Antisocial PD - lecture 7

Question 1

General info

What are the general characteristics of ASPD?

Answer 1

Impulsivity, Irresponsibility, Criminal behavior

Question 2

What are the diagnostic criteria for ASPD?

Answer 2

• Failure to conform to social norms in regards to lawful behaviors
• Deceitfulness (e.g. repeated lying, using aliases, conning others for personal profit or pleasure)
• Impulsivity or failure to plan ahead
• Irritability or aggressiveness (indicated by repeated fights
• Disregard for safety of self and others
• Consistent irresponsibility (failure to sustain constant work behavior, failure to honor work obligations
• Lack of remorse -> Indifference about others or rationalizing their mistreatment

Question 3

What are the prevalence rates?

Answer 3

• General population: 0.2 - 3.3%
• Forensic samples: 30%
• Higher in men than in women
• Over 15 years prevalence of ASPD has doubled among youth in America

Question 4

When do ASPD-like behaviors start?

Answer 4

Usually in childhood or adolescence.
(What diagnosis does this usually lead to? = Conduct Disorder)
- CD prior to age 15 is a prelude to adulthood ASPD

Question 5

What are some other terms that have been used to describe ASPD?

Answer 5

Sociopathy, psychopathy, or dissocial personality disorder

Question 6

What are the different definitions of sociopathy?

Answer 6

• According to sociologists, it refers to the spectrum of low/no conscience disorders that come about from learned behavior, and not innate pathological tendencies
• Others refer to patterns of attitudes and behaviors that are considered antisocial and criminal by society at large but are regarded as normal/necessary in some subcultures or social environments in which these behaviors developed
  !!! The second definition implies that sociopaths have a conscience and a capacity for empathy, guilt and loyalty. These feelings are just expressed according to how and when they learned to express it based on their environment !!!

Question 7

What is the difference between ASPD and psychopathy?

Answer 7

Psychopathy also includes personality traits such as lack of empathy, grandiosity and shallow emotion

Question 8

What are the factors of psychopathy?

Answer 8

• Factor 1 (PRIMARY PSYCHOPATHY): affective/interpersonal
  -> Affective = lack of guilt/remorse, emotionally shallow, callous (lack of empathy), failure to accept
  responsibility for actions
  -> Interpersonal = superficial charm, grandiose, pathological lying, conning/manipulative
• Factor 2 (SECONDARY PSYCHOPATHY): antisocial/lifestyle
  -> Antisocial = poor behavioral control, early behavioral problems, juvenile delinquency, revocation of conditional release, criminal versatility
  -> Lifestyle = need for stimulation, lack of realistic long term goals, parasitic lifestyle, impulsivity, irresponsibility
• Other:
  -> Promiscuous sexual behavior
  -> Many short-term relationships

Question 9

What are the 4 dimensions to study psychopathy?

Answer 9

• Identity
• Self-direction
• Empathy
• Intimacy

Question 10

Identity

Answer 10

Egocentrism, self-esteem derived from personal gain, power, pleasure etc.

Question 11

Self-direction

Answer 11

Based on personal gratification, absence of normative ethical behaviors

Question 12

Empathy

Answer 12

Lack of concern for others and lack of remorse

Question 13

Intimacy

Answer 13

Incapacity for mutual relationships and exploit others, use domination or intimidation

Question 14

What is NOT and what IS related to antisocial behavior?

Answer 14

NOT:
- The ability (or lack of it) to socialize
- Not a description of those who are shy, inhibited, reclusive, withdrawn etc.
IS: A rebellion against society and denial of your obligations towards others

Question 15

History - 1800’s

What did Pinel speak of which is considered the first description of antisocial behavior?

Answer 15

“Mania without delirium” -> People exhibit explosive and irrational violence but understand their actions and surroundings

Question 16

What did James refer to with moral insanity?

Answer 16

He explained the difference between willful behavior that violates social norms and what we consider madness.

Question 17

What does Koch’s psychological inferiority refer to?

Answer 17

It’s a term used to describe behavior that was a reaction against society and a rejection of its rules and obligations

Question 18

History - 1900’s

What did Kraeplin replace psychological inferiority with?

Answer 18

Psychopathic personality.
Defined it using seven types:
- excitable
- unstable
- eccentric
- liars
- swindlers,
- antisocial
- quarrelsome
Later, another guy (Schneider) extended this to include 10 subcategories (including those who caused suffering to others, themselves, or both)

Question 19

What was Henderson’s book “The mask of sanity” about?

Answer 19

It has the first coherent description of personality

Question 20

When was the term ASPD introduced?

Answer 20

DSM - II, but was finalized as we know it in the DSM-III

Question 21

What did Robert Hare develop?

Answer 21

Psychopathy checklist (Revised) -> PCL-R
- Has 20 items scored from 0 (not present) to 2 (clearly present)
- If you score above 26 or 30 = psychopathy

Question 22

Development and causes

What are the three main views on the development of ASPD?

Answer 22

• Those who believe it develops through social and environmental factors (they believe ASPD is similar, if not equal to ASPD)
  -> They believe the disorder is acquired through learned conditioning, such as exposure to pathological environments
• Those who believe the condition derives from a number of biological and generic factors (they believe ASPD is similar, if not equal to ASPD)
• cause in today’s highly mobile society, wherein individual accountability to family, community, and moral standards has been diminished, which may present fewer restraints in relatively anonymous urban settings (Not so important as the other two)

Question 23

What were the findings of family and relative studies on ASPD?

Answer 23

• adopted as well as biological children of antisocial parents face an increased risk of having this disorder and having criminal behavior as adults.
• Heritability of 54%
• Biological relatives of individuals with
  ASPD are also more likely to develop substance-abuse disorders and somatization disorder
• 67% concordance rates in identical twins

Question 24

What have been some findings regarding the heritability of ASPD?

Answer 24

!!! In general, generic factors play at least an important role in the disorder !!!
- 8 sociopathic symptoms were heritable

Question 25

What have been some findings regarding the role of parents in the development of ASPD?

Answer 25

The following two factors lead to the development of ASPD - maternal deprivation during the child’s first five years, leading to insufficient nurturing and socialization - having an antisocial or alcoholic father

Question 26

# Effects and Costs What are the effects of people with ASPD on society and the costs of their harm?

Answer 26

- Breaking the law -> In prison populations, 60% have ASPD -> 20% of male and female prisoners are sociopaths, responsible for more than 50% of the crimes -> Recidivism among those with ASPD is double that of other offenders - Cost estimates for their crimes: 250-400 billion - At a higher risk of dying from unnatural causes (e.g. suicide, accidents, murder etc.) - Poor interpersonal relationships and negative conssequences for others

Question 27

# In society in general How else does ASPD present in society?

Answer 27

- They don't just violate social norms, but they perform a variety of behaviors that constitute significant violations of the criminal code - Commit economic crimes

Question 28

What are some characteristics about those with ASPD?

Answer 28

- Salient feature of the criminal behaviors performed by antisocial individuals is not necessarily the violence of the behavior but the blatant disregard for others - Does not matter how often or how much the rights of these others are violated because they are not important enough to count for anything other than what they can give to the antisocial perpetrator -> Level of unimportance though isn't the same for everyone: People belonging to the same group as the person with ASPD may have a slightly more important position for the person with ASPD -> Examples are leaders of cults

Question 29

# At Work How does ASPD show itself in the workplace?

Answer 29

- Irresponsible work behavior and financial irresponsibility: -> Repeated absences from work that are not illness related -> Borrow money from coworkers without repaying debt - Contempt for the rights and feelings of others paired with an inflated and arrogant appraisal of themselves -> regard themselves as too smart or too important to perform ordinary work activities -> individuals’ behaviors may come across as excessively opinionated and self-assured, or even cocky, contributing to a negative work atmosphere !!! But, when paired with superficial charm and verbal facility, they may impress their supervisors leading to undeserved promotions. This leads them to be able to be successful in the workplace many times, when you'd expect them not to be able to !!!

Question 30

What is the result of the behavior of people with ASPD in the workplace?

Answer 30

Dismissal from work or job termination. Because of individuals’ inflated self-appraisals and lack of insight into their own shortcomings, any reason for termination will be interpreted as undue and unjustified punishment. This might lead to acts of revenge and punishment

Question 31

# In relationships What is observed in those with ASPD (more specifically, sociopaths) regarding relationships?

Answer 31

Although they can't genuinely fall in love, intelligent people with these problems with may become with practice fluent in conversational emotion.

Question 32

What is the Sociopath-Empath-Apath-Triad (SEAT)?

Answer 32

In order to be successful in their schemes, antisocial individuals use the help of other people, the "apaths" - The apath shows indifference to the targeted person - Requirement for the apath is that he or she has some connection to the sociopath's target - Apath's conscience sees to go to sleep when interacting with the sociopath (similar to how people blindly follow a leader, evidenced by Milgram's experiments)

Question 33

In the SEAT tried, who are "empaths"?

Answer 33

The most frequently targeted people from those with ASPD - They have a greater than average ability to empathize - Since they are vulnerable to other people's distress they have difficulty comprehending that other people may lack compassion for others, making them the perfect target for those with ASPD - If empaths sense something's going wrong in the person with ASPD, that poses a threat. But this threat also makes the sociopath more interested since the empath poses a challenge

Question 34

# Theory and Research What gene has been shown to play an important role in the development of ASPD?

Answer 34

The gene that encodes the the monoamine oxidase A (MAO-A). This monoamine is responsible for breaking down neurotransmitters such as serotonin and norepinephrine. Variants in this gene that lead to reduced MAO-A production have associations with aggressive behavior

Question 35

What combination of genes and environment leads to antisocial behavior?

Answer 35

Early maltreatment and negative experiences as well as the low activity variant of the MAO gene (MAO-L) than the high one -> MAO-L leads to lower levels of serotonin which might contribute to antisocial behaviors

Question 36

What has been found regarding evoked potentials to emotional words in people with ASPD?

Answer 36

- Evoked potentials show that normal people react to emotional words more rapidly and intensely than to relatively neutral words - People with ASPD show no difference in evoked potentials between neutral and emotional words

Question 37

What has been found regarding blood flow to temporal lobes in those with ASPD?

Answer 37

They have increased blood flow compared to controls when faced with a task that involves emotional words, indicating processing emotional stimuli is as if asking them to figure out a difficult problem (whereas in controls it's instantaneous and automatic processing these words)

Question 38

Findings on specific brain regions?

Answer 38

- Damage to PFC and reduction of gray matter in it -> associated with inability to make morally and socially acceptable decisions, low arousal, poor fear conditioning, lack of conscience, and deficits in decision making that characterize psychopathic behavior - Damage to amygdala might interfere with the PFC's ability to interpret feedback from the limbic system. This results in uninhibited signals manifested in violent and aggressive behavior - Reduced gray matter in temporal lobes as well (thinner cortices in another 12 brain regions in general)

Question 39

What is a myth regarding psychopathic individuals?

Answer 39

That their intellect is above average. Actually, ASPD is related to lower IQ and SES

Question 40

What patterns of activity have been observed in people with ASPD?

Answer 40

- Increased activation of PFC and amygdala, reflecting them needing greater effort to make emotional associations - Decreased activation of amygdala when viewing images of moral violations (dissociation from such actions)

Question 41

# Treatment What is the general prognosis of ASPD?

Answer 41

Chronic disorders that rarely remits

Question 42

How do people with ASPD respond to treatment?

Answer 42

In general they don't respond well to treatment. - Group therapy might be helpful at times - But there are high dropout rates - Involuntary therapy holds an even smaller rate of success - Medication is used to reduce associated symptoms of anxiety and depression

Question 43

What can we do to treat ASPD, given that treatment of it is so difficult?

Answer 43

Because there are no standard treatments for ASPD, it is important to identify coexisting problems that can respond to intervention - helps reduce some antisocial behaviors and prepare the person for the more complicated task of addressing ASPD