Speech therapy can harm you

Dissocial Personality Disorder

Personality traits as a disturbing burden (page 8/16)

Antisocial Personality Disorder: Constant disregard for social norms and violation of the rights of others

Antisocial or dissocial personality disorder is characterized by the fact that someone constantly disregards social norms and ruthlessly asserts their own goals.

The conspicuous behavior can usually already be observed in childhood and adolescence: those affected disregard rules, repeatedly skip school, steal, willfully destroy things or constantly lie. In adulthood, many are prone to criminal and violent behavior, break laws, and have a high willingness to take risks. They have a hard time dealing with frustrations and are then prone to aggressive and violent behavior. As a rule, punishments or negative experiences do not lead them to change their behavior.

Some of those affected are not criminals either, but are socially well adapted and even professionally successful. It is also characteristic that people with antisocial personality disorder have a lack of empathy and therefore do not feel guilty or a sense of responsibility when they cause harm to others. At the same time, however, they often have a good ability to recognize the feelings of others and to use them for their own purposes - for example, to manipulate them through special charm.

A classic case study comes from Robert Hare, one of the first researchers to study antisocial personality disorder. He reports how he is supposed to treat the inmate "Ray" during his first psychological activity in a state prison.

Ray had a long criminal record, which included a lot of violence - and spent almost half of his adult life in prison. From the very first contact, Hare notices how direct, intense and demanding the eye contact of the mid-30-year-old prisoner is. During the therapy sessions, Ray sometimes pulls a knife and thereby puts his therapist under pressure. He tests him again and again, for example to find out whether Hare adheres to the rules of the prison administration. In addition, he constantly tries to manipulate his therapist and persuades him, for example, to find him a particularly good job in the prison kitchen or in the car repair shop. Overall, Ray is also very adept at manipulating and tricking others. He lies without remorse, and when others present him with disagreements, he simply changes the subject and comes up with another lie.

When Hare quits his job in prison and drives to his new job at a university, he discovers that Ray has also tampered with his car: he has changed the hoses to the radiator and cut the brake cable, so that Hare barely escapes a serious accident.

Transitions to normality - dissocial personality style (according to Kuhl & Kazén)

People with an antisocial personality style - which is similar to but less pronounced antisocial personality disorder - are adventurous and risk takers. They attach particular importance to self-determined behavior and are particularly adept at pursuing their own interests. Especially when it comes to verbal dexterity and quick action, they appear socially very competent. Many are successful in professions in which the willingness to take risks plays a role - for example as an athlete or in building construction. There they can be very successful and get a lot of recognition.

What are the typical symptoms of Antisocial Personality Disorder?

Show people with antisocial personality disorder according to DSM a profound pattern of disregard for and violation of the rights of others. To make the diagnosis, the affected person must be at least 18 years old. The conspicuous behavior has existed since at least the age of 15, and a disorder of social behavior was already recognizable before that. The symptoms also do not occur during the course of a schizophrenia or manic episode. According to the DSM, at least three of the following criteria must be met:

  1. Those affected are unable to adapt to laws and social norms. This is shown by the fact that they repeatedly commit acts that are grounds for arrest.
  2. They misbehave by repeatedly lying, cheating, or using aliases. This behavior is solely for personal gain or pleasure.
  3. You are impulsive and unable to plan ahead.
    They are irritable and aggressive, which manifests itself in repeated brawls or assaults.
  4. They ruthlessly disregard their own safety and the safety of others.
  5. They behave consistently irresponsibly and, for example, are unable to perform a permanent job or meet financial obligations.
  6. Those affected show no remorse if they have offended, mistreated or stolen from other people. This shows in indifference or a rational attitude towards the events.

While the DSM emphasizes criminal acts and violations of the law, the ICD-10 focuses on typical patterns in experience, action and interpersonal relationships.

To ICD-10 In contrast, a dissocial personality disorder shows abnormalities in character, namely egocentricity, a lack of empathy and a lack of conscience. Criminal acts can occur but are not required for diagnosis. According to ICD-10, at least three of the following characteristics must be met:

  1. Those affected have a lack of empathy and show coldness towards others.
  2. They repeatedly disregard social norms.
  3. You have a weakness in building relationships and bonds with others.
  4. They have a low tolerance for frustration and often behave impulsively or aggressively.
  5. Those affected feel little or no guilt and are incapable of social learning.
  6. They often make a superficial explanation of their own behavior and tend to unjustifiably blame others.
  7. You are persistently irritable.

How Common is Antisocial Personality Disorder?

Studies have shown that one to four percent of the population is affected by antisocial personality disorder. The disorder is four times more common in men than in women.

What Are Possible Causes Of Antisocial Personality Disorder?

As with other personality disorders, it is assumed that the disorder arises from the interaction of biological, psychological and environmental factors.

Antisocial personality disorder is more common if one or both parents have already had the disorder, which suggests a genetic cause. On the other hand, those affected often come from broken homes and have experienced violence, neglect and little attention in their childhood.

It was found that the likelihood of antisocial behavior is increased when a certain gene variant and physical abuse or abuse in childhood come together. It is the weakly active variant of the so-called MAO-A gene, which means that the enzyme monoamine oxidase A is present in smaller quantities. This in turn leads to an increased release of the messenger substances serotonin, dopamine and norepinephrine in the brain, which can affect aggressiveness and impulsiveness.

Antisocial behavior disorder in childhood and adolescence, which involves physical violence, criminal behavior, lying, and truancy, is considered a risk factor for later antisocial personality disorder. Attention and hyperactivity disorder (ADHD) in childhood also seems to increase the risk of the disorder.

From the perspective of psychoanalysis, those affected experienced a lack of parental love in childhood and were therefore unable to develop “basic trust” in others. As a result, they cannot form emotional bonds and only develop relationships in which they can exert power or behave in a destructive manner.

Cognitive behavioral therapy assumes that learning factors also play a role in the disorder. Those affected may have taken over the behavior from their parents. It could also be that the parents paid special attention to aggressive behavior or did not stop reckless, aggressive, or selfish behavior. This behavior was thus rewarded and subsequently occurs more frequently.

Treatment of Antisocial Personality Disorders

Psychotherapeutic approaches

Psychotherapeutic treatment approaches are also in the foreground in the case of dissocial personality disorder. The main goal is to change the characteristics of the patient that can lead to aggressiveness, violence and criminal acts. Therefore, important goals of therapy are to improve interpersonal and social skills and to achieve better control over impulses that have led to criminal acts. In addition, the empathy of those affected should be promoted - especially in the effects of their actions on their victims. In addition, the patients learn strategies with which they can avoid relapsing into old behavior patterns.

It seems to be beneficial for the success of a therapy if those affected show signs of guilt. Even if they suffer from other psychological problems such as anxiety or depression, they are often more willing to participate in therapy and think about changes.

Possible problems in psychotherapy and possible solutions

A special feature of psychotherapy is that those affected usually do not come to therapy voluntarily, but rather through a court order or under pressure from their employer. Many also compulsorily take part in therapy offers in prisons. In many therapy concepts, a change in crime and violence is aimed primarily at a change - rather than a change in typical personality traits. Therefore, the motivation of the patients to participate in the therapy and to change their behavior is often not particularly high.

However, some factors can significantly increase the chances of success of a therapy. This includes that the therapist himself believes in the success of the therapy and communicates this to the patient. It is beneficial if he adopts a committed attitude and on the one hand responds to the patient's point of view, but on the other hand also sets clear boundaries and retains authority over the therapy. The goals of the therapy should be presented convincingly and tailored to the patient's personal needs. A clearly structured procedure in which the contents and their order are defined has proven to be beneficial.

Targeted support and follow-up care beyond the period of therapy - for example by the therapist himself or a probation officer - can help ensure that the success of the therapy remains stable in the long term.

On the other hand, a very authoritarian, punitive attitude that relies on deterrence, but also a relaxed therapeutic “community”, in which those affected are allowed a lot, have proven to be unsuccessful.

Psychoanalytic and deep psychology-based therapy

Psychoanalytic approaches assume that the therapist should behave in a supportive manner, but should also provide a lot of structure. The patients should be informed about the background of their disorder and about possibilities for change. Therapy approaches that are poorly structured and in which interpretations play a role, on the other hand, are viewed as not very effective.

Cognitive behavioral therapy

So far, cognitive behavioral therapy has proven to be the most successful form of therapy in the treatment of dissocial personality disorder. It can both reduce criminal behavior and change personality traits favorably.

An important element of therapy is improving social skills. Patients should learn how to realize their own needs, but at the same time how to take the needs of other people into consideration. You can also practice becoming more aware of other people's desires, intentions, and feelings, improving self-control, building positive interpersonal relationships, and dealing with anger better. For this purpose, role plays, intellectual exercises and behavioral experiments are used, for example.

Another important step in therapy is for patients to develop compassion for their victims and thus also take responsibility for their actions. This can be done by imagining the consequences of their crimes for their victims. In addition, they are often asked to write two letters - one in which they apologize to their victim and one in which they write from the victim's point of view what he or she wants to say to the perpetrator.

In order to prevent relapses, thoughts, feelings and behaviors are collected that could lead to a relapse into old behavior patterns - especially into criminal or violent behavior. Then concrete steps are worked out with which violent acts can be prevented as early as possible. These strategies are recorded in writing and given to the patient, but also to a person they trust, such as the therapist or probation officer. This is to ensure that all those involved can counteract a slide into renewed violence at an early stage.

Therapy with psychotropic drugs

The use of psychotropic drugs seems to do little or no contribution to effectively and permanently changing an antisocial personality disorder.