Early Warning
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Harvard
Mental Health Letter, December 2000
ANTISOCIAL
PERSONALITY--PART I
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Callous,
deceitful, reckless, guiltless, often intimidating, sometimes
violent --
that is a standard description of a psychopath, sociopath, or
antisocial
personality. The terms "sociopath" and "antisocial
personality"
refer mainly to behavior and its consequences, "psychopath"
to inner
experience. But the three terms are used more or less
interchangeably
today. Psychopathy formerly had a broader meaning, and
at one
time it was even used as a synonym for mental illness in general.
In some
popular or casual uses, it still suggests a condition close to
psychosis
-- an irresistible drive to commit bizaarre violent and sexual
crimes.
The present psychiatric terminology has no such connotations;
antisocial
personalities are sane in the everyday sense.
In the
psychiatric classification system, an enduring pattern of
thinking,
feeling, and behavior is called a personality disorder if it
causes
personal distress or poor functioning. Although human beings are
hard to
classify precisely in this way, certain general patterns appear
often
enough to be to be considered in deciding how to provide care.
According
to the American Psychiatric Association's manual, a diagnosis
of
antisocial personality requires at least three of the following: a
failure to
conform to social norms, consistent deceitfulness,
impulsiveness,
and failure to plan ahead, irritability and
aggressiveness,
a consistent disregard for work and family obligations,
a
consistent disregard for the safety of oneself and others, and a lack
of regret
or remorse.
The Classic Sociopath
To expand
on this definition, we can picture a hypothetical model
sociopath --
a person who has all these characteristics to the highest
degree. He
is probably male; the disorder is at least three times more
common and
generally far more serious in men than in women. Although he
is neither
autistic nor psychotic, he is entirely indifferent to the
well-being
and interests of others. He understands intellectually that
they have
wishes and concerns of their own, but he cares so little that
this
knowledge rarely affects his behavior. Believing that he has the
right to
do what he wants and take what he can, he manipulates others by
deception
or intimidation or both. He has an inflated opinion of himself
and avoids
responsibility to anyone else. He constantly seeks to exploit
weaknesses
in others, which for him include any apparent fair-mindedness,
self-doubt,
or susceptibility to compassion or affection. He believes
that only
the threat of punishment and other fears cause people to obey
social
rules and subscribe to moral principles. He feels only contempt
or
indifference toward his victims, who, in his eyes, usually "'have it
coming."
He does not maintain a regular job, pay his debts, or act as a
responsible
parent. If he has sexual partners and children, he
repeatedly
abuses, neglects, betrays, or abandons them. He drifts
through
life with no sense of a future, perhaps conceiving vague schemes
that he
never puts into practice. Even his short-term planning is often
ruined by
casual impulsive acts. Although not all sociopaths are
actively
criminal and even a habitual criminal is not necessarily a
sociopath,
many antisocial personalities are found in jails and prisons.
One
estimate is that 15%-20% of prisoners deserve this diagnosis.
The word
"slippery" seems to have been invented to describe the
sociopath.
Conning -- playing the confidence game -- is a way of life
for him.
Often he has an ingratiating manner and considerable
superficial
charm or even powers of fascination. He may seem unusually
poised and
sure of himself, because he lacks the scruples or self-
consciousness
that make others hesitate. He practices deceit constantly
in many
forms -- outright lying, evasiveness, distortion, pretending to
forget. He
answers questions vaguely and inconsistently, especially
questions
about himself and his past -- partly to confuse and manipulate,
partly
because he is indifferent to truth. He lies for strategic
purposes
-- to boast, to flatter, to excuse himssself and blame others --
but also,
often, simply for the pleasure of deceiving. He lies so freely
and so
often fails to cover his tracks that he is regularly exposed.
Then he
may confess, offer superficial rationalizations or insincere
apologies,
and go on to tell new lies, as if he is indifferent to being
recognized
for what he is.
A lack of emotional depth
Underlying
this behavior is a disconcerting emotional shallowness that
resembles
some of the traits of narcissistic personality. The model
sociopath
seems incapable of loyalty, shame, or guilt. He has no lasting
close
relationships with other people. He rarely even feels sustained
hatred,
although he may be irritable and quick to anger. When he talks
about
love, he may mean sexual attraction or a desire for flattery,
physical
comfort, or material support. If he says he is sad, he may mean
that he is
in trouble because his most recent schemes have failed. His
anger
takes the form of sudden rage or a general sense of grievance
against
anyone who stands in the way of his getting what he wants.
Because of
this shallowness, he has little sense of the suffering he
causes and
almost no sense of how others regard his behavior. He may
refer to
serious crime as though it is harmless naughtiness. Although he
can talk
about himself sentimentally, he often has to test the reactions
of others
to decide what feelings to display, because otherwise he would
not know
what is appropriate. If he is asked what he feels and has no
reason to
lie, he may give a "practical" answer. A bank robber who had
threatened
a teller while holding a gun to his head was asked how he
would feel
if someone did that to him. His answer was, "I would try to
get the
drop on him."
Not all
sociopaths commit violent acts or have violent tendencies. They
can be
swindlers, thieves, cult leaders, nonviolent child molesters,
corrupt
businessmen, and demagogic politicians as well as gangsters,
armed
robbers, rapists, and professional killers. The boundaries of
antisocial
personality are narcissism on one side and paranoia or sadism
on the
other; people who fall toward the narcissistic side are less
likely to
be violent than those with paranoid or sadistic inclinations.
But our
model sociopath is likely to be hotheaded as well as
coldhearted.
He is easily provoked by perceived slights and challenges
to his
inflated opinion of himself. Compared with other men who commit
violent
crimes, psychopaths are more likely to attack male strangers and
more
likely to respond to trivial or nonexistent provocations.
Some
authorities believe that the traits classified as antisocial by the
American
Psychiatric Association fall into two distinct groups. One
group
includes glibness, selfishness, callousness, and deceit; the other
includes
thrill seeking, irresponsibility, self-defeating impulsiveness,
and
lawbreaking. Most sociopaths are constantly in trouble because of
their poor
judgment and short time horizons. But some people with
features
of antisocial personality, especially those in the first group,
are more
capable of long-range planning. Less reckless and more
intelligent
than most, they can even achieve a kind of social success
while
doing a great deal of damage in both public and private life.
The model
sociopath is emotionally stable. Although he may suffer from
boredom,
tenseness, irritability, psychosomatic symptoms, and
inconvenient
sudden rages, in general he is more troublesome than
troubled,
at least on the surface. But this character is rare, if not
mythical.
In real life, most people with sociopathic characteristics
have many
other symptoms as well. Investigators have found high rates of
depression,
bipolar disorder, and panic disorder in psychopaths. In one
study, 11%
had made suicide attempts. Many have other personality
disorders,
especially borderline and narcissistic personality.
Substance abuse and sociopathy
Irresponsible,
reckless, impulsive people are naturally susceptible to
substance
abuse. A great many sociopaths are drug or alcohol abusers or
addicts;
their addictions begin early in life, last long, and are
especially
difficult to treat. For obvious reasons, they often choose
illicit
drug trafficking as a vocation. A complication arises because
the
symptoms and consequences of substance abuse and antisocial
personality
may become so similar that they are difficult to separate.
Addicts
and alcoholics rationalize, deny, and evade the truth. Heroin
addicts
commit crimes to support their habit; alcohol provokes
aggressive
behavior by reducing anxiety and crippling judgment; cocaine
heightens
energy and confidence along with irritability and paranoia.
Sometimes
a person who seems to have all the typical antisocial traits
changes
completely when he recovers from an addiction. Antisocial
tendencies
may be the cause or the consequence of addiction -- or both
addiction and
sociopathy may be results of a common predisposition.
Psychodynamic views
Partly
because most sociopaths have other psychiatric symptoms and
disorders
and partly because of a distrust of moralizing, some
authorities
reject the notion of antisocial personality entirely. They
regard it
as too crude a way of describing the relationship between
character
and behavior. Some say that the people labeled sociopaths have
little in
common except the feelings -- often a mixture of fascination
with fear,
dislike, and distrust -- that they inspire in others,
especially
psychotherapists. Some dynamically oriented therapists have
argued
that psychopathic character traits are emotional defense
mechanisms.
If this view is correct, sociopaths conceal anxiety because
they
cannot tolerate it either in themselves or in others, and they
avoid
close personal attachments because they are terrified by their own
need to
depend on others. Their denial of depression is so effective
that they
are hardly aware of genuine suffering, and their conscious
discomfort
is limited to false grievances and superficial
frustration.
They need to maintain a posture of cool assurance and self-
sufficiency
that protects them from the intolerable fate of being shamed
or pitied.
A basis in upbringing?
Whatever
the underlying emotional reality may be, the symptoms that lead
to the
diagnosis appear early in life. According to the American
Psychiatric
Association's definition, no one can be diagnosed as an
antisocial
personality who has not been given a diagnosis of conduct
disorder
before age 15. The description of conduct disorder includes
stealing,
lying, truancy, bullying, fighting, cruelty to animals, fire
setting,
burglary, vandalism, malicious mischief, running away from home
--
consistent precocious aggression, deceit, impulsiveness, and rule
violations.
Conduct disorder is often associated with learning
disabilities
and especially with attention deficit disorder
(distractibility,
impulsiveness, and hyperactivity). Many children with
conduct
disorders have attention deficit disorder, and about 20% of
children
with attention deficit disorder are diagnosed with conduct
disorder.
Many
children with conduct disorders are raised in a chaotic and
destructive
environment. There may be constant family conflict and a
lack of
supervision, parents who are alcoholics or addicts, mothers who
are
hostile or indifferent, fathers who desert the family or impose
brutal but
erratic discipline -- or no true family at all but repeated
shifts of
custody among relatives, foster agencies, and institutions.
Children
who grow up this way may lack reliable emotional bonds and
models of
responsible behavior. They may also be neurologically impaired
because of
child abuse. In the familiar cycle of violence, abused boys
may rage
against others to make themselves feel powerful. They have come
to see the
world as dangerous and unpredictable and consider aggression
a
necessary response.
Antisocial
behavior by children and adolescents is also more likely
where the
sense of community is feeble and there are few legitimate
opportunities
or rewards for socially acceptable behavior. In these
circumstances,
many boys do not learn respect for social rules but come
to value coolness,
toughness, and immediate gratification. Recklessness
and
lawbreaking become their ways of demonstrating independence and
maturity.
They take refuge in adolescent gangs, where they try to
impress
one another and demonstrate their manliness by testing the
limits of
personal and social tolerance.
But there
is much evidence that family and social environment by
themselves
do not explain psychopathy. The parents of a future sociopath
will
always seem to be inadequate because the child does not respond to
their love
or discipline. If their parents do not have criminal records,
abused and
neglected children are not more likely than others to become
antisocial
personalities. And psychopathy is not simply the effect of
certain
social environments or cultural values. Middle-class men and
women
raised in sober, law-abiding, two-parent families are not immune
to it.
Most adolescent gang members are not sociopaths; often they show
strong
loyalties and adhere to strict codes of conduct of their own.
Only a few
become adult criminals. In one study, 6% of the boys in a
neighborhood
accounted for more than half of all the delinquent acts and
two-thirds
of the violent acts that became known to the police. A model
sociopath
has not adopted any cultural values -- good or bad, majority
or
minority -- because except for strategic purposes, he has no interest
in what
other people think. And he is not just a public enemy but a
devastating
influence in his private life and intimate relationships.
The
character traits of callousness, deceitfulness, glibness, and self-
inflation
must be distinguished from recklessness, lawbreaking, and
violence,
which have many other causes. According to some studies, the
character traits
are more persistent with age and less closely related
to IQ,
social class, and education than antisocial behavior itself is.
Fundamental
inclinations are not the same as adaptations to a family or
social
environment. There is no simple relationship between antisocial
conduct
and any particular temperamental disposition, intellectual
limitation,
emotional disturbance, or traumatic experience.
That also
means there can be no direct inherited propensity to
antisocial
conduct in general or to violence in particular -- no
"criminal
gene" or anything like it. But some people may be genetically
vulnerable
to psychopathy. Antisocial personality is common in the
fathers of
both male and (especially) female sociopaths. The concordance
(matching)
rate for sociopathy in genetically identical twins is
estimated
at nearly 50% -- two or three times higher than is found in
fraternal
twins. A high proportion of adopted children with criminal
records
have biological fathers with criminal convictions. In a Danish
study of
adopted children, the 4% who had a biological parent with a
serious
criminal record committed 70% of the crimes in the entire group.
There is a
high rate of antisocial personality in the families of
alcoholics
and narcotic addicts, and some types of alcoholism and
addiction
may be genetically related to the personality disorder.
Millon T, et
al., eds. Psychopathy: Antisocial, Criminal, and Violent
Behavior.
Guilford, 1998.
Hare RD.
Without Conscience: The Disturbing World of the Psychopaths
Among Us.
Guilford, 1998.
Reid WH.
Unmasking the Psychopath: Antisocial Personality and Related
Syndromes.
W. W. Norton, 1986.
Brennan PA
and Raine A. "Biosocial Bases of Antisocial Behavior:
Psychophysiological,
Neurological, and Cognitive Factors." Clinical
Psychology
Review (1997): Vol. 17, No. 6, pp. 589-604.
Vaillant
G. "Sociopathy as a Human Process." Archives of General
Psychiatry
(February 1975): Vol. 32, pp. 178-83.
Source:
Harvard Mental Health Letter, Dec2000, Vol. 17 Issue 6, p1, 4p.
Item
Number: 3826533