Tag Archives: Antisocial Personality Disorder

G – #AtoZChallenge on Mental Health

Welcome to the #AtoZChallenge on mental health, letter G. This was a pretty hard letter for me, so most of the words I chose are not specifically related to mental health.

Gender

There is an increasing interest in gender-specific medicine, ie. medical research and practice that takes into account how medical (including psychiatric) conditions affect women differently from men. For example, autism spectrum disorders and ADHD used to be thought of as typically male conditions whereas borderline personalitty disorder was thought to affect females primarily. It now turns out that many women have been misdiagnosed with for instance BPD when they really have an ASD and/or ADHD. The reverse is also true: eating disorders are stereotypically thought of as female disorders, so men with eating disordes often remain undiagnosed.

Men and women also differ in their treatment-seeking patterns. Women seek counseling more often, whereas men are overrepresented in psychiatric hospitals and are sectioned or taken into forensic treatment more often.

Genetics

When DSM-5, the current edition of the psychiatrist’s manual, was being prepared, initially they wanted to use a dimensional diagnosis with genetics on one axis. However, they finally decided too little is known about the gentics of mental illness yet. Mental illness is not a purely genetic thing and it isn’t purely caused by life events. For example, when I studied psychology in 2007, there was some recent research into the interplay between a particular gene called the lazy MAO A gene and one’s upbringing in causing antisocial behavior. MAO A is an enzyme that breaks down certian neurotransmitters in the brain. When people have the lazy MAO A gene, they produce too little of this enzyme. This is linked to antisocial behavior. However, even if a person had this lazy gene, upbringing played a role in the risk for developing conduct disorder in childhood and antisocial personality disorder in adulthood. The two factors together cause people to become antisocial.

Geriatrics

Geriatrics is the branch of medicine specializing in older people and diseases of the elderly. Geriatrists may work in mental health care, but more often on units for people with neurocognitive disorders (dementia). The city institution I used to reside in had several units for older people, some of whch specialized in neurocognitive disorsers where behavior was particularly dysregulated. On these units, geriatrics and psychiatry are combined.

GP

Everyone in the Netherlands (and other countries with socialized healthcare) is entitled to the care of a general practitioner (G). Most peope in long-term inpatient mental health treatment don’t have a GP where they used to live. I for one have yet to find a GP near the tiny village. Therefore, the hospital employs GPs. GPs in mental hospitals do not generally involve themselves with the patients’ mental health and psychiatrists do not generally take care of the patients’ physical health. In this sense, a GP in a mental hospital has a different role than in the community. In the community, GPs are the gatekeeper to all care whether it’s mental or physical, after all.

Narcissistic and Antisocial Personality Disorders #Write31Days

31 Days of Mental Health

Welcome to day 13 in the #Write31Days challenge on mental health. Today, I’m continuing to write on personality disorders. Two personality disorders that are in cluster B along with borderline and histrionic personality disorders, are narcissistic and antisocial personality disorder. I have decided to lump these together as there’s a lot of overlap between them.

People with antisocial personality disorder (often referred to as sociopaths) display a pervasive pattern of disregard for or violation of the rights of others starting by age fifteen and continuing into adulthood. They meet at least three of the following criteria:


  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.


People with antisocial personality disorder (APD) showed evidence of conduct disorder (severe antisocial behavior) in childhood.

Skeptics say that antisocial personality disorder basically describes recidivist criminals and as such is not really an illness. They have proposed a more severe form of the disorder, called psychopathy, that they say more accuratey describes an actual disorder. Psychopathy referst o a combination of antisocial behavior, as well as lack of empathy and remorse and disinhibited behavior.

Proponents of the idea of psychopathy developed the psychopathy checklist, currently in its revised version as PCL-R. The PCL-R consists of a number of items rated by a mental health professional. A high PCL-R score is associated with narcissistic, antisocial and borderline personality disorder diagnoses.

Narcissistic personality disorder (NPD) refers to a pervasive pattern of feelings of grandiosity, as well as lack of empathy. People with NPD meet at least five of the following criteria.


  1. Has a grandiose sense of self-importance (e.g., exaggerates achievements and talents, expects to be recognized as superior without commensurate achievements).

  2. Is preoccupied with fantasies of unlimited success, power, brilliance, beauty, or ideal love.

  3. Believes that he or she is “special” and unique and can only be understood by, or should associate with, other special or high-status people (or institutions).

  4. Requires excessive admiration.

  5. Has a sense of entitlement, i.e., unreasonable expectations of especially favorable treatment or automatic compliance with his or her expectations.

  6. Is interpersonally exploitative, i.e., takes advantage of others to achieve his or her own ends.

  7. Lacks empathy: is unwilling to recognize or identify with the feelings and needs of others.

  8. Is often envious of others or believes that others are envious of him or her.

  9. Shows arrogant, haughty behaviors or attitudes.

Both antisocial and narcissistic personality disorder are seen more in males than females. Narcissistic personality disorder occurs in roughly 6% of the population, while antisocial personality disorder may occur in up to 3%.

People with antisocial or narcissistic personality disorder do not usually seek treatment voluntarily. Many are referred to treatment through the criminal justice system. That being said, some narcissists may seek treatment if they experience a threat to their grandiose self-image, which may lead them to becoming depressed. They are also at increased risk of experiencing psychotic symptoms, which may then be incorrectly diagnosed as schizophrenia. Since both APD and NPD are hard to treat, mental health professionals should focus on co-existing disorders such as depression and on risk management if the person engages in criminal behavior.

What Are Personality Disorders? #Write31Days

31 Days of Mental Health

Welcome to day 10 in the #Write31Days challenge on mental health. Today, I will discuss the broad category of disorders I’ve been diagnosed with: personality disorders. Though there is some debate as to whether borderline personality disorder should be conceptualized as a personality disorder, it currently is.

A personality disorder is a pervasive pattern of dysfunctional thought, behavior and emotion that is stable across time and across situations. It is out of line with cultural expectations and causes distress or impairment. It usually emerges in early adulthood, though adolescents may be diagnosed as being at risk for developing a personality disorder. In fact. when I attended a conference on BPD in 2013, a psychiatrist specializing in this said that BPD can be reliably diagnosed from age sixteen on. In other disorders, such as antisocial personality disorder, there is a specific age requirement of being over eighteen.

The Diagnostic and Statisticla Manual of Mental Disorders, both DSM-IV and DSM-5, divides specific personality disorders into three subcategories, called clusters. These are:


  • Cluster A includes paranoid, schizoid and schizotypal personality disorders. Individuals exhibiting these disorders often appear odd or eccentric. The disorders in this cluster can precede schizophrenia. I tend to think of cluster A personality disorders as “psychosis light”.

  • Cluster B includes antisocial, narcissistic, borderline and histrionic personality disorders. Individuals with disorders in this cluster are often seen as dramatic, emotional or erratic. People with cluster B personality disorders are often perceived as among the most difficult people to get along with. When peope think of personality disorders in general, they mostly mean cluster B disorders. The same goes for treatment programs focused on personality disorders.

  • Cluster C includes avoidant, dependent and obsessive-compulsive personality disorders. Individuals with cluster C personality disorders tend to be anxious or fearful.


In DSM-5, it is stated clearly that the clustering of personality disorders, while it has some merit, may not be very useful in clinical practice. After all, many people exhibit traits of personality disorders across clusters. When a person has features of more than one personality disorder but doesn’t teet the full criteria of any, they may be diagnosed with an unspecified personality disorder. People with other specified personality disorder display behavior that is seen as a personality disorder but isn’t listed specifically in DSM-5. Examples include passive-aggressive and self-defeating personality disorder.

There are some clear gender differences in how commonly personality disorders occur. Antisocial personality disorder occurs far more often in males than females. Borderline, histrionic and dependent personality disorder occur more in females. Though this may reflect real gender differences, it is also likely that stereotypical views shape clinicians’ diagnoses. For example, I once read that BPD is really about as common in males as in females but is overdiagnosed in women and underdiagnosed in men. Women misdiagnosed with BPD are often later found to have ADHD, which interestingly used to be seen as a typical male disorder.

diagnosticians always need to be aware of a patient’s cultural background and life history. After all, in some cultures, behavior that is seen as disordered in the western world may be normal. People who experienced extreme stress or trauma may also exhibit long-lasting dysfunctional behavior patterns and be misdiagnosed with personality disorders when they really have PTSD. Veterans are disproportionately often diagnosed with personality disorders, for example.