Cluster B PD: Antisocial PD

Question 1

Main characteristics

Answer 1

• Disregard for the rights of others
• Violation of rights of others

Question 2

DSM Criteria

Answer 2

• 3 or more
  1. Failure to comform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
  2. Deceitfulness as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
  3. Impulsivity or failure to plan ahead
  4. Irritability and aggressiveness as indicated by repeated physical fights or assaults
  5. Reckless disregard for safety of self or others
  6. Consistent irresponsibility as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
  7. Lack of remorse as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
• At least 18 yrs old
• evidence for conduct disorder prior to age 15
• The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder

Question 3

Associated features

Answer 3

• especially important to integrate info from collateral sources
• Lack of empathy, inflated self appraisal, superficial charm\
• May be excessively opinated, self-assured, or cocky
• May display superficial charm and can be quite voluable and verbally facile
• May be irresponsible to parents (as well exploitative in their sexual relationships)

Question 4

Prevalence and gender

Answer 4

• Prevalence: 0.2-3.3%
• Much more common in males

Question 5

Cultural considerations

Answer 5

• Low SES
• Living in urban settings (both contribute to disproportionate dx of POC)

Question 6

Early signs

Answer 6

• Conduct disorder is required
• Early signs of cruelty, aggression, lying, theft, and rule-breaking
• Environmental factors: child abuse or neglect, incosistent, unstable, or harsh parenting, lack of supervision
• Genetic risk is higher in biological relatives
  
  • Males more likely to develop ASPD and substance use issues
  • Females from same families may develop somatic symptom disorder

Question 7

Differential diagnosis

Answer 7

Conduct Disorder (before age 18) — ASPD is not diagnosed under 18; CD must have been present prior.

Substance Use Disorders — ASPD should only be diagnosed if traits were present before and during substance use.

Schizophrenia/Bipolar Disorder — Exclude ASPD if antisocial behaviors occur only during active episodes.

Narcissistic PD — Both exploitative and lack empathy; ASPD includes impulsivity, aggression, deceit; NPD craves admiration.

Histrionic PD — Both can be manipulative; histrionic individuals use manipulation for attention/nurturance, not material gain.

Borderline PD — BPD is more emotionally unstable and manipulative for nurturance; ASPD is more aggressive and calculating.

Paranoid PD — Antisocial acts stem from revenge, not exploitation.

Criminal Behavior Without PD — ASPD must show personality traits, not just isolated criminal behavior.