Antisocial Personality Disorder (301.7

that would be considered pro-social, and mild, moderate, or severe condition.

Oppositional defiant disorder is a common premorbid condition in younger children. The

symptoms of conduct disorder happen between the age of 12-18 years of age with frequent

rejection of pro-social peers, adopting associations with delinquent peers. The prevalence is

around 4 percent, seen more commonly in boys than in girls. Risk factors include parental rejection/neglect, child abuse, sexual abuse, certain temperaments, and low verbal IQ states.

Parents with conduct disorder or ADHD will have a greater likelihood of having a child with

conduct disorder. Parental overindulgence can lead to the disorder as well.

There is a great impact on functioning with this disorder, including educational deficits, STDs,

unwanted pregnancies, and physical injuries from altercations or accidents. Parents are often

deeply affected and blame themselves for their teen’s behavior. Family conflict is a big

complication of this disorder.

Things in the differential diagnosis include ADHD, oppositional defiant disorder, bipolar

disorder, intermittent explosive disorder, adjustment disorder, and substance use disorder.

ODD is seen in younger children when compared to conduct disorder, which is more commonly

seen in older teens. ADHD will present with similar symptoms but they do not usually have

malicious intent. Bipolar people do not usually have malicious intent. Patients with IED will

have remorse after their outbursts. Adjustment disorders tend to fade over time after an

identifiable stressor. While CD and substance use disorder are comorbid conditions, they are

discrete entities.

ANTISOCIAL PERSONALITY DISORDER (301.7)

Antisocial personality disorder or APD is a personality disorder when the patient habitually and

pervasively violates and disregards the rights of others and who have no remorse in doing this.

They can be recurrent criminals, may engage in criminal behavior, or engage in behaviors that

skirt the edges of the law. They are considered to be amoral, unethical, and irresponsible,

continually violating social norms and expectations. They make personal decisions based on

their desires of the moment and do not consider the needs or the effect they are having on

other individuals. These individuals are considered sociopaths or psychopaths.

The person is not generally a loner or isolated socially as the name implies but is against rules,

norms, laws, and societally-acceptable behavior. They can be attractive and charismatic, being

very good at manipulating others, often gaining others’ sympathy and portraying themselves as

the victim of social injustice. They tend to be bright and superficially charming; they are

intuitive and know how to use this to manipulate others. They can harm others without feeling

guilty or remorseful. Some will use empathy to derive pleasure out of another’s suffering but

others are unempathetic.

There are four major criteria for APD, which have some sub-features. Criterion A describes an

individual who disregards and violates the rights of others since the age of fifteen to include

lying or deception for profit or amusement, failure to obey laws, impulsive behavior, aggression

and irritability, disregarding the safety of self or others, lack of remorse, and irresponsibility.

Criterion B includes being at least 18 years of age. Criterion C includes having the symptoms

prior to 15 years of age. Criterion D includes not being schizophrenic or bipolar.

Individuals who are 15-18 years of age can have antisocial features but cannot actually have the

disorder. In such cases, the individual would be diagnosed with conduct disorder. The

prevalence of APD is about 0.02-3 percent. Risk factors include being male, having a first-

degree relative with the disorder, and possibly having certain neuroanatomical abnormalities.

This can also be a developmental outcome for children who have conduct disorder,

oppositional defiant disorder, or reactive attachment disorder. Comorbid states include other

personality disorders and substance abuse disorders.

There is no effective treatment for APD except for incarceration or legal supervision to contain

their often-harmful behaviors. Those who have some degree of empathy can be trained to be

more socially appropriate but this is uncommon. There are reports of some finding “religion”

and reforming their behavior. Incarceration does not actually deter these people as they are

unresponsive to punishment. They do not see themselves as part of society nor are they