Edit concept Question Editor Create issue ticket

Sociopathic Personality Disorder

Antisocial Personalities

Sociopathic personality disorder is a psychiatric condition characterized by repetitive antisocial behavior, lack of empathy, illegal activity and sexual promiscuity. It may begin in early childhood or adolescence and last through the adulthood. 


Presentation

Sociopathic behavior can be narrowed down to most characteristic traits in behavior such as impulsiveness, irritability and egocentricity [7] [8].

More broadly, sociopathic personality disorder may be viewed as inability of affected individual to focus on multiple actions or thought complexes and link the consequences with one’s actions. Some authors go as far as suggesting sociopaths lack self-identity rather than moral values.

The key points of sociopathic personality disorder were identified as early as 1941 in 'The Mask of Sanity' by Cleckley and were used by psychiatrists to diagnose sociopathic personality disorder. Although psychopathy and sociopathy are used overlapping in earlier studies, in the Diagnostic and Statistical Manual of Mental Disorders (DSM) it is referred to as antisocial personality disorder [1]. For the diagnosis of sociopathic personality disorder at least three or more of the DSM criteria are required to be present in patient of 18 years of age or older, consistently over time and circumstances. 

The DSM criteria comprise the following classic presentation: frequent problems with law and arrests due to committed crimes such as assault, robbery and fraudulence, aggressive behavior and cruelty towards other people due to lack of empathy and poor understanding of other's emotions and feelings, little or no displayed emotions of themself, extensive lying with use of fake names and biographies, uncontrolled impulsivity resulting in inconsistence of actions and problems with planning of the future, risky and promiscuous sexuality.

A lot of the criminal people such as rapists and muggers have sociopathic personality disorder. Some of them develop strong feelings of gratification from demonstrating control and domination over their victims by violence [9]. Frightening, aggressive, violent and hurting behavior is common in sociopaths.

However, not all of the affected individuals are killers or criminals and such criterion is not required for the diagnosis of sociopathic personality disorder.

Some of the sociopaths demonstrate the highly deceiving ability of superficial charisma. With their scheming and controlling behavior they frequently trick people into romantic relationship, but often leave them unsatisfied and hurt due to the unstable and controlling nature.

Physician
  • If you suspect a friend or family member may have the disorder, you might gently suggest that the person seek medical attention, starting with a primary care physician or mental health professional.[mayoclinic.org]
  • The physician is therefore challenged to find a way to create an effective therapeutic alliance.[health.am]
  • Google Scholar Kraepelin, E. ( 1907 ) Clinical Psychiatry: A Text-book for Students and Physicians. New York : Macmillan . Google Scholar Lewis, A. ( 1973 ) ‘Psychopathic Personality: A Most Elusive Category’ , Psychological Medicine 4: 133 – 40 .[doi.org]
  • Diagnosis Antisocial behavior and childhood antisocial disorders such as conduct disorder may be diagnosed by a family physician or pediatrician, social worker, school counselor, psychiatrist, or psychologist.[encyclopedia.com]
Nausea
  • Figures and Tables - Analysis 6.1 Comparison 6 phenytoin versus placebo, Outcome 1 Adverse events, nausea. Table 1.[doi.org]
Aggressive Behavior
  • Patients frequently engage in aggressive behavior, making a vast list of possible complications. Physical or verbal violence and abuse of children or relatives are quite common amongst them.[symptoma.com]
  • Testosterone and Aggressive Behavior in Man Menelaos L. L.[doi.org]
  • MAOA knockout (KO) mice display elevated levels of DA, NE and 5-HT and male KO mice exhibit increased aggressive behavior [8] .[doi.org]
  • Likewise, the neurotransmitter serotonin has been linked with impulsive and aggressive behavior. Both the temporal lobes and the prefrontal cortex help regulate mood and behavior.[psychcentral.com]
  • Previous studies of MAO A activity in both mice and humans have shown that low levels of this enzyme increase aggressive behavior. "There are known genes that protect against malaria and other parasites," says Moffitt.[eurekalert.org]
Social Isolation
  • In children, cruelty to animals, bullying behavior, impulsivity or explosions of anger, social isolation, and poor school performance may be, in some cases, early signs of the disorder.[pharmacypedia.org]
  • Traits that are common in those with these disorders include frequent aggressive behaviors, sometimes social isolation, lack of empathy, manipulative behaviors, and breaking rules, laws or norms.[draxe.com]
  • The term antisocial may be confusing to the lay public, as the more common definition outside of clinical usage is an individual who is a loner or socially isolated.[theravive.com]
  • Low Extraversion Social isolation, interpersonal detachment, and lack of support networks; flattened affect; lack of joy and zest for life; reluctance to assert self or assume leadership roles, even when qualified; social inhibition and shyness.[ptypes.com]
Explosive Personality Disorder
  • personality (disorder) Type 2 Excludes antisocial personality disorder ( F60.2 ) F60.3 ) The following code(s) above F60.2 contain annotation back-references Annotation Back-References In this context, annotation back-references refer to codes that contain[icd10data.com]
Ganser Syndrome
  • Ganser's syndrome . Investigations Toxicology screen because substance abuse is common (as with many personality disorders).[patient.info]
Asthenia
  • Am J Psychiatry 1979 ; 136:120–121 Link , Google Scholar 8 Cohen ME , White PD , Johnson RE : Neurocirculatory asthenia, anxiety neurosis, or the effort syndrome .[doi.org]

Workup

Psychiatric evaluation is necessary for the diagnosis. For the diagnosis of this disorder at least three or more of the following criteria are needed to be present in patient of 18 years of age or older, consistently over time and circumstances:

  • No displayed emotions
  • Aggressive, violent behavior with frequent fights
  • Complete lack of empathy to other people
  • Impulsiveness, inability to plan for the future ahead
  • Deceitful actions, such as extensive lying, fraudulence, using of the fake names and biography 
  • Problems with following the law and consistently being arrested
  • Absence of the concern for safety of others and/or themselves
  • Inconsistency of actions, behavior, inability to concentrate on one's course of actions
  • Promiscuity

A physical exam should be conducted to check for possible co-occurring medical issues, which may be a cause of or have an influence on the personality disorder course.

Laboratory work-up may include routine tests such as complete blood count (CBC) as well as hormonal levels (i.e. thyroid) to exclude biological causes of behavior problems. Alcohol and drugs of abuse levels should be screened for.

A psychological evaluation may also be helpful and diagnosis and management of the disorder course. Psychologists may conduct tests for personality, family history and behavior patterns.

Treatment

As with other personality disorders, sociopathic personality disorder is quite resistant to treatment. Compliance of patients is also a challenging issue, as often they won’t want to receive the treatment.

Current standards of treatment are based on combination of psychological therapy and medications. There is no definitive protocol, and the treatment should be considered depending on every patient’s individual situation.

Psychotherapy, although not always effective, may be used in such modalities as group therapy, individual sessions or family/friends sessions. However, if the course is severe with deep impairment, the patient with sociopathic personality disorder may not be willing to participate. The most commonly used behavioral therapy has shown successful outcomes in a way of reducing malevolent behaviors.

Pharmacotherapy with antipsychotics, antidepressants and mood-stabilizers may be useful for treatment of frequently co-occurring depression, anxiety and substance abuse or for specific symptoms such as aggressive behavior. However, there is no specific drug for treatment of the personality disorder itself.

Prognosis

Sociopathic personality disorder has been linked with lower socioeconomic status and homelessness. The extent of consequences of sociopathic personality disorder may vary. Symptoms are reported to peak in late teenage through early 20s. Sometimes the course of disease may decrease to some extent by the age of 40s.

Patients frequently engage in aggressive behavior, making a vast list of possible complications. Physical or verbal violence and abuse of children or relatives are quite common amongst them. The sociopathic personality disorder is also characterized by consistent problems with law. Patients may participate in gang activity, demonstrate homicidal ideations and may be regularly imprisoned or jailed. Due to the difficult impulse control, affected individuals also often participate in risky and promiscuous sexual behaviors, alcohol and drugs abuse and gambling. The problematic personality of these patients sometimes makes it difficult for health care workers, school personnel and law enforcement authorities to work with them.

Etiology

The exact etiological factor has not been identified. Sociopathic personality disorder is assumed to be the result of combined influence of genetic and environmental factors in a way that the affected patient may be born with predisposition for developing the disorder. Having born with a specific temperament, the combination of external factors such as abusive parenting affect psychological state of the child or adolescent, and may result into full-blown sociopathic personality disorder.

Several associated factors in patients’ history have been linked to the antisocial personality disorder and may be used to identify possible future causes of this personality disorder and improve long-term outcomes in patients. Prominent lack of empathy in childhood is one of the associated factors. It presents with difficulties in understanding the problems and emotions of other persons (parents and other children). The arson and cruelty towards animals are also the possible warning signs.

Sociopathic personality disorder has an increased incidence among children who faced abuse in their childhood and had alcoholic or antisocial parents. Sociopathic personality disorder is frequent among imprisoned people. Men are affected more than women.

Epidemiology

The prevalence rates for sociopathic personality disorder among the general population are reported to be as high as 3% in men and 1% in women. Imprisoned people have much higher rates. There is an increased incidence in people with abusive, alcoholic and antisocial parents.

Sex distribution
Age distribution

Pathophysiology

Personality is viewed as a confluence of the one’s view on the world, thoughts, behavior and emotions. It is thought to be formed by a combination of genetic factors, such as temperament and environmental, such as parenting and social interaction. A personality disorder is believed to be the result of defect in one or both of these modalities [4].

From the psychological point of view, sociopathic behavior is characterized by impulsiveness of thoughts and actions seeking personal profit, disregarding the interests and emotions of other people and social rules. Patients tend to frequently violate common-sense social norms, pose harm to others and commit violent crimes. 

Although no definite underlying biological cause has been revealed, researchers believe involvement of certain brain areas in causing sociopathy. According to one belief, the orbital frontal cortices are responsible for inadequate assessment of socially unconditioned somatic signals. There is a lack of linkage between sociopath’s memory and relevance of behavior. Individual's capacity to learn from own mistakes is disrupted causing lack of empathy for others. The other theory suggests underlying hormonal fluctuations as the cause of sociopathic personality disorder development. However, there is no direct evidence confirming these as possible causes for the condition and more direct evidence is required.

Prevention

As there is no definitive etiology, prevention is difficult. Preventive measures should be focused on reducing the risk factors, such as revealing and interfering with cases of child abuse and neglect. Long-term observation and management of psychological health of affected patients is crucial.

Parents, teachers and pediatricians should pay attention to detecting the warning signs of possible future sociopathic personality disorder and apply early interventions, such as disciplinary measures, behavioral and family therapy. Such possible early signs may be:

  • Violence against peers, bullying in schools
  • Cruelty towards humans and animals
  • Property destruction, arson
  • Poor performance in school
  • Repeated problems with law: stealing, assault, gang activity, weapons use
  • Difficulty in following authority figures, such as teachers and family
  • Inappropriate sexual behavior

Summary

Sociopathic personality disorder, also known by alternative names of sociopathic personality, antisocial personality disorder, or sociopathy, is a psychiatric condition, classified as one of the personality disorders. The exact criteria for diagnosis remain as a topic of scientific discussion [1]. Despite the disorder often considered as a single entity by most psychiatrists, there may be a variability in the symptoms which allows for further differentiation into groups [2] [3] [4]. Some authors suggest a presence of anxiety as another prominent differential factor [5] [6]. 

The etiology of the disorder is unknown, however, presumed to be a result of combination of genetic and environmental factors.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) lists several criteria for Scoiopathic Personality Disorder; 3 or more of criteria from the list are required to be present in a person of 18 years or older age for the diagnosis. These criteria are a general outline of the disorder’s presentation; however, the severity may vary. Sociopaths neither feel nor understand emotions of other people and behave disregard of other’s safety. Affected individuals frequently face problems with law, they have a tendency to commit crimes, engage in illegal and violent behavior, stealing and often got themselves arrested or jailed for their acts. Due to uncontrolled impulsivity, patients with sociopathic personality disorder may have inconsistent course of actions throughout their lives, engaging in multiple relationship and risky sexual behavior. The disorder peaks at the age of early 20s and may somewhat fade by 40s.

There is no definitive treatment. Psychotherapy is used to manage the disease, but the patient’s compliance may pose a challenge. Antipsychotics, antidepressants and mood-stabilizers may be used for co-occurring disorders.

Attention of parents, teachers and pediatricians is required for possible warning signs of development of sociopathic personality disorder in the future, such as cruelty towards animals and humans, difficulties following the rules, property destruction and arson. Early identification may pose an opportunity for intervention and adequate management.

Patient Information

Sociopathic personality disorder is a psychiatric condition, which may be called by other names such as antisocial personality disorder, or simply sociopathy.

Sociopathic personality disorder is characterized by a variety of symptoms. Sociopaths may behave aggressively, frequently engaging in violent behavior such as assaults and fights. They also tend to commit other crimes like stealing and fraud, making these people frequently arrested and imprisoned or jailed. Sociopaths have problems with controlling their impulsivity in a way that they cannot stop themselves from having an immediate pleasures at any cost and they often engage in promiscuous sexual activities, gambling and substance abuse. Another prominent feature is lack of empathy, meaning that sociopaths do not understand or care for other people’s emotions, feelings or them being hurt. Sociopaths tend to have manipulating personalities.

The exact cause of sociopathic personality disorder in unknown, however, it is presumed to come from a combination of genetic and environmental factors. Genetics can act upon a person’s nervous system response characteristics, called temperament. Environment can have its effect via abusive parents, teachers or other adults or any childhood trauma.

There is no cure for sociopathic personality disorder. Treatment is focused on managing the complications and minimizing volatile behavior. This can be achieved with psychotherapy. The patient can either have a session alone with a psychotherapist or have it with family members or friends. Medications may be prescribed to regulate patient’s emotional response.

The prevention of this disorder can be difficult, but should put parents, teachers and pediatricians on a watch to detect possible indicators in children for the development of sociopathy in the future. Such signs may be bullying in school, cruelty towards animals and people, problems with authorities such as parents and teachers, property destruction and setting of fire.

References

Article

  1. Skilling T, Harris G, Rice M, Quinsey V. Identifying persistently antisocial offenders using the Hare Psychopathy Checklist and DSM antisocial personality disorder criteria. Psychological Assessment. 2002;14(1):27-38. 
  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. First Edition. Washington, DC: American Psychiatric Press, Inc.; 1952.
  3. Slee V. The International Classification of Diseases: Ninth Revision (ICD-9). Annals of Internal Medicine. 1978;88(3):424-426. 
  4. Lykken D. A study of anxiety in the sociopathic personality. The Journal of Abnormal and Social Psychology. 1957;55(1):6-10. 
  5. Blackburn R. An Empirical Classification of Psychopathic Personality. The British Journal of Psychiatry. 1975;127(5):456-460. 
  6. Blackburn R. Patterns of personality deviation among violent offenders: replication and extension of an empirical taxonomy. British Journal of Criminology. 1986;26:254-269.
  7. Presly A S, Walton H J. Dimensions of abnormal personality. British Journal of Psychiatry. 1973;122,269-276
  8. Tyrer P, Alexander J. Classification of personality disorder. British Journal of Psychiatry. 1979;135,163-167.
  9. Katz J. Seductions Of Crime. New York: Basic Books; 1988.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2018-06-21 18:10