PsychoStud.com

Affective Processes of

Antisocial Personality Disorder (ASPD)

Jerry Smith, Psy.D.

Argosy University/Dallas

Affective Processes of Antisocial Personality Disorder

Antisocial personality disorder is characterized by diagnostic features such as superficial charm, high intelligence, poor judgment and failure to learn from experience, pathological egocentricity and incapacity for love, lack of remorse or shame, impulsivity, grandiose sense of self-worth, pathological lying, manipulative behavior, poor self-control, promiscuous sexual behavior, juvenile delinquency, and criminal versatility among others (Hare, Harpur, & Hakstain, 1990). As a consequence of these criteria the antisocial personality (ASP) has the image of a cold, heartless, inhuman being. But do all ASPs show a complete lack of normal emotional capacities and empathy? Like healthy people, many antisocial personalities love their parents, spouse, children and pets in their own way, but have difficulty loving and trusting the rest of the world. Furthermore, ASPs do suffer emotionally as a consequence of separation, divorce, death of a beloved person or dissatisfaction with their own deviant behavior (Martens, 1999).

Antisocial personalities can suffer emotional pain for a variety of reasons. Like anyone else, ASPs have a deep wish to be loved and cared for. This desire remains frequently unfulfilled, however, as it is obviously not easy for another person to get close to someone with such repellent personality characteristics. ASPs are at least periodically aware of the effects of their behavior on others and can be genuinely saddened by their inability to control it. The lives of most ASPs are devoid of a stable social network or warm, close bonds.

The life histories of antisocial personalities are often characterized by a chaotic family life, lack of parental attention and guidance, parental substance abuse and antisocial behavior, poor relationships, divorce, and adverse neighborhoods (Martens, 2000). Catherine Stanger (1999) hypothesizes that parental substance abuse and psychopathology exert much of their influence on children’s behavior by disrupting parenting. This hypothesis is consistent with the stage model of the development of antisocial behavior articulated by Patterson and colleagues (1992). This model suggests that problems such as parental substance use, psychopathology and social disadvantage lead to early parent-child interaction problems, especially the use of ineffective discipline. These parenting problems lead directly to externalizing problems in early childhood. At later ages, children’s externalizing problems predict other poor outcomes such as academic problems, rejection by non-deviant peers, association with deviant peers, low self-esteem, depressed mood, antisocial attitudes, delinquency and substance use. Furthermore, ASPs may feel that they are prisoners of their own etiological determination and believe that they had, in comparison with normal people, fewer opportunities or advantages in life.

Despite their outward arrogance, inside ASPs may feel inferior to others and know they are stigmatized by their own behavior. Although some antisocial personalities are superficially adapted to their environment and are even popular, they may feel they must carefully hide their true nature because it will not be accepted by others. This leaves ASPs with a difficult choice: adapt and participate in an empty, unreal life, or do not adapt and live a lonely life isolated from the social community. They see the love and friendship others share and feel dejected knowing they will never take part in it.

Antisocial personalities are known for needing excessive stimulation, but most foolhardy adventures only end in disillusionment due to conflicts with others and unrealistic expectations. Furthermore, many ASPs may be disheartened by their inability to control their sensation-seeking and repeatedly confronted with their weaknesses. Although they may attempt to change, low fear response and associated inability to learn from experiences lead to repeated negative, frustrating and depressing confrontations, including trouble with the legal system.

As ASPs age, they are not able to continue their energy-consuming lifestyle and become burned-out and depressed, while they look back on their restless life full of interpersonal discontentment. Their health deteriorates as the effects of their recklessness accumulate.

Social isolation, loneliness and associated emotional pain in ASPs may precede violent criminal acts (Martens, 2000). They may see the whole world as against them, eventually becoming convinced that they deserve special privileges or rights to satisfy their desires. As psychopathic serial killers Jeffrey Dahmer and Dennis Nilson expressed, violent psychopaths (i.e., ASPs) ultimately reach a point of no return, where they feel they have cut through the last thin connection with the normal world. Subsequently their sadness and suffering increase, and their crimes may become more and more bizarre.

One possible rationale for the aggressive nature of ASPs towards others lies in miscommunication. Research has suggested that individuals suffering from antisocial personality disorder have an underdeveloped prefrontal cortex. One effect of this may be the inability to accurately read the facial expressions of others indicating the other’s emotional state. Another rationale lies in temperament developed as a child. Parental interaction and parenting have been shown to influence the development of temperament. According to Bates (2000), “studies suggest…that highly stress-reactive infants with stern parents are less likely to develop behavioral inhibition in toddlerhood than stress-reactive infants with parents who are not stern.”

Violent ASPs are at high risk for targeting their aggression toward themselves as well as toward others. A considerable number of antisocial personalities die a violent death a relatively short time after discharge from legally-imposed psychiatric treatment due to their own behavior (for instance as a consequence of risky driving or involvement in dangerous situations) (Black, Baumgard, Bell, & Kao, 1996). ASPs may feel that all life is worthless, including their own (Martens, 1999).

In trying to treat antisocial personalities, the therapist must remember that they uniformly lacked benevolent, sustained relationships with their parents. They are afraid of intimacy and of assuming responsibility for it. ASPs cannot believe that others can tolerate their anxiety, and all devoutly fear responsibility for achieving success by open competition. They can neither identify with authority nor accept this criticism, and they resent any thwarting of their actions, even when such intervention is clearly in their interest. Their consciences are too rigid, not too lenient, and so they reject all moral standards and ideals, rather than experience their punitive self-judgment. (Martens, 1999)

Emotions are usually a key aspect of treatment of this disorder. Patients often have had little or no significant emotionally-rewarding relationships in their lives. The therapeutic relationship, therefore, can be one of the first ones. This can be very scary for the client, initially, and it may become intolerable. A close therapeutic relationship can only occur when a good and solid rapport has been established with the client and he or she can trust the therapist implicitly.

The content of therapy should focus on the patient’s emotions (or lack thereof). As the ASP learns to experience various emotional states, one of the first may be depression. The client will likely be unfamiliar with the feelings associated with depression, and so it is beneficial for the clinician to be supportive and empathetic to the individual during this time. Reinforcing any emotions, outside of anger or frustration, is usually beneficial. Experiencing intense affect is usually a sign of progress in therapy. Staying on “safe issues,” and discussing more real-life concerns, while one way of treating this disorder, is not likely to be as effective in long term behavioral change as an approach emphasizing the discovery and labeling of appropriate emotional states. (Martens, 2000)

References

Bates, J.E. (2000). Temperament as an emotional construct: theoretical and practical issues. In M. Lewis & J. Haviland-Jones (Eds.), Handbook of emotions (2^nd ed., pp. 382-396). New York: The Guilford Press.

Black, D.W., Baumgard, C.H., Bell, S.E., Kao, C. (1996). Death rates in 71 men with antisocial personality disorder. A comparison with general population mortality. Psychosomatics, 37,(2):131-136.

Hare, R.D., Harpur, T.J., Hakstian, A.R. et al. (1990). The Revised Psychopathy Checklist: descriptive statistics, reliability, and factor structure. Psychological Assessment, 2:338-341.

Martens, W.H.J. (1999). Marcel — A case report of a violent sexual psychopath in remission. International Journal of Offender Therapy and Comparative Criminology, 43:391-399.

Martens, W.H.J. (2000). Antisocial and psychopathic personality disorders: causes, course and remission — a review article. International Journal of Offender Therapy and Comparative Criminology, 44:406-430.

Patterson, G.R., Reid, J.B., Dishion, T.J. (1992). Antisocial Boys. Vol. 4. Eugene: Castalia.

Stanger, C., Higgins, S.T., Bickel, W.K .et al. (1999). Behavioral and emotional problems among children of cocaine- and opiate-dependent parents. J Am Acad Child Adolesc Psychiatry, 38,(4):421-428.