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Explain the Antisocial Personality Disorder

Explain the Antisocial Personality Disorder

The Antisocial Personality Disorder

The essential characteristic of the antisocial personality disorder (ASP) is the

chronic manifestation of antisocial behavior patterns in amoral and impulsive persons.

Persons with ASP are usually unable to delay gratification or to deal effectively

with authority, and they show narcissism in interpersonal relationships. The

pattern is apparent by mid-adolescence (usually earlier) and continues into adult

life with consistency across a wide performance spectrum, including school, vocational,

and interpersonal behaviors (Meyer & Weaver, 2006; Hare, Hart, & Harpur,

1991; Lykken, 1995).

Related Diagnostic-Etiological Considerations

In the nineteenth century, Caesare Lombroso advanced the theory that criminals

manifest distinct physical markers, such as a low forehead. Although the theory

has been discredited, much modern research (Bartol & Bartol, 2008; DiLalla, 2004;

Lykken, 1995) supports the idea that biological factors, especially those that are

derived genetically, influence the production of criminality, antisocial personality

disorder, and, epecially, psychopathy. For example, even by the age of 2 weeks,

babies are more alert and exploratory if they have a “novelty-seeking” gene that

may influence sensation-seeking in adults. Babies with the gene DRD4 were more

likely to follow a red ball with their eyes, respond to a human face, and pay atten-

Case Studies in Abnormal Behavior, Eighth Edition, by Robert G. Meyer, L. Kevin Chapman, and Christopher M. Weaver. Published by Allyn & Bacon.

Copyright © 2009 by Pearson Education, Inc.

ISBN 0-558-51041-8

tion to the sound of a rattle than were other babies. The novelty-seeking gene is

controversial because some studies have failed to find a link to personality,

whereas others have indicated connections to antisocial behaviors, addiction, and

hyperactivity.

It is unclear how these biological factors translate into specific behaviors.

Possibilities include deficits in specific types of intelligence or learning skills, brain

dysfunctions, neurohormonal disorders, and so on. For example, Robert Hare

(Hare, Hart, & Harpur, 1991) views psychopaths as language disordered at a neurological

level; hence, they are weak at processing the emotional meaning of

words. Others point to psychological factors as primary, such as patterns of parenting

(i.e., arguing that harsh or abusive parenting or even permissive parenting

can facilitate psychopathy, especially in predisposed individuals).

One major difference theoretically is between those like Hare who view

psychopathy as stemming from some “defect” causing one to be “born bad” or

“defective,” and those (namely, Lykken [1995]) who view psychopaths as “born

difficult.” In the latter theory, a particular constellation of “normal” characteristics

is inherited that predisposes one to psychopathy, and the degree and direction of

disorder are then determined by how often and how intensely the factors occur,

and/or the type of parenting received. I have devised the FUMES acronym to

describe such characteristics:

Fearless

Unresponsive to pain

Mesomorphic (muscular)

Empathy-deficient

Stimulation-seeking

Although these can be reasonably termed “normal” characteristics, they

require skill—indeed, great skill—in parenting in order to develop a conscience,

prosocial habits, success in a standard classroom, avoidance of using power to

manipulate others, and so on. In an environment with models for aggression, sexual

or physical abuse, dishonesty, substance abuse, deviant sexual patterns, and

the like, the flavor of the psychopathic “stew” is set into a particular direction.

The most influential modern conceptualization has viewed psychopathy as

composed of two main factors (1 = Affective-Cognitive Instability, 2 = Behavioral-

Social Deviance) (Hare, Hart, & Harpur, 1991). This view has helped generate and,

in turn, has been facilitated by Hare’s Psychopathy Checklist-Revised (PCL-R), a

20-item assessment technique that uses self-report and interview observation data,

which are then cross-checked with collateral information. There has been considerable

debate in the research literature about whether the material covered by the

PCL-R could be better explained by three or even four factors (four factors now

being favored by Hare), rather than the traditional two. However, in each of these

The Personality Disorders 213

Case Studies in Abnormal Behavior, Eighth Edition, by Robert G. Meyer, L. Kevin Chapman, and Christopher M. Weaver. Published by Allyn & Bacon.

Copyright © 2009 by Pearson Education, Inc.

ISBN 0-558-51041-8

scenarios factor 1 is similar to the traditional concept, and is most reflective of true

psychopathy.

The following components contribute to factor 1 (the Affective-Cognitive Instability):

glibness, a grandiose sense of self, pathological lying, conning-manipulative

behaviors, lack of remorse, shallow affect, callousness and lack of empathy, and failure

to accept responsibility. Components of the Behavioral-Social Deviance (factor 2)

are a higher need for stimulation, a parasitic lifestyle, poor behavioral controls, early

behavior problems, lack of realistic goals, impulsivity, irresponsibility, having been

adjudicated delinquent, and a history of violating supervision or probation.

In general, research (Bartol & Bartol, 2008; Hare, Hart, & Harpur, 1991; Lykken,

1995) on the psychopath (much of which includes use of the PCL-R) indicates:

1. Although there is a decrease in criminal activity for psychopaths at about

ages 40 to 45, this effect holds primarily for nonviolent crimes. There is only a

slight decrease for violent crimes.

2. Concomitantly, while the Behavioral-Social Deviance factor starts to drop off

somewhere in the age range of 35 to 45, the Affective-Cognitive Instability

factor (closer to true “psychopathy”) lessens only slightly with age.

3. Similarly, the Behavioral-Social Deviance factor 2 is a good predictor of general

criminality and recidivism, is highly correlated with criminality, and is

negatively correlated with socioeconomic status and, to a lesser degree, IQ.

Factor 1 is a better predictor of violence, but it is virtually uncorrelated with

socioeconomic status and IQ.

4. Although treatment may effect a positive change in the average criminal, it seldom

does so with psychopaths, especially to the degree they are strong on factor

1, as was Ted Bundy. Indeed, there is evidence that psychopaths who are

high on factor 1 may in some instances get worse with treatment, thus group

and individual psychotherapy can be a “finishing school” for psychopaths

(Rice, Harris, & Cormier, 1992). True to their nature, true psychopaths seem to

learn little about themselves in therapy, but learn more about others, and then

more boldly use such information. At least in part this is because they are language

disordered, such that the emotional components of language are weak

or missing, voiding the likelihood of empathy or remorse.

5. In general, socioeconomic and family background variables are good predictors

of general criminal behavior, but they are relatively nonpredictive for

psychopathy, especially where it is loaded on the Affective-Cognitive Instability

factor.

6. Expect high factor 1s to be deceptive about virtually anything they report. To

the degree feasible, independent corroboration of any critical questions

about history or present behaviors is necessary (Boyd et al., 2007).

Identifying criminals is up to each of us. Usually they can be recognized by

their large cufflinks and their failure to stop eating when the man next to them

is hit by a falling anvil.

—Woody Allen, comedian and filmmaker

214 C H A P T E R E L E V E N

Case Studies in Abnormal Behavior, Eighth Edition, by Robert G. Meyer, L. Kevin Chapman, and Christopher M. Weaver. Published by Allyn & Bacon.

Copyright © 2009 by Pearson Education, Inc.

ISBN 0-558-51041-8

Proposed “Common Path” for the Development

of Psychopathy

As described by Meyer (Meyer & Brothers, 2001; Meyer & Weaver, 2007), the following

is an outline of the evolution of the psychopath-antisocial personality disorder:

Preexisting Risk Factors

1. Biological (genetic, prenatal, birth, or early childhood) disruption

2. Low SES (socioeconomic status)

3. Family history of vocational-social-interpersonal dysfunction

4. Family history of psychopathy

5. Characteristics of a FUMES child (see page 213) (i.e., fearless, unresponsive

to pain, mesomorphic, empathy-deficient, stimulation-seeking)

From Birth to School Age

1. Child temperament factors

a. Child’s lack of emotional responsiveness and lack of social interest foster

rejecting responses from parents

b. Child’s high activity levels may cause parental annoyance and elicit punitive

responses

c. Lack of responsiveness to physical punishment, emotional “numbness,”

and deficit in associating emotion in language learning result in failing to

learn behavioral contingencies and the consequences of destructive behaviors

on others

2. Parental factors

a. Inconsistent parenting results in child’s failing to learn behavioral contingencies

b. Aggressive, punitive parenting and/or family interaction result in child’s

modeling aggression, experiencing hostility, becoming enured to punishing

consequences, and developing a repressive defensive style (emotional

“hardness”)

3. Parent/child interaction

a. Unreliable parenting, along with defective “expressed emotion,” results

in insecure attachment (i.e., interpersonally “avoidant” attachment style);

child “goes it alone” rather than risk rejection and disappointment associated

with unreliable and/or abusive parents

4. Environmental factors (can occur anytime during life span)

a. High exposure from the media, to models (often likeable models) of violence,

amorality, and a variety of other deviant behaviors can lead to imitation

or at least disinhibition

b. Although not common, toxic levels of heavy metals, especially lead, facilitate

antisocial-aggressive patterns

c. Although not common, trauma and/or disease that results in some forms

of brain disorder, especially frontal lobe damage and especially if it occurs

at a very young age, can facilitate a loss of inhibitory behaviors

The Personality Disorders 215

Case Studies in Abnormal Behavior, Eighth Edition, by Robert G. Meyer, L. Kevin Chapman, and Christopher M. Weaver. Published by Allyn & Bacon.

Copyright © 2009 by Pearson Education, Inc.

ISBN 0-558-51041-8

School Age to Adolescence

1. Predisposing personality factors

a. Low baseline level of brain stem arousal (i.e., Eysenck’s biological extraversion)

contributes to impulsive, undercontrolled, and stimulationseeking

behavior

b. A combination of distorted physiological arousal, repressive psychodynamics,

and habitual “numbness” to social contingencies results in child

being insensitive to and unable to “condition” to environmental events;

therefore, the child does not learn or “profit” from experience and does

not relate to the experiences of others

c. Mesomorphic (muscular) and energetic components lead to increased

physical manipulation/control of others, and, along with stimulation seeking,

lead to increased risk taking

d. Commonly correlated Attention-Deficit Hyperactivity Disorder and/or

“soft” neurological disorder may exacerbate behavior problems

2. Personality development

a. Peer/teacher labeling may result in self-fulfilling prophecy effects

b. School failure and social failure result in sense of inferiority and increased

interpersonal hostility; child develops “moving against” interpersonal style

c. Initial forays into antisociality (e.g., theft, fire setting, interpersonal violence)

occur, often with some “success”; evidence for diagnosis of conduct

disorder mounts

Adolescence

1. The young psychopath hones exploitative style in order to express hostility

and “rise above” feelings of inferiority; “proves superiority” by hoodwinking

and humiliating teachers, parents, and peers

2. Continued antisocial behavior results in initial scrapes with the law

3. Increased use of physical and psychological aggression to control others

4. Physiological impulsivity, inability to profit from experience

5. A disordered cognitive-attentional style and interpersonal hostility and

antagonism combine to make repeated legal offenses highly probable

6. Contact with other antisocials in the context of juvenile-criminal camps or

prison results in “criminal education”; increased criminality results, accompanied

by a loss of the “time in place” that eventually brings accrued benefits

to those who stay in the “mainstream” of life; criminal and antisocial behavior

become a lifestyle at which the psychopath can “excel”

Adulthood

1. Antisocial behavior escalates through the psychopath’s late twenties; increasingly

frequent failure, rejection by others, and/or incarceration result in

increased hostility and hardened feelings

2. Unable to profit from experience, lacking in insight and empathy, and unable

to form therapeutic bonds, the psychopath becomes a poor therapy-rehab

risk and bad news for society

216 C H A P T E R E L E V E N

Case Studies in Abnormal Behavior, Eighth Edition, by Robert G. Meyer, L. Kevin Chapman, and Christopher M. Weaver. Published by Allyn & Bacon.

Copyright © 2009 by Pearson Education, Inc.

ISBN 0-558-51041-8

3. There is a crystallization of these underlying cognitive beliefs:

a. Rationalization: “My desiring something justifies whatever actions I need

to take”

b. The devaluing of others: “The attitudes and needs of others don’t affect

me, unless responding to them will provide me an advantage, and if they

are hurt by me, I need not feel responsible for what happens to them”

c. Low-impact consequences: “My choices are inherently good. As such, I

won’t experience undesirable consequences, or if they occur, they won’t

really matter to me”

d. Entitlement: “I have to think of myself first; I’m entitled to what I want

or feel I need, and if necessary, I can use force or deception to obtain

those goals”

e. Rule-avoidance: “Rules constrict me from fulfilling my needs”

4. Antisocial behavior decreases or “burns out” unevenly beginning in the midthirties

(although less so with violent offenses); this may be due to lengthier

incarcerations, to changes in age-related metabolic factors that formerly contributed

to sensation-seeking and impulsive behavior, or perhaps to decrements

in the strength and stamina required to engage in persistent criminal

endeavors

Treatment Options

The treatment problem with all the personality disorders—getting the client to

agree to therapy and then to become meaningfully involved—is acute with ASP,

and success is rare. As the British prime minister William Gladstone (1809–1898)

put it, “The disease of an evil conscience is beyond the practice of all the physicians

of all the countries in the world,” and this seems to include psychologists

and psychiatrists as well.

A variety of treatment possibilities have been suggested as appropriate for

the ASP. However, like Bundy, most have no interest in changing their behavior

and are in a treatment program only because they have been forced by circumstances

(Rice, Harns, & Cormier, 1992). Some antisocial personalities, usually those

with less factor 1 psychopathy, are changed as a result of treatment, and, as noted,

there are some changes as a result of aging. The great majority, however, are not

changed markedly by either their environment or by treatment techniques (Bartol

& Bartol, 2008)

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