Dissocial Personality Disorder

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F60.2 Dissocial Personality Disorder
ICD-10 online (WHO version 2019)

The antisocial personality disorder or antisocial personality disorder ( APS ) is a mental disorder and conduct disorder . The term dissocial is derived from the Latin prefix dis = 'un - , away -' and socialis = 'community'. It should not be confused with dissociative identity disorder .

Typical of this personality disorder are irresponsibility and disregard for social norms , rules and obligations, a lack of a sense of guilt and a lack of empathy for others. Often there is a low threshold for aggressive or violent behavior, a low tolerance for frustration, and a lack of learning ability due to experience. Relationships with other people are formed, but are not stable. APS also includes psychopathy ; the term sociopathy , however, is defined differently and is rarely used in a clinical context.

People with dissocial personality disorder come into conflict with the law more often than the population average. According to DSM-5 , around 3% of men and 1% of women are affected. Antisocial personality disorder is most common among people in addiction treatment centers and forensic prisons (sometimes more than 70% of those examined).

description

The antisocial personality is usually already noticeable in childhood and adolescence through disregard of rules and norms (e.g. skipping school, vandalism, running away from home, stealing, frequent lying) as well as through the inability to social learning from experience. If the behavior begins before the age of 10, this personality disorder usually develops from a chronic disorder of social behavior . In adulthood, those affected often continue their behavior and are often noticed through only temporary work, breaking the law, irritability and physically aggressive behavior, failure to pay debts, recklessness and sometimes also through the use of intoxicants. It is not uncommon for them to end up in prison as a result.

However, crime is not necessary for the diagnosis of APS, as there are also many adapted people with APS who are professionally successful. In the professional world, anti-social personality traits can be an advantage: The results of a study indicate that company executives could be more frequently affected by this disorder. Nor should one make the mistake of assuming APS for every delinquent person. There are many reasons for delinquency and GSP is just one of them.

People with APS are often impulsive, easily irritable, and do not plan ahead. In addition, they show no remorse for their misdeeds and crimes. Their emotional relationships with other people are so weak that they cannot empathize with other people and have no feelings of guilt or sense of responsibility. This makes it difficult for them to respect personal boundaries and show consideration for other people. Your own emotional repertoire (especially that for negative feelings) may be limited, which is why you are imitating other people's gestures. On the other hand, they perceive the feelings of others well and can manipulate them, while they themselves can sometimes be extraordinarily charming. But they can also exude a playful lightness and with good intellectual talent they can be quite witty, funny and entertaining.

Subtypes

Dissocial personality disorders can be further divided into three subtypes, which, however, have led to scientific controversy.

Instrumental dissocial behavior

This subtype is primarily geared towards money, material values ​​and power. The people do not have psychological stress, but an excessive self-confidence and a sense of power and therefore no willingness to change. This nature bears a resemblance to what was previously known as psychopathy : lack of empathy, guilt or fear, superficial charm and emotions, and unstable, changing relationships. However, this can sometimes correspond to the social norm.

Impulsive hostile behavior

It is characterized by poor action control, mainly due to strong impulsiveness . The person is hardly aware of the lack of control over their actions. The participation is high here; among other things, anger and anger can almost always be found. Material gain is not a decisive trigger for action here. Similar to paranoid personality disorder, actions of others are rashly interpreted as negative, for example as a threat or provocation, and, combined with a low tolerance for frustration , people react aggressively accordingly. The actions are spontaneous and unplanned.

Anxious and aggressive behavior

The third group is particularly noticeable in the forensic field. Here one often finds depressed, shy and anxious people who, in extreme situations, produce outbursts of violence that can surpass those of the other two subtypes. Outside of their outbursts, most are controlled and otherwise less conspicuous people. Traumatic experiences are most common here.

Mixed types can also occur.

After Theodore Millon

The American psychologist Theodore Millon suggested five subtypes of antisocial personality disorder. However, these constructs are not included in the DSM-5 or ICD-10.

Subtypes properties
Nomadic 

(schizoid and avoidant traits)

Is disturbed, feels unhappy, condemned; often like a stray, outsider, gypsy-like (in the original: "gypsy-like") wandering vagabond. Acts impulsively and usually not benign.
Vicious 

(sadistic and paranoid traits)

Vicious, scary, brutal, resentful; argumentative, combative. Expect treason and punishment; desires revenge; fearless and guiltless, heartless, defiant.
Greedy (negativistic) Deliberately feels denied and deprived of identity; greedy, merciless, dissatisfied; jealous, resentful. Dissatisfied, longing, seeks retribution; avaricious avarice; has more pleasure to take than to own.
Risk taker

(theatrical traits)

Fearless, daring, daring; reckless, foolhardy, impulsive, careless; unhindered by danger; pursues dangerous, risky projects.
Reputation-defending 

(narcissistic traits)

Must be perceived as infallible, unbreakable, invincible, indomitable, terrible, inviolable; adamant when status is in doubt; overreacts very easily.

In another version, Millon even distinguishes ten subtypes, some of which overlap with the above: Stingy, Risky, Vicious, Tyrannical, Insidious, Dishonest, Explosive and Harsh. However, this classification is rarely used.

Differentiation from psychopathy and sociopathy

Even if the terms psychopathy and antisocial personality disorder have considerable similarities and, especially in common usage, are usually not clearly differentiated, it is necessary to differentiate between psychopathy and APS. Although the two disorders correlate significantly with one another and show clear overlaps in terms of their characteristics, both are not to be regarded as identical. Mostly psychopathy is viewed as a particularly severe form of antisocial personality disorder.

According to Hare et al. (1990), psychopathic behaviors can be divided into two groups:

  1. Those of the selfish , pitiless, self- esteeming individuals who exploit others.
  2. That of the individuals with an anti-social , impulsive and irresponsible lifestyle (according to the criteria of the APS).

According to Hare, in order to meet the criteria of psychopathy, a person must have personality traits such as an inability to empathy , a terrific sense of self-importance, and a lack of depth of feeling , which are not required for a diagnosis of APS.

According to Hare et al. (1990) only about 20% of people with an antisocial personality disorder show high scores in the field of psychopathy. So some people with antisocial personality disorder are psychopaths, but many others are not.

On the other hand, psychopathy can sometimes occur in people who do not meet the diagnostic criteria of APS, e.g. B. as comorbidity of a narcissistic or borderline personality disorder (see: Psychopathy ). Some psychopaths can be socially adapted for a long time and completely unremarkable psychiatrically and forensically , have a normal or even successful biography and sometimes even reach high management positions through special ambition , calculation and striving for power ( highly functional → "successful psychopaths" ).

The term sociopathy must also be differentiated . This does not represent an official psychiatric diagnosis and is not listed in diagnostic systems such as ICD-10 or DSM-5 . Sociopathy refers to patterns of behavior that are generally viewed by society as illegal, anti-social, or criminal. Often sociopaths learned these behavior patterns in their (former) social environment or were even dependent on them for survival there.

Classification and diagnosis

The ICD-10 uses the term " dissocial personality disorder ", the DSM-5 uses the phrase " antisocial personality disorder ". While the DSM-5 expressly only allows the diagnosis of an antisocial personality disorder from the age of 18, the ICD-10 does not specify a correspondingly narrow age limit.

ICD-10

The disorder is listed on the ICD as a "specific personality disorder" and is outlined as follows:

“A personality disorder characterized by disregard for social obligations and heartless indifference to feelings for others. There is a significant discrepancy between behavior and prevailing social norms . The behavior does not appear to be changeable as a result of adverse experiences, including punishment. There is a low tolerance for frustration and a low threshold for aggressive, including violent behavior, a tendency to blame others or to offer ostensible rationalizations for behavior through which the patient in question has come into conflict with society . "

- ICD (2011) : German Institute for Medical Documentation and Research

In addition to social deviations, the ICD-10 criteria describe character peculiarities, in particular egocentricity , lack of empathy and poor conscience. Criminal acts are therefore not absolutely necessary. At least three of the following characteristics or behaviors must be present:

  1. Heartless indifference to the feelings of others
  2. Clear and persistent irresponsible attitude and disregard for social norms, rules and obligations,
  3. Inability to maintain lasting relationships when there is no difficulty in forming them,
  4. Very low tolerance for frustration and a low threshold for aggressive, including violent behavior,
  5. Lack of guilt or inability to learn from negative experience, particularly punishment,
  6. Clear tendency to blame others or offer plausible rationalizations for behavior that has brought them into conflict with society.

DSM-5

A. There has been a profound pattern of disregard for and violation of the rights of others that has existed since the age of 15. At least three of the following criteria must be met:

  1. Failure to conform to societal norms regarding lawful conduct, which manifests itself in repeated commission of acts that constitute grounds for arrest.
  2. Falsehood expressed in the form of repetitive lying, the use of aliases, or deceiving others for personal gain or pleasure.
  3. Impulsiveness or failure to plan ahead.
  4. Irritability and aggressiveness, which manifests itself in repeated brawls or assaults.
  5. Reckless disregard for your own safety or the safety of others.
  6. Persistent irresponsibility manifested in repeated failure to perform a permanent job or meet financial obligations.
  7. A lack of remorse, which manifests itself in indifference or rationalization when the person has offended, abused or stolen from other people.

B. The person is at least 18 years old.
C. A disorder of social behavior was already recognizable before the age of 15.
D. Antisocial behavior is not exclusive to schizophrenia or bipolar disorder .

DSM-5 alternative model

The alternative model of the DSM-5 in Section III suggests the following diagnostic criteria:

A. Moderate or severe impairment in the functional level of the personality, which is manifested by typical difficulties in at least two of the following areas:

  1. Identity: egocentrism; self-esteem is dependent on personal gain, power, or pleasure.
  2. Self-control: Personal goals are based on personal benefit; there is a lack of prosocial internal standards combined with the failure to behave in accordance with the law or in accordance with ethical-cultural norms.
  3. Empathy: Lack of concern for the feelings, needs, or suffering of others; lack of remorse after being injured or mistreating others.
  4. Proximity: aversion to mutual close relationships, since taking advantage of is a preferred form of creating relationships, including deception and coercion; Using domination or intimidation to control others.

B. Presence of at least six of the following problematic personality traits:

  1. Tendency to manipulate: frequent use of cunning to influence or keep others under control; Use of seduction, charm, eloquence or flattery to achieve your own goals.
  2. Coldness of feeling: Lack of concern with the feelings and problems of others; Lack of guilt or remorse about negative or adverse effects of one's actions on others; Aggression; Sadism.
  3. Dishonesty: insincerity and deceit; inaccurate self-presentation; Embellishments and inventions in depicting events.
  4. Hostility: Persistent or frequent feelings of anger; Anger or irritability even with minor insults and insults; mean, hateful, or vengeful behavior.
  5. Tendency towards risky behavior: performing dangerous, risky and potentially self-damaging activities without external necessity and without considering possible consequences; Susceptibility to boredom and thoughtless taking up activities in order to escape boredom; Lack of awareness of one's limits and denial of real personal danger.
  6. Impulsivity: Actions are headlong as an immediate reaction to a trigger; they are instantaneous, with no plan or consideration of the consequences; Difficulty developing or pursuing plans.
  7. Irresponsibility: disregard for and failure to meet financial or other commitments or promises; lack of respect for and lack of consistency in agreements and promises.

Note: The person is at least 18 years old.

diagnosis

For the diagnosis of antisocial personality disorder or antisocial personality disorder, the above criteria of the DSM-5 or ICD-10 must be met.

The diagnosis can e.g. B. be done through questionnaires. The problem with diagnosing personality disorders, however, is that those affected often know what the therapist expects from them and they respond accordingly. In order to get a realistic picture of the person, therapists often ask relatives for information.

In order to rule out other causes of the deviant behavior, the doctor pursues an exclusion diagnosis. To do this, the doctor will perform some physiological examinations, e.g. B. a blood or urine test to determine if the behavior was not due to drug use. By imaging possible are lesions excluded or in the brain, if necessary discovered.

causes

The development of the clinical picture is a combination of biological, psychological and environmental factors.

Biological factors

Genetics and epigenetics

In the genes, causes for the development of the disorder can be found. However, it is not just a few genes that play an important role here, but rather the interactive genetic predisposition.

Recent research confirms the hypothesis that this disorder is caused by an interplay of biological and social factors. Avshalom Caspi and his colleagues (2002) examined 442 male, adult New Zealanders, 154 of whom were sexually abused or physically abused in their childhood. They analyzed the influence of a particular gene that affects brain chemistry. This gene comes in a strongly and a weakly active variant. It determines the level of monoamine oxidase-A (MAO-A). This is an enzyme that metabolizes the neurotransmitters serotonin , dopamine and norepinephrine (norepinephrine). 85 percent of the subjects who had been traumatized and who also had the weakly active variant of the gene developed forms of antisocial behavior. However, the study participants with the highly active variant of this gene were only very rarely conspicuous for their antisocial behavior - regardless of whether or not they had been abused as a child (see also: Warrior Genes ).

Most recently, there was a (presumably epigenetic ) correlation between cigarette consumption during pregnancy and the development of an antisocial personality disorder in the child.

Frontal dysfunction

There have long been indications of an organic brain dysfunction in the area of ​​the frontal lobe. A deficit in the limbic, paralimbic system as well as in the neocortical and frontal structures of the brain is responsible for a deficit in emotional, motivational, motor and also cognitive processing. The prefrontal cortex and the temporal lobe, in particular the amygdala, the hippocampus and the superior temporal gyrus, are impaired. These are involved in learning fear responses as well as morality and compassion.

In addition, social and emotional self-regulation is controlled by the functions of specific frontal and limbic areas, which in turn is reflected in the behavior of a person with an anti-social personality.

Further evidence for this theory is provided by patients with damage to the frontal cortex after head trauma, cerebrovascular disease or degenerative neurological diseases. These diseases lead to precisely these characteristic syndromes, which are defined, among other things, by impulsiveness, socially inappropriate behavior, high distractibility and emotional lability.

These findings on deficits in the frontal cortex can be found not only in antisocial personality disorder, but also in borderline personality disorder .

Family accumulation

Adoption studies show that genes and the environment play a role:

“A research team sampled 95 men and 102 women who had been given up for adoption a few days before they were born. Institutional data provided sufficient information about the biological parents to be able to assess whether they suffered from an antisocial personality disorder. These data allowed the contribution of genetic factors to the disorder to be recorded. The researchers also collected data on the living conditions in the adoptive families: with the help of interviews, they determined whether the participants grew up under adverse environmental conditions, for example whether they had adoptive parents who had marital problems, drug or alcohol problems. These data allowed the contribution of environmental factors to the antisocial personality disorder to be recorded. The results showed that both variables are important: People whose biological parents had the disorder or who grew up under adverse environmental conditions were, on average, more likely to be diagnosed with an antisocial personality disorder. "

A familial accumulation can therefore be found among first-degree relatives of the person concerned, who are more likely to develop or develop an antisocial personality disorder. In addition, an antisocial disorder occurs more often in identical twin pairs than in dizygotic twins. This also suggests that the risk of developing this disorder is partly inherited.

Furthermore, twin studies suggest that there is a biological basis for the antisocial personality disorder. Viding et al. found out in 2005 that approx. 80% of the variance could be explained by genetic factors.

Neurobiological Findings

In MRI studies , a reduced frontal lobe volume or volume reduction in prefrontal gray matter was determined.

Using functional nuclear medicine imaging, a reduced prefrontal metabolic activity was found, which was reflected in a low glucose turnover.

Scientists have also found evidence that the brains of people with antisocial personalities react differently to images of violence than that of a healthy person. A small area of ​​the outer layer of the brain called the islet cortex is activated to experience pain and empathize with others. In people with this disorder, the insular bark is hardly or not at all active.

Further clues can be found in the amygdala, which has a lower volume in this disorder. Since it plays an important role in fear conditioning and emotional evaluation, this finding corresponds to the behavior of the person.

Neuropsychological test results

In 2000, Dinn and Harris used various neuropsychological tests to investigate the cognitive functions, frontal executive functions and electrodermal reactivity in men with an antisocial personality disorder.

Compared to the existing "healthy" control group, the group of men with the antisocial disorder showed neuropsychological deficits in tests that can be assigned to orbitrofrontal dysfunction. In this area, the processing of feedback information, which coordinates reward and punishment, as well as the planning of action, is particularly impaired. This means that antisocial personality disorder is associated with a selective deficit in the orbitofrontal cortex system.

However, it was also observed that the men showed better divergent thinking than the control group with the “healthy” test subjects.

Environmental factors

Bowlby found a link between APS and a lack of maternal care. Glueck und Glueck noted a lack of affection and a tendency to be impulsive in the mothers of people with APS. They were also prone to alcoholism. Antisocial personalities often come from broken homes where either violence prevailed or where they were neglected. In addition, there is a lack of love and care, which leads to a lack of orientation on the part of the child. In many cases there were family conflicts. Many antisocial personalities grew up in a large family in a confined space, experienced ambiguous upbringing styles by their parents who rarely or rarely considered prosocial behavior, or had delinquent siblings. A precursor to the lockable adult antisocial behavior was the presence of antisocial behavior problems in childhood.

A study by Horwitz et al. from 2001 confirms this assumption that those affected who had been mistreated in childhood were more likely to be diagnosed with an antisocial personality disorder even after 20 years. Lobbestael et al. pointed out again in 2010 that physical abuse in particular would lead to an increased risk of an antisocial disorder.

As a result of this lack of attention, the patients were unable to build up basic trust in early childhood and were also unable to form an emotional bond. Due to this lack of socialization, after early childhood they only develop relationships in which they can exercise power or in which they behave in a destructive manner.

From the point of view of cognitive behavioral therapy, learning factors play a major role, as those affected have (possibly) adopted their own behavior from that of their parents. It is very likely that the parents or one of the parents rewarded aggressive behavior with special attention or did not prevent reckless, aggressive or selfish behavior. As a result, this behavior pattern occurs more frequently and with each repetition it becomes more difficult to change this behavior. Especially the antisocial behavior disorder in childhood and adolescence is a huge risk factor for later antisocial personality disorder.

Comorbidities

From a study by Javdani et al. from 2011 and from Swogger et al. From 2009 it emerged that those affected have an increased risk of suicide without having an increased risk of major depression. The reason for the increased risk is probably the impulsiveness of the people and the lack of security awareness.

Rane et al. (2000) also found that an antisocial personality disorder often coexists with other disorders. Of the subjects examined with an antisocial personality disorder, 33% also had schizophrenia, 38% an affective disorder, 19% an anxiety disorder and 24% another personality disorder.

therapy

In principle, treatment is difficult because of the comorbidities, as the behavioral disorder usually occurs with other disorders, e.g. B. addictions, a mood disorder or a psychopathy.

Accordingly, several treatment approaches are necessary, including psychotherapy, depth psychological counseling or cognitive behavioral therapy. The success of these forms of therapy depends on the severity of the individual case, but most cases are less likely to be treatable. The use of psychotropic drugs also seems to do little to effectively and permanently change an antisocial personality disorder.

Studies have shown that people with an antisocial personality disorder can be changed, but only if they have not already become violent criminals. Above all, the lack of pathological fear complicates the treatment and the learning processes that the patient has to go through.

In addition, the patient's lack of emotional empathy is a negative indicator that affects the psychotherapeutic exchange. Furthermore, it may well happen that the patient tries to manipulate the therapist or shows complete resistance by means of monosyllabic answers. Due to the weak subjective level of suffering, the patient has little motivation for therapy and externalises any responsibility. It is not uncommon for the patient to try to dominate or engage in power struggles over the therapist in order to gain a sense of control over him.

Another complication for the therapist can be the phenomenon of projection; H. the patient perceives the therapist as dishonest and only interested in personal exploitation. Accordingly, he projects his own character traits onto the therapist.

The treatment of children with antisocial abnormalities is more effective. When encouraged with emotional affection and intensive leisure activities, children before the age of 3 lose the risk of long-term antisocial behavior.

Psychotherapeutic approaches

Psychotherapeutic treatment is the most popular treatment for antisocial personality disorder. The aim here is to change those characteristics of the patient in the long term that can lead to aggressiveness, violence and criminal behavior. The aim is to improve interpersonal and social skills and to achieve better control of impulsiveness. In addition, the empathy of those affected can be promoted, especially with regard to the effects of their actions on the affected persons of the lack of empathy.

Furthermore, the patients learn strategies with which they can avoid relapsing into old behavior patterns. It is based on approaches of a sense of guilt. If the patients are comorbid with e.g. For example, if you suffer from depression, they are often more willing to participate in therapy and talk about changes.

Possible problems and possible solutions

Most of the time, participation in psychotherapy is not voluntary, but a court order or is done under pressure from the employer. In the case of delinquent patients who are incarcerated because of their behavior, it may well happen that they are compelled to participate in a therapy offer in prison. For these reasons, many therapy concepts work to bring about a change in crime and violence.

Increase in therapy success

Much of the counseling depends on the therapist's attitude towards the potential for success. The therapist should be motivated and confident to speak to the person and accept the patient's point of view, but also be able to set clear limits on authority. In the best case, the therapist should convincingly present his goals to the patient and respond to the patient's individual needs. A clearly structured procedure and targeted follow-up care also have a positive effect. This treatment is primarily about the interplay between authoritarian, punitive and relaxed therapy.

Therapy based on depth psychology

This form of therapy is primarily used to provide support and brings a lot of structure into the patient's everyday life. The focus is mainly on the background of the disorder and the possibilities for change, which should be brought closer to the patient. Therapeutic approaches that have little structure and in which interpretations or ambiguities play an important role, on the other hand, are viewed as not very effective.

Cognitive behavioral therapy

Cognitive behavior therapy is probably the most successful form of therapy. It can both reduce criminal behavior and change personality traits favorably. Social skills are improved, which is the most important element of therapy. The patient should learn how to realize their own needs, but also take the needs of other people into consideration.

In this form of therapy, the patient practices to better perceive the wishes, intentions and feelings of other people, to improve their own self-control, to build positive interpersonal relationships and to deal better with anger. This can be practiced, for example, with role-plays, mental exercises and behavioral experiments.

Another important aspect of behavior therapy is developing compassion for those affected by your behavior. Above all, this includes taking responsibility for one's own actions, e.g. B. by imagining this. The technique of writing two letters is known, one of which contains a statement from the perspective of the person concerned and the other an apology to the person concerned.

All these thoughts, feelings and behaviors are bundled and documented in order to prevent relapses by working them up again with the therapist if a relapse is threatened. In doing so, your own strategies, with which violent acts can be prevented at an early stage, are recorded in writing, so that it is ensured that all those involved can counteract a slide into renewed violence at an early stage.

history

The first version of the DSM in 1952 listed the so-called "sociopathic personality disorder". Individuals who were classified in this category were defined as "sick primarily with regard to social interaction and in accordance with the prevailing milieu and not only with regard to personal complaints and relationships with other individuals". Accordingly, there were 4 subtypes which were categorized as “reactions”: antisocial, antisocial, sexual and addictive. The antisocial response included individuals who "were always in trouble" and did not learn from it, did not maintain loyalty, took little responsibility, and tended to rationalize their behavior. This category was significantly more specific and limited than the existing concepts of the "constitutional psychopathic state" or the "psychopathic personality", which encompassed a broad milieu. A narrower definition was developed based on the criteria of Hervey M. Cleckley from 1941, while the term sociopathy was coined by George Partridge.

The DSM-II from 1968 rearranged these categories so that the “anti-social personality” was taken up in the 10 personality disorders. However, it was still sparsely described and diagnosed in people who are “fundamentally unsocialized”, have recurring conflicts with society, are incapable of taking responsibility, are selfish, incapable of feeling guilty or learning from experience, and others Knowingly embarrassing people. The foreword in the manual contains so-called "special instructions", which describe that "antisocial persons should always be specified as mild, moderate or severe cases." The DSM-II also warns that a history of legal or social offenses is not enough in order to justify a diagnosis of this disorder and “criminal group act” in childhood or adolescence as well as “social maladjustment without manifest psychiatric disorder” should first be excluded. The dissocial personality type can be found in the DSM-II under “dissocial behavior”, in which individuals who act in a predatory manner and more or less follow criminal activities, such as B. prostitutes or drug dealers can be found. This term would later be described in the name of the diagnosis from the ICD, a manual from the World Health Organization (WHO), as dissocial personality disorder and roughly synonymous with the APSD diagnosis.

The 1980 DSM-III included the full term antisocial personality disorder and, as with many other disorders, a symptom checklist was published for the first time, focusing on observable behavior in order to improve the consistency of the diagnosis between the different psychiatrists (inter-rater reliability). The ASPD symptom list is based on the diagnostic research criteria, which were developed from the so-called Feighner criteria from 1972 and these in turn largely lead to one of the most influential research by the sociologist Lee Robins, published in 1966 under the title "Deviant Children Grown Up", counted. Robins made it clear early on that while the new criteria for early childhood conduct disorder came from her work, she and her research colleague and psychiatrist Patricia O'Neal received the diagnostic criteria from Lee's husband, Eli Robins, one of the authors of the Feighner criteria, who made those criteria as part of his diagnostic interview.

The DSM-IV retains the structure for behavioral antisocial symptoms, with the comment: "This pattern is also shown in psychopathy, sociopathy or dissocial personality disorder" and thus again includes the "associated properties" of the underlying personality traits of earlier diagnoses. The DSM-5 makes the same diagnosis as the DSM-IV. However, the paperback version of the DSM-5 suggests that a person with APSD may appear "with psychopathic traits" if they show a "lack of fear or bold interpersonal style."

Cultural reception

Siri Hustvedt (an American writer) describes in her book What I loved (original title What I loved - A Novel , 2003) at least two characters with symptoms of anti-social personality disorder. Towards the end of her book she mentions another fictional character turning to this phenomenon in the following words: Violet's “Research has taken her from the 18th century to the present, from the French psychiatrist Pinel to a living psychiatrist named Kernberg. The terminology and etiology of the disease she studies may have changed over time, but Violet tracked it down in all its forms: folie lucide, insanity, bullshit, sociopathy, psychopathy, and antisocial personality, APS for short. Nowadays psychiatrists use checklists to diagnose the disorder, which they review in committees and update, but the most common traits are: versatility and charm, pathological lying, lack of empathy and remorse, but impulsiveness, cunning and Tendency to manipulate, early behavioral disorders and the inability to learn from mistakes or to react to punishment. ”In her acknowledgment, she quotes various sources of secondary literature, such as the Otto F. Kernberg and Donald W. Winnicott mentioned above .

One of the first films to deal with antisocial personality disorder is Böse Saat (original title The Bad Seed , 1956). The child murderess “Rhoda” makes her victims responsible for their own death and hides her dark side behind a mask of polite charm . However, the film attributes their behavior solely to heredity.

The "Dissocial Personality Disorder" is discussed in Tatort: ​​Der Wüsten Gobi from December 26, 2017, in which a psychiatrist allegedly makes it the only diagnosis.

See also

literature

  • Thomas Boetsch: Psychopathy and Antisocial Personality Disorder. Development of ideas in the history of ideas in German and Anglo-American psychiatry and their relationship to modern diagnostic systems . VDM Verlag Dr. Müller , Saarbrücken 2008, ISBN 978-3-8364-8559-3 .
  • ZV Dikman, JJB Allen: Error monitoring during reward and avoidance learning in high- and low-socialized individuals. In: Psychophysiology . (2000); 37, pp. 43-54.
  • RJ Davidson, KM Putnam, CL Larson: Dysfunction in the Neural Circuitry of Emotion Regulation - A Possible Prelude to Violence. In: Science . (2000); Vol. 289, pp. 591-594.
  • Heinz Katschnig (Ed.): The extroverted personality disorders. Borderline, histrionic, narcissistic and anti-social life strategies . Facultas-Universitäts-Verlag, Vienna 2000, ISBN 3-85076-486-9 .
  • Frederick Rotgers (Ed.): The Antisocial Personality Disorder. A comparison of therapies. A practical guide. Huber, Bern 2007, ISBN 978-3-456-84403-9 .

Web links

  • Volker Faust: Antisocial personality disorder seen scientifically: Psychological and biological aspects. PSYCHIATRIE HEUTE, Psychosocial Health Working Group, July 8, 2011 ( archive ).
  • Volker Faust: The unscrupulous psychopath: the most serious of all personality disorders. PSYCHIATRIE HEUTE, Psychosocial Health Working Group, November 6, 2008 ( archive ).
  • Birger Dulz, Peer Briken, Otto F. Kernberg, Udo Rauchfleisch: Handbook of Antisocial Personality Disorder. Schattauer Verlag, Stuttgart 2015, ISBN 3-7945-3063-2 . ( Excerpt as a reading sample , 72 pages, PDF 1.3 MB, archive ).
  • Volker Faust: Dissocial behavior in childhood and adolescence . PSYCHIATRIE HEUTE, Psychosocial Health Working Group, November 6, 2008 ( archive ).

Individual evidence

  1. ^ Keyword dissociality in Dorsch - Lexicon of Psychology .
  2. ↑ Extensive specialist information on the definition and manifestations of psychopathy. (PDF) (No longer available online.) In: Sonderheft Neuropsychiatrie (1/2009): Forensische Psychiatrie, 23 / S1, ISSN  0948-6259 . Formerly in the original ; Retrieved December 23, 2015 (1.3 MB).  ( Page no longer available , search in web archives )  Info: The link was automatically marked as defective. Please check the link according to the instructions and then remove this notice.@1@ 2Template: Toter Link / www.i-med.ac.at  
  3. ↑ a b c d Birger Dulz, Peer Briken, Otto F. Kernberg, Udo Rauchfleisch: Handbook of Antisocial Personality Disorder. Schattauer Verlag, Stuttgart 2015, ISBN 3-7945-3063-2 . ( Excerpt as a reading sample , 72 pages, PDF 1.3 MB, archive ).
  4. ↑ a b c Prof. Dr. med. Volker Faust: ANTISOCIAL PERSONALITY DISORDER - SCIENTIFICALLY SEEN: Psychological and biological aspects. (PDF) In: PSYCHIATRIE HEUTE Recognize, understand, prevent, treat mental disorders. psychosoziale-gesundheit.net, July 7, 2011, accessed July 9, 2017 .
  5. ↑ a b c Peter Falkai, Hans-Ulrich Wittchen (Ed.): Diagnostic and statistical manual of mental disorders DSM-5 . Hogrefe, Göttingen 2015, ISBN 978-3-8017-2599-0 , pp. 903-908 .
  6. ^ David Korten : When Corporations Rule the World. Berret-Kohler Publications, 2001.
  7. ^ Benedict Carey: Theodore Millon, Psychologist and Student of Personality, Dies at 85. In: The New York Times. January 31, 2014, accessed May 4, 2018 .
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