I found difficult at first was how to provide the necessary information without falling into the role of a “lecturer”. I solved it by giving a series of options:

“So if I want to be a park keeper, where should I look?”

“Oh… well, I think a lot of people can look at job centers, some people sign up for a course at Green College, for example, some people buy lawnmowers and stickers. notice at the local post office. There are also people who act completely differently… I don't know what the best option is either.”

“Hmm, maybe I'll register at the tree club. What do you think?” “Who knows, maybe they have something useful.”

And as it turned out, Sarah was strong enough to make better decisions for her own life. And how did I arouse her newfound ability? Actually, from the outside, I didn't do anything. Why? Because Sarah can lose herself to please others, so when the only person to be satisfied in this situation is herself:

“I went to the tree association the other day to look for courses - what do you think about

“It's so hard, I don't know - I've never been there. Anything cool?" “Yes - Maybe I'll try and sign up for a key…”

Read the last conversation again - what makes me say? “Is that good”?

“A good idea, Sarah”? "Do that please"? But then who would be satisfied if she signed up? Her - or is it me? At first, working like this may seem difficult and unusual because in part it seems to go against the qualities of the profession: it is caring, caring, empathetic, and supportive. However, if these qualities are not used skillfully, it can be the most harmful method for people with borderline tendencies.

Sarah's life experiences have taught her that she is bad, sick, irresponsible, and unloved - that whatever she voluntarily strives to achieve is wrong, that she is to blame and must. punished, that gaining control and accountability is too risky. Personally, at first, I also felt that Sarah's beliefs and thoughts were meaningless. Therefore, in the beginning, in order to avoid being sucked into it and avoid being used as a filler, I had to maintain constant vigilance. Sarah is extremely adept at getting others to do so - thanks to everything she's learned in her childhood for her own safety and survival.

After about 9 months of “no therapy” therapy, Sarah informed me that she no longer needed my help, as she had started work at the Botanical Garden and could hardly attend therapy sessions. . Plus, she was starting to feel that our work was going nowhere. You're right - you've just reached the finish line. She has made the right decisions and is responsible for her life. And, the important thing is that I didn't ask or ask for it (or in fact I didn't ask for it at all) of her - I simply tried not to make it up to her.

Also, she was able to end our relationship without feeling guilty or accused, and as far as I know, this is the first time she's felt this way. She came with the intention of “wrapping in cotton and wool and being safe,” but departed gratefully “you gave me control” in an atmosphere of sympathy (rather than hostility). naughty - as in her childhood). We have no such thing as therapy, but everything is fine.

The DSM-IV-TR defines antisocial personality as a pattern of behaviors that are disrespectful and destructive to the interests of others, occurring at the age of 15 or older. Its main manifestations include:

Repeated acts of the display may result in the individual being arrested.

Repeatedly lying, using nicknames, defrauding others for personal gain or satisfaction.

Impulsive or unable to have a long-term plan.

Disregard, disregard for the safety of yourself and others.

Constantly irresponsible: always failing to fulfill long-term tasks or committed financial obligations.

Lack of tolerance towards others.

Individuals with antisocial personalities are described as immature in terms of moral character and cognitive functions (Davidson 2000), they tend to engage in concrete rather than abstract thought activities. As a result, they lack problem-solving skills and tend to act rashly with little consideration for the long-term consequences. They often believe that they can do exactly what they want, that people are there for them to take advantage of. The rate of antisocial personality reached 3.7% (Widiger and Corbitt 1995). Antisocial personality seems to decrease with increasing age: almost no people over 45 years of age are diagnosed with antisocial personality (Swanson et al. 1994).

In the absence of specific DSM diagnostic criteria, those who view antisocial and psychopathic personality as two different diseases use Hare's (1991) diagnostic criteria to define psychopathic personality. Hare's diagnostic criteria identify two groups of behaviors that characterize people with psychopathy: emotional apathy and antisocial lifestyles. Emotional apathy is related to a lack of ability to process emotional information. Therefore, the individual does not understand and disregard the feelings of others. That's how Hare defines the personality trait. Using this definition of psychopathology, Hare has found that of those who commit crimes, up to 80% have antisocial personalities, only 15-25% have psychopaths (Hare et al. . 2000). This finding further strengthens his view of the clinical differences between the two diseases.

Causes of antisocial personality and pathological personality

The considerable confusion between antisocial personality and psychopathic personality also means that in the literature, the two concepts are often confused with each other. Several studies on antisocial personality have used Hare and other authors' notions of psychopathic personality. A few other studies have specifically focused on psychopathology as defined by Hare. Psychopathic personality is related to antisocial lifestyle, perhaps not surprising if the factors that contribute to antisocial behavior are also related to psychopathic personality. To distinguish psychopathic from antisocial, neuropathic factors are taken into account - compared with antisocial personality, central to psychopathy is apathy and emotionally shallow. Accordingly, this part,

Genetic factors

Gene studies have shown that it is difficult to distinguish between the genes responsible for antisocial behavior, crime or alcoholism, all of which appear to be closely related. However, at least two studies of adopted children have shown that genetic factors influence antisocial risk. Crowe (1974) reported that the children of female prisoners with antisocial personality disorder, despite being placed in foster care, were also at higher risk of antisocial behavior compared to the control group without having the above family history. Similarly, Cadoret (1982) studied adolescents who were blood relatives of those who had experienced antisocial behavior. As a result, the level of antisocial behavior was higher in this group than in the control group. The risk of antisocial behavior is higher if the family adopting these children provides a harmful environment, This confirms the interaction between social factors and genetic factors in the development of antisocial behaviors. Children with antisocial parents, whose behavior itself provokes reactions from those who adopt them, exacerbates this pattern of behavior in the child (O'Connor et al. . 1998).


Impulse severity, excitability, aggression, and sensation seeking are all associated with low serotonin levels. Sometimes low levels of sympathetic activity during stress can lead to antisocial behavior (Raine et al. 1998), perhaps because they lead individuals to no longer fear and just want to go. Find the thrills of adventure as a means of rocking. High levels of testosterone can lead to criminal behavior (see Dolan 1994).

Some evidence has also been found for a neurological etiology of the disorder. Raine et al. (2000) studied a group of adolescents who had experienced antisocial behavior and found that compared with a control group, their forebrain gray matter volume was 11% less. This finding complements the results of psychometric studies such as that of Chretien and Persinger (2000). They gave antisocial people a psychological test to assess skills in the prefrontal region, including thinking skills, conceptual flexibility, and spatial coherence. As a result, people with antisocial personality disorder performed worse than the general population.

Cultural and social factors

Social factors clearly influence the risk of antisocial behavior and diagnosis of antisocial personality. Henry et al. (2001) give the following research results: if at the age of 12, an individual lacks emotional closeness to family and experiences poor upbringing, then at the age of 17, they may have violent and illegal behavior. At this time, the child's play with peers who engage in violent behavior may lead to delinquency with a tendency to violence or non-violence later in life. Perhaps the most enduring longitudinal study is the Cambridge study of delinquency development (Farrington 2000). This study shows that factors that exist in childhood can predict antisocial personality and crime in adulthood (before age 40). The main reason is similar to what Henry et al. (2001) once reported: a criminal parent, a large family, low education and illiterate, a young mother, and a broken family. Family factors also contribute to the emotional deficits associated with psychopathy. It is thought that once individuals experience prolonged negative emotional events throughout childhood, they will "suppress" their emotions, both in response to the negative events. , both to answer the behavior affecting others

Borduin (1999) summarizes the non-family causes of antisocial behavior as follows:

Peer relationship: likes to play with spoiled peers, has poor social skills, doesn't play with socially supported peers.

School factors: poor academic performance, dropout, laziness to study.

Neighbors and community: subculture has elements of crime, less participation in organized activities in residential areas, little social support, and frequent relocation.

Eddy and Chamberlain (2000) conducted experiments to determine the role of family and peer factors in antisocial behavior. In this experiment, they followed a group of criminals for more than two years. As a result, during this time period, poor family management skills and peer bonding caused 32% of the changes in antisocial behavior.

In many countries, the prevalence of antisocial behavior is increasing with time. After 15 years, this rate nearly doubled in the US, with 3.6% of the population. This percentage is also different in different countries, from about 0.14% in Taiwan to more than 3% in countries like New Zealand. These divergent results lead Paris (1996) to conclude that Asian culture is protected from antisocial behavior because of its family structure, a typical cohesive structure with clearly acceptable limits to the individual's behavior - These are characteristics that do not favor the development of antisocial behavior.

Cognitive pattern

Children living in high-risk antisocial families do not have clear boundaries for their behavior. As a result, if other children are successful, they often fail to exercise behavioral control. This environment also gives rise to beliefs about the individual and the world that promote antisocial behavior. Dodge and Frame (1982) suggest that in all children everyday reactions develop to guide their behavior: antisocial children develop a behavior that is violent, hostile, and hardly socially friendly. Lopez and Emmer (2002) have found that juvenile offenders believe that aggression is an effective and appropriate response to threats. Similarly, Vernberg et al. (1999) found that aggression in adolescents is associated with three basic beliefs:

Fighting is justified and warranted.

Fighting will increase strength and be appreciated.

People do not interfere in fights.

Finally, Liau et al. (1998) found that particular beliefs lead to particular behaviors. Beliefs that expose overt behavior (“One has to get a little irritated sometimes!”) cause overt antisocial behavior rather than covert behavior. In contrast, beliefs associated with stealthy behaviors (“If someone is so careless that they lose their wallet, they deserve to be stolen”) leads to stealthy antisocial behavior. never made public.

Similar manifestations form the basis of psychopathic behavior as they mature. Beck et al. (1990) argue that one of the key beliefs is "People are born to be taken advantage of", which builds an individual's action strategy - to be an attacker. Other key beliefs include:

Force and lies are the best way to get things done.

We live in the forest and the strong are the survivors.

If I don't get a hold of people, they'll attack me first.

I have been treated unfairly and I have the right to get justice in any way that I can.

If people don't take care of themselves, that's their problem.

Neural mechanism

The collected evidence has focused on confirming that in psychopathic personalities, deficits in emotional processing are associated with damage to the limbic system, which controls the processing of emotional information. Laakso et al. (2001) used brain imaging techniques to collect accurate data on the brain anatomy of 18 criminals with psychopathic personalities and frequent violent behavior. They found a very strong negative association between the size of the hippocampus and the scores these criminals scored on Hare's "Sick Personality Behaviors Index". This suggests that damage to this area is related to the acquisition of conditioned fears, which may explain the individual phenomenon of fearlessness, one of the factors of psychopathic behavior.

The finding of Kiehl et al. (2001) supplement these data. he used brain images to study the inner workings of the limbic system in response to an emotional memory task. In this study, three groups of participants (criminal psychopaths, non-psychopathic criminals, and normal controls) were asked to repeat and memorize a list of both neutral and words that describe negative emotions; In the next exercise, they were asked to recall these words. Compared with the other two groups, when processing words indicating negative emotions, the limbic system of psychopaths was significantly less active and the frontal lobes were more active. This speaks to the fact that psychopaths and non-psychopaths use completely different brain systems to process emotional information. These results are similar to those of Intrator et al. (1997). He suggested that, compared with other people, individuals with psychopathic personalities have difficulty and need more cognitive processes in processing emotional information. It is not yet known whether these factors are present at birth or develop as a result of childhood experiences.

Antisocial personality therapy

Psychological intervention

Although much research has been focused on and there are many possible interventions available for those considered to have an antisocial personality disorder, experimental therapy has focused almost exclusively on behaviors. crime and violence among minors. As such, they should only be viewed as projects designed with the aim of influencing criminal behavior rather than treating the antisocial personality itself. What these studies have in common is that they all confirm that the classic form of "concentration camps" (individual concentration in a re-education facility) has proved ineffective. A more effective form of intervention has been found that is family-oriented. Bourdin (1999) describes a cross-platform, family-based approach, the goal of which is to equip participants with skills to deal with family and extra-family problems. Family interventions are aimed at improving parenting skills, encouraging parents to be supportive and empathetic to their children. Thereby, it contributes to reducing the level of psychological trauma caused by parents. Parents are instructed to develop strategies for monitoring and appreciating their child's academic progress, and in addition, assigning daily chores as a form of homework. Peer-directed interventions are designed to increase relationships with socially beneficial peers. This is realized through participation in youth group meetings, athletics, and extracurricular activities. If the individual maintains contact with bad friends, the individual will be penalized. Cognitive-behavioral interventions focus on teaching social skills and problem-solving skills.
The final stage requires only weekly therapy.

This approach has had considerable success. Henggeler et al. (1992) compared this approach with a general counseling and control approach for a group of serious juvenile delinquents, most of whom had committed some form of crime or violence. Immediately after being intervened in this way, the family and friend relationships of the participants improved more than those in the control group. One year of follow-up, they were arrested less often and spent less time in detention. This result was maintained for the next two years. Borduin et al. (1998) conducted a similar experiment on this same group of subjects, followed up for the next four years, obtained the following results: compared with the control group, the recidivism rate in this group was only half ( 21% versus 47%).


Various pharmacological interventions have been used to treat people with antisocial behavior. Some have proven effective, especially in the treatment of aggressive people. For example, at a correctional center in the US, lithium was able to reduce the number of aggressive impulses in criminals, although still up to a quarter of young criminals received treatment with almost no change in behavior. . In contrast, in older but co-centric individuals, chronic aggressive behavior was completely abrogated with lithium treatment and returned to borderline levels with placebo treatment (Sheard, 1971). SSRIs are also drugs that can control sudden aggression, but there are no trials to test their effectiveness. It is still unknown, compared with the psychological approach,

Treatment of sick personality

Individuals with psychopathy often do not seek therapy on their own, and almost all interventions take place in prison or another detention facility. Due to the lack of motivation to change, people with a sick personality are often seen as incurable patients, although some opinions disagree with this somewhat negative view. There have been 3 journals (2 years/1 issues) written on the treatment of psychopathic personality and reiterate the nature of this problem. Salekin (2002) conducted a meta-analysis of the literature from 42 therapeutic studies. He concludes that while ECT and community therapy are relatively ineffective interventions, psychoanalytic and cognitive therapy have shown very promising results. Also evaluating these documents, Reid and Gacono (2000) conclude less optimistic. They found nothing to suggest that any form of therapy is consistently effective. Similarly, Wong and Hare (2002) concluded that of the 74 studies performed that they were able to identify, only two had satisfactory results, while the rest of the evidence was so weak that people It is also unclear whether any form of intervention could be effective.

Measuring the effectiveness of personality trait treatments is a dilemma. A characteristic to identify individuals with psychopathic personalities is that they often lie and like to manipulate others. Self-reported results should therefore be handled with great care. Even behavioral self-assessments cannot be trusted. The results of a study by Seto and Barbaree (1999) proved this. Their study examined the impact of recidivism prevention programs on sex offenders (like those described in chapter 9). Participants include normal people, not just individuals with sick personalities.

Their report focused on the relationship between the marked improvement made by therapy (due to in-therapy behavior, quality of homework, increased therapeutic motivation) and the frequency of recidivism after treatment. In individuals without psychopathy, if therapy helps them to improve their behavior, it can be predicted that the likelihood of committing a crime will be lower after being released from prison. On the contrary, for people with a psychopathic personality, the more advanced the treatment, the higher the recidivism rate later on. They seem to learn the responses that the therapist considers to be signs of progress and may pretend to act as such. The people who excelled at pretending were also the most likely to re-offend. Therapy did nothing to change the underlying motives of their behavior.


A large amount of early research on personality therapy involves psychoanalytic methods (Salekin 2002). Almost all were case studies, and none compared this intervention with any other form of therapy or changes in the control group. In general, personal history is always carefully considered. Clinicians often report on therapeutic successes rather than failures, so they lack objectivity when presenting sample cases. The reported success in these studies, therefore, does not mean that there will be similar success rates in unselected groups of individuals, nor does it provide strong enough evidence to conclude about its effectiveness. the results of psychoanalysis on the masses.

Therapeutic Community

Therapeutic communities were first developed under the leadership of Maxwell Jones in the UK in the late 1940s. They organize active interventions 24 hours a day to change personality behavior. It is individuals with psychopathic personalities who are responsible for taking care of the physical and emotional well-being of others in the community. The group itself determines what is acceptable and unacceptable behavior. Members are required to abide by the rules of the group and obey the rules of reward and punishment if they violate them. The community here relies on Rogers' flexibility principles (see chapter 2) and strives for a high level of sincerity, honesty, and empathy.

Rice et al. (1992) gave one of the highest evaluations of the effectiveness of this approach. They conduct the therapeutic community approach in a strictly centralized facility. The participants themselves control the program. They split into short-term therapy groups of 80 hours per week. Therapy aims to develop in participants empathy and responsibility towards their peers. The person with a good response will be the team leader and participate in the management of the program. All participants have the right to make decisions about who will be disqualified from the program.

Participants had very little contact with professional staff. They do not have many opportunities for entertainment: television and even access to social news are severely limited. Participation in the program is mandatory: for example, if they fail to complete the assignment, they are referred to a subcommittee where the individual discusses the reasons why they do not want to participate in the program anymore, but Finally, they want to continue participating. The authors note that the program was highly regarded at the time of its launch, the 1960s, and 1970s.

The program involved both sick and normal individuals, who were followed up for an average of 10 years after recovery. Researchers compared cures in individuals with psychopathy, participants without psychopaths, and a control group who did not join this community. They obtained results like those of Seto and Barbaree (1999). Individuals without psychopathy were less likely to commit crimes after recovery than those in the control group. In contrast, after the end of therapy, individuals with psychopathy were more likely to engage in violent crime than those in the control group, with known recidivism rates of 78% and 55%, respectively. . The therapeutic community has taught individuals with psychopathy how to manipulate others more effectively - an outcome that is neither desirable nor desirable.

Cognitive therapy

Cognitive-behavioral interventions are probably no exception to this paradoxical outcome. Hare et al. (2000) examined the results of short-term cognitive-behavioral therapy programs in prisons, including anger management and social skills training. Their data revealed that the intervention proved to be somewhat effective when assessing the overall recidivism rate in most individuals with psychopathic personalities. However, in criminals with severe personality disorder, the rate of recidivism increases with the course of treatment. Again, it seems that these courses taught them how to “become a psychopath”.

Despite such disappointing results, numerous research groups have examined adaptive cognitive-behavioral therapy goals and strategies in the treatment of psychopathic personality. Beck et al. (1990) tried to determine the actual goal of this therapy. They note that individuals often act primarily for their own benefit. The goal of therapy, therefore, is to help them act in an appropriate way and accommodate these limitations. Cognitive tasks, central to therapy, not only point to the main flowchart like “I am always right” or “Other people should see things my way,” but also pose this problem. : whether antisocial behavior is in the interests of the individual himself. Participants in therapy are encouraged to question themselves, whether behaving according to the hypothetical “People should see things my way” causes interpersonal conflicts, undermining their own purpose. Thereby, they will change their behavior if the answer is yes. This approach allows the client and the therapist to work together towards a unified goal.

Wong and Hare (2002), develop a significant cognitive-behavioral approach to psychopathic personality therapy, that is, an intervention that changes aspects related to "prison" and changes children. people. Their interventions focus on the problem and provide a special outlet for people with psychopaths. The following are the key elements of the method:

Support socially acceptable attitudes and behaviors: many psychopaths in prison seek out like-minded individuals to strengthen their beliefs. To reduce this risk, Wong and Hare (2002) suggest creating a “pro-social milieu” within the prison/re-education facility. For high-ranking individuals, this method is effective in forming positive attitudes in them; towards others, can promote such a view, and further reinforce socially acceptable behaviors within the group. It should be noted that the research results of Rice et al. (1992) show that this is not easy to do.

Change unusual behaviors - aggressive, manipulative, intimidating: strategies for achieving change include: self-learning training to prevent overreaction in situations the individual feels excessive fear or anger; Social skills training aims to fill in the gaps and reduce the individual's use of it for intimidation and the development of other abnormal behaviors. This can be through role-playing or positive behavioral reinforcement to accomplish this therapeutic purpose.

Learn to take responsibility for your actions: it is necessary to analyze in detail the factors that lead to crime, to determine what is the most basic choice that causes the individual to act like that. It is possible that this step is similar to the purpose of recidivism training, as the information here simultaneously encourages individuals to take responsibility for what leads to criminal behavior and identifies strategies to avoid it in the future. future.

The program also studies reducing substance abuse, helping individuals gain work skills or enhancing recreational activities, avoiding boredom once work is done - because of this. may lead individuals to turn to antisocial behavior. Ultimately, the program aims to establish a social network that individuals can join after they leave the re-education camp. Individuals are encouraged to try to maintain and re-establish relationships with family or other forms of social support. Even so, it is necessary to carefully control family contact because relationships with family members, in this case, are often not beneficial. Evidence for the effectiveness of these therapies is currently being tested by experts.