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Personality

Antisocial Personality or Antisocial Behavior?

Antisocial acts must be differentiated from personality disorder.

Antisocial personality disorder (APD) is one of the most difficult psychological diagnoses. Those with APD, also known as sociopaths, once discovered, are indelibly branded, for it’s a pernicious condition from which, so far as we know, there’s no return. Given the APD motto “rules are for fools,” coupled with profound lack of empathy stemming from a predatory schema, it takes no clinician to understand encountering someone deemed sociopathic means “danger ahead.”

Mohamed Hassan/Pixabay
Source: Mohamed Hassan/Pixabay

Psychological diagnoses are generally meant to guide treatment. APD is unique in that it’s meant more to help society than the afflicted. It’s also a diagnosis carrying valid stigma which, in fact, is almost the point. Due to the incorrigible, predatory nature of APD, the best we can do is protect ourselves, for they take no responsibility for their social problems and don’t seek help in that department.

Bearing this in mind, it doesn’t mean if someone with APD suffers other conditions they shouldn’t be helped. They may enter treatment for other psychological conditions, but treatment providers must also beware of the underlying character flaws.

Showing empathy, for example, is a sign of weakness the APD will see as opportunity for exploitation. A simple example is an APD patient noticing their therapist is kind and understanding. Not liking $25 co-payments, they lie about not working much lately because of the panic attacks they’re in treatment for. They charm and convince the therapist saying, “I’d like to offer something in good faith. I’ll pay $5 each visit, and when I’m working regularly pay it off, OK?” Of course, after learning to manage their panic they vanish, along with the repayment.

True sociopaths, those with antisocial personality disorder, are social chameleons, blending into environments, laying in wait to take advantage of unsuspecting passers-by, as illustrated. Therapists not versed in APD would do well to partake in continuing education about APD, for there are clues you can be attuned for. Having begun my career in a correctional facility, I was fortunate to develop APD radar and know when boundaries required an extra layer. These included:

  • Asking for special favors they knew were against policy, but claiming it was necessary for them to “not go off,” like allowing them phone calls in a private office.
  • Signs of intimidation, the most popular being threatening stares and saying they’ll report you for not wanting to help them.
  • Demanding help to get out of situations they will not take responsibility for, e.g., “I need you to write a letter to my probation officer about how anxious I’ve been so they don’t violate me for not going yesterday.”
  • Wanting to know about the therapist’s personal life.
  • I also developed a 6th sense for detecting hoodwinks in the eyes and unsettling charm.

APD versus antisocial behavior

Now that readers understand the gravity of an APD diagnosis, it’s important to realize people can perform antisocial actions and not be a sociopath. In fact, this is addressed on page 726 of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), where there are V-codes regarding antisocial behavior. They are meant to recognize that people can engage in isolated patterns of antisocial behavior but APD need not apply.

This is particularly important to be vigilant for, given the doom of an APD diagnosis. As will be discussed in an upcoming UP & Running blog post, it's unfortunately easy for some to jump to diagnostic conclusions based on minimal evidence and without context. This is never more dangerous than with personality disorders, where a long-standing, pervasive, baseline pattern of inflexible, maladaptive ways of relating to others and the world must be established. Personality diagnoses have their place, but given the stigma often attached, the evaluator had better be thorough in their assessment.

You may be asking, “How can someone act in an antisocial way and not have APD?” Consider Jake (name disguised):

In his late 20s, Jake became opiate-dependent after an operation. A previously hard-working guy who never colored outside the lines, by 30 he was pawning goods he stole from friends and family for drug money, leading to legal problems. Probation stipulated that he attend therapy. Jake also lied incessantly about where he was going and how much he was using. It seems he took no responsibility for his actions, nor cared how those actions affected others.

Bastian Pudill/Unsplash
Source: Bastian Pudill/Unsplash

At first glance, Jake fits APD criteria in that he appears to lack empathy, violates the rights of others, lies, and takes no responsibility. The reality is, however, Jake’s presentation must be taken in context of the addiction. He had no early developmental or young adult history indicative of APD; the character disturbance onset correlated to his addiction. Personality disorders must be present by adolescence. In the case of APD, the person was a Conduct-Disordered youth. In the absence of this, Jake’s diagnoses, therefore, would be Opiate Abuse and, since his drug-seeking behavior became its own focus of treatment, Adult Antisocial Behavior. This acknowledges Jake engages in serious socially-unacceptable activities as a result of drug abuse, but is not a sociopath. Due diligence to explain this in diagnostic formulations is essential, so no one reviewing records at any point confuses Jake as being a sociopath.

Students have asked why use “antisocial” anywhere if someone doesn’t meet APD criteria, and it’s such a damning term. The answer is, the antisocial behaviors stand out. By noting adult antisocial behavior, clinicians acknowledge there are indeed antisocial actions, but also protecting the person in noting that they’re no sociopath.

If Jake were viewed through an antisocial personality lens, the reality is that this would likely lead to treatment bias that he is incorrigible, and less effort may be put forth in trying to help him. Should he be transferred to another provider and APD is in his file, Jake is stigmatized as potentially dangerous and incorrigible from the start. It could also have legal ramifications if he encountered further legal trouble and his records were subpoenaed.

Most treatment providers have at least textbook familiarity with APD. However, if personality disorders are not your forte, it will benefit both you and clientele to refine your conceptualization of what it is and isn’t. It will help to:

  • Recognize/correct tendencies to diagnose based on drawing conclusions from one chief behavior or symptom.
  • Attend continuing education on Cluster B personality disorders, particularly offerings by psychologists Joseph Shannon or Gregory Lester.
  • Make it a topic of supervision. If your clinical supervisor isn’t versed in personality disorders, seeking supplemental supervision from someone well-versed can prove essential.

To find a therapist, please visit the Psychology Today Therapy Directory.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).

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