Antisocial Personality Disorder Treatment

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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Genetic Factors In Personality Disorders

As already noted, the findings of behavioral genetic research justify a search for biological markers associated with personality disorders. In addition to neurotransmitter activity, suggestive findings have emerged from neurophysiological and neuropsychological research. The most consistent results demonstrate functional abnormalities in prefrontal cortex associated with traits of impulsive aggression. Raine, Lencz, and Bilhul (2000) reported decreases in the mass of frontal gray matter in subjects with antisocial personality. Patients with antisocial and borderline personality demonstrate deficits in executive function as measured by the Wisconsin Card Sorting Test (O'Leary, 2000). Traits associated

Psychological Factors In Personality Disorders

A famous follow-back study of children with conduct disorder (Robins, 1966) found that the strongest predictor of adult antisocial personality among conduct-disordered children was parental psychopathy (usually in the father). This association has also been supported by other researchers (Farrington, 1998). Similarly, first-degree relatives of patients with borderline personality disorder have increased levels of impulsive spectrum disorders (Links, Steiner, & Huxley, 1988 Zanarini, 1993). The precise mechanism of these relationships is unclear (it could involve inheritance, modeling, or pathological parenting). To separate the effects of personality traits common between parents and children from the effects of family dysfunction, research designs are needed in which temperament is controlled for. An ongoing study (Dionne, Tremblay, Boivin, Laplante, & Perusse, 2003) has been prospectively following large cohorts of monozygotic and dizygotic twins beginning in early childhood, but...

Social Factors In Personality Disorders

Answering these questions requires transcultural epidemiological research. The largest community surveys, such as the Epidemiological Catchment Area Study (Robins & Regier, 1991) and the National Comorbidity Survey (Kessler et al., 1994), have examined only antisocial personality disorder (with behavioral symptoms that are readily measured). The upcoming International Comorbidity Study will make use of a previously validated instrument, the International Personality Disorder Examination (Loranger et al., 1994), to determine the prevalence of borderline personality disorder. The strongest evidence for sociocultural factors in personality disorders has come from cohort effects (changes in prevalence over short time periods). Antisocial personality, as well as other impulsive spectrum disorders, has become more common in adolescents and young adults, both in North America and Europe, since World War II (Rutter & Smith, 1999). Cross-cultural studies have also supported the importance of...

Etiology Of Identity Diffusion

The lack of integration of the concept of self and of significant others also interferes with the internalization of the early layers of internalized value systems, leading particularly to an exaggerated quality of the idealization of positive values and the ego ideal, and to a persecutory quality of the internalized, prohibitive aspects of the primitive superego. These developments lead, in turn, to a predominance of splitting mechanisms at the level of internalized value systems or superego functions, with excessive projection of internalized prohibitions, while the excessive, idealized demand for perfection further interferes with the integration of a normal superego. Under these conditions, antisocial behavior may emerge as an important aspect of severe personality disorders, particularly in the syndrome of malignant narcissism, and in the most severe type of personality disorder, namely, the antisocial personality proper, which evinces most severe identity diffusion as well...

The Heritablity of Personality Traits

Four factors were extracted from all five matrices. The first factor, Emotional Dysregu-lation, representing unstable and reactive affects and interpersonal problems, resembled neuroticism as measured by the NEO-PI-R (Costa & McCrae, 1992 Schroeder, Worm-worth, & Livesley, 1992) and the Eysenck Personality Questionnaire (EPQ Jang & Lives-ley, 1999) and the DSM-IV diagnosis of borderline personality disorder. The second factor, Dissocial Behavior, which was negatively correlated with NEO-PI-R agreeableness, described antisocial traits. The factor resembled the DSM-IV antisocial personality disorder, Eysenck's psychoticism, and Zuckerman's impulsive-sensation seeking. The third factor, Inhibition, was defined by intimacy problems and restricted expression of inner experiences and feelings. The factor correlated negatively with NEO-PI-R and EPQ extraversion and resembled the DSM-IV avoidant and schizoid personality disorders. The fourth factor, Compulsivity, clearly resembled NEO-PI-R...

Partnership and Adult Lifestyle

If the delinquent behaviour persists into adulthood, this may indicate an antisocial personality disorder or the more narrowly defined psychopathy (Hare, 1995, 2001). In these cases, deviant behaviour is very hard to modify (Losel, 1998). Such chronic delinquents often have difficulties in forming stable intimate relations or they chose partners that have similar problems (Quinton et al., 1993). Although most criminal careers fade out after the age of 40, other difficulties such as alcoholism, chronic unemployment, psychiatric problems and violence in the family often continue (Farrington, 1989). Such lifestyles, and the inheritance of genetic information create, in turn, developmental risks for the next generation. But, again, this is not necessarily a closed cycle and depends on interactions with protective factors and mechanisms.

The Fivefactor Model In The Service Of Dsmiv Categories

DSM-IV diagnoses are based on the presence of a specified number of criteria from a defined set. For example, a paranoid PD diagnosis requires the presence of four or more of seven criteria, such as persistently bears grudges. Self-report PD instruments such as the PDQ-4+ (Hyler, 1994) typically formulate these criteria into questionnaire items and generate categorical diagnoses by using DSM-IV rules about the number of endorsements necessary to cross the diagnostic threshold. There is no directly comparable way to score PDs from trait data, such as the facets in the Revised NEO Personality Inventory (NEO-PI-R), because for the most part there is no one-to-one correspondence between traits and criteria. A disagreeable person is likely to hold grudges, but some disagreeable people do not. To establish a DSM-IV diagnosis, the clinician must ascertain for this particular patient whether he or she holds grudges. There are 80 such criteria in the DSM-IV (plus 14 others if the provisional...

The Construct Of Psychopathy

Influenced by psychodynamic and sociological interest in crime, North American concepts of psychopathic, sociopathic, or antisocial personality focused on a narrower and specific kind of socially deviant person while emphasizing a constellation of deviant Somewhat inconsistently, Cleckley regarded the DSM-II category of antisocial personality disorder as a fair summary of psychopathy. This category included the attributes of chronically antisocial and hedonistic excluded from his own concept. However, these three concepts may emphasize different, though related, personality constructs. Several of Cleckley's criteria, for example, appear in current descriptions of histrionic personality disorder (superficial charm, egocentric, emotionally shallow, suicide gestures, impersonal sex life). On the other hand, the McCords' focus on persistently antisocial behavior resulting from a craving for excitement reflects a hypothesis common in criminology that criminality results from impulsivity or...

Psychopathy As Personality Disorder

Cleckley's acceptance of DSM-II antisocial personality and his concept of a distinct clinical entity encouraged the assumption that psychopathy is currently represented in DSM-IV, albeit inadequately, by the APD category. PCL-R criteria were, in fact, considered as a replacement for APD in DSM-IV (Hare, Hart, & Harpur, 1991). However, psychopathic traits appear in other personality disorders, notably narcissistic (grandiosity, lack of empathy) and histrionic (superficial charm, insincerity, shallow affect, egocen-tricity). DSM-IV adds that narcissistic disorder shares with APD the traits of tough-mindedness and exploitativeness, while impulsivity, excitement seeking, recklessness, and manipulativeness are common to both histrionic disorder and APD. Apart from criteria of seeking admiration or attention, histrionic and narcissistic disorders are distinguished from APD by usually lacking a history of conduct disorder or criminality. Given that criminal behavior was not intrinsic to...

Psychopathy As Human Variation

The construct is also clearly biased by explicit and implicit value connotations. The shift from the earlier concept of psychopathic personality as a psychologically damaged person (i.e., suffering from psychopathology) to one of a socially damaging individual represented a morally biased conception of psychopathic personality as a type of criminal rather than a form of abnormal personality (Blackburn, 1988). This became most explicit in the pejorative antisocial personality, an enemy of society. Interpersonal styles express fundamental motivational concerns, and in interpersonal theory, interpersonal behavior sends signals to others that function to elicit anticipated reactions. For example, a coercive individual has learned to expect hostile-dominant reactions from others and behaves in ways that get them. This has affinities with Millon's suggestion that the aggression of antisocial personalities is a preemptive counterattack in the face of anticipations that others will exploit...

Psychological Theories

According to Millon (1981, 1996), the development of any personality disorder, including BPD, is a function of biological, psychological, and social factors. Borderline personality disorder, in Millon's conceptualization, is a dysfunctional, or extreme, variant of dependent, histrionic, and passive-aggressive personality disorders. As such, the etiology, including biological underpinnings and psychosocial experiences, is related to the subtype. The more dependent types generally have more sluggish temperaments and a history of being overnurtured (with the inevitable metamessage that the child is incompetent and requires care). The more histrionic types have highly active temperaments and were reinforced for performing for their parents and others. The passive-aggressive (negativistic) types tend to have moody, irascible temperaments and were raised with extreme inconsistency. In all cases, repeated failures of their attempts to cope with the world have led to increasing desperation....

Implications For Assessment

The use of objective personality tests such as the Millon Clinical Multiaxial Inventory can certainly be of assistance in such a quest. In using such tests, however, the psychologist must be careful not to misinterpret characterologic findings as premorbid traits without considering the possibility that any posttrauma psychometric assessment may be yielding data on the person's extant posttrauma character style. Interviews with friends and family members should always be conducted to ascertain some sense of the premorbid personality and determine how those findings compare with posttrauma psychometric data. For example, could it be that posttraumatic objective assessment findings of an aggressive personality (or even an antisocial personality) are more consistent with a fighting back posttraumatic compensatory style, rather than a pretraumatic personality disorder Could it be that posttraumatic objective assessment findings of an avoidant personality are more consistent with a...

Issues In Translation Of Personality Scales

Paranoid), eight basic personality patterns (schizoid, avoidant, dependent, histrionic, narcissistic, antisocial, compulsive, and passive-aggressive), and two correctional scales of denial versus complaint. The instrument identifies or calculates whether a patient is or is not a member of a diagnostic entity. Each scale is composed of a number of items. The raw score is transformed into base rate scores, and a conversion is determined by known prevalence data and by using cutting lines designed to maximize correct classification. The MCMI-I uses an item overlap keying for theoretical, practical, and empirical reasons. Because it is based on Millon's theory on psychopathology, you might expect that the avoidant and the dependent personalities share some common basic features, a finding gauged by empirical covariations. By using item overlap, the number of items in the 20-scale inventory could be kept to a minimum.

Psychotherapeutic procedures

The basis of the treatment program is a four-step procedure developed, practiced and described by LoPiccolo and Friedman (1988). As almost every treatment program aimed at sexual dysfunctions, the LoPiccolo and Friedman program is heavily influenced by the work of Masters and Johnson (1970). It is also, in one way or another, influenced by a series of speculations as to the cause of low sexual desire. The number of potential causes listed by LoPiccolo and Friedman (1988) is impressive indeed, and goes far beyond my previous discussion of etiology. The potential causes are religious orthodoxy, anhedonic or obsessive-compulsive personality, problems with gender identity or object choice, sexual phobias and aversions, fear of loss of control over sexual urges, masked sexual deviation, fear of pregnancy, depression, side effects of drugs, concerns about aging, lack of attraction to the partner, poor sexual skills in the partner, marital conflict, fear of closeness, couple differences...

Self Psychologically Influenced Framework For Personality Disorders

Crucial imperative in the histrionic, dependent, and antisocial personality disorders if a compensatory structure can be acquired. The prototypic disorder of the self, narcissistic personality disorder, can represent any of these three mechanisms, and admixtures also are not uncommon. Finally, preserving a stable or anchored self through idealization or twinship may represent struggling with a destabilized self that is fragile but still holding steady because a compensatory structure has been formed. Compensatory structures are ways of repairing self-cohesion when mirroring deficits have become too pronounced or extensive to be overcome. Forming a compensatory structure is based on there being a strong enough alternative route to cement self-cohesion when the damage in the mirroring sector is beyond repair. Usually taking the form of idealization or twinship, compensatory structures are not fleeting or temporary adjustments. Rather, they represent stable psychologically sustaining...

Early Onset Course And Outcome In Personality Disorders

Well before the development of diagnosable disorders, children may express their vulnerability through early behavioral disturbances. Children at the age of 3 with unusually high levels of aggression and irritability have been shown to be at risk for antisocial personality disorder in early adulthood (Caspi, Moffitt, Newman, & Silva, 1996). When conduct symptoms begin earlier in childhood and are more severe, antisocial personality is likely to develop in adulthood (Zoccolillo, Pickles, Quinton, & Rutter, 1992). However, environmental factors are equally important, and conduct disorder is one of the few diagnoses in psychiatry with a large shared environmental component (Cadoret et al., 1995).

Natural History And Longterm Outcome In Personality Disorder

Data on the natural history of personality disorders are skewed towards the most severe cases and most of these have been identified in psychiatric hospitals and forensic settings. Furthermore, most of the follow-up studies in this area are not really accounts of the natural history of these disorders, but are reports of long-term outcome after variable degrees of widely divergent interventions. Borderline and antisocial personality disorders have attracted particular attention because the impulsive and destructive behaviour of these individuals causes such concern among both carers and society in general. As noted above, borderline patients often make heavy demands on the health service. In contrast, individuals with antisocial Stone (2001) reviews the available data on the natural history and long-term outcome of personality disorders, noting that individuals within the 'antisocial realm' historically constituted a diverse group incorporating those meeting criteria for DSM...

Gene Stress Interaction Life Events and Other Natural Stressors

Two exceptions are literatures generated by two early gene-environment studies (Caspi et al, 2002, 2003), in which a sufficient number of investigations testing the same hypothesis are available to evaluate the replica-bility of gene-stress interactions. In the first of these, the initial study found self-rated aggressiveness, conduct disorder, symptoms of adult antisocial personality disorder, and commission of a violent crime potentiated by childhood maltreatment among males with low-transcription variants of a functional promoter polymorphism of monoamine oxidase-A (MAOA), relative to men having an alternate, high-activity MAOA allele (Caspi et al, 2002). Two meta-analyses, the latter of which included the initial study and seven attempted replications, have now been reported (Kim-Cohen et al, 2006 Taylor and Kim-Cohen, 2007). In the second meta-analysis, the authors derived the correlation of adversity with antisocial outcomes for each MAOA genotype and expressed the MAOA x...

Prevalence

Epidemiological surveys using a variety of diagnostic criteria estimate a prevalence of 10 to 15 of at least one personality disorder within the general population (Mattia & Zimmerman, 2001). The diagnosis is more commonly made in younger people (25 to 44 years). The sex ratio varies according to the specific disorder for example, women are more likely to be diagnosed with borderline personality disorder (BPD) whereas most individuals diagnosed with antisocial personality disorder are men. Unsurprisingly, both prisons and psychiatric hospitals have a particularly high prevalence of personality disorder. Within the former this has been estimated to be as high as 78 Singleton, Meltzer & Gatward (1998), while figures for the latter range from one-third to two-thirds. The role of personality disorder in psychological morbidity is also significant in general practice. In a one-year prevalence study of 'conspicuous psychiatric morbidity' in patients attending two general practices in...

Mental Disorders

The fact that more women than men are treated in mental health clinics and psychiatric hospitals would lead one to believe that the rate of mental illness is higher among women than among men. This appears to be the case with respect to some, but certainly not all, mental disorders. Women tend to be more vulnerable to anxiety disorders, depression, and eating disorders, and they probably have a higher rate of attempted suicide than men. On the other hand, boys are more likely than girls to stutter, to be hyperactive, and to develop other conduct or behavioral disorders (Myers, 1995). As adults, they are more likely to become alcoholics and or substance abusers and to develop antisocial personalities (Unger, 1979). Men also commit more crimes than women, and crimes of violence in particular (U.S. Department of Justice, 1996). Finally, substantially more men than women, and especially older white men, succeed in committing suicide (Singh et al., 1996).