Antisocial Personality DisorderAntisocial Personality Disorder

Ashley WheelerAshley WheelerUniversity of South Florida St. PetersburgUniversity of South Florida St. Petersburg

Fall 2013Fall 2013

DSM-5 Criteria for APDDSM-5 Criteria for APD

A. A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1. Failure to conform 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. B. The individual is at least age 18 years. C. There is evidence of conduct disorder with onset before age 15 years. D. The occurrence of antisocial behavior is not exclusively during the course of

schizophrenia or bipolar disorder.

Psychopathy

● New conceptualization of the Personality Disorders in Section III of the DSM-5

● Hare's (2003) Psychopathy Checklist (PCL-R)

● Factor 1: grandiosity, lying, lack of remorse/guilt

● Factor 2: early behavior problems, juvenile

delinquency, and impulsivity

Heritability

● Differences in genetic and environmental factors between individuals, not within individuals

● High heritability does not mean that we cannot change that trait

Risk FactorsDSM-5:● Biological predisposition● Environment:

● Abuse or neglect● Unstable or erratic parenting or discipline

Kendler et al. (2012)● Genetic: aggressive disregard & disinhibition● Environmental: lack of remorse

From Conduct Disorder to APD

Frick (2012):

● Preadolescent-onset Conduct Disorder:

● More violence and aggression

● More neurological and cognitive deficits

● More impulsivity and emotional regulation issues

● More likely to develop APD

● Adolescent-onset Conduct Disorder:

● More likely to come from stable and financially secure homes

● Most concerned with defying authority

● May not display lack of remorse

Treatment

● Pharmocological: focus on reduction of substance abuse

● Psychological: ● Mentalization-Based Treatment (MBT)

– Mentalization is “the process by which we make sense of each other and ourselves, implicitly and explicitly, in terms of subjective states and mental processes” Bateman and Fonagy (2010).

Where do we go from here?

● Prevention through early treatment via IDEA

● Research for psychological and pharmacological interventions