Psychology

Anti social personality disorder refers to a mental and behavioral disorder that compels the victim to persistently disregard and violate the rights of others (Cole  Dodge, 1998). This usually begins during childhood or early teenage and continues through adulthood. In most cases, individuals with this disorder get in trouble with the law enforcement agencies because of violation of the law. The interviewee, Tyler Murphy asserts this by indicating that he has been in jail for long periods of time because of stealing, fighting, drinking, setting fire to an abandoned house and breaking and entering. Medical statistics indicate that currently, approximately one in forty seven US citizens suffers from this disorder (Torgersen et al, 2007). This translates in to 2.1 or 5.7 million US citizens. Further, the statistics show that men are four times more likely to develop the disorder than women. With regard to the familial pattern, Torgersen (2007) contends that the disorder is more likely to affect the first-degree biological relatives of persons with the disorder than the entire population.
Causes
According to Coid (2003), the exact cause of anti social personality disorder is still unknown. However, researchers have developed various theories that attempt to explain the causes and seemingly, this condition is contributed to by various augmenting factors. Primarily, biological traits, dysfunctional family environments and various other environmental factors have been cited to contribute significantly to its development (Campell et al, 1995 Hill  Maughan, 2001).
A theory suggested by Campell et al (1995) asserts that abnormal development of the central nervous system causes ASP. Symptoms of this condition are manifested through different disorders that include hyperactivity, consistent bedwetting and learning disorders. Further, emergent studies show that smoking during pregnancy increases the probability of the offspring developing anti social personality disorder. According to this school of thought, smoking lowers the oxygen levels that the fetus is exposed to. This then results in to subtle brain injury that affects its behavioral development.
The theory presented by Borduin (1999) asserts that individuals suffering from ASP require an increase in sensory input to enable their brain to function normally. This presumption is supported by the evidence that anti social individuals show decreased amplitude on specific brain measures, have low skin conductance and exhibit low resting pulse rates. This study also ascertains that persons whose arousal is chronically low are likely to opt for potentially dangerous and or risky behaviors in an attempt to raise their arousal to maximum levels for satisfaction of their internal craving for excitement.
This contention has been supported by brain imaging studies that confirm that abnormal functioning of the brain contributes to anti social behavior (Borduin, 1999). In addition, serotonin has also been linked to aggressive and impulsive behavior. Basically, the prefrontal cortex and temporal lobes are instrumental in regulating a persons mood and general behavior. In his review, Scotts et al (2001) suggests that aggression and impulsive behavior stem from abnormal levels of serotonin in the specific brain regions.
Furthermore, Lerner and Steinberg (2003) consider the home and social environment to contribute significantly to the development of anti social personality disorder. According to this, parents with antisocial children often exhibit behavioral constraints themselves. A survey conducted in US in 2008 indicates that parents of delinquent children were in most instances violent, alcoholic and or engage in crime (Caspi, 2008). This contention is also ascertained by Tyler who asserts that his father had a violent temper and engaged in heavy drinking. In addition, he affirms that his sister has an anti social personal behavior too. As such, it can be ascertained that the problem was inherited from their father who seemingly suffered from anti social personality behavior.
In his study, Borum et al (2000) indicates that in most instances, the homes of persons affected by anti social personality behavior are disrupted by incidences of divorce, separation or absence of one parent. This environment does not give the children a chance to engage in constructive activities and establish viable relations. In some cases, the children are taken to foster homes or are given up for adoption. In their consultative review, Farrington and Coid (2003) cite the environment provided in foster or adoption homes to contribute to anti social behavior. This is because such environments deprive a child of the critical emotional bond during his or her childhood. This has the capacity to damage the childs ability to establish trusting and intimate relationships that are essential for appropriate development of behavior. It is because of the fact that in most cases, such children are mobile as they are forced to be under the care of several care givers before their final adoption. This disrupts their ability to establish lasting and trusting attachments with specific adults as they are exposed to varying psychological environments.
In addition, Macmillan (2000) reports that inappropriate and erratic modes of discipline also contribute to the development of anti social personality disorders in children. Tyler asserts this by indicating that the parents used to punish him and make him do extra chores as a mode of punishment to his maladaptive behavior. Often, the parents of these children scrutinize the behavior of the children, set stringent rules and ensure that the rules are obeyed accordingly. In addition, they tend to watch their children, frequently find out about their whereabouts and in most cases steer them from their troubled playmates.
On the other hand, Macmillan (2000) postulates that anti social parents usually lack the vital motivation to watch their children. This is compounded by the situation of their broken homes that is characterized by absent parents and lack of good supervision. Further, anti socials that happen to grow up in large families are often accorded minimal supervision and attention. Ultimately, this undermines their ability to develop appropriate and socially acceptable behavior.
In their review, Loeber and Loeber (2002) lament that troubled homes have a plethora of negative effects to the affected children. Essentially, they enter adulthood with emotional injuries that are characterized by self absorption and indifference to others. This condition is attributable to their inability to establish strong emotional bonds. These children also lack consistent discipline that culminates in little regard for societal rules and lack of gratification. The troubled home environment deprives the child of role models. As such, she learns to employ aggression in conflict resolution. This greatly inhibits the development of critical virtues like concern and empathy for others.
Furthermore, Campell et al (1995) indicate that the aggressive and anti social children tend to choose the company of children with similar disorders as playmates. This pattern of association develops during elementary education where children seek to belong to a certain social group. It is contended that children with aggressive behaviors are usually rejected by their peers. This makes them feel outcast and drives them to form social bonds with other children that have similar behavior. This situation is exemplified by Tyler who indicates that in most instances, he used to associate himself with older kids and considered his age mates stupid ad annoying and only talked to them when he wanted to start a fight or take their money. Macmillan (2000) indicates that the older company rewards and encourages the aggression of children with anti social personality disorders. In the long run, such associations culminate in gang membership.
In his survey, Caspi (2008) argues that child abuse is also linked to antisocial personality disorder. Statistics indicate that persons with this disorder are more likely to have experienced child abuse than their counterparts. According to researchers views, these persons grow up with violent parents and in neglectful homes. As such, abusive behavior is learnt by the children, who then pass it on to their children in adulthood. Likewise, Scotts et al (2001) points out that early abuse is harmful as it leads to brain injury. In addition, traumatic events reportedly disrupt the development of the nervous system of the child. Notably, this trend continues through teenage years and early adulthood. In particular, traumatic events such as war and conflicts have been reported to have adverse effects on the psychological wellbeing of the populations. Furthermore, they deprive the society of relevant resources and sources of livelihood that then affects the nutritional wellbeing. In this respect, Lerner and Steinberg (2003) posit that exposure to malnutrition during the early sages of life contributes to ASP.
In his study, Scotts et al (2001) indicates that the cultural perceptions are also linked to anti social personality disorder. In particular, the various cultural beliefs and practices, customs, values, attitudes and traditions have been identified to influence the development of ASP in various ways. For instance, cultural attitudes towards certain sex of the children contribute to a feeling of rejection that then leads to development of the disorder.
In contrast, positive cultural perceptions of certain children inhibit the development of the disorder as they feel secure and cared for by the entire society. In this respect, it can be argued that in most traditional societies, children born out of wedlock are often disregarded by the entire society and treated as outcasts. Comparatively, their legitimate counterparts are held in high regard and accorded full support during growth. In addition, some cultural aspects that reinforce and promote domestic violence, sexual promiscuity, chemical dependence and substance abuse and other types of criminal behavior often increase the prevalence of ASP in the respective societies.
The social class structure is also cited by Cole and Dodge (1998) to influence personality disorders. Research evidence from the Latino community indicates that social class determines the type of parenting style and attitudes that the parents assume towards their children (Cole  Dodge, 1998). Essentially, parents from the lower class are more likely to have been rejected by their guardians or parents than their counterparts from a higher social class. In addition, the study postulates that the parents from a lower socio economic class tend to be emotionally colder and less responsive to the emotional needs of their children. In most cases, they fail to demonstrate their affection towards their children and even reject them in extreme cases.
From the above considerations, it can be ascertained that anti social personality disorder is contributed to by different genetic, social, cultural and environmental factors that interplay to culminate in this complex condition. Although a distinct cause has not been identified, psychological studies contend that the dysfunctional nature of the social, psychological and physical environments contribute significantly to its development. While these environments can be amended to enhance the healing of affected individuals, biological and genetic factors can not be easily manipulated. In stead, they make the specific individuals vulnerable to the development of the behavior.
Diagnosis
For the diagnosis of this disorder to be given, the affected person needs to be at least eighteen years. In addition, this individual needs to have had some symptoms of personality disorder such as delinquency before the age of fifteen years. Tyler indicates that he was diagnosed for this disorder during his childhood, although he had been considered a delinquent when he was still young. Basically, the anti social personality disorder can only be diagnosed when the specific behaviors become distressing, consistent or disabling. In addition, the DSM manual indicates that diagnosis is done if the anti social behavior does not exclusively occur during a manic episode or in the course of schizophrenia.
Essentially, three or more of these is requisite rebellion to social norms and failure to assume lawful behavior that is manifested through repeated engagement in actions that can lead to arrests deceitfulness that is indicated by persistent use of alliances, lying and conning other people for reasons of personal pleasure or personal profit impulsivity or inability to plan ahead irritability and aggression that is manifested through frequent assaults or physical fights reckless disregard for security of oneself and others consistent irresponsibility that is manifested through inability to honor financial obligations and sustain consistent work behavior and lack of remorse that is exhibited through indifference to rationalizing having hurt, stolen or mistreated others.
Notably, Tyler exhibited these symptoms as he dropped out of school because of his tendency to make trouble and fight wit hid peers. In addition, he indicates that he used to take money from his age mates whom he considered stupid and annoying. He asserts that currently, he still gets in to fights with his friends. In addition, he shows that he can not stand his co workers and boss in employment. Presently, he is satisfied with working at a construction because of the fact that he is paid cash. According to Cole and Dodge (1998), this can be a clear indication of financial irresponsibility.
Studies indicate that these disorders are in most instances observed in children and adolescents. As such, the disorder can only be diagnosed of the behaviors are manifested by adults.
Prevention, Intervention and Management
Antisocial personality disorders have far reaching implications on the functioning of an individual and the society in general. Angold et al (1999) refer to it as a social handicap that can not be treated easily. Prevention is therefore imperative to avoid incidences of mortality, improve the health and productivity of the population as well as save resources that are employed in management of the same.
To begin with, there is need for initiation of education programs that are geared towards informing the public about the problem. This can be achieved through incorporation of the concept of behavioral constraints in the curriculum of elementary schools. Notably, most youth offenders develop the disorder while in schools and therefore, knowledge about the same would enable them to devise viable measures and prevent the development of deviant behavior. Since teachers understand the behavioral facets of their students, Farrington and Coid (2003) argue that they can be used to identify the same for enrollment in youth justice system. Alternatively, special education programs can be introduced as mainstream schools to cater for the needs of children with behavioral disorders. The curriculum of such schools is then customized to meet the specific needs of these children.
Further, Meltzer et al (2000) points out that the health and social services department can be used to disseminate vital information to the public about the disorder. Specific measures in this regard include distributing leaflets containing vital information about personality disorder to the members of the public that seek medical attention. In addition, the government can introduce screening tools in the heath facilities. These can be used to screen all individuals that seek the medical care and introduce the identified victims to relevant programs. In addition, Coid (2003) shows that the media can also be employed in creating public awareness about the problem. In this respect, health based programs that are aired by the media can address specific aspects of antisocial personality disorders. In his study, Scotts et al (2001) contends that since the media highly influences the decisions that are made by the population, such measures would go a long way in encouraging the affected population to seek timely medication.
Further, the government can liaise with the community workers to introduce community outreach programs in various communities. These can work in conjunction with the community members to raise awareness about the problem and encourage the affected individuals to seek timely medical attention. During such initiatives, it is important to employ persons from the specific population in order to enhance sustainability of the projects.
Hill and Maughan (2001) indicate that family based therapy can also be instrumental in managing the behavioral disorder. This therapy aims at changing the patterns of communication that are employed at the family level in order to enhance adaptation of the members to the problem. Essentially, it seeks to modify the perception of the family members and enable them to approach the anti social behavior from a functional perspective. The therapist basically identifies the dependencies and the family problems that stem from the antisocial behavior. This identification according to Hill and Maughan (2001) provides an impetus for change.
In instances where the youth and children in the family are affected with the anti social problem, Scotts et al (2001) suggests that parent training is essential. This measure is based on the assumption that in most cases, the maladaptive behaviors that children develop are caused by poor interactions between the child and the parents. However, emergent studies note that this situation is bidirectional and in some cases, children influence their parents to refrain from sustainable interactions (Caspi, 2008). In this respect, psychological studies indicate that in certain instances, children purposely assume anti social behaviors to prompt unhealthy interactions from the parents. Parent training provides the parents with ideal procedures and measures that can be undertaken to alter the anti social behavior of the child in the home environment. The main aim of such programs is to reduce deviance and enhance pro social behavior. However, Caspi (2008) shows that this approach is not effective for chronic cases that often characterize the adolescents. As such, he asserts that it should be employed when dealing with young children whose anti social personality disorders are not yet established.
Borum et al (2000) also indicates that the behavioral constraint can be addressed through cognitive problem-solving skills training. This is based on the realization that most of the persons that are affected by anti social personality disorder, and especially aggression, exhibit various deficiencies and distortions in their thinking process. In particular, they often have difficulties in generating viable alternative solutions to various interpersonal problems, lack the ability to understand the feelings of others and tend to attribute hostility to other people in ambiguous situations.
Essentially, problem solving skills training aims at developing interpersonal problem solving skills. These enable the affected persons to approach the problems in a more structural manner. In particular, they are equipped with vital skills that enable them to generate various solutions to the interpersonal problems. In addition, they are encouraged to develop social behaviors that are vital for sustainable social interactions.
Interventions also need to focus on anger management and coping strategies (Farrington  Coid, 2003). This is derived from the understanding and appreciation that antisocial persons usually have distorted perceptions of social problems and tend to employ more aggressive solutions when addressing the problems. Specific activities in this respect include anger reducing self talk, generation of multiple solutions to problems and management of anger arousal. Since its inception, this strategy has been effective in management of anti social behavioral constraints among the youths in high schools. Scotts et al (2001) ascertains that its employment in these settings reduced the frequency of suspensions and exclusions of students from schools in the UK.
Pharmacological treatments are also widely employed in the management of anti social personality disorders. However, Macmillan (2000) indicates that in order for them to be effective, they should be used in combination with behavioral therapies. To begin with, stimulants like dexamphetamine are known to reduce the degree of hyperactive behavior as well as aggression and other anti social behaviors. In addition, medical studies ascertain that lithium is effective in preventing severe episodic aggression especially in children (Scotts et al, 2001).
Further, anticonvulsants like carbamazepine have been used for a long time by adolescents that exhibit anti social behavior. In particular Campell et al (1995) indicates that they control neural over activity. Finally, neuroleptics have been effectively used over time to reduce obsessive behaviors in children and adolescents. Scotts et al (2001) indicate that they can also be used to reduce aggression in children that have intellectual impairment. However, these should be used sparingly for adolescents as they have a sedative effect that can affect their learning ability. Tyler indicates that medical treatment helped him to feel less depressed and anxious. Currently, he still uses medical treatment as a sole mode of managing his behavioral disorder.
Apart from preventive and curative measures, maintenance strategies play a critical role in reducing the severity of the problem. In particular, Scotts et al (2001) asserts that these are instrumental in reducing the disabilities that culminate from the consequences of the disorder. The identified strategies include prevention of recurrence and prevention of comorbid disorders and other forms of complications. Measures that seek to prevent the recurrence of the problem include educating the affected individuals about the early signs and symptoms of the relapse. This is important as it makes the person to be aware of the symptoms and enable the same to seek medical attention in a timely manner. Angold et al (1999) also indicates that regular medical check ups are important as they enable the persons to take timely measures to prevent relapses.
With regard to prevention of comorbid disorders, Angold et al (1999) ascertains that anti social personality behaviors are related to different comorbid problems with the most common being substance abuse and depression. Notably, anti social personality disorders encourages the affected individuals to engage in drug and substance abuse in order to experience temporary relief from this problem. This leads to other social problems like stealing in order to get finances for the substances. To counter this, different therapies like cognitive and behavioral therapies and family therapies are use to reduce the occurrence of negative thoughts and associated abusive behaviors.
In addition, Borum et al (2000) indicate that participation is self help groups is instrumental in enabling the affected person to cope with the problem accordingly. These meetings often seek to involve the individuals in group therapy. In addition, they enable the individual to have a chance to benefit from follow up or after care programs. The peers in the group contexts also support the recovering members and help them to realize the negative implications of substance abuse. Tyler affirms this by appreciating the fact that therapy helped him solve his anger problems and other associated disorders.
These persons also suffer from depression and often experience suicidal feelings. In this regard, Angold et al (1999) ascertain that anti social behavior is associated with different emotional disorders like post traumatic stress disorder, depression and anxiety disorders. Tyler affirms this by indicating that in some instances, he experiences suicidal feelings because of the feeling that persons around him get on his nerves. In order to counter feelings of self harm, it is contended that group therapy and cognitive behavioral therapy should be employed.