2.2.4: Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is one of a class of diagnoses that describe persistent, longstanding, maladaptive ways of thinking and feeling about oneself and others that detrimentally affect how one functions. ASPD is the personality disorder most strongly linked with violence; it is defined by a continual remorseless disregard for the rights of others, including repeated criminal acts, impulsiveness, irresponsibility, deceptiveness, and aggression.

To be diagnosed with this disorder, the person must have exhibited aspects of antisocial behavior prior to age 15, such as aggression toward people or animals, theft, or property destruction (American Psychiatric Association, 2013). Only adults over the age of 18 can be diagnosed with personality disorders under DSM-5 criteria; however, personality disorders are commonly attached to youth to secure treatment.

Psychopathy

Although psychopathy is not recognized in the DSM-5, it is associated with, but distinct from, conceptualizations of ASPD. Psychopathy is characterized by two main factors: 1) interpersonal and emotional traits, such as manipulation, grandiosity and impaired empathy, and 2) antisocial behavior and lifestyle traits, such as impulsive behavior, sensation seeking and a parasitic lifestyle. Psychopathy is defined by subjective emotional and interpersonal criteria that are not part of ASPD, and because the DSM emphasizes observable, objective behavioral criteria, not part of the DSM. The Psychopathy Checklist – Revised, developed by Hare (1991) is the most used measure for psychopathy (Hare, 2016).

The twenty traits assessed by the PCL-R score are:

• glib and superficial charm
• grandiose (exaggeratedly high) estimation of self
• need for stimulation
• pathological lying
• cunning and manipulativeness
• lack of remorse or guilt
• shallow affect (superficial emotional responsiveness)
• callousness and lack of empathy
• parasitic lifestyle
• poor behavioral controls
• sexual promiscuity
• early behavior problems
• lack of realistic long-term goals
• impulsivity
• irresponsibility
• failure to accept responsibility for own actions
• many short-term marital relationships
• juvenile delinquency
• revocation of conditional release
• criminal versatility (Hare, 2016).

Research generally indicates that psychopathy, particularly the theorized sub-type called primary psychopathy, involves brain-based differences that impact emotional and cognitive functioning (Blair et al., 2008; Kiehl, 2006; Koenigs, 2012; Patrick, 2018; Yang & Raine, 2009). Two models are the current top explanations for this impaired emotional functioning (Smith & Lilienfeld, 2015): 1) the low fear model, which states that emotional deficits result from an impaired recognition/experience of fear (Lykken, 1957, 1995), leading to increased sensation seeking and an inability to be deterred by fear of punishment and 2) the response modulation hypothesis, which describes an individual’s impaired ability to modify their behavior once they have focused their attention, even though the situation might warrant a behavior change (Newman et al., 1987).

Psychopathy is associated with high reoffending rates (Shepherd et al., 2018; Thomson et al., 2018) and treatment resistance (Olver et al., 2011). For these reasons, psychopathy has been an important consideration for decision-making in the justice system, with a diagnosis of psychopathy leading to dangerous offender classifications and indefinite sentencing. In recent years, though, there have been concerns about how psychopathy has been defined and utilized in the justice system (Skeem et al., 2011), leading to alternative conceptualizations of psychopathy (Lilienfeld & Widows, 2005). What Psychopathy addresses, what psychopathy is, and differentiates between psychopathy and ASPD.