Antisocial Personality Disorder Flashcards
What are the DSM5 criteria for a diagnosis of ASPD?
DSM-5 criteria
- A→ A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15, as indicated by three (or more) of the following
- 1. Failure to conform to social norms with respect to lawful behaviors
- 2. Deceitfulness
- 3. Impulsivity or failure to plan ahead
- 4. Irritability and aggressiveness
- 5. Reckless disregard for safety of self or others
- 6. Consistent irresponsibility
- 7. Lack of remorse→ rationalizing hurting other people
- B→ have to be 18yo
- C→ evidence of conduct disorder with onset before the age of 15
When was the term ASPD introduced?
DSM-III→ Antisocial Personality Disorder
- strong emphasis on objectively measured behaviour criteria
- do not include affective traits as criteria
What was Cleckley’s description of psychopathy?
Cleckley→ early description of psychopathy
- behavioral features→ impulsivity, antisocial behavior, sexual deviancy, and irresponsibility
- Affective and interpersonal traits→ egocentricity, superficial charm, lack of empathy
Use the book Mask of Sanity to find 16 criteria for psychopathy
- 6 are still used today
- sueprficial charm, lacking remorse, antisocial behaviors, poor judgment and failure to learn by experience, incapacity for love, poverty in major affective reactions
What are some early signs of conduct disorder?
Signs
- aggression to people and animals
- destruction of property→ fire setting
- deceitfulness or theft→ stealing and lying
- serious violation of rules→ ignore curfew (before 13yo)
What are some specifiers of conduct disorder?
Specifiers
- Childhood-onset type→ prior to age 10
- Adolescent-onset type→ no symptoms prior to 10
- With limited prosocial emotions→ descripted as lacking empathy, unconcerned about performance, lack of remorse, shallow affect (seems to put an act)
—>conduct disorder more common than ASPD and psychopathy BUT need conduct disorder to be diagnosed with ASPD
What is the Psychopathy Checklist (PCL)?
Psychopathy Checklist (PCL)→ Robert Hare
- 20 items
- rated via interview and records
- not all psychopaths are criminal
- law enforcement, medicine, politics, business very attractive for psychopath
- often used in parole decisions
- need 30 to be diagnosed as psychopath
SEE table for complete checklist
Also other tests derived
- PCL:SV-> for psychiatry, non instutionalized
- PCL:YV-> for adolescent
- Self report psychopathy scale
What are factor 1 and factor 2 of the Psychopathy Checklist?
Factor 1→ Emotional/Interpersonal
- charm, grandiosity
- lying, manipulation
- lack of remorse
- emotional depth
- low empathy
Factor 2→ Behavioral deviance
- child behavior problems
- juvenile delinquency
- boredom, impulsivity
- irresponsibility
- violent behavior
–>some argue that better capture by one factor view
What are the prevalence of ASPD and psychopathy in a study looking at a prison inmates sample?
Sample of prison inmates
- 70-80% qualified for ASPD diagnosis
- 25-30% met criteria for psychopathy
- BUT people with psychopathy→ 2x as many crimes
What is the link between recidivism and psychopathy?
Recidivism→ psychopathy is single best predictor of violence and recidivism
- 4x more likely to reoffend and more quickly
What are the lifetime prevalence of both ASPD and psychopathy?
Lifetime prevalence→ ASPD
- 2-3%→ for both females and males
- higher in criminal settings AND hospital settings
Lifetime prevalence→ psychopathy
- no epidemiological studies
- difficult to measure in community
- hare estimates 1%
- over represented in prison settings (15-49%)
What is the fear potentiated startle (FPS)?
Startle Reflex and Emotion
- Defensive response
- magnitude of reflex increased when organism is fearful-> FPS
magnitude of reflex is decreased when organism feels good
What are the findings of the study looking at startle reflex in psychopathy?
Measurement of startle
- can measure eyeblink reflex by recording electrical activity in response to startle probe
Study-> slide viewing paradigm→ see pleasant, neutral and unpleasant images and hear probe
- groups did not differ in self report of emotional response
- BUT psychopaths do not show increased startle reflex for unpleasant stimuli
–> sign of fearlessness
What is the neurocircuitry behind the startle reflex?
Fear conditioning-> amygdala-> Nuclueus Reticularis Pontis Caudalis-> Spinal and pacial motonuerons-> startle reflex
Abrupt noise can probe startle by the cochlea neurons
–>only three neurons involved so very quick response
What are some prenatal factors associated with risk of ASPD?
Risks
- low birth weight
- malnutrition (possible protein deficiency) during pregnancy
- lead poisoning
- mother’s use of nicotine, marijuana, other substances during pregnancy
- maternal alcohol use during pregnancy
—>not direct causal link between risk factors and conduct disorder
What are the genetics risk of ASPD?
Familial aggregation of ASPD
- also see ADHD, substance use problem
- might be a genetic component toward externalizing disorders
—>BUT estimates vary
Possible genetic pathways
- Genes lead to difficult temperament, impulsivity, tendency to seek rewards, and insensitivity to punishment
- Genes may moderate susceptibility to environmental risk factors
- Genes increase likelihood for child’s exposure to environmental risk factors (parental divorce, maltreatment)
MOA-A gene→ degrades amine neurotransmitters (dopamine, norepinephrine and serotonin)
- could be a diathesis
- child maltreatment is risk factor for conduct problems BUT most maltreated children do not engage in criminal behaviors
- low level of MOA-A is associated with higher aggression
–>gene x environment interaction
What are some environmental risks of psychopathy?
Abused or maltreated kids→ higher PCL scores (prospective)
- Retrospectively→ people with high score on PCL report more negative upbringing
- inconsistent parenting
—>Gene-environment correlations
Antisocial individuals prefer to associate with similar→ miss opportunities to learn positive pro-social behaviors
- early criminality and drug use can also eliminate future social opportunities
What is the difference between gene/environment correlations and gene x environment interactions?
Gene/ environment correlations→ as gene risk increase, environment risk as well increase
Gene x environment interaction→ link between environment and outcome is mediated by genes
What is the difference between social causation and social selection?
Social causation-> social situation causes the outcome
- ex: living in poverty increase the rates of delinquency
Social selection-> the person selects its social environment
- ex: people with psychopathology drift down to poverty
What are some cultural factors influencing antisocial behaviors?
Cultural factors
- Across cultures, socialization of children for aggression is one of the strongest predictors of aggressive acts
- Rates of antisocial behavior vary widely across and within cultures
- Antisocial behavior is associated with minority status in North America, but this is likely due to low SES
What are some potential interventions for psychopathy?
No effective treatment
Person with psychopathy→ treatment is challenging because do not feel bad
- without distress→ little motivation to change
- believe that smarter than the therapist
- psychotherapy might not be very effective
- weak evidence that SSRIs reduce aggressive behaviour
Some treatment reduce rates of reoffending among criminal offenders
- BUT those treatment seems to increase rate of reoffending for psychopaths
- might be because train psychopath to be more successfully manipulative by teaching empathy and social skills
What are some potential interventions for ASPD?
Sustainable Transformation of Youth in Liberia
- young soldiers after civil wars in Liberia who missed the chance to develop social skills
- homeless, drug, very low SES, from dangerous neighborhoods
Study
- 8-week program of group cognitive therapy
- taught skills of self control→ to manage anger and emotions, reduce impulsivity, become more conscientious
- Randomly assigned to CBT-only (28%), Cash-only (25%), CBT-plus cash (25%), neither (22%)
Results-> only see improvement in long term anti social behaviours with money AND therapy
- changing their beliefs about themselves with therapy and give them the material opportunities to make changes possible
- can then train their skills learned in therapy
- people treat them differently
What was Gray’s model of BIS/BAS functioning and its link to psychopathy?
three systems to regulate behaviors
- fight/flight system (FFS)
- Behavioral activation system (BAS)
- Behavioral inhibition system (BIS)
–>psychopathy might be deficits in BIS
What is Lykken’s low fear hypothesis of psychopathy?
psychopathic individuals had
- lower scores on self-report of fearfulness
- less electrodermal conditioning with electric shock study
- deficient passive avoidance performance
What is Blair’s theory of psychopathy and the amygdala?
amygdala based model-> Theorized that psychopathy results from an impairment in the amygdala functioning
- explain why don’t perform badly on normal passive avoidance test (because conditiniong learning in not associated with amygdala) BUT show impairment in the CS-affect representation associations
