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Dr. Paul LatimerSomeone with a history and pattern of disregard for the rights of others would probably be termed a bully by most, but it could be that this individual has what is known as antisocial personality disorder (ASPD).

ASPD is defined as a pervasive pattern of disregard that begins by the mid-teenage years. This attitude should be indicated by three or more characteristics such as repeated illegal activity that is grounds for arrest, repeated lying, use of aliases, conning or other deceitful behaviour.

Other characteristics include impulsivity, irritability and aggression, reckless disregard for the safety of self or others and repeated lack of responsible behaviour in work or financial matters. A lack of remorse is also part of this personality disorder. This could be shown by indifference or rationalization after hurting, mistreating or stealing from someone.

Although an antisocial individual is capable of superficial wit, charm and flattery, these are often used to manipulate the emotions of others.

Individuals who develop ASPD also typically experience some sort of conduct disorder as children and very often have extensive substance abuse and legal problems. In fact, more than 80 percent of individuals with ASPD also struggle with substance abuse.

Some estimates say that although less than 10 percent of the general population experiences ASPD, 75 percent of prison populations experience the disorder.

Although the exact cause of ASPD is unknown, studies show that there are both genetic and environmental links. Child abuse, lack of affection, multiple temporary placements during childhood and family discord are all known to be contributing factors in the development of ASPD.

Far more men are affected than women and the disorder usually peaks during the late teen years or early 20s and may improve on its own by the person’s 40s. Unfortunately, by this time the affected individual usually has a serious legal record as well as substance abuse problems and a lack of relationships.

Antisocial personality disorder is very difficult to treat. Individuals rarely seek treatment on their own and there are no proven medications for this disorder.

Usually, the patients are afraid of intimacy and can neither identify with authority nor accept criticism and resent any restriction of their actions.

It is very important for a treating physician to do a thorough diagnosis and differentiate between ASPD and other psychiatric conditions such as schizophrenia, bipolar disorder or ADHD. Also, as this disorder commonly co-exists with other conditions such as ADHD, it is important to screen for these as well.

Obviously, being a parent to a teenager with these characteristics or a younger child with a conduct disorder is very difficult. No one wants to accept that their child does not respond with empathy or conscience to others.

It is important for parents to be aware of the problem though and to apply firm, structured discipline that is consistent. These children and teens may not respond to pleas for consideration or attempts to use guilt, but clear consequences for socially unacceptable behaviour can help them learn what is acceptable and what is not.

Dr. Latimer is president of Okanagan Clinical Trials and a Kelowna psychiatrist.

Antisocial Personality Disorder

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