Treatment ASPD is considered to be among the most difficult personality disorders to treat.[84][85][verification needed][86] Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community.[87] Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.[84] They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment.[88][verification needed] Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.[89] Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment.[90] Those with ASPD may stay in treatment only as required by an external source, such as parole conditions.[86][verification needed] Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended.[84] There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.[91] Psychotherapy also known as talk therapy is found to help treat patients with ASPD.[92]Schema therapy is also being investigated as a treatment for ASPD.[93] A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However, this treatment requires complete cooperation and participation of all family members.[94] Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use,[95] although others have reported contradictory findings.[96] Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors.[84] Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of even this form of therapy.[97] The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD.[98] A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD.[99] Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.[citation needed][100][101] Prognosis [icon] This section needs expansion. You can help by adding to it. (September 2019) According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores and reading problems.[102] The strongest relationship between these variables and ASPD are childhood hyperactivity and conduct disorder. Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD.[103][104] Like many disorders, genetics play a role in this disorder but the environment holds an undeniable role in its development. Boys are twice as likely to meet all of the diagnostic criteria for ASPD than girls (40% versus 25%) and they will often start showing symptoms of the disorder much earlier in life.[105] Children that do not show symptoms of the disease through age 15 will not develop ASPD later in life.[105] If adults exhibit milder symptoms of ASPD, it is likely that they never met the criteria for the disorder in their childhood and were consequently never diagnosed. Overall, symptoms of ASPD tend to peak in late-teens and early twenties, but can often reduce or improve through age 40.[5] ASPD is ultimately a lifelong disorder that has chronic consequences, though some of these can be moderated over time.[105] There may be a high variability of the long-term outlook of antisocial personality disorder. The treatment of this disorder can be successful, but it entails unique difficulties. It is unlikely to see rapid change especially when the condition is severe. In fact, past studies revealed that remission rates were small, with up to only 31% rates of improvement instead of remittance.[105] As a result of the characteristics of ASPD (e.g., displaying charm in effort of personal gain, manipulation), patients seeking treatment (mandated or otherwise) may appear to be "cured" in order to get out of treatment. According to definitions found in the DSM-5, people with ASPD can be deceitful and intimidating in their relationships.[106] When they are caught doing something wrong, they often appear to be unaffected and unemotional about the consequences.[106] Over time, continual behavior that lacks empathy and concern may lead to someone with ASPD taking advantage of the kindness of others, including his or her therapist.[106] Without proper treatment, individuals suffering with ASPD could lead a life that brings about harm to themselves or others. This can be detrimental to their families and careers. ASPD victims suffer from lack of interpersonal skills (e.g., lack of remorse, lack of empathy, lack of emotional-processing skills).[107][108] As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide.[109][110] They also see higher rates of committed crime, reaching peaks in their late teens and often committing higher-severity crimes in their younger ages of diagnoses.[105] Comorbidity of other mental illnesses such as Depression or substance use disorder is prevalent among ASPD victims. People with ASPD are also more likely to commit homicides and other crimes.[105] Those who are imprisoned longer often see higher rates of improvement with symptoms of ASPD than others who have been imprisoned for a shorter amount of time.[105] According to one study, aggressive tendencies show in about 72% of all male patients diagnosed with ASPD. About 29% of the men studied with ASPD also showed a prevalence of pre-meditated aggression.[111] Based on the evidence in the study, the researchers concluded that aggression in patients with ASPD is mostly impulsive, though there are some long-term evidences of pre-meditated aggressions.[111] It often occurs that those with higher psychopathic traits will exhibit the pre-meditated aggressions to those around them.[111] Over the course of a patient's life with ASPD, he or she can exhibit this aggressive behavior and harm those close to him or her. Additionally, many people (especially adults) who have been diagnosed with ASPD become burdens to their close relatives, peers, and caretakers. Harvard Medical School recommends that time and resources be spent treating victims who have been affected by someone with ASPD, because the patient with ASPD may not respond to the administered therapies.[106] In fact, a patient with ASPD may only accept treatment when ordered by a court, which will make their course of treatment difficult and severe. Because of the challenges in treatment, the patient's family and close friends must take an active role in decisions about therapies that are offered to the patient. Ultimately, there must be a group effort to aid the long-term effects of the disorder.[112] Epidemiology As seen in two North American studies and two European studies, ASPD is more commonly seen in men than in women, with men three to five times more likely to be diagnosed with ASPD than women.[113][105] The prevalence of ASPD is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. It has been found that the prevalence of ASPD among prisoners is just under 50%.[113] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) use treatment programs than in the general population, suggesting a link between ASPD and AOD use and dependence.[113][109] As part of the Epidemiological Catchment Area (ECA) study, men with ASPD were found to be three to five times more likely to excessively use alcohol and illicit substances than those men without ASPD. While ASPD occurs more often in men than women, there was found to be increased severity of this substance use in women with ASPD. In a study conducted with both men and women with ASPD, women were more likely to misuse substances compared to their male counterparts.[114][115] Individuals with ASPD are at an elevated risk for suicide.[110] Some studies suggest this increase in suicidality is in part due to the association between suicide and symptoms or trends within ASPD, such as criminality and substance use.[116] Offspring of ASPD victims are also at risk.[117] Some research suggests that negative or traumatic experiences in childhood, perhaps as a result of the choices a parent with ASPD might make, can be a predictor of delinquency later on in the child's life.[104] Additionally, with variability between situations, children of a parent with ASPD may suffer consequences of delinquency if they're raised in an environment in which crime and violence is common.[103] Suicide is a leading cause of death among youth who display antisocial behavior, especially when mixed with delinquency. Incarceration, which could come as a consequence of actions from a victim of ASPD, is a predictor for suicide ideation in youth.[117][118] History The first version of the DSM in 1952 listed sociopathic personality disturbance. This category was for individuals who were considered "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals".[119][verification needed] There were four subtypes, referred to as "reactions": antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.[120] The DSM-II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize.[121] The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM-II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.[122] The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up".[123] However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.[124] The DSM-IV maintained the trend for behavioral antisocial symptoms while noting "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".[81] See also Anti-social behaviour order Anti-social behaviour Conduct disorder Psychopathy

 

Treatment[edit]

ASPD is considered to be among the most difficult personality disorders to treat.[84][85][verification needed][86] Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community.[87] Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.[84] They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment.[88][verification needed] Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.[89]

Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment.[90] Those with ASPD may stay in treatment only as required by an external source, such as parole conditions.[86][verification needed] Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended.[84] There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.[91] Psychotherapy also known as talk therapy is found to help treat patients with ASPD.[92]Schema therapy is also being investigated as a treatment for ASPD.[93] A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However, this treatment requires complete cooperation and participation of all family members.[94] Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use,[95] although others have reported contradictory findings.[96]

Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors.[84] Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of even this form of therapy.[97]

The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD.[98] A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD.[99] Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.[citation needed][100][101]

Prognosis[edit]

According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores and reading problems.[102] The strongest relationship between these variables and ASPD are childhood hyperactivity and conduct disorder. Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD.[103][104] Like many disorders, genetics play a role in this disorder but the environment holds an undeniable role in its development.

Boys are twice as likely to meet all of the diagnostic criteria for ASPD than girls (40% versus 25%) and they will often start showing symptoms of the disorder much earlier in life.[105] Children that do not show symptoms of the disease through age 15 will not develop ASPD later in life.[105] If adults exhibit milder symptoms of ASPD, it is likely that they never met the criteria for the disorder in their childhood and were consequently never diagnosed. Overall, symptoms of ASPD tend to peak in late-teens and early twenties, but can often reduce or improve through age 40.[5]

ASPD is ultimately a lifelong disorder that has chronic consequences, though some of these can be moderated over time.[105] There may be a high variability of the long-term outlook of antisocial personality disorder. The treatment of this disorder can be successful, but it entails unique difficulties. It is unlikely to see rapid change especially when the condition is severe. In fact, past studies revealed that remission rates were small, with up to only 31% rates of improvement instead of remittance.[105] As a result of the characteristics of ASPD (e.g., displaying charm in effort of personal gain, manipulation), patients seeking treatment (mandated or otherwise) may appear to be "cured" in order to get out of treatment. According to definitions found in the DSM-5, people with ASPD can be deceitful and intimidating in their relationships.[106] When they are caught doing something wrong, they often appear to be unaffected and unemotional about the consequences.[106] Over time, continual behavior that lacks empathy and concern may lead to someone with ASPD taking advantage of the kindness of others, including his or her therapist.[106]

Without proper treatment, individuals suffering with ASPD could lead a life that brings about harm to themselves or others. This can be detrimental to their families and careers. ASPD victims suffer from lack of interpersonal skills (e.g., lack of remorse, lack of empathy, lack of emotional-processing skills).[107][108] As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide.[109][110] They also see higher rates of committed crime, reaching peaks in their late teens and often committing higher-severity crimes in their younger ages of diagnoses.[105] Comorbidity of other mental illnesses such as Depression or substance use disorder is prevalent among ASPD victims. People with ASPD are also more likely to commit homicides and other crimes.[105] Those who are imprisoned longer often see higher rates of improvement with symptoms of ASPD than others who have been imprisoned for a shorter amount of time.[105]

According to one study, aggressive tendencies show in about 72% of all male patients diagnosed with ASPD. About 29% of the men studied with ASPD also showed a prevalence of pre-meditated aggression.[111] Based on the evidence in the study, the researchers concluded that aggression in patients with ASPD is mostly impulsive, though there are some long-term evidences of pre-meditated aggressions.[111] It often occurs that those with higher psychopathic traits will exhibit the pre-meditated aggressions to those around them.[111] Over the course of a patient's life with ASPD, he or she can exhibit this aggressive behavior and harm those close to him or her.

Additionally, many people (especially adults) who have been diagnosed with ASPD become burdens to their close relatives, peers, and caretakers. Harvard Medical School recommends that time and resources be spent treating victims who have been affected by someone with ASPD, because the patient with ASPD may not respond to the administered therapies.[106] In fact, a patient with ASPD may only accept treatment when ordered by a court, which will make their course of treatment difficult and severe. Because of the challenges in treatment, the patient's family and close friends must take an active role in decisions about therapies that are offered to the patient. Ultimately, there must be a group effort to aid the long-term effects of the disorder.[112]

Epidemiology[edit]

As seen in two North American studies and two European studies, ASPD is more commonly seen in men than in women, with men three to five times more likely to be diagnosed with ASPD than women.[113][105] The prevalence of ASPD is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. It has been found that the prevalence of ASPD among prisoners is just under 50%.[113] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) use treatment programs than in the general population, suggesting a link between ASPD and AOD use and dependence.[113][109] As part of the Epidemiological Catchment Area (ECA) study, men with ASPD were found to be three to five times more likely to excessively use alcohol and illicit substances than those men without ASPD. While ASPD occurs more often in men than women, there was found to be increased severity of this substance use in women with ASPD. In a study conducted with both men and women with ASPD, women were more likely to misuse substances compared to their male counterparts.[114][115]

Individuals with ASPD are at an elevated risk for suicide.[110] Some studies suggest this increase in suicidality is in part due to the association between suicide and symptoms or trends within ASPD, such as criminality and substance use.[116] Offspring of ASPD victims are also at risk.[117] Some research suggests that negative or traumatic experiences in childhood, perhaps as a result of the choices a parent with ASPD might make, can be a predictor of delinquency later on in the child's life.[104] Additionally, with variability between situations, children of a parent with ASPD may suffer consequences of delinquency if they're raised in an environment in which crime and violence is common.[103] Suicide is a leading cause of death among youth who display antisocial behavior, especially when mixed with delinquency. Incarceration, which could come as a consequence of actions from a victim of ASPD, is a predictor for suicide ideation in youth.[117][118]

History[edit]

The first version of the DSM in 1952 listed sociopathic personality disturbance. This category was for individuals who were considered "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals".[119][verification needed] There were four subtypes, referred to as "reactions": antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.[120]

The DSM-II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize.[121] The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM-II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.[122]

The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up".[123] However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.[124]

The DSM-IV maintained the trend for behavioral antisocial symptoms while noting "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".[81]

See also[edit]

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Antisociale persoonlijkheidsstoornis Naar navigatie springenNaar zoeken springen Esculaap Neem het voorbehoud bij medische informatie in acht. Raadpleeg bij gezondheidsklachten een arts. Antisociale persoonlijkheidsstoornis Coderingen ICD-10 F60.2 DSM-IV 301.7 Portaal Portaalicoon Geneeskunde De antisociale persoonlijkheidsstoornis en in de ICD-10 de dissociale persoonlijkheidsstoornis is een persoonlijkheidsstoornis die wordt gekenmerkt door een patroon van veronachtzaming of schending van de rechten van anderen en door impulsief en antisociaal gedrag. Er is vaak sprake van een gebrekkig geweten en normbesef en van een geschiedenis van crimineel, agressief en/of impulsief gedrag en juridische problemen.[1] In de samenleving heeft ongeveer 3% van de mannen en minder dan 1% van de vrouwen de antisociale persoonlijkheidsstoornis (volgens de DSM-IV). Vroeger werd deze stoornis ook wel sociopathie of sociopathische persoonlijkheiddstoornis genoemd. Inhoud 1 Classificatie 1.1 DSM IV-TR 1.2 ICD-10 1.3 Comorbiditeit 2 Kenmerkend gedrag 3 Criminaliteit 4 Gradaties 5 Oorzaken 6 Behandeling 7 Prognose 8 Sociopathie 9 Zie ook Classificatie DSM IV-TR Het DSM-IV definieert de antisociale persoonlijkheidsstoornis als een pervasief patroon van veronachtzaming en schending van de rechten van anderen dat zich openbaart vanaf het 16e levensjaar. De diagnose dient aan de volgende voorwaarden te voldoen: A: Een algeheel patroon van gebrek aan achting voor en schending van de rechten van anderen, vanaf het vijftiende jaar aanwezig en tot uiting komend in diverse situaties, zoals blijkt uit drie (of meer) van de volgende kenmerken: niet in staat zich te conformeren aan de maatschappelijke norm dat men zich aan de wet moet houden, zoals blijkt uit het bij herhaling tot handelingen komen die een reden voor arrestatie kunnen zijn oneerlijkheid, zoals blijkt uit herhaaldelijk liegen, het gebruik van valse namen of anderen bezwendelen ten behoeve van eigen voordeel of plezier impulsiviteit of onvermogen ‘vooruit te plannen' prikkelbaarheid of agressiviteit, zoals blijkt uit bij herhaling komen tot vechtpartijen of geweldpleging roekeloze onverschilligheid voor de veiligheid van zichzelf of anderen constante onverantwoordelijkheid, zoals blijkt uit het herhaaldelijk niet in staat zijn geregeld werk te behouden of financiële verplichtingen na te komen gebrek aan berouw, zoals blijkt uit de ongevoeligheid voor of het rationaliseren van het feit anderen gekwetst, mishandeld of bestolen te hebben B: De leeftijd is ten minste achttien jaar. C: Er zijn aanwijzingen voor een gedragsstoornis beginnend vóór het vijftiende jaar. D: Het antisociale gedrag komt niet uitsluitend voor in het beloop van schizofrenie of manische episodes. ICD-10 De WHO's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10) beschrijft de dissociale persoonlijkheidsstoornis.[2] Voor een diagnose moet aan ten minste drie van de onderstaande criteria zijn voldaan: Een harteloze ongevoeligheid voor de gevoelens van anderen Onverantwoordelijkheid en een langdurige onverschilligheid voor sociale normen, waarden en regels Een onvermogen tot het aangaan van langdurige relaties, hoewel er geen moeite is met het aangaan van relaties Lage frustratie-tolerantie en een lage drempel voor agressie Onvermogen tot het ervaren van schuld of om te leren uit ervaring, bijvoorbeeld straf Bereidheid om anderen de schuld te geven of het rationaliseren van het schadelijke gedrag De aandoening beschrijft de ICD-versie van de antisociale persoonlijkheidsstoornis, maar de aandoening is niet hetzelfde als de antisociale gedragsstoornis. Comorbiditeit Een antisociale persoonlijkheidsstoornis gaat vaak samen met een of meer van de volgende psychische aandoeningen:[3] Angststoornissen Klinische depressie Stoornis in de impulsbeheersing Periodieke explosieve stoornis Middelenmisbruik Reactieve hechtingsstoornis Somatisatiestoornis ADHD en ADD Borderline-persoonlijkheidsstoornis Theatrale persoonlijkheidsstoornis Narcistische persoonlijkheidsstoornis Sadistische persoonlijkheidsstoornis Paranoïde persoonlijkheidsstoornis Kenmerkend gedrag Mensen met een antisociale persoonlijkheidsstoornis zijn vaak heel charmant en innemend, maar ze kunnen door impulsiviteit en gebrek aan inlevingsvermogen snel in conflicten terechtkomen. Ze zijn niet bang aangelegd en hebben moeite de consequenties van hun handelingen in te zien. Berouw, empathie of schuldgevoel komt bij AsPS-lijders niet of slechts in verminderde mate voor omdat zij niet of in verminderde mate kunnen empathiseren met anderen; dat wil zeggen dat het inlevingsvermogen en het vermogen om zich in een ander te verplaatsen verminderd aanwezig is of geheel ontbreekt. Het uit zich vooral door versterkt egocentrisch gedrag, waarbij het eigenbelang vaak of altijd boven dat van anderen prevaleert. Personen met deze persoonlijkheidsstoornis hebben meestal geen problemen met het uitbuiten van anderen voor hun eigen voordeel of plezier en kunnen manipulatief of bedrieglijk zijn tegenover anderen. Ze bereiken dit door middel van humor, oppervlakkige charme of intimidatie en geweld. AsPS-lijders gedragen zich vaak arrogant, denken negatief over anderen en hebben een gebrek aan berouw voor hun schadelijke handelingen. Typerend voor iemand met een antisociale persoonlijkheidsstoornis, is bijvoorbeeld het aanwenden van "sociaal wenselijk gedrag" om uit eigenbelang een doel te bereiken, ook al gaat dat ten koste van de ander. Hiermee onderscheidt de persoonlijkheidsstoornis zich duidelijk van andere stoornissen die de emoties en de empathische vermogens negatief beïnvloeden. Bij AsPS is het antisociale gedrag echter geen bewuste keuze, hoewel dit vaak wel zo overkomt op de omgeving.[4] Het komt ook voor dat een AsPS-patiënt zich aardig en sociaalvoelend voordoet. Dit noemt men "aangeleerd sociaal wenselijk gedrag"; dit is echter slechts cognitief, verstandelijk en rationeel aanwezig: het komt niet voort uit intrinsieke emoties. Toch kan het sociaal wenselijke gedrag ook aangewend worden op manieren die ertoe leiden dat de patiënt dermate socialiseert, dat hoewel van genezing geen sprake is, het aangeleerde gedrag als copingmechanisme de patiënt het gedrag laat vertonen dat zeer nauw overeenkomt met dat van een gezond persoon, ook in het voordeel van de omgeving. Het is een misverstand dat iedereen met een antisociale persoonlijkheidsstoornis ongeneeslijk ziek is, als dat wordt uitgelegd als niet voor verbetering vatbaar. Een heel specifiek verschijnsel bij AsPS is in bepaalde gevallen het ziekelijk liegen. Een patiënt kan een uitgebreid web van leugens vertellen ten behoeve van zijn eigen voordeel of plezier. Hij kan ook iemand financieel voordeel of romantiek in het vooruitzicht stellen, terwijl het verantwoordelijkheidsgevoel om aan de geschapen verwachtingen te voldoen volledig ontbreekt. Het komt voor dat het liegen zodanig een tweede natuur geworden is, dat de personen in kwestie liegen terwijl zij er geen concreet plan of doel voor hebben. Opvallend is voorts dat zij zich enerzijds in de slachtofferrol kunnen opstellen en anderzijds zich voor kunnen doen als iemand met succes. Criminaliteit Crimineel gedrag is niet noodzakelijk voor de diagnose, maar lijders aan AsPS komen vaker dan gemiddeld in aanraking met politie en justitie door hun veronachtzaming van de normen en waarden in de maatschappij en de rechten van anderen. Een gebrekkig of verstoord inlevingsvermogen is hiervan een belangrijke oorzaak. Het is echter onjuist om alle criminelen af te doen als AsPS-lijders: veel criminelen hebben geen AsPS en omgekeerd zijn veel AsPS-lijders niet crimineel. Sommigen zijn van mening dat mensen die buitengewoon goed presteren in de maatschappij kenmerken van AsPS vertonen, omdat ze minder moeite zouden hebben met het nemen van harde beslissingen: oppervlakkige charmes worden dan bijvoorbeeld gezien als inspirerende kwaliteiten, gevoelsarmoede wordt zakelijkheid, impulsiviteit wordt "knopen durven doorhakken" en weerbarstigheid wordt assertiviteit en doorzettingsvermogen. Opmerkelijk is vaak ook hun perfecte inschatting van de situatie en hun slimme kijk op dingen.[5] Gradaties Net als andere persoonlijkheidsstoornissen valt de antisociale persoonlijkheidsstoornis in een spectrum, wat betekent dat de ernst per persoon kan verschillen. Het gedrag kan variëren van incidenteel slecht gedrag tot het herhaaldelijk overtreden van de wet en zelfs tot het plegen van zeer ernstige misdrijven zoals moord.[6] Oorzaken De oorzaken van de antisociale persoonlijkheidsstoornis zijn in drie groepen te verdelen. Doorgaans is een combinatie van deze factoren aanwezig bij personen met een antisocialepersoonlijkheidsstoornis: Emotionele verwaarlozing Door een opvoeding waarin geborgenheid en genegenheid, met name in de baby- en peuterfase, onvoldoende aanwezig is, kan er een persoonlijkheidsstructuur ontstaan waarin de socialisatie onvoldoende is en het ik-gevoel (egocentrisme) op de voorgrond komt te staan. Deze verstoring en onevenwichtigheid kan later door antisociaal gedrag zichtbaar worden. Vrijwel altijd is op weg naar de volwassenheid een gedragsstoornis opgetreden, met name antisociale gedragsstoornis. In de vroege jeugd kan als gevolg van emotionele verwaarlozing een reactieve hechtingsstoornis zijn ontstaan. Organische oorzaken Hersenontsteking, hersenvliesontsteking en andere ernstige hersenbeschadigingen door ongelukken, zuurstofgebrek of vergiftigingen door een verslavingsziekte, kunnen tot een zodanige karakterverandering leiden dat een verpsychopathiseerde persoonlijkheid ontstaat. Erfelijkheid In bepaalde situaties kan gedacht worden dat psychopathie mede een erfelijke oorzaak heeft. Welke beschadiging of afwijking in de structuur van hersencellen hierbij een rol speelt, is onvoldoende bekend. Hoge testosteron-gehaltes tijdens de zwangerschap speelt mogelijk ook een rol. Een persoon met een antisociale persoonlijkheidsstoornis is meestal opgegroeid in een moeilijk, instabiel gezin in combinatie met een gebrek aan ouderlijke zorg en middelenmisbruik. Als een gevolg van deze problemen waren AsPS-lijders vaak al op jonge leeftijd bekend bij sociale diensten.[6] Behandeling Mensen die lijden aan een antisociale persoonlijkheidsstoornis worden vaak verkeerd begrepen door professionals en soms ook gediscrimineerd als gevolg van de symptomen van de aandoening. Het gebrek aan berouw en de onjuiste veronderstelling dat AsPS-lijders geen gevoelens hebben, kan moeilijkheden geven in de behandeling. De meeste AsPS-lijders komen via de rechterlijke macht of familieleden terecht bij de geestelijke gezondheidszorg.[7] Voorheen werd gedacht dat er weinig succesvolle behandelmethoden waren voor een antisociale persoonlijkheidsstoornis.[8][9] Er werd daarbij vermoed dat behandelingen de patiënt juist de gelegenheid gaven zijn of haar antisociale vaardigheden te verbeteren.[10] Uit voorlopige resultaten van een onderzoek aan de Universiteit Maastricht dat werd gepubliceerd in 2012 bleek echter dat mensen met een antisociale persoonlijkheidsstoornis mogelijk baat hebben bij schematherapie. Het onderzoek werd uitgevoerd bij patiënten van tbs-klinieken in Nederland. De kans op recidive daalde en de proefpersonen die de therapie ondergingen mochten gemiddeld 103 dagen eerder op proefverlof. Er werd ook een vooruitgang in het emotioneel functioneren geboekt: ze hadden een diepere band met anderen en waren minder agressief.[11] Cognitieve gedragstherapie (CGT) is bewezen effectief voor mensen met een lichte vorm van antisociale persoonlijkheidsstoornis. Het is een misverstand dat mensen met een antisociale persoonlijkheidsstoornis zich niet bewust zijn van hun stoornis en hun gedrag niet willen verbeteren of nooit behandeling zullen aanvaarden of zoeken.[12] Prognose Patiënten die lijden aan een antisociale persoonlijkheidsstoornis hebben een hogere kans op vroegtijdig overlijden als gevolg van moord of zelfmoord, roekeloos gedrag of seksueel overdraagbare aandoeningen. Vaak neemt de heftigheid van de stoornis toe in de puberteit en vroege volwassenheid en weer af rond of voor het veertigste levensjaar. In ernstige gevallen verblijft een AsPS-lijder zijn of haar hele leven in een beveiligde instelling of een tbs-kliniek. Sociopathie Iemand met een antisociale persoonlijkheidsstoornis lijdt aan sociopathie, een verouderde term die van een nieuwe betekenis werd voorzien door de psychiater Robert Hare. De aandoening is volgens Hare niet hetzelfde als de psychopathische persoonlijkheidsstoornis. Wel worden AsPS-lijders soms ook secundaire psychopaten, pseudopsychopaten en factor 2-psychopaten genoemd.[13] Sociopathie of AsPS ontstaat als gevolg van een genetische aanleg voor psychopathie die pas tot uiting kwam als gevolg van omstandigheden.[14] Een sociopaat had in feite een normaal en gezond persoon kunnen zijn, maar de emotionele en persoonlijkheidsontwikkeling werd verstoord als gevolg van externe factoren waardoor een genetische aanleg tot uiting kwam in de vorm van pseudo-psychopathisch gedrag. Externe factoren kunnen bijvoorbeeld kindermishandeling, verwaarlozing, armoede, frontaal syndroom en aangeleerd gedrag zijn.[14] De aandoening kenmerkt zich vooral door emotionele problemen, impulsiviteit en antisociaal gedrag. In tegenstelling tot een psychopaat is een sociopaat in staat tot emotionele gehechtheid en schuldgevoel. Een sociopaat is in staat tot empathie, maar slechts voor een beperkt aantal mensen.[15]. In de kindertijd en jeugd kunnen er zich symptomen van het ontremde type van de reactieve hechtingsstoornis (ICD-10) hebben voorgedaan.[16] Een hoogfunctionerende sociopaat of AsPS-lijder is een sociopaat zoals hierboven beschreven is, maar in combinatie met psychopathische trekken zoals welbespraaktheid, hoge verbale intelligentie, oppervlakkige charme en afwezigheid van impulsiviteit, of ze zijn in staat om hun antisociale gedrag duidelijk te verminderen wanneer het hen uitkomt. Een hoogfunctionerende sociopaat is net als de "normale" sociopaat in staat tot emotionele banden en schuldgevoel. Een hoogfunctionerende sociopaat heeft juist door zijn of haar psychopathische eigenschappen een functioneler bestaan en meer controle over impulsen, waardoor er minder problemen zijn in het sociaal en beroepsmatig functioneren.[17][18] Zie ook Persoonlijkheidsstoornis Geen-Bodem-Syndroom Frontaal syndroom Psychopathie Bronnen, noten en/of referenties http://www.psychiatrictimes.com/psychotic-affective-disorders/hidden-suffering-psychopath http://www.scientias.nl/psychopaat-heeft-wel-inlevingsvermogen-maar-het-is-niet-zo-vanzelfsprekend-dat-hij-het-gebruikt/ "Overzicht - antisociale persoonlijkheidsstoornis - Mayo Clinic" . Www.mayoclinic.org . Ontvangen 12 April 2016 . Dissocial personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) ^ Jump up to: a b c http://www.mentalhealth.com/home/dx/antisocialpersonality.html https://www.mentaalbeter.nl/Pages/nl-NL/Volwassen-Persoonlijkheidsstoornis/Antisociale-Persoonlijkheidsstoornis http://www.e-psychiater.nl/psychiatrie/persoonlijkheidsstoornissen/antisociale-persoonlijkheidsstoornis/ http://www.nhs.uk/conditions/antisocial-personality-disorder/pages/introduction.aspx http://psychcentral.com/disorders/antisocial-personality-disorder-treatment/ Cleckley, H. ([1941] 1955). The Mask of Sanity. Revised Edition. Mosby Medical Library. ISBN 0-452-25341-1 Hare, Robert D. (1999). Without Conscience: The Disturbing World of the Psychopaths Among Us. New York: Guilford Press. ISBN 1-57230-451-0. Hervé, H. & Yuille, J.C. (2006): The psychopath: Theory, research and practice. NJ: Lawrence Erlbaum Associates. Hogrefe.nl, 28 augustus 2012, Behandeling psychopaten blijkt effectief https://web.archive.org/web/20160503142259/http://psychcentral.com/blog/archives/2013/04/06/surprising-myths-facts-about-antisocial-personality-disorder https://web.archive.org/web/20160514153644/http://inquiringminds.cc/psychopathy-or-sociopathy-dr-robert-hare-one-of-the-leading-experts-in-the-study-of-psychopathy-suggests-that-the-difference-between-sociopathy-and-psychopathy-may-primarily-reflect-how-the-perso http://www.encyclo.nl/begrip/pseudopsychopathie http://www.kennislink.nl/publicaties/psychopaat-of-sociopaat http://www.beachpsych.com/pages/cc94.html http://www.healthyplace.com/personality-disorders/sociopath/high-functioning-sociopaths-and-the-damage-they-cause/ https://web.archive.org/web/20160511184325/http://www.md-health.com/Sociopath-Traits.html Categorie: Persoonlijkheidsstoornis Navigatiemenu Niet aangemeld Overleg Bijdragen Account aanmaken Inloggen ArtikelOverleg LezenBewerkenBrontekst bewerkenGeschiedenis Zoeken Doorzoek Wikipedia Hoofdpagina Vind een artikel Vandaag Etalage Categorieën Recente wijzigingen Nieuwe artikelen Willekeurige pagina Informatie Gebruikersportaal Snelcursus Hulp en contact Doneren Hulpmiddelen Links naar deze pagina Gerelateerde wijzigingen Bestand uploaden Speciale pagina's Permanente koppeling Paginagegevens Deze pagina citeren Wikidata-item Print/export Create a book Download as PDF Printvriendelijke versie In andere projecten Wikimedia Commons In andere talen العربية English Español Français Bahasa Indonesia 한국어 Português Русский 中文 Nog 32 Koppelingen bewerken Deze pagina is voor het laatst bewerkt op 19 nov 2021 om 21:31. 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  Antisociale persoonlijkheidsstoornis Naar navigatie springen Naar zoeken springen Neem het  voorbehoud bij medische informatie  in acht. Raadpleeg bij gezondheidsklachten een  arts . Antisociale persoonlijkheidsstoornis Coderingen ICD-10 F 60.2 DSM-IV 301.7 Portaal       Geneeskunde De  antisociale persoonlijkheidsstoornis  en in de ICD-10 de  dissociale persoonlijkheidsstoornis  is een  persoonlijkheidsstoornis  die wordt gekenmerkt door een patroon van veronachtzaming of schending van de rechten van anderen en door  impulsief  en  antisociaal gedrag . Er is vaak sprake van een gebrekkig  geweten  en  normbesef  en van een geschiedenis van crimineel,  agressief  en/of impulsief  gedrag  en juridische problemen. [1]  In de samenleving heeft ongeveer 3% van de mannen en minder dan 1% van de vrouwen de antisociale persoonlijkheidsstoornis (volgens de  DS...
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"Antisocial Personality Disorder". National Library of Medicine. Retrieved 16 May 2018. American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 661, ISBN 978-0890425558 "Antisocial personality disorder". nhs.uk. 12 February 2021. Retrieved 12 September 2021. Mayo Clinic Staff (2 April 2016). "Overview- Antisocial personality disorder". Mayo Clinic. Retrieved 12 April 2016. Berger FK (29 July 2016). "Antisocial personality disorder: MedlinePlus Medical Encyclopedia". MedlinePlus. Retrieved 1 November 2016. Black, Donald W (July 2015). "The Natural History of Antisocial Personality Disorder". Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie. 60 (7): 309–314. ISSN 0706-7437. PMC 4500180. PMID 26175389. "Personality Disorders: Facts And Statistics". Vertava Health. Retrieved 12 September 2021. Black, Donald (May 2010). 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    "Antisocial Personality Disorder" .  National Library of Medicine . Retrieved  16 May  2018 . ^  Jump up to: a   b   c   d   American Psychiatric Association (2013),  Diagnostic and Statistical Manual of Mental Disorders (5th ed.) , Arlington: American Psychiatric Publishing, pp.  661 ,  ISBN   978-0890425558 ^  Jump up to: a   b   "Antisocial personality disorder" .  nhs.uk . 12 February 2021 . Retrieved  12 September  2021 . ^  Jump up to: a   b   c   d   e   f   g   h   i   Mayo Clinic Staff (2 April 2016).  "Overview- Antisocial personality disorder" .  Mayo Clinic . Retrieved  12 April  2016 . ^  Jump up to: a   b   c   d   e   f   Berger FK (29 July 2016).  "Antisocial personality disorder: MedlinePlus Medical Encyclopedia" .  MedlinePlus . Retrieved  1 Novembe...
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