Dissocial personality disorder - Causes, symptoms and treatment. MF.

Dissocial personality disorder is one of the most controversial categories in the clinical field. Some people argue that this is just a pseudoclinic name for scammers and other criminal elements. Others believe that this is a serious mental disorder that clinicians should better understand and treat more effectively. The main anomaly that unites this group of psychopathic personalities is considered to be the underdevelopment of higher moral feelings.

The isolation of this type of personality disorder is carried out on the basis of social criteria, the main one being the inability to follow the prevailing social norms, to live in compliance with the law.

Sociopaths are indifferent to public standards;they are fans of strong feelings, impulsive, devoid of feelings of responsibility, despite the numerous penalties and punishments they are not able to learn from the negative experience.

The isolation of this type of personality disorder , if approaching the problem from a clinical perspective, is largely conditional. In the domestic nosographic tradition, such a group of personality disorders did not stand out, because it was believed that there could not exist a specific group of psychopathic personalities whose main property is the tendency to violate the law. Such a view undoubtedly has certain grounds and it can be argued that offenses are possible in all types of personality disorders as well as in fully healthy individuals. At the same time, the clinical, mainly forensic psychiatric, reality is that individual persons of a psychopathic warehouse are permanent residents of places of detention who commit repeatedly criminal acts. Usually they were referred to and referred to individuals of an excitable type, although certain differences from them can be detected. Some of them are adjacent to the circle of schizoid psychopathy( emotionally cold expansive schizoids), others - to emotionally unstable and narcissistic personality disorders.

Stages of becoming a dissocial personality disorder

Psychopathic personality, united in this group, from an early age are distinguished by the absence of any spiritual interests, promiscuity, selfishness, impulsiveness. They are stubborn, quarrelsome, lying, cruel - mocking the younger, torturing animals, they are early forming an opposition to their parents, and sometimes open hostility to others. In early school and adolescence, sociopaths demonstrate models of negative behavior, for example, skip classes, run away from home, commit cruelties, spoil property, and set on arson. In communicating with people, they are characterized by quick temper, sometimes reaching fits of rage and anger. In school they foul language, they start fights;not reaching adulthood, begin to steal, run away from home, wander. Systematic production activity is intolerable for them. Their track record is full of frequent absenteeism and job changes. And when dismissal, as a rule, future employment is not planned. In connection with the lack of spiritual motives, attachments, attention to neighbors, they ignore traditions, ignore social, moral and legal norms and grossly violate the family way of life. Over time, sociopaths find themselves in places of deprivation of liberty. In many people with this disorder, criminal behavior is declining after 40 years;some, however, continue to engage in criminal activities all their lives.

Symptoms of dissocial personality disorder

Complacency, a strong certainty of their rightness, they combine with the lack of a critical assessment of their actions. Any penalty or reminder is regarded as a manifestation of injustice. Usually these people carelessly handle money. In a state of intoxication, they become even more vicious, conflict, fight, destroy everything around. Their whole life is a chain of continuous conflicts with the public order: from forgery of securities, thefts and robberies to brutal acts of violence. At the same time they are guided not only by vested interests, but also by the desire to annoy and offend those around them. Usually they skillfully achieve their own benefit at the expense of others. They are deprived of feelings of compassion, shame, honor, repentance, conscience. Their main feature is heartlessness. In addition to the disorders caused by the use of narcotic drugs, this personality disorder is most closely associated with the criminal behavior of adults.

In the most typical, "nuclear" cases of this group with pronounced emotional changes, differential diagnosis with an endogenous process( schizophrenia) is always necessary, early morbid stupidity is often a sign of a previous attack or slowly developing schizophrenia with heboid manifestations or chronic mania.

Causes of dissocial personality disorder

The explanations of the antisocial personality disorder are based on psychodynamic, behavioral, cognitive and biological theories.

1. Psychodynamic theorists suggest that this disorder, like many other personality disorders, begins with a lack of parental love during infancy, and this leads to a lack of general trust in people. Children who have an antisocial personality disorder, react to such early experience by emotional alienation and try to establish contacts with others only by force and destructive means. In support of the psychodynamic theory, researchers find that people with this disorder have experienced stress in their childhood years more often than others, in particular in such forms as family poverty, domestic violence and parental quarrels or divorce. Many of them were also brought up by parents who themselves suffered from an antisocial personality disorder. Undoubtedly, having such a parent, a person could lose faith in other people.
2. Many behavioral theorists suggest that antisocial symptoms could be acquired through imitation, or imitation. As evidence, they also indicate a high prevalence of antisocial personality disorders among parents of people with this disorder.
3. Other behaviorists believe that some parents unintentionally instill in their children antisocial behavior, regularly reinforcing the child's aggressive behavior. For example, when a child behaves badly or responds violently to parental requests or demands, parents may yield to him in order to restore peaceful relations. Unintentionally, they can instill a stubbornness in the child, and perhaps even cruelty.
4. Cognitive theorists believe that people with antisocial personality disorder adhere to attitudes that do not take into account the importance of the needs of others. People with this disorder really find it difficult to take into account a point of view that is different from their own.
5. Finally, a number of studies suggest that biological factors may play an important role in the antisocial personality disorder .Studies show that people with this disorder are often less anxious than others. In turn, they may lack the element, which is the key in the learning process. This can explain why it is so difficult for them to learn from their mistakes or to catch the emotional reactions of others. Several studies have found that subjects with an antisocial personality disorder are less able than laboratory subjects to solve laboratory tasks, such as finding a way out of the labyrinth, when key reinforcements are punishments, for example, some kind of shock or monetary penalty. When the experimenters make the punishment more explicit or make the subjects pay attention to them, learning improves. However, provided to themselves, subjects with this disorder do not react very much to punishments. Perhaps negative events simply do not cause these individuals such anxiety, as in other people. Biological researchers have found that subjects with this disorder often respond to warnings or expectation of stress by low brain excitement, for example, slow excitation of the autonomic nervous system and low-frequency EEG waves. Due to low excitement, these people may find it difficult to capture threatening or emotional situations, and such situations can have little impact on them. It is also possible that a small physiological stimulation causes people with this personality disorder to take risks and seek adventure. Antisocial activity can attract them precisely because it satisfies the need for greater excitement. In favor of this idea is the fact that antisocial personality disorder, as we observed earlier, is often accompanied by behavior characterized by the search for acute sensations.

Diagnosis of dissocial personality disorder

A personality disorder usually attracting attention by a gross disparity between behavior and prevailing social norms, characterized by the following:

1. a heartless indifference to the feelings of others;
2. is a rough and persistent position of irresponsibility and neglect of social rules and duties;
3. inability to maintain relationships in the absence of difficulties in their development;
4. extremely low tolerance to frustrations, as well as a low threshold for the discharge of aggression, including violence;
5. inability to experience feelings of guilt and benefit from life experience, especially punishment;
6. expressed a tendency to blame others or put forward plausible explanations for their behavior leading the subject to conflict with society.

As an additional sign, there may be persistent irritability. In childhood and adolescence, the confirmation of the diagnosis may be a behavioral disorder, although it is not necessary.

It should be noted:

For this disorder, it is recommended that the ratio of cultural norms and regional social conditions be taken into account to define rules and duties that are ignored by the patient.

Includes:

• sociopathic disorder;
• is a sociopathic personality;
• is an immoral person;
• asocial personality;
• antisocial disorder;
• is an antisocial personality;
• psychopathic personality disorder.

Excluded:

• behavior disorder( F91.x);
• is an emotionally unstable personality disorder( F60.3-).

Treatment of dissocial personality disorder

Approximately one third of all people with this disorder are treated, but none of the treatment methods seems to be effective. Most of them are forced to be treated by their employers, educational institutions or law enforcement agencies, or they fall into the nostalgia of the therapists in connection with some other disorder.

Some cognitive-behavioral therapists are trying to force clients with an antisocial personality disorder to think about moral issues and the needs of others.

The "fight against wildness" programs are aimed at giving a person self-confidence, elevating his self-esteem and making himself more committed to the interests of the group. Some people seem to benefit from such programs. However, as a rule, most of today's treatment approaches have little effect on people with an antisocial personality disorder or not at all on them.