Antisocial (Dissocial) Personality disorder

Antisocial personality disorder is characterized by pattern of disregard for the safety & rights of others without feeling remorse.

They are unreliable, manipulative, incapable of lasting relationships & unable to conform to social norms.

As thought previously, it is not synonymous with criminality.

Epidemiology:

3% in general population
Male to female ratio: 2:1 to 7:1
Most common in Younger Adults.
More common in Urban areas & Lower socio-economic groups.

Aetiology:

# Biological :

• Genetic factors strongly contribute.

• Antisocial personality in males is often associated with ‘hysteria’ in female of same family.

• Reduced brain serotonin activity (Reduced 5-HIAA in CSF) is also seen.

# Early development:

• Parental deprivation, Inconsistent maternal care & Family violence can lead to development of Antisocial Personality Disorder.

# Social Determinants:

• Antisocial Personality can be due to normal adaptation to an abnormal environment.

(However, early onset indicate that it can not be attributed to cultural conflicts and social determinants.)

Clinical Features:

• Reckless behavior unaffected by punishment is typical of antisocial individuals.
• Lack sense of responsibility.
• An easy going hedonistic attitude may be interrupted by rage, cruelty & violence.
• Lying, truancy, running away from home, thefts, fights, substance abuse & illegal activities may be typical experiences, beginning in early childhood.
• Reduced ability to anticipate the negative consequences of behaviour.
• Frequent suicide threats & attempts.

• ICD-10 criteria:( Dissocial P.D.) F60.2


1.Unconcern of the feelings of others.


2.Disregard for social norms, rules & obligations.


3.Incapacity to maintain enduring relationships, though having no difficulty in establishing them.


4.Very low tolerance to frustration & a low threshold for discharge of aggression.


5.Incapacity to experience guilt & to profit from experience/ punishment.


6.Marked proneness to blame others.

Comorbidity:

• Depression

Differential Diagnosis:

• Bipolar disorder (mania)
• Mental Retardation (learning difficulties)
• Substance Abuse
• Atypical schizophrenic disorder (pseudopsychopathic schizophrenia)
• Temporal lobe syndrome
• Limbic lobe syndrome
• Borderline personality disorder
• Histrionic personality disorder

Course & Prognosis:

• Most pronounced in early adult years & gradually decreases with age.
• Professional motivation & establishing a stable couple or partnership may have a beneficial effect.
• Depression & hypochondriasis emerge when rage and aggression are abandoned.

Treatment :

For anxiety, Depression, rage or aggression:
• SSRIs
• Lithium
• Valproic acid
• Carbamazepine

If any evidence of ADHD:
• Methylphenidate

*Benzodiazepines should be used with caution as they might cause behavioral disinhibition.

Reference:

  • New Oxford Textbook of Psychiatry(2nd edition).
  • ICD-10 Classification of Mental and Behavioural Disorders.

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