Antisocial Personality Disorder: causes, symptoms and treatment
Most people use the word antisocial to refer to the people who have trouble, do not like or do not seem to like to relate . Basically it is used as a synonym of a withdrawn and selective person.
However, in psychology the term antisocial is used to designate something completely different, a type of disorder known as antisocial personality disorder that tends to be linked to behaviors contrary to social norms and even to the laws, ignoring the rights of others in favor of their own.
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Throughout our development, human beings are building our identity little by little. During childhood, adolescence and youth we try and acquire values, beliefs, ideologies or even appearances that allow us to finally find who we are, forming a self that we would like to be and configuring a way of seeing, thinking and acting in the world. This continuous and relatively stable pattern of way of being is what we call personality .
However, in many cases the personality that is configured throughout the life cycle is extremely maladaptive, being a very inflexible and continuous element that causes suffering to the person and hinders their integration in social, work and personal life.
The study of these behavioral maladaptive patterns, which are considered personality disorders due to the high level of maladaptation and discomfort they cause in themselves or in the environment, has generated different categories according to the patterns of thought, emotion and behavior that have those who suffer it.
Generally they are divided into three large groups or clusters, sharing several common characteristics among themselves. Within cluster A there are behavioral patterns considered eccentric and the disorders that would be part of it would be the paranoid, schizoid and schizotypal disorder.
Cluster C groups personality disorders that include Fearful and anxious behaviors as in the case of the disorder by avoidance, by dependence and obsessive-compulsive personality.
Cluster B groups disorders characterized by the presence of drama, emotionality and / or instability . Among them we find the disorders of the borderline personality, the narcissistic, the histrionic or the one that concerns us today, the antisocial personality disorder.
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Antisocial personality disorder
Antisocial personality disorder is a pattern of behavior characterized by inattention and violation of the rights of others in favor of their own , which appears before the age of fifteen. This contempt can be manifested through behaviors of various kinds, including criminal behavior punishable by law.
At the level of personality it is observed that those who present this disorder usually have a Low level of kindness and responsibility , which jointly facilitates that they get into disputes with other individuals and with the system.
In general, these people are ambitious and independent; these are individuals with little tolerance for frustration, little sensitivity to the feelings of others and a very high level of impulsivity . They act without thinking about the consequences of their actions both for themselves and for others.
As with psychopaths, many of them are extraverted people and have considerable charm and ease of relationship, but only superficially. They tend to possess narcissistic characteristics, considering their well-being above the rest, and they often use deception and manipulation to achieve their goals.
These people have an unstable lifestyle , because they have great plans to make future and consider the repercussions of their actions. That is why they are generally irresponsible and find it difficult to take charge of what constitutes a commitment, which together with the other characteristics mentioned above, causes people with antisocial personality disorder to face serious problems of adaptation to society, having difficulties on a personal, work and social level.
All this causes that they frequently suffer from depressive, tensional problems and addictions to different substances or activities. While this disorder facilitates the performance of criminal behavior, it is necessary to bear in mind that this does not imply that all criminals are antisocial or that all antisocials are criminals .
As with the rest of personality disorders, establishing the causes of antisocial personality disorder is a complex process that requires taking into account a wide variety of variables, given that the personality is an element that is being built continuously throughout the development.
Although its specific causes are not known, a wide variety of more or less accepted hypotheses have been established .
1. Biological hypotheses
The studies carried out with twins and adopted individuals show the presence of a certain genetic component, t Transmitting some personality characteristics that can cause the disorder to end up generating .
The characteristics of this disorder suggest frontal and prefrontal activation problems, the areas that regulate the inhibition of impulses and govern processes such as planning and forecasting of results.
In people with antisocial personality disorder, it has also been found that there is less than usual activation in the amygdala. Bearing in mind that this area of the limbic system governs aversive responses such as fear, an element that leads to the negative evaluation of a situation and therefore allows inhibiting an impulse, this could lead to difficulty in curbing behavior which people with this type of personality show off.
2. Psychosocial hypotheses
At a more psychosocial level, it is frequent that those who suffer from antisocial personality disorder tend to have lived a childhood in which they have had ineffective parental models, in conflictive or excessively permissive environments.
It is common to have parents who are hostile, abuse or mistreat them. So, with these types of models they may end up assuming that exercising their will is above other considerations , which they will replicate in adulthood.
Cases have also been found at the opposite extreme: with absent or excessively permissive parents the children end up learning that they can always do their will, and that they react in a vengeful manner to the cessation or threat to that end.
Another element to keep in mind is that antisocial personality disorder can come preceded by another type of behavioral disorder in childhood: the dissocial disorder . Although it does not occur in all cases, having had a dissocial disorder in childhood multiplies the risk that the individual ends up developing the antisocial disorder as an adult.
Some authors consider that the basic problem is slowing down cognitive development, which prevents them from being able to put themselves in the role of other people and see the world from different perspectives to theirs.
The treatment of personality disorders in general is complicated , since these are configurations that include behaviors and ways of seeing and acting that have been acquired and reinforced throughout life. In addition, people often consider that it is their way of being, so they do not usually want to change it unless they perceive that they cause excessive discomfort.
In the case of antisocial personality disorder, the treatments usually have one more complication, and that is that the treatment usually comes imposed or by close beings or judicially after committing a crime. Thus, the subject in question does not usually appear cooperative to see it as an external imposition, not accepting in general the need for treatment.
In therapy, the management of these cases requires that the patient be asked not only what they want to achieve and how to do it, but especially to make them aware of the need for change and the advantages and disadvantages that this would entail in their lives.
To the extent possible, the therapist must be able to be seen as someone respectable and close who does not intend to impose their authority, avoiding possible resistance on the part of the patient and facilitating the establishment of a good therapeutic relationship.
The passage through psychotherapy
The application of cognitive therapy is frequent (specifically brief cognitive therapy with dialectical orientation, based on Linehan's dialectical therapy), in which training sessions are used in which skills of consciousness, interpersonal effectiveness, emotional regulation and tolerance to frustration are treated.
It is searched at first arouse interest in the long-term consequences of treatment and to understand how others affect their own behavior and then try to increase interest in the welfare of others. Community and group therapies also seem to be of some help.
Other useful elements involve narrating the patient's life history, as this can greatly help to help him observe the events that have happened to him in a different way and to reflect on his life. The work in the capacity of empathy, although complicated for this type of patients, can be increased through exercises such as role reversal .
Psychoeducation is also helpful to the immediate environment of the subject, in order to help establish limits in behavior and to have greater ability to cope with the situation.
At the pharmacological level there is no specific treatment for antisocial personality disorder . This is due, among other things, to the fact that the behavioral patterns associated with this condition are so established in the day-to-day of the person that an approach based on the reductionism of acting on certain brain circuits is to encompass the full extent of this phenomenon. Finally, part of the disorder is also in the way in which the person establishes relationships with others, and these reinforce this type of behavior adaptive because of their expectations.
However, it may help to administer substances that keep mood stable, such as some antidepressants (the use of SSRIs is common). Of course, this does not solve the problem in its entirety, but it can be a complement.
Despite this, we must take into account that this type of disorder is associated with a certain frequency to the consumption of psychoactive substances, not being the occurrence of addictions.
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. Fifth edition. DSM-V. Masson, Barcelona.
- Davidson, K.M. & Tyrer, P. (1996). Cognitive therapy for antisocial and borderline personality disorders. Single case study series. British Journal of Clinical Psychology, 35 (3), 413-429.
- Quiroga, E. & Errasti, J. (2001). Effective psychological treatments for personality disorders. Psicothema, Vol. 13, no. 3, pp. 393-406. University of Almería and University of Oviedo.
- Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J .; de los Ríos, P .; Left, S .; Román, P .; Hernangómez, L .; Navas, E .; Thief, A and Álvarez-Cienfuegos, L. (2012). Clinical psychology. CEDE Preparation Manual PIR, 02. CEDE. Madrid.