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New Treatments for Antisocial Personality Disorder

DSM-IV Diagnostic Criteria

Since age 15 years, the patient continues to display disregard for, and violation of, the rights of others, indicated by at least three of the following:

Failure to conform to social norms by repeatedly engaging in unlawful activity.

Deceitfulness: Repeated lying, use of aliases, or "conning" others for personal profit.

Impulsivity or failure to plan ahead.

Irritability and aggressiveness, as indicated by repeated physical fights.

Reckless disregard for the safety of self or others.

Consistent irresponsibility: Repeated failure to sustain consistent work behavior.

Lack of remorse for any of the above behavior

A history of some symptoms of conduct disorder before age 15 years as indicated by:

Aggression to people and animals.

Destruction of property.

Deceitfulness or theft.

Serious violation of rules.

Clinical Features of Antisocial Personality Disorder

Interactions with others are typically exploitative or abusive.

Lying, stealing, fighting, fraud, physical abuse, substance abuse, drunk driving are common.

Patients may be arrogant, but they are also capable of great superficial charm.

These patients have no capacity for empathy. 

Epidemiology of Antisocial Personality Disorder

The male-to-female ratio is 3:1.

More common in first-degree relatives of those with the disorder.

Differential Diagnosis of Antisocial Personality Disorder

Adult Antisocial Behavior: This diagnosis is limited to the presence of illegal behavior only and lacks the pervasive, long term patterns required for a personality disorder.

Substance-Related Disorder: Substance abuse is common in Antisocial Personality Disorder and crimes may be committed to obtain drugs, or to obtain money for drugs. Consider both diagnoses if chronic drug use anti-social personality disorder and chronic antisocial acts are present.

Narcissistic Personality: Narcissistic patients also lack empathy and are exploitative, but they are not as aggressive or deceitful as Antisocial patients.

Borderline Personality Disorder: These patients are also impulsive and manipulative, but they are more emotionally unstable and less aggressive. The manipulativeness of Borderline patients is aimed at getting emotional gratification rather than aimed at financial or power motivations. 

Treatment of Antisocial Personality Disorders

These patients will try to destroy or avoid the therapeutic relationship.

Inpatient self-help groups appear to be the most useful because the patient is not allowed to leave and enhanced peer interaction minimizes authority issues.

The use of psychotropic medication has been described with mixed results. Consider using them in patients whose symptoms interfere with functioning or who meet criteria for an Axis I psychiatric.