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What Antisocial Personality Disorder Looks Like Later in Life

... and what you can do to protect yourself.

Key points

  • Researchers examined how people with psychopathy don’t necessarily act out by committing antisocial behaviors.
  • Older adults with undiagnosed ASPD lacked the "criminal energy” to engage in physically demanding actions that could lead to their arrest.
  • Researchers found that it is possible for older adults with ASPD to continue to cause disturbance and create conflict in their lives.

That older adults are incapable of antisocial behavior may seem like a truism. After all, don’t people mellow out as they get older? Aren’t older individuals more likely to agree with conventional society’s bounds on propriety just because they’ve had more time to gain exposure to these standards of behavior?

Indeed, if you stop and think about the ages of criminal characters portrayed in the media, it may be difficult to come up with any examples in which the culprit was over the age of even 40 years old. You might even have to go back to 1979’s classic film, "Going in Style," starring George Burns, Art Carney, and Lee Strasberg. Television series with psychopathic characters, such as any of the "Law and Order" franchise, rarely feature aging characters other than those who serve as prosecutors or detectives.

Does all this mean that criminality, or its diagnostic counterpart, antisocial personality disorder, indeed just fades away in the later years of life? According to Washington University School of Medicine’s Katherine Holzer and colleagues (2021), it’s plausible that the so-called theory of “criminal energetics” applies (Vaugn & DeLisi, 2018) and that those with antisocial personality disorder simply run out of steam.

However, there’s another explanation you might consider. Perhaps these individuals are there all along, but they don’t measure up to the current diagnostic criteria, the majority of which lean heavily toward behaviors evident in youth. As the Washington University researchers note, “the development of the DSM [Diagnostic and Statistical Manual] criteria for ASPD (antisocial personality disorder) was heavily influenced by research with younger rather than older adults…these studies are still considered among the most prominent in the field” (p. 445). Has this misguided approach inadvertently led to a failure to detect the ASPD that might actually still exist in older populations?

Some Diagnostic Considerations

Before getting to this question about a possible age bias in the criteria for ASPD, it’s important to remind yourself of the fact that ASPD and psychopathy are distinct entities, and both are distinct from criminal behavior. People with psychopathy don’t necessarily act out by committing antisocial behaviors and, as a result, would be less likely to be incarcerated than individuals diagnosed with ASPD, nor do all criminals meet the criteria for this disorder.

A second diagnostic consideration relates to the co-occurrence of mood and substance use disorders in older individuals with ASPD. As a result, clinicians treating their aging patients with these co-occurring disorders may focus less on the antisocial behaviors that accompany or could even be masked by these conditions.

“A Veritable Crime Wave Onto Himself”

As background to their investigation, the authors drew from a case (DeLisi et al., 2020) of a “Mr. Z.,” a 77-year-old white man with a lifetime history of antisocial behaviors that included multiple homicides, both in and out of prison. This “veritable crime wave” met the criteria for ASPD as well as a paranoid personality disorder, along with several forms of substance use disorder. He didn’t desist from his violence and substance use until his 80s, and “even then, his rehabilitation was considered precarious” (p. 445).

As this case illustrates, it’s possible for older adults to continue, as the authors note, a “highly energetic” career as a criminal. The question is, could they receive a new diagnosis in later life based on the ASPD criteria?

What Might ASPD Symptoms Look Like in Older Adults?

To answer the question of whether the ASPD diagnostic criteria have an inherent age bias, the Washington University authors began by taking advantage of the National Epidemiological Survey on Alcohol and Related Conditions III or NESARC-III. The authors used a nationally recognized measure of specific antisocial behaviors (the AUDADIS-5) to compare responses from a sample of 11,755 younger adults (18-34) matched with 14,738 adults ages 50 and over.

The extensive nature of the AUDADIS-5 made it possible for the research team to determine whether an individual exhibited “ASPD pathology" by showing elevated scores across the entire measure. As examples, the AUADIS-5 asked participants to rate themselves on the frequency of behaviors such as "ever hurt an animal on purpose" or "often scare people to do things."

If an individual met the standard of showing ASPD pathology according to the entire instrument, the next question became whether this pathology would be picked up on items specific to the ASPD diagnostic criteria. As it turned out, it was not. Older adults with higher ASPD pathology were less likely to endorse key diagnostic indicators, specifically:

  1. Failure to conform to norms regarding legal behavior as indicated by repeatedly performing acts that are grounds for arrest.
  2. Irritability and aggressiveness as indicated by repeated physical fights or assaults.
  3. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

Based on these findings, older adults with undiagnosed ASPD would, indeed, seem to lack the “criminal energy” to engage in physically demanding actions that could lead to their arrest. Nevertheless, the authors noted that it is still “possible for older adults with ASPD to continue to cause disturbance and create conflict in their lives” (p. 449). Such individuals may behave in irritable and even aggressive ways towards fellow residents and staff in nursing homes. Perhaps those living in the community might also commit these antisocial acts toward family members, neighbors, and friends.

As the authors pointed out, it's also possible that the antisocial older adult whose disorder is undetected may be incorrectly diagnosed as having a cognitive disorder that affects their ability to inhibit aggressive behavior. Missing the ASPD diagnosis for these individuals can have important practical consequences. They can continue to present harm toward those around them without anyone realizing that their behavior represents a psychological disorder, or they may receive inappropriate medical treatment or institutionalization.

Outwitting the Older Adult with ASPD

What if you're someone who's been scammed or is being scammed by an older adult who may have undiagnosed ASPD? Without recognizing it, you could easily hand over your cash or possessions to someone who seems to be on the up and up because of their age. They may have a "great" investment opportunity to offer you or a "need" to help them pay for their medications, rent, or transportation. Indeed, as Holzer et al. suggest, this individual may have learned to use various cagey methods more typically associated with narcissism, such as exploitation and manipulation.

Because so many people do assume that older people lack "criminal energetics," i.e., physical strength or agility, it's easy to miss the possibility that someone with gray hair is capable of engaging in other behaviors that can leave you blindsided. Consider three diagnostic criteria individuals with ASPD pathology endorsed to a lesser degree than their younger counterparts and use these as a guide.

To sum up, from a clinical point of view, knowing that ASPD can continue to exist in the people you think have “grown out” of it can benefit a mental health perspective. In your own life, you may not know a “Mr. Z.,” but you protect yourself by becoming wise to his less intense counterparts.

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References

Holzer, K. J., Vaughn, M. G., Fearn, N. E., Loux, T. M., & Mancini, M. A. (2021). Age bias in the criteria for antisocial personality disorder. Journal of Psychiatric Research, 137, 444-451. https://doi.org/10.1016/j.jpsychires.2021.03.025

DeLisi, M., Drury, A.J., Elbert, M.J., 2020. Psychopathy and pathological violence in a criminal career: a forensic case report. Aggression and. Violent Behavior. https://doi.org/ 10.1016/j.avb.2020.101521.

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