ANTISOCIAL PERSONALITY DISORDER

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1 ANTISOCIAL PERSONALITY DISORDER Antisocial personality disorder is a type of chronic mental illness in which your ways of thinking, perceiving situations and relating to others are dysfunctional. When you have antisocial personality disorder, you typically have no regard for right and wrong. You may often violate the law and the rights of others, landing yourself in frequent trouble or conflict. You may lie, behave violently, and have drug and alcohol problems. And you may not be able to fulfill responsibilities to your family, work or school. Antisocial personality disorder is sometimes known as sociopathic personality disorder. It's also sometimes referred to as psychopathy. But some researchers believe that antisocial personality disorder and psychopathic personality are different conditions. Signs and symptoms of antisocial personality disorder may include: Disregard for right and wrong Persistent lying or deceit Using charm or wit to manipulate others Recurring difficulties with the law Repeatedly violating the rights of others Child abuse or neglect Aggressive or violent behavior Lack of remorse about harming others Impulsive behavior Agitation Poor or abusive relationships Irresponsible work behavior Intimidation of others The intensity of antisocial symptoms tends to peak during the 20s and then may decrease over time. It's not clear whether this is a result of aging or an increased awareness of the consequences of antisocial behavior. But while you might be less likely to commit crimes against others later in life, you may still have trouble functioning in relationships, work or school.. When to see a doctor If you have any signs or symptoms of antisocial personality disorder, see your doctor, mental health provider or other health care professional as soon as possible. If untreated, antisocial personality disorder can cause significant problems in your life, and it may also result in serious harm to others. Helping a loved one If you have a loved one who you think may have symptoms of antisocial personality disorder, have an open and honest discussion about your concerns. You may not be able to force someone to seek professional care, but you can offer encouragement and support. You can also help your loved one find a qualified doctor or mental health provider and make an appointment. You may even be able to go to an appointment with him or her. If you have a loved one who has harmed himself or herself, or someone else, or is seriously considering doing so, take him or her to the hospital or call for emergency help.

2 Causes Personality is the combination of thoughts, emotions, and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of two factors: Inherited tendencies, or your genes. These are aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook. This is sometimes called your temperament. It's the "nature" part of the nature vs. nurture debate. Environment, or your life situations. This is the surroundings you grew up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting you had, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate. Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some research suggests that you may have a genetic vulnerability to developing antisocial personality disorder and that your life situation may trigger its actual development. Although the precise cause of antisocial personality disorder isn't known, researchers have identified certain factors that seem to increase the risk of developing or triggering antisocial personality disorder, including: Being diagnosed with childhood conduct disorder A family history of antisocial personality disorder or other personality disorders or mental illness Being subjected to verbal, physical or sexual abuse during childhood Having an unstable or chaotic family life during childhood Loss of parents through death or divorce during childhood Antisocial personality disorder is relatively uncommon. It affects about 3 to 5 percent of men and 1 percent of women. Complications Complications and problems that antisocial personality disorder may cause or be associated with include: Depression Anxiety Aggression or violence Suicidal behavior Reckless behavior Risky sexual behavior

3 Child abuse Alcohol or substance abuse Gambling problems Incarceration Preparing for your appointment Relationship difficulties Social isolation School and work problems Strained relationships with health care providers In some cases, a health care provider or other professional may ask you about your mood, thoughts or behavior. Your doctor may bring it up during a routine medical appointment if you seem to be sad, agitated or angry, for instance. Or you may decide to schedule an appointment with your family doctor or general practitioner to talk about your concerns. In either case, because antisocial personality disorder often requires specialized care, you may be referred to a mental health provider, such as a psychiatrist or psychologist, for evaluation and treatment. In other cases, you may seek out a mental health provider on your own first. In some cases, the court system may order you to seek evaluation and treatment. What you can do Being an active participant in your care can help your efforts to manage your antisocial personality disorder. One way to do this is by preparing for your appointment. This may be especially important when you have antisocial personality disorder because it tends to create antagonistic relationships with medical professionals. Think about your needs and goals for treatment. Also, write down a list of questions to ask. These may include: Why do I think I have antisocial personality disorder? Why can't I get over antisocial personality disorder on my own? How do you treat antisocial personality disorder? Will psychotherapy help? Are there medications that might help? How long will treatment take? What can I do to help myself? Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting? In addition to the questions that you've prepared to ask, don't hesitate to ask questions at any time during your appointment if you don't understand something. What to expect from your doctor During your appointment, your doctor or mental health provider is likely to ask you a number of questions about your mood, thoughts, behavior and urges. You may be asked such questions as:

4 When did you first notice symptoms? How is your daily life affected by your symptoms? What other treatment, if any, have you had? Tests and diagnosis When doctors believe someone has antisocial personality disorder, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include: Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen. Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function. Psychological evaluation. A doctor or mental health provider talks to you about your thoughts, feelings, relationships and behavior patterns. He or she asks about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You also discuss any thoughts you may have of suicide, self-injury or harming others. Pinpointing which personality disorder you have It sometimes can be difficult to determine if you have antisocial personality disorder or another personality disorder. For one thing, some personality disorders share similar symptoms. In addition, a diagnosis is often based largely on how you describe your symptoms and behavior, along with how your doctor interprets those symptoms and observes you behaving. Because of this, it can take some time and effort to get an accurate diagnosis. Be sure to stick with it, though, so that you can get appropriate treatment designed for your particular illness and situation, whether it's antisocial personality disorder or another condition. Diagnostic criteria To be diagnosed with antisocial personality disorder, you must meet the symptom criteria for that disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment. Symptom criteria required for a diagnosis of antisocial personality disorder include: You are at least 18 years old. Repeatedly breaking the law. Conning others. Lying. Aggressiveness. Lack of remorse after harming others.

5 Disregard for the safety of yourself or others. Impulsive behavior. You had symptoms of conduct disorder before age 15, which may include such acts as stealing, vandalism, violence, cruelty to animals and bullying. Antisocial personality disorder can be challenging to treat, and there's no specific treatment for it. You may not even want treatment or think you need treatment. But because antisocial personality disorder tends to be chronic and can sometimes last much of your adult life, you may need long-term treatment. You may also need treatment for other conditions you may have, such as depression, anxiety or thyroid disorders. Treatment teams Often, a team approach is appropriate to make sure all of your psychiatric, medical and social needs are met. The team involved in treatment of antisocial personality disorder may include your: Family or primary care doctor Psychiatrist Psychotherapist Family members Social workers Counselors Pharmacist If possible, find medical and mental health providers with experience in treating antisocial personality disorder. Treatment options Several treatments are available for antisocial personality disorder. They include: Psychotherapy Stress and anger management skills Medications Hospitalization The treatment that's best for you depends on your particular situation and the severity of your symptoms. Psychotherapy Psychotherapy is the main way to treat antisocial personality disorder. Psychotherapy is a general term for the process of treating a condition by talking about your condition and related issues with a mental health provider. During psychotherapy, you learn about antisocial personality disorder and your mood, feelings, thoughts and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn healthy ways to manage your symptoms. Types of psychotherapy used to treat antisocial personality disorder may include:

6 Cognitive behavioral therapy. This combines features of both cognitive and behavior therapies to help you identify unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones. Psychodynamic psychotherapy. This is based on the theories of psychoanalysis, focuses on increasing your awareness of unconscious thoughts and behaviors, developing new insights into your motivations, and resolving conflicts to live a happier life. Psychoeducation. This teaches you and sometimes family and friends about your illness, including treatments, coping strategies and problem-solving skills. Psychotherapy may be provided in individual sessions, in group therapy, or in sessions that include family or even friends. The type of psychotherapy that's right for you depends on your individual situation. Stress and anger management skills Irritability, aggression, violence and anger are common features of antisocial personality disorder. Building skills to cope with volatile emotions may help you control behavior before it becomes harmful to yourself or someone else. Medications There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. However, several types of psychiatric medications may help with certain symptoms sometimes associated with antisocial personality disorder: Antidepressant medications. Antidepressants may be useful if you have a depressed mood, anger, impulsivity, irritability or hopelessness. Mood-stabilizing medications. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression. Anti-anxiety medications. These may help if you have anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior. Antipsychotic medications. Also called neuroleptics, these may be helpful if your symptoms include losing touch with reality (psychosis) or in some cases if you have anxiety or anger problems. Hospitalization and residential treatment programs In some cases, your antisocial personality disorder symptoms may be so severe that you require psychiatric hospitalization. Psychiatric hospitalization is generally recommended only when you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live. Participating in your own care Try to be an active participant in your treatment. Working together, you and your doctor or therapist can decide which treatment options may be best for your situation, depending on the severity of your symptoms, your personal preferences, insurance coverage, affordability, treatment side effects and other factors. In some cases, your personality disorder may be so

7 severe that a doctor, loved one or guardian may need to guide your care until you're well enough to participate in decision making. Lifestyle and home remedies In addition to professional treatment, consider following these lifestyle and self-care steps for antisocial personality disorder: Stick to your treatment plan. Don't skip therapy sessions, even if you don't feel like going. Take your medications as directed. Even if you're feeling well, resist any temptation to skip your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly. And don't take a higher dosage than what's been prescribed for you. Learn about your condition. Education about your condition can empower you and motivate you to stick to your treatment plan. Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms, especially feelings or thoughts involving destructive or harmful behavior. Make a plan so that you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel. Consider involving family members or friends in watching for warning signs. Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Activity can also counteract the effects of some psychiatric medications that may cause weight gain. Consider walking, jogging, swimming, gardening or taking up another form of exercise you enjoy. Avoid drugs and alcohol. Alcohol and illicit drugs can worsen antisocial symptoms or interact harmfully with medications. Get routine medical care. Don't neglect checkups or skip visits to your family doctor, especially if you aren't feeling well. You may have a new health problem that needs to be addressed, or you may be experiencing side effects of medication. Coping and support Coping with antisocial personality disorder can be challenging. Having antisocial personality disorder makes it hard to engage in the behavior and activities that may help you feel better. Talk to your doctor or therapist about improving your coping skills, and consider these tips: Simplify your life. Cut back on obligations when possible, and set reasonable schedules for goals. Write in a journal to express pain, anger, fear or other emotions.

8 Read reputable self-help books and consider talking about them to your doctor or therapist. Don't become isolated. Try to participate in routine activities and get together with family or friends regularly. Take care of yourself by eating a healthy diet and getting sufficient sleep. Join a support group for people with antisocial personality disorder so that you can connect to others facing similar challenges. Stay focused on your goals. Recovery from antisocial personality disorder is an ongoing process. Stay motivated by keeping your recovery goals in mind. Remind yourself that you're responsible for managing your illness and working toward your goals. Learn relaxation and stress management. Try such stress-reduction techniques as meditation, yoga or tai chi. Structure your time. Plan your day and activities. Try to stay organized. You may find it helpful to make a list of daily tasks. Prevention There's no sure way to prevent antisocial personality disorder. Trying to identify those most at risk, such as children living with neglect or abuse, and offering early intervention may help. Taking steps to control your stress, increase your resilience and boost low self-esteem also may offer benefits. Getting appropriate treatment early, and sticking with it for the long term, may prevent symptoms from worsening. Because antisocial behavior is thought to have its roots in early adolescence, parents, teachers and pediatricians may be able to spot early warning signs. While diagnosis of antisocial personality disorder generally isn't done before age 18, children at risk may have symptoms of conduct disorder, especially behavior that involves violence or aggression toward others, such as: Stealing during confrontations, such as a mugging Cruelty to people Use of weapons Sexual assault Repeated lying Early, effective and appropriate discipline, lessons in behavioral skills, and psychotherapy may help reduce the chance that at-risk children go on to become adults with antisocial personality disorder.