1. Antisocial Personality Disorder Profiling Psychopathology Dr. Kline FSU-PC Summer 2004

2. What is a personality Disorder? Is a long-standing, pervasive, & inflexible pattern of behavior. Is a long-standing, pervasive, & inflexible pattern of behavior. Usually impairs social & occupational functioning. Usually impairs social & occupational functioning. Personality disorders comprise all disorders in the Axis II of the DSM & these are often comorbid with other Axis I disorders (substance use, depression, etc.) Personality disorders comprise all disorders in the Axis II of the DSM & these are often comorbid with other Axis I disorders (substance use, depression, etc.) Presence of personality disorders complicate treatment of other Axis I disorders Presence of personality disorders complicate treatment of other Axis I disorders

3. What is an Antisocial Personality Disorder (APD)? Two major criteria: Two major criteria: 1. The presence of a conduct disorder before the age of 15. Symptoms include: truancy; running away from home, theft, compulsive lying, arson, & vandalism. 2. The continuation of this pattern of antisocial behavior into adulthood. 2. The continuation of this pattern of antisocial behavior into adulthood.

4. DSM-IV-TR Diagnostic Criteria for APD: Pervasive pattern of disregard for the rights of others since age 15 & at least 3 of the characteristics 1 through 7. Eight through 10 must be present for diagnosis. Pervasive pattern of disregard for the rights of others since age 15 & at least 3 of the characteristics 1 through 7. Eight through 10 must be present for diagnosis. 1. Repeated law-breaking**Core symptom** 1. Repeated law-breaking**Core symptom** 2. Deceitfulness; lying 2. Deceitfulness; lying 3. Impulsivity 3. Impulsivity 4. Irritableness & aggressiveness 4. Irritableness & aggressiveness 5. Reckless disregard for own safety & that of others. 5. Reckless disregard for own safety & that of others. 6. Irresponsibility as seen in unreliable employment history or not meeting financial obligations. 6. Irresponsibility as seen in unreliable employment history or not meeting financial obligations. 7. Lack of remorse***not necessary for diagnosis*** 7. Lack of remorse***not necessary for diagnosis*** 8. Age at least 18 8. Age at least 18 9. Evidence of conduct disorder before age 15. 9. Evidence of conduct disorder before age 15. 10. Antisocial behavior not occurring exclusively during episodes of schizophrenia or mania. 10. Antisocial behavior not occurring exclusively during episodes of schizophrenia or mania.

5. What % of conduct disordered youth become Antisocial Personality Disorders in adulthood? Roughly 60% of children with conduct disorder develop APD into adulthood (Myers, Stewart, & Brown, 1998). Roughly 60% of children with conduct disorder develop APD into adulthood (Myers, Stewart, & Brown, 1998).

6. What is general profile of person with Antisocial Personality Disorder? Individual: Individual: Irresponsible Irresponsible Criminality Criminality Displays antisocial behavior (sketchy work history, illegal activities, irritability) Displays antisocial behavior (sketchy work history, illegal activities, irritability) Physically aggressive and violent Physically aggressive and violent Has financial problems (defaults on debts) Has financial problems (defaults on debts) Reckless & impulsive behavior Reckless & impulsive behavior May be promiscuous May be promiscuous May lack remorse or show little regard for truth May lack remorse or show little regard for truth

7. Prevalence of APD Effects 3% of males; 1% of females in U.S. Effects 3% of males; 1% of females in U.S. Rates may be higher among younger adults than older adults. Rates may be higher among younger adults than older adults. Disorder is more common in people of low SES. Disorder is more common in people of low SES. Comorbidity is high with other personality disorders (e.g., narcissistic PD) as well as other Axis I disorders (substance use). Comorbidity is high with other personality disorders (e.g., narcissistic PD) as well as other Axis I disorders (substance use).

8. What is the difference between APD and psychopathy? Major distinction appears to be in symptomatology. Major distinction appears to be in symptomatology. “Lack of remorse,” a core symptom of psychopathy, is not required for diagnosis of APD. “Lack of remorse,” a core symptom of psychopathy, is not required for diagnosis of APD. In one study, 75 to 80% of convicted felons met criteria for APD, but failed to meet criteria for psychopathy. In one study, 75 to 80% of convicted felons met criteria for APD, but failed to meet criteria for psychopathy.

9. Problems with diagnosing APD: 1. One major criticism centers around method by which diagnosis is made. 1. One major criticism centers around method by which diagnosis is made. An APD diagnosis relies on reports of patient’s past life events. Since these people are often pathological liars, how can we verify their claims??? An APD diagnosis relies on reports of patient’s past life events. Since these people are often pathological liars, how can we verify their claims??? **This is especially problematic—when family members are deceased.*** **This is especially problematic—when family members are deceased.*** 2. Many psychologists argue that a diagnostic concept in the field of psychopathology shouldn’t be linked with criminality. 2. Many psychologists argue that a diagnostic concept in the field of psychopathology shouldn’t be linked with criminality.

10. What is Psychopathy? Core features- –Psychopaths lack remorse –Poverty of emotions (positive & negative) Psychopaths are: Superficially charming Pathological liars & cheaters Impulsive; sensations seekers Manipulative, will change story to fit facts Less responsive to fear/anxiety Immoral Occurs predominantly in men!!!

11. Psychopaths identified by Hare checklist Two clusters: Two clusters: 1. Emotional detachment cluster (a selfish remorseless individual with inflated self-esteem who exploits others.) 1. Emotional detachment cluster (a selfish remorseless individual with inflated self-esteem who exploits others.) 2. Antisocial lifestyle cluster- marked by impulsivity & irresponsibility. 2. Antisocial lifestyle cluster- marked by impulsivity & irresponsibility.

12. Are psychopaths born or made? Most likely there are components of both that account for the development of full fledged psychopathy. Most likely there are components of both that account for the development of full fledged psychopathy.

13. Putative causes of APD & psychopathy? 1. Family 1. Family McCord & McCord (1964) concluded that lack of affection & severe parental rejection may be primary causes of psychopathic behavior. McCord & McCord (1964) concluded that lack of affection & severe parental rejection may be primary causes of psychopathic behavior. Other suspected family related factors are: Other suspected family related factors are: Inconsistencies in discipline or no discipline at all, physical abuse, marital discord, & substance use. Inconsistencies in discipline or no discipline at all, physical abuse, marital discord, & substance use.

14. 2. Both antisocial personalities & criminal behavior have heritable components. Twin Studies: Twin Studies: 1. Higher concordance rate for MZ twins than for DZ twins in APD (Lyons et al., 1995). 1. Higher concordance rate for MZ twins than for DZ twins in APD (Lyons et al., 1995). Adoption Studies: Adoption Studies: 2. Higher rate of antisocial behavior in adopted children of biological parents with APD. 2. Higher rate of antisocial behavior in adopted children of biological parents with APD.

15. 3. Father’s behavior Fathers of psychopaths are likely to be antisocial personalities themselves!!!!!! Fathers of psychopaths are likely to be antisocial personalities themselves!!!!!!

16. 4. Environmental Factors Environment seems to play an important role in APD. Environment seems to play an important role in APD. It has been shown that environmental factors such as marital problems and substance abuse) are related to the development of APD. It has been shown that environmental factors such as marital problems and substance abuse) are related to the development of APD. Also high levels of conflict & negativity and low levels of parental warmth predict APD. Also high levels of conflict & negativity and low levels of parental warmth predict APD.

17. What’s likely to be going on? Child with diathesis for antisocial behavior may be difficult to deal with & produce environmental changes that result in harsh conditions (treatment) by family members. Child with diathesis for antisocial behavior may be difficult to deal with & produce environmental changes that result in harsh conditions (treatment) by family members. This may fuel development of full blown antisocial behavior. This may fuel development of full blown antisocial behavior.

18. Are psychopaths less prone to anxiety than normal people? Yes!!! Yes!!! Lykken (1957) studied the ability of psychopaths & controls to avoid shock. Lykken (1957) studied the ability of psychopaths & controls to avoid shock. Psychopaths were poorer than controls at avoiding the shocks, suggesting they are low in anxiety compared to controls. Psychopaths were poorer than controls at avoiding the shocks, suggesting they are low in anxiety compared to controls.

19. Do psychopaths show less autonomic arousal to fear eliciting stimuli than controls? Psychopaths show a pattern of autonomic activity that suggests they “tune out” aversive stimuli. Their hearts beat faster than normals when anticipating stress, but their skin conductance levels are lower than controls in response to aversive stimuli. This makes them appear underaroused when they are not.