Psychological Disorders: Antisocial Personality Disorder

American Description
A. There is 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 a Manic Episode.

European Description
Personality disorder, usually coming to attention because of a gross disparity between behaviour and the prevailing social norms, and characterized by at least 3 of the following:

(a) callous unconcern for the feelings of others;
(b) gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations;
(c) incapacity to maintain enduring relationships, though having no difficulty in establishing them;
(d) very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
(e) incapacity to experience guilt and to profit from experience, particularly punishment;
(f) marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society.

There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.

Includes:
* amoral, antisocial, asocial, psychopathic, and sociopathic personality (disorder)

Excludes:
* conduct disorders
* emotionally unstable personality disorder

Personality Disorders
A personality disorder is a severe disturbance in the characterological constitution and behavioural tendencies of the individual, usually involving several areas of the personality, and nearly always associated with considerable personal and social disruption. Personality disorder tends to appear in late childhood or adolescence and continues to be manifest into adulthood. It is therefore unlikely that the diagnosis of personality disorder will be appropriate before the age of 16 or 17 years. General diagnostic guidelines applying to all personality disorders are presented below; supplementary descriptions are provided with each of the subtypes.

Diagnostic Guidelines
Conditions not directly attributable to gross brain damage or disease, or to another psychiatric disorder, meeting the following criteria:

(a) markedly dysharmonious attitudes and behaviour, involving usually several areas of functioning, e.g. affectivity, arousal, impulse control, ways of perceiving and thinking, and style of relating to others;
(b) the abnormal behaviour pattern is enduring, of long standing, and not limited to episodes of mental illness;
(c) the abnormal behaviour pattern is pervasive and clearly maladaptive to a broad range of personal and social situations;
(d) the above manifestations always appear during childhood or adolescence and continue into adulthood;
(e) the disorder leads to considerable personal distress but this may only become apparent late in its course;
(f) the disorder is usually, but not invariably, associated with significant problems in occupational and social performance.

For different cultures it may be necessary to develop specific sets of criteria with regard to social norms, rules and obligations. For diagnosing most of the subtypes listed below, clear evidence is usually required of the presence of at least three of the traits or behaviours given in the clinical description.