Personality disorders: antisocial personality disorder (ASPD) (Florence Sheen)

What are personality traits

enduring patterns of perceiving, relating to, and thinking about the environment and onself that are exhibited in a wide range of social and personal contexts

Describe a personality disorder

• a long-lasting, inflexible pattern in thinking, feeling, relating to others, or controlling impulses

• affects multiple areas of life

• causes significant distress or problems at work, socially, or personally

• starts in adolescence or early adulthood

• not explained by another mental disorder, substance use, or medical condition

Personality disorder cluster A - DSM-5 criteria

• cluster a: odd/eccentric

  • paranoid

    • pervasive distrust and suspicious of others

  • schizoid

    • pervasive pattern of detachment from social relationships; individuals don’t enjoy social relationships, and usually have no close friends

  • schizotypal (similar to schizoid)

    • eccentric thoughts and behaviours, cognitive or perceptual distortions

Personality disorder cluster B - DSM-5 criteria

• cluster b: dramatic/erratic

  • borderline

    • instability of interpersonal relationships, self-image

  • histrionic

    • excessive emotionality, and attention-seeking

  • narcissistic

    • grandiosity, need for admiration, and lack of empathy

  • antisocial

    • disregard for the rights of others, antisocial/criminal behaviour

Personality disorder cluster C - DSM-5 criteria

• cluster c: anxious/fearful

  • avoidant

    • social inhibition, feelings of inadequacy and extreme sensitivity to criticism, fear of disapproval or rejection

  • dependent

    • excessive need to be taken care of (i.e. submissive or clingy behaviour), unable to function adequately without the help of others

  • obsessive compulsive

    • preoccupation with orderliness, perfectionism, and mental and interpersonal control

What is the prevalence rate for any personality disorder

12.16

List the antisocial personality disorder (ASPD) diagnostic criteria (DSM-5-TR)

• ‘a pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years’

• failure to conform to social norms, criminal behaviour

• deceitfulness

• impulsivity or failure to plan ahead

• irritability and aggressivness

• reckless disregard for safety of self or others

• consistent irresponsibility

• lack of remorse, indifference, or rationalising have hurt, mistreated, or stolen from another

What is required to get an ASPD diagnosis

• the individual is at least age 18 years, evidence of conduct disorder (CD) with onset before age 15

• the occurrence of antisocial behaviour is not exclusively during the course of schizophrenia or bipolar disorder

What are the prevalence rates for ASPD diagnosis

• between 0.2-6.5%

• more common in men

  • the highest prevalence is among samples of men with alcohol use disorders and from substance abuse clinics, prisons, or other forensic settings

Individuals with ASPD frequently lack … and can be …

lack empathy and can be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others

Is psychopathy diagnosable

no its not a diagnosable disorder

Do all ASPD individuals display core affective features of psychopathy

no

What is the difference between ASPD and psychopathy (Hare, 1991)

• ASPD - criminally antisocial

• psychopathy - might involve ASPD behaviours, individuals are unable to process emotional information and show no regard for the emotions of others

What is the PCL-R and its two main factors

PCL-R: 20-item “gold standard” psychopathy scale (interview + file info)

• factor 1 (Interpersonal/Affective): charm, grandiosity, lying, no guilt/empathy

• factor 2 (Lifestyle/Antisocial): poor self-control, impulsive, irresponsible, no long-term goals, parasitic, easily bored

What are the two studies on genetic basis of psychology

• Viding, Blair, Moffitt, & Plomin (2005)

  • 3687 twin children aged 7 years

    • strong genetic influence for callous-unemotional (CU) traits

• Tuvblad, Bezdijan, Raine, & Baker (2014)

  • community sample of 14-15 year old twins

    • genetic influences explained 69% of the variance in the psychopathic personality factor

What are the structural differences in the brain of individuals with psychopathy compared to those without

• reduction in prefrontal grey matter volume

• grey matter loss in the right superior temporal gyrus

• amygdala volume loss

• a decrease in posterior hippocampal volume

• an exaggerated structural hippocampal asymmetry

What brain differences were found in violent offenders with ASPD and psychopathy (Gregory et al., 2012)

areas of significantly reduced grey matter volume among the violent offends with ASPD with psychopathy compared with those with ASPD without psychopathy

• offenders with ASPD+P displayed significantly reduced grey matter volumes in the anterior rostal prefrontal cortex and temporal poles

• these reductions were not attributable to substance use disorders

What did Blair (2003) argue

suggested that brain or biological factors might contribute to psychopathy, but environmental factors (e.g. drug abuse or other life experiences) can make the condition worse

What did Rijsdijk, Viding, de Brito et al., (2010) argue

• grey matter concentrations in the left posterior and right dorsal anterior cingulate has moderate heritability estimated (37-46%)

• common genes may influence both these brain areas and psychopathic traits.

In short: Some brain structures linked to psychopathy are partly inherited.

What did Frazier et al., (2019) state

• reviewed biological and environmental evidence

  • evidence is insufficient to suggest a largely biological ethology for the disorder

  • information from developmental and epigenetic research may suggest complex, multidimensional

What is the prefrontal cortex (PFC)

social and affective decision-making, self-control

What is anterior cingulate cortex (ACC)

thought to be involved in processing moral emotions (e.g. guilt), empathy, self-regulation of negative emotions

What is the amygdala

affective porcesses, responding to emotional stimuli

What is the striatum

modulating behaviour toward potentially rewarding stimuli

What is the anterior insula (AI)

sensory integration and introceptive awareness

What did Marsh & Blair (2008) find evidence of

• meta-analysis of 20 studies

• evidence of fearful face recognition deficits among antisocial populations

What did Blair, Colledge, Murray et al., (2001) find

impaired processing of sad and fearful facial expression in children with psychopathic tendencies

What does fear related processing stimuli depend on

a circuit involving the amygdala and the hypothalamus

What did Birbaumer et al., (2005) find

psychopaths showed no activation of limbic-prefronal circuit (including the amaygdala) which is activated in healthy controls during fear conditioning

What did Dadds et al., (2006) find

• community sample of children/adolescents

• deficit in fear recognition could be the result of visual neglect of the eye region of other people’s faces, as with amygdala damaged patients

A great number of fixations on the eyes were associated with …

increased accuracy for angry and fearful expression recognition

Low arousal in adolescence might be linked to

future criminal behaviour

• reduced autonomic reactivity - less arousal and greater impulsivity to positive and negative stimuli (Raine, 2000)

• abnormally high threshold to aversive stimuli (higher levels of violence are needed in order to induce a reaction)

Psychopaths show poor avoidance learning - Lykken (1957)

mental maze paradigm where wrong choices resulted in electric shocks

• compared to controls, psychopaths continuously made errors to a higher degree than controls

Psychopaths show poor avoidance learning - Newman (1993)

criminal psychopaths are relatively unresponsive to punishment

What did Wilson (2014) find about treatment effectiveness for individuals with ASPD

• controlled studies: no significant differences in treatment outcomes

• uncontrolled studies: treatment equally effective for people with or without ASPD

Why is ASPD challenging to treat

• low engagement

• often mandated

• treatment usually delivered in typically underfunded correctional settings

What do studies show about treatment effectiveness for psychopathy in adults vs. adolescents

• adults: low to moderate success (3/8 studies) (Salekin, Worley, & Grimes, 2010)

• adolescents: higher success (6/8 studies) (Salekin, Worley, & Grimes, 2010)

• example: Juvenile offenders at JCI are more than twice as likely to violently recidivate in the community during a 2 year follow up (Caldwell et al., 2006)

What effect do short-term prison-based CBT programmes have on reoffending of most psychopathic individuals

little effect

• rates can rise among individuals with high levels of psychopathy

Challenges to treating those with ASPD

• lack of emotional response to punishment/threat of punishment

• lack of motivation to change

• deception and manipulation

• lack of specific treatment programmes

  • limited research