Antisocial Personality Disorder: causes, symptoms and treatment.

This personality disorder is characterized by impulsive behaviors and rule-breaking.

Most people use the word antisocial to refer to people who find it hard, don't like, or don't seem to like people who find it difficult, do not like or do not seem to like to relate to others.. It is basically used as a synonym for a withdrawn and selective person.

In psychology, however, the term antisocial is used to designate something completely different, a type of disorder known as antisocial personality disorder. antisocial personality disorder, which tends to be linked to behaviors that are contrary to social norms and even laws, ignoring and even laws, ignoring the rights of others in favor of their own.

Personality disorders

Throughout our development, human beings gradually build our identity. During childhood, adolescence and youth we test and acquire values, beliefs, ideologies or even appearances that allow us to finally find who we are, forming a self that we would like to be and shaping a way of seeing, thinking and acting in the world. This continuous and relatively stable pattern of way of being is what we call personality..

However, in many cases the personality that is configured throughout the life cycle is extremely maladaptive, being a very inflexible and continuous element that causes suffering to the person and hinders his or her integration into social, work and personal life.

The study of these maladaptive patterns of behavior, which come to be considered personality disorders due to the high level of maladaptation and discomfort they cause in themselves or in the environment, has generated different categories according to the patterns of thought, emotion and behavior of the sufferers.

They are generally divided into three large groups or clusters, sharing several characteristics in common. Within cluster A are behavioral patterns considered eccentric and disorders that would be part of the and the disorders that would form part of it would be paranoid, schizoid and schizotypal disorder.

Cluster C groups together personality disorders that include fearful and anxious behaviors as in the case of avoidance, dependence and obsessive-compulsive personality disorder.

Cluster B groups together disorders characterized by the presence of drama, emotionality and/or instability.. Among them we find the borderline personality disorders, the narcissistic, the histrionic or the one that concerns us today, the antisocial personality disorder.

Antisocial personality disorder

The antisocial personality disorder is a pattern of behavior characterized by the inattention and violation of the rights of others in favor of its own.which appears before the age of fifteen. This disregard can manifest itself in a variety of behaviors, including criminal behavior punishable by law.

At the personality level, it is observed that those who present this disorder usually have a low level of kindness and responsibility. low level of kindness and responsibilityThis makes it easier for them to get into disputes with other individuals and with the system.

They are generally ambitious and independent; they have a low tolerance for frustration, little sensitivity to the feelings of others, and a very high level of impulsivity. and a very high level of impulsivity.. They act without thinking about the consequences of their actions both for themselves and for others.

As with psychopaths, many of them are extraverted people and have considerable charm and ease of relationship, but only at a superficial level. They tend to possess narcissistic characteristics, considering their own well-being above that of others, and often use deception and manipulation to achieve their goals.

These people have an unstable lifestyleThey have an unstable lifestyle, because they have great difficulty making plans for the future and considering the repercussions of their actions. That is why they are generally irresponsible and find it difficult to take charge of what involves a commitment, which together with the other characteristics mentioned above causes people with antisocial personality disorder to present serious problems of adaptation to society, having difficulties at personal, occupational and social levels.

All this causes them to frequently suffer from depressive problems, tension and addictions to different substances or activities. Although this disorder facilitates the realization of criminal behavior, it is necessary to take into account that this does not imply that does not imply that all criminals are antisocial or that all antisocial people are criminals..

Possible causes

As with other personality disorders, establishing the causes of antisocial personality disorder is a complex process that requires taking into account a wide variety of variables, given that personality is an element that is continuously constructed throughout development.

Although its specific causes are not known, a variety of hypotheses have been established, a wide variety of more or less accepted hypotheses have been established..

1. Biological hypotheses

Studies carried out with twins and adopted individuals show the presence of a certain genetic component, transmitting some personality characteristics that may lead to the development of the disorder..

The characteristics of this disorder suggest frontal and prefrontal activation problems, the areas that regulate impulse inhibition and govern processes such as planning and forecasting outcomes.

In people with antisocial personality disorder, a lower than usual activation of the amygdala has also been detected. Considering that this area of the limbic system governs aversive responses such as fear, an element that leads to the negative evaluation of a situation and therefore allows the inhibition of an impulse, This could lead to the difficulty in restraining the behavior that people display behavior displayed by people with this type of personality.

2. Psychosocial hypotheses

At a more psychosocial level, it is frequent that those who suffer from antisocial personality disorder tend to have lived a childhood in which they have had ineffective parental models, in conflictive or excessively permissive environments.

It is common for them to have parents who are hostile, abusive or mistreat them. Thus, with these types of models they may end up assuming that exercising their will is above all other considerations.This is something they will replicate in adulthood.

Cases have also been found at the opposite extreme: with absent or excessively permissive parents, children end up learning that they can always do as they please, and that they react vindictively to the cessation or threat that this will end.

Another element to take into account is that the antisocial personality disorder can be preceded by other types of be preceded by another type of behavioral disorder in childhood: dissocial disorder.. Although it does not occur in all cases, having had a dissocial disorder in childhood multiplies the risk that as an adult the individual will end up developing antisocial disorder.

Some authors consider that the basic problem is a slowing of cognitive development, which prevents them from being able to put themselves in the role of other people and see the world from perspectives different from their own.

Treatments applied

The treatment of personality disorders in general is complicated by the fact that they are configurations that include behaviors and ways of seeing and acting that have been acquired and reinforced throughout life.The treatment of personality disorders in general is complicated, since they are configurations that include behaviors and ways of seeing and acting that have been acquired and reinforced throughout life. In addition, people usually consider that it is their way of being, so they usually do not want to change it unless they perceive that they cause them excessive discomfort.

In the case of antisocial personality disorder, treatments often have a further complication, and that is that treatment is often imposed either by those close to them or by court order after committing or by court order after committing a crime. Thus, the subject in question is usually uncooperative, seeing it as an external imposition, and generally does not accept the need for treatment.

In therapy, the management of these cases requires that the patient not only be told what is to be achieved and how to do it, but especially that he/she be made aware of the need for change and the advantages and disadvantages that this would entail for him/her in his/her life.

As far as possible, the therapist must be able to be seen as someone respectable and approachable who does not intend to impose his authority, avoiding possible resistance on the part of the patient and facilitating the establishment of a good therapeutic relationship.

The passage through psychotherapy

It is frequent the application of cognitive therapy (specifically brief cognitive therapy with dialectical orientation, based on Linehan's dialectical therapy), in which training sessions are used in which skills of awareness, interpersonal effectiveness, emotional regulation and frustration tolerance are treated.

The initial aim is to to arouse interest in the long term consequences of treatment and to understand how one's own behavior affects others and then to try to increase interest in the well-being of others, community and group therapies also seem to be of some help.

Other useful elements include having the patient narrate his or her life history, as this can greatly help the patient to look at the events that have happened to him or her in a different way and to reflect on his or her life. The work on the capacity for empathy, although complicated for this type of patient, can be increased through exercises such as role reversal..

Psychoeducation of the subject's close environment is also helpful, in order to help establish limits in behavior and to have a greater ability to cope with the situation.

Pharmacological treatments?

At the pharmacological level, there is no specific treatment for antisocial personality disorder.. This is due, among other things, to the fact that the behavioral patterns associated with this condition are so established in the person's daily life that an approach based on the reductionism of acting on certain brain circuits does not cover the full extent of this phenomenon. After all, part of the disorder is also in the way in which the person establishes relationships with others, and these reinforce this type of maladaptive behavior because of their expectations.

However, it may help to administer substances that keep the mood stable, such as some antidepressants (SSRIs are frequently used). Of course, this does not solve the problem in its totality, but can be a complement.

Nevertheless, it should be taken into account that this type of disorder is frequently associated with the consumption of psychoactive substances, and addictions are not uncommon.

Bibliographical references:

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Fifth edition. DSM-V. Masson, Barcelona.

• Davidson, K.M. & Tyrer, P. (1996). Cognitive therapy for antisocial and borderline personality disorders. Single case study series. British Journal of Clinical Psychology, 35 (3), 413-429.

• Quiroga, E. & Errasti, J. (2001). Effective psychological treatments for personality disorders. Psicothema, Vol. 13, nº 3, pp. 393-406. University of Almería and University of Oviedo.

• Santos, J.L. ; García, L.I. ; Calderón, M.A. ; Sanz, L.J. ; de los Ríos, P. ; Izquierdo, S. ; Román, P. ; Hernangómez, L. ; Navas, E. ; Ladrón, A and Álvarez-Cienfuegos, L. (2012). Psicología Clínica. CEDE Manual of PIR Preparation, 02. CEDE. Madrid.