Hello people, welcome back to the blog, people! I hope everyone had a fantastic father’s day. Last week, we started getting into the signs and symptoms of personality disorders. We talked about the Cluster A odd and eccentric disorders: paranoid, schizoid, and schizotypal personality disorders. This week, we’ll be getting into Cluster B disorders, the dramatic and erratic disorders.
Cluster B disorders are characterized by overly emotional or unpredictable thinking or behavior, and include antisocial personality disorder, borderline personality disorder, histrionic personality disorder, and narcissistic personality disorder. People with these disorders typically have difficulty regulating their emotions, as well as maintaining relationships, as others often see their behaviors as threatening or disturbing. Treating any personality disorder is challenging, but Cluster B has some of the most difficult to treat disorders for a variety of reasons, not the least of which is the stigma associated with the diagnosis. Another factor has to do with the affected person’s propensity to give an inaccurate account of signs and symptoms. These can be especially true for antisocial personality disorder or ASPD.
Antisocial personality disorder is characterized by a pervasive pattern of disregard for the rights of others. People with this disorder consistently show no regard for right and wrong, and ignore the feelings of the other people around them. This generally begins in childhood or early adolescence and continues into adulthood. After treating many people with ASPD, I can tell you that they can be the most charming, entertaining, witty, and fun to be around people you’ll ever meet. But in severe cases, they can live to exploit others in something akin to sport. ASPD makes people uncaring. They can act rashly, unsafely, and destructively, without an ounce of guilt when their actions hurt other people. That may even be the goal. They tend to be callous, cynical, and contemptuous of the feelings of others. They can be very manipulative, and due to these tendencies, it’s often difficult to tell whether they’re lying or telling the truth.
Speaking of, let me correct a myth. Two common terms affiliated with ASPD are psychopath and sociopath, but these terms are not interchangeable. Neither psychopath or sociopath are actual diagnoses in the world of psychiatry. They are colloquial terms to describe people with impulsive or reckless personalities who lack empathy for others. A psychopath is someone whose actions more tend to reflect calculation, manipulation, and cunning. They are deceptively charismatic and charming, and tend to mimic rather than experience emotions. They can do so with ease, as this is their stock in trade. By contrast, sociopaths are more able to form attachments to others, but they still tend to act insensitively, or in an unfeeling manner, and generally disregard social rules. They are also more easily agitated, and have a tendency to be more impulsive. Psychopaths are usually thought of as more deviant and violent, and less likely to blend into society than sociopaths. Everyone has their own definitions of the words psycopathy and sociopathy, and they probably come from movies and television. In reality, in the world of psychiatry, both carry a diagnosis of ASPD, and psycopathy is just a very severe form of ASPD. These are the individuals I was referring to that can be the most charming. Believe me, they make it easy to want to lower your guard, but with some, you may do so at your peril.
ASPD signs and symptoms may include:
-Disregard for right and wrong
-Persistent lying or deceit to exploit others
-Callous, cynical, and disrespectful of others
-Applying charm or wit to manipulate others for personal pleasure
-Arrogance, a sense of superiority, extremely opinionated
-Lack of compassion and empathy for others
-Unremorseful when confronted with wrongdoing
-Inability to admit mistakes
-Bullying demeanor, use threats to deal with personal conflict
-Impulsiveness or failure to plan ahead
-Unnecessary risk-taking or dangerous behavior
-No regard for the safety of self or others
-Instability when it comes to work and home life
-Hostility, irritability, agitation, aggression, intimidation, violence
-Consistently irresponsible and repeatedly fail to fulfill work or financial obligations
-Mental health issues, may include talk of suicide or threatening suicide
ASPD affects approximately 2 to 4 percent of the population, often occurs alongside problems with drugs and alcohol, and is much more common in men. Some research has suggested when ASPD does develop in women, the condition may become more severe; and women with ASPD are even more likely to abuse substances than men. That said, research also indicates antisocial behavior may persist longer in men, and men with ASPD have an increased risk of early death. People with ASPD frequently fail to consider the negative consequences of their behavior, and they don’t generally learn from them either. In addition, they often violate the law, and behave violently or impulsively, becoming criminals. They are commonly unable to fulfill daily responsibilities related to family, school, or work. For all of these reasons, the highest prevalence of ASPD- 70 percent- is found among males who are in jails, prisons, or similar institutions.
The risk factors associated with ASPD have been better studied than some of the other personality disorders. The genetic component applies, especially family history of ASPD or another personality disorder. But of note, adults with ASPD typically show symptoms of another disorder in childhood called conduct disorder, before the age of 15. Signs and symptoms of conduct disorder include serious, persistent behavioral problems, such as aggression toward people and animals, serious violation of rules, destruction of property, lying, cheating, and theft. Although ASPD is considered lifelong, in some people, there are certain symptoms- especially destructive and/ or criminal behavior- that may decrease over time. It’s not very clear on whether this is due to aging, or an increased awareness of the consequences of their behavior. Speaking of, some of the complications associated with ASPD can include homicidal or suicidal behaviors, low social and economic status, homelessness, and premature death, usually as a result of violence. Behaviors have consequences, that’s the lesson many people with ASPD fail to learn.
Like anything else, symptoms occur on a spectrum, and vary in severity. ASPD doesn’t have to mean a person is violent or evil. The stigma associated with personality disorders in general, and ASPD in particular, may make it even more difficult for people who want to improve to get the help they need. More than 90 percent of people diagnosed with ASPD also live with another mental health issue, most often depression and/ or anxiety. Early intervention may be the key to treatment, so the ability of caregivers and educators to spot childhood conduct disorder is important. Negative attitudes toward “delinquents” may reinforce ideas such as, “I’m bad,” “I’ll never amount to anything,” or “No one cares what happens to me,” and these play a role in the development of ASPD.
When people with ASPD do enter treatment, it’s more often to get help for a co-occurring condition, or because a legal authority or family member has required to do so. Among those who do get help, many drop out of treatment early. Negative attitudes and ineffective treatment methods can contribute to this. It’s important for people with ASPD to work with therapists who are willing to try a range of approaches to find the most effective treatment. A key factor in successful therapy is recognizing individual fault. People with ASPD who can’t admit or accept that their actions are harmful may not be able to improve. Exploring state of mind, including emotions, desires, and feelings toward others is critical for progress. Once the person better understands their thoughts, they can use this understanding to address their impulses, and potentially help control them. Research has shown treatment can help improve many of the behaviors associated with ASPD, with the strict caveat that the person is willing to work toward change. When successful, treatment not only improves the quality of life for the person with ASPD, it also has a positive impact on the people in their lives.
Next week, we’ll continue with cluster B disorders, starting with borderline personality disorder.
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