History

Fact Explanation
Ego centrism and other impairments in self functioning of identity. Ego centrism is having or regarding the self or the individual as the center of all things. An individual with this personality also has self-esteem derived from personal gain, power, or pleasure and therefore attempts to get personal recognition regardless of others. According to DSM -5 to diagnose antisocial personality disorder, an individual must have a significant impairment in personality functioning in both self functioning and interpersonal functioning. Identity is one of the two categories in self functioning in which an impairment needs to be present to diagnose Anti social personality disorder.[1][2]
Impairments in self-direction Self direction is one of the two categories in impairment of self functioning, which is needed to diagnose antisocial personality disorder. Impairments in self direction include goal-setting based on personal gratification, absence of pro-social internal standards associated with failure to conform to lawful or culturally normative ethical behavior. [1][2][3]
Lack of empathy Empathy is the intellectual identification with or vicarious experiencing of the feelings, thoughts, or attitudes of another. The individual lacks concern for feelings, needs, or suffering of others and have no remorse after hurting or mistreating another. [3] Lack of empathy is an impairment in interpersonal functioning, which needs to cause significant impairment of personality functioning for diagnosis of antisocial personality disorder.[1][2]
Lack of intimacy The Individual has an Incapacity for mutually intimate relationships, as exploitation is a primary means of relating to others, including by deceit and coercion and use of dominance or intimidation to control others. Lack of intimacy is an impairment in interpersonal functioning, which needs to cause significant impairment of personality functioning for diagnosis of antisocial personality disorder.[1][2]
Manipulativeness Manipulativeness is the frequent use of subterfuge to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one's ends. It is one of the four pathological personality traits in the domain of antagonism, which is needed for a diagnosis of antisocial personality disorder to be made.[1][2][3]
Deceitfulness The individual displays dishonesty and fraudulence,misrepresentation of self and embellishment or fabrication when relating events. It is one of the four pathological personality traits in the domain of antagonism.[1][2]
Callousness Callousness is the lack of concern for feelings or problems of others, lack of guilt or remorse about the negative or harmful effects of one's actions on others.[3] Individuals with this personality trait also tend to display aggression and sadism. It is one of the four pathological personality traits in the domain of antagonism.[1][2]
Hostility The individual has persistent or frequent angry feelings, displays anger or irritability in response to minor slights and insults and demonstrates mean, nasty, or vengeful behavior. It is one of the four pathological personality traits in the domain of antagonism.
Irresponsibility The individual has disregard for – and failure to honor – financial and other obligations or commitments and displays lack of respect for – and lack of follow through on – agreements and promises. It is one of the three pathological personality traits in the domain of disinhibition, which needs to be demonstrated for a diagnosis of antisocial personality disorder to be made.[1][2]
Impulsivity The individual has a tendency to act on the spur of the moment in response to immediate stimuli, a tendency to act on a momentary basis without a plan or consideration of outcomes and difficulty establishing and following plans. It is the second of the three pathological personality traits in the domain of disinhibition.[1][2]
Risk taking tendency The individual tends to engage in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences due to boredom, proneness and thoughtless initiation of activities to counter boredom. This behavior also stems from a lack of concern for one's limitations and denial of the reality of personal danger. It is the third of the three pathological personality traits in the domain of disinhibition.[1][2]
References
  1. DSM-IV and DSM-5 Criteria for the Personality Disorders. American Psychiatric Association. 2012. [viewed on 06 June 2014] Available from: http://www.psi.uba.ar/academica/carrerasdegrado/psicologia/sitios_catedras/practicas_profesionales/820_clinica_tr_personalidad_psicosis/material/dsm.pdf
  2. Alternative DSM-5 Model for Personality Disorders. Focus [online] 2013 March [viewed 07 June 2014] Available from: doi:10.1176/appi.focus.11.2.189
  3. BATEMAN ANTHONY, BOLTON RORY, FONAGY PETER. Antisocial Personality Disorder: A Mentalizing Framework. Focus [online] 2013 March [viewed 07 June 2014] Available from: doi:10.1176/appi.focus.11.2.178

Examination

Fact Explanation
Mental State Examination: Appearance and Behaviour General appearance is normal with good self care. May display irritability and agitation due to low tolerance of frustration, but most often there will not be any apparent deviation from the behavior of a psychologically healthy individual.[1]
Mental State Examination: Speech Speech will be coherent rational and appropriate.[2]
Mental State Examination: Mood Mood can be euthymic or angry depending on how the individual perceives and tolerates the interview. Mood changes will be congruent and reactive.[1]
Mental State Examination: Thoughts No abnormalities in form or content of thought will be present. But significant disregard for others' feelings and well being, lack of guilt or remorse and ego centrism will be apparent.[1]
Mental State Examination: Perception No perceptual abnormalities are associated with antisocial personality disorder.
Mental State Examination: Cognitive functions Orientation,attention,concentration and memory will be within normal range. Intelligence will be normal or high, even though unsuccessful career records can be present due to lack of consistent striving towards a goal. [2]
Insight Will often not accept the presence of a disorder or need for treatment. Attempts to convince so, may result in resistance and hostility.[3]
References
  1. BATEMAN ANTHONY, BOLTON RORY, FONAGY PETER. Antisocial Personality Disorder: A Mentalizing Framework. Focus [online] 2013 March [viewed 07 June 2014] Available from: doi:10.1176/appi.focus.11.2.178
  2. Michael Gelder, Richard Mayou and John Geddes. Psychiatry. 3rd Ed. Oxford University Press. 2005
  3. MCRAE L. Rehabilitating antisocial personalities: treatment through self-governance strategies. J Forens Psychiatry Psychol [online] 2013 Feb, 24(1):48-70 [viewed 07 June 2014] Available from: doi:10.1080/14789949.2012.752517

Differential Diagnoses

Fact Explanation
Antisocial personality traits According to DSM-5, certain pathological personality traits and significant impairments in personality functioning in the categories of self and interpersonal functioning needs to be present for a diagnosis of antisocial personality disorder to be made. The impairments in personality functioning and the individual's personality trait expression should also be relatively stable across time and consistent across situations. An individual may have one or many of the personal traits associated with anti social personality disorder without them being significant enough to be classified into a personality diorder.[1]
Personality changes associated with adolescence and normal psychological development According to DSM-5 , an individual must be over the age of 18 and the impairments in personality functioning and the individual‟s personality trait expression should not better understood as normative for the individual‟s developmental stage for a diagnosis of antisocial personality disorder to be made.[1][2][3]
Personality changes associated with substance abuse Substance abuse is associated with changes in personality traits, especially personality traits classified under disinhibition. According to DSM-5, the impairments in personality functioning and the individual‟s personality trait expression should not be solely due to the direct physiological effects of a substance such as a drug of abuse, medication for a diagnosis of personality disorder to be made.[4]
Conduct diorders Conduct disorder is characterized by a pervasive pattern of antisocial and violent behavior in which the rights of others are violated. It is most common in adolescents and is associated with an increased risk of developing antisocial or borderline personality disorder and/or substance dependence.[2][3][5][7]
Schizioid personality disorder The individuals with schizoid personality disorder are emotionally cold, callous, self sufficient and detached.They have marked lack of concern for opinion of others and are insensitive. [6]
Paranoid personality disorder The individuals with paranoid personality disorder are sensitive, suspicious, touchy,irritable,argumentative and stubborn. they have a strong sense of self importance.[6]
References
  1. Alternative DSM-5 Model for Personality Disorders. Focus [online] 2013 March [viewed 07 June 2014] Available from: doi:10.1176/appi.focus.11.2.189
  2. MYERS MG, STEWART DG, BROWN SA. Progression from conduct disorder to antisocial personality disorder following treatment for adolescent substance abuse. Am J Psychiatry [online] 1998 Apr, 155(4):479-85 [viewed 07 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9545992
  3. OSGOOD DW, FEINBERG ME, GEST SD, MOODY J, RAGAN DT, SPOTH R, GREENBERG M, REDMOND C. Effects of PROSPER on the influence potential of prosocial versus antisocial youth in adolescent friendship networks. J Adolesc Health [online] 2013 Aug, 53(2):174-9 [viewed 07 June 2014] Available from: doi:10.1016/j.jadohealth.2013.02.013
  4. OSGOOD DW, FEINBERG ME, GEST SD, MOODY J, RAGAN DT, SPOTH R, GREENBERG M, REDMOND C. Effects of PROSPER on the influence potential of prosocial versus antisocial youth in adolescent friendship networks. J Adolesc Health [online] 2013 Aug, 53(2):174-9 [viewed 07 June 2014] Available from: doi:10.1016/j.jadohealth.2013.02.013
  5. MAGHSOODLOO S, GHODOUSI A, KARIMZADEH T. The relationship of antisocial personality disorder and history of conduct disorder with crime incidence in schizophrenia. J Res Med Sci [online] 2012 Jun, 17(6):566-71 [viewed 07 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23626636
  6. Michael Gelder, Richard Mayou and John Geddes. Psychiatry. 3rd Ed. Oxford University Press. 2005
  7. FAIRCHILD G, HAGAN CC, PASSAMONTI L, WALSH ND, GOODYER IM, CALDER AJ. Atypical neural responses during face processing in female adolescents with conduct disorder. J Am Acad Child Adolesc Psychiatry [online] 2014 Jun, 53(6):677-687.e5 [viewed 07 June 2014] Available from: doi:10.1016/j.jaac.2014.02.009

Management - General Measures

Fact Explanation
Develop a successful relationship among patient and psychiatrist/therapist. As insight is poor and treatment is often refused by patients with personality disorders building up an effective therapeutic relationship is crucial as the first step of management. [1][2]
Identification of provoking factors Patients need to be guided and encouraged to identify and find new ways of dealing with or avoiding provoking factors and situations which cause problems.[2]
Prevention of substance and alcohol misuse. Individuals with antisocial personality disorder may have a tendency to have substance or alcohol abuse and it may in turn provoke abnormal and aggressive behavior. [2][3]
Anger management Even though anger is not specifically included in the diagnostic criteria for antisocial personality disorder, anger may be related to impulsivity and aggression.[4][5]
References
  1. MCRAE L. Rehabilitating antisocial personalities: treatment through self-governance strategies. J Forens Psychiatry Psychol [online] 2013 Feb, 24(1):48-70 [viewed 07 June 2014] Available from: doi:10.1080/14789949.2012.752517
  2. Michael Gelder, Richard Mayou and John Geddes. Psychiatry. 3rd Ed. Oxford University Press. 2005
  3. MYERS MG, STEWART DG, BROWN SA. Progression from conduct disorder to antisocial personality disorder following treatment for adolescent substance abuse. Am J Psychiatry [online] 1998 Apr, 155(4):479-85 [viewed 07 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/9545992
  4. BATEMAN ANTHONY, BOLTON RORY, FONAGY PETER. Antisocial Personality Disorder: A Mentalizing Framework. Focus [online] 2013 March [viewed 07 June 2014] Available from: doi:10.1176/appi.focus.11.2.178
  5. MAGHSOODLOO S, GHODOUSI A, KARIMZADEH T. The relationship of antisocial personality disorder and history of conduct disorder with crime incidence in schizophrenia. J Res Med Sci [online] 2012 Jun, 17(6):566-71 [viewed 07 June 2014] Available from: http://www.ncbi.nlm.nih.gov/pubmed/23626636

Management - Specific Treatments

Fact Explanation
Cognitive and behavioral interventions (CBI) cognitive and behavioral interventions include reasoning and rehabilitation and enhanced thinking skills.They focus on current behavior and the patients role in changing their behavior.CBIs are often developed with the aim of reducing offending behavior.[1] [3]
Therapeutic community method This is used to guide individuals to learn from each others experiences of their relationships. [1][2]
Training in social skills and problem solving When combined with cognitive behavioral interventions, has a high efficacy.[1]
emotion recognition training (ERT) Involve interventions focused on increasing understanding and internalization of specific emotions. ERT across emotions and modalities has been found to be effective for reducing problematic behaviors.[1]
Mentalization-Based Treatment (MBT) MBT encourages mentalizing problems associated with high emotional arousal in the context of attachment relationships. MBT for ASPD focuses on: -Understanding emotional cues -Recognition of emotions in others -Exploration of sensitivity to hierarchy and authority -Generation of an interpersonal process to understand subtleties of others’ experience in relation to ones’ own -Explication of threats to loss of mentalizing which lead to teleological understanding of motivation[1]
References
  1. BATEMAN ANTHONY, BOLTON RORY, FONAGY PETER. Antisocial Personality Disorder: A Mentalizing Framework. Focus [online] 2013 March [viewed 07 June 2014] Available from: doi:10.1176/appi.focus.11.2.178
  2. Michael Gelder, Richard Mayou and John Geddes. Psychiatry. 3rd Ed. Oxford University Press. 2005
  3. MCRAE L. Rehabilitating antisocial personalities: treatment through self-governance strategies. J Forens Psychiatry Psychol [online] 2013 Feb, 24(1):48-70 [viewed 07 June 2014] Available from: doi:10.1080/14789949.2012.752517