Antisocial Personality Disorder Treatment

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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Causes and symptoms

Certain social and behavioral characteristics, however, are more commonly seen among individuals who become dependent on opioids than those who do not. For instance, many heroin users come from families in which one or more family members use alcohol or drugs excessively or have mental disorders (such as antisocial personality disorder). Often heroin users have had health problems early in life, behavioral problems beginning in childhood, low self-confidence, and anti-authoritarian views.

Cultural Differences And Young Adulthood

Socially sensitive disorders characterized by impulsivity tend to be less prevalent in traditional societies. For example, in Taiwan (Hwu, Yeh, & Change, 1989) and Japan (Sato & Takeichi, 1993), there is a low prevalence of substance abuse and antisocial personality among young people. The increasing prevalence of these same disorders among young adults in modern societies suggests that contemporary social conditions may be stressful. Even if many, or most, young people thrive under modernity, a vulnerable minority is at risk for mental disorders.

Passive Aggressive Personality

Although deleted as a direct listing in DSM-IV and DSM-IV-TR and included instead under the heading a personality disorder not otherwise specified, the passive-aggressive personality structure remains common in children, adolescents, and adults, and, for clinical purposes, it is advantageous to continue to refer to it. A passive-aggressive trait organization is essentially designed to frustrate authority and avoid punishment simultaneously, so that the individual is able to salvage some sense of autonomy along with the expression of defiance. The defiance is masked by an apparently accommodating facade or manner. For example, the child of an overdemanding parent extracting full obedience and absolute deference frequently responds with a passive-aggressive obedience that is invariably qualified with traits such as tardiness, procrastination, forgetful-ness, incompleteness, and stubbornness. In this way, the individual's character partially forms along the line of passive-aggressive...

Character Traits as Controls

By observing patterns of behavior during the testing session, the psychologist can establish the particular kind of character or personality configuration being displayed. This organization of traits or character patterns frequently may be broadly separated into an active as opposed to passive pattern. The pattern of character traits associated with the compulsive characterology is active, for example, because the need for control is extensive and necessitates a broad range of idiosyncratic activities such as rituals, efforts toward closure and completion, manifestations of orderliness, and a careful organization of schedules and activities. Such a weave of highly active character traits is all-encompassing, binding substantial anxiety so that little tension or emotion is able to surface. In contrast, in a passive-aggressive characterology, there is a studied neglect with respect to the completion of tasks, exasperating delay, lack of closure, and inconsistent attention to detail....

Zyprexa see Olanzapine

Alzheimer's disease antisocial personality disorder borderline personality disorder conduct disorder intermittent explosive disorder may occur with tic disorders may occur with vascular dementia oppositional defiant disorder paranoid personality disorder substance intoxication Agitation antisocial personality disorder Cross-dressing

Natural History And Longterm Outcome In Personality Disorder

Data on the natural history of personality disorders are skewed towards the most severe cases and most of these have been identified in psychiatric hospitals and forensic settings. Furthermore, most of the follow-up studies in this area are not really accounts of the natural history of these disorders, but are reports of long-term outcome after variable degrees of widely divergent interventions. Borderline and antisocial personality disorders have attracted particular attention because the impulsive and destructive behaviour of these individuals causes such concern among both carers and society in general. As noted above, borderline patients often make heavy demands on the health service. In contrast, individuals with antisocial Stone (2001) reviews the available data on the natural history and long-term outcome of personality disorders, noting that individuals within the 'antisocial realm' historically constituted a diverse group incorporating those meeting criteria for DSM...

Case Study Jon and Linda

Jon and Linda were referred to the author by Jon's current psychopharmacolo-gist. Jon is a 62 years old financier who has been married to Linda (53 years old) for over 20 years. She began HRT 4 years ago, which successfully stopped her hot flashes. This is his second marriage and her first marriage. They had three teenage children together. Their marriage was marked by periods of disharmony secondary to multiple etiologies. Jon and Linda had a symbiotic relationship where she dominated much of their daily life. She tended to be explicitly critical of him, which he resented but managed passive-aggressively. This, of course, merely exacerbated their marital tension. Linda was particularly sensitive to rejection, and was considerably upset when Jon withdrew from her in response to her criticism. This infuriated her and she provoked confrontations. He eventually responded, becoming loud and aggressive, which initially dissipated his tension. He then felt guilty as she expressed hurt and...

Theoretical Components Of The Model

Copying exists in normal as well as disordered individuals. The SASB model defines normal in terms of behaviors that are friendly and that show moderate degrees of enmeshment (one person is in control and the other submits) and differentiation (one person emancipates and the other separates). Pathological behavior includes characteristic positions that are hostile and or that are extremely enmeshed or differentiated. A normal person can be hostile or extreme, too, but only in appropriate time-limited contexts. By contrast, a disordered person is characteristically hostile or occupies positions of extreme enmeshment or differentiation regardless of context. For example, consider the characteristic positions of personality-disordered individuals. Paranoid and antisocial patients are characteristically hostile. Schizoid and avoidant persons show extreme differentiation. Borderline, histrionic, dependent, and obsessive-compulsive individuals too often can be described as extremely...

Range Of Psychopathology And Personality Disorders Within The Scope Of Treatment

Adjustment disorders can occur with any of the personality adaptations. In terms of subtypes, adjustment disorders with anxious or depressed mood are likely to be seen across the spectrum in individuals with Histrionic, Obsessive-Compulsive, Passive-Aggressive, Schizoid, or Paranoid adaptations. Adjustment disorders with disturbance of conduct are most likely to be seen in individuals with an Antisocial adaptation. The personality adaptations that are most likely to experience anxiety and mood disorders are the performing adaptations (Histrionic, Obsessive-Compulsive, and Passive-Aggressive). When the symptoms of anxiety and depression are more severe, the surviving adaptations of Schizoid and Paranoid are likely to be involved as well. The Antisocial adaptation will tend to act out rather than experience anxiety and depression. At the level of the personality disorders, the negative sides of the adaptations are used as a chronic maladaptive style. Pure types of adaptations are seen...

Personality Disorders And Social Sensitivity

Mental disorders whose prevalence changes with time and circumstance can be described as being socially sensitive. Disorders that have a stable prevalence across cultures and time can be described as being socially insensitive. Many of the socially sensitive disorders (e.g., substance abuse, eating disorders, antisocial personality, borderline personality) have externalizing symptoms. Impulsive traits, which tend to be contained by structure and limits and amplified by their absence, are particularly responsive to social context. At the same time, disorders characterized by internalizing symptoms (e.g., unipolar depression, anxiety disorders) are also socially sensitive. Anxious and depressive traits can be either contained or amplified by social supports.

Millons Evolutionary Model

Millon (Millon & Davis, 1997) has suggested that all the DSM personality disorders can be included in this polarity model and viewed as representing one of three possible conditions. The deficient condition involves a style in which the individual is unable to emphasize either side of a polarity. The schizoid individual, for example, is deficient in his or her ability both to seek pleasurable experiences and to avoid painful ones. The imbalanced personality emphasizes one side of a polarity, often to the exclusion of the other. The dependent individual, for example, relies heavily on others for nurturance, with little ability to provide self-support. The conflicted personality oscillates between the two sides of one of the polarities. The passive-aggressive individual, for example, wavers between emphasizing the expectancies of others and focusing on his or her own wishes and needs. (APA, 1987) and the DSM-IV (APA, 1994, 2000). They also include scales for possible Axis II syndromes...

Complex Syndrome Treatment Goals

The interpersonal style of the schizoid, avoidant, dependent, histrionic, narcissistic, and antisocial personalities seem better assessed by the circumplex than do compulsive, borderline, negativistic (passive-aggressive), paranoid, and schizotypal individuals (Pincus & Wiggins, 1989). We would conclude then that any assessment of clinical syndromes and personality that is anchored only in the interpersonal domain, while informative, must be regarded as incomplete. Clinicians of an interpersonal bent must balance the increased specificity gained by using an exclusively interpersonally oriented instrument with the knowledge that the paradigm itself is acknowledged to be an incomplete representation of psychic pathology.

Impact of Demographic Socioeconomic and Health Characteristics

In addition to considering group differences and the effect of language, the clinician should use demographic and socioeconomic factors as additional pieces of data when assessing for health and pathology. For example, it is common for Indian or Native females to have children at a young age and, within some tribes and groups, this behavior is encouraged. A seventeen-year-old Indian female with two children has not necessarily experienced family or peer disapproval, stress related to dropping out of high school, or be considered irresponsible. In a similar vein, because of higher unemployment rates, a jobless Inupiaq male should not automatically be considered as meeting the Antisocial Personality Disorder criterion C(l) ( inability to sustain consistent work behavior ). The availability of jobs in his village and the norms in his community regarding employment should be explored first. Subsistence remains the primary way many Inupiaq Eskimos provide for themselves with seasonal...

Psychiatric conditions

Dilemma, although sometimes they are present together. Both depressive and manic symptoms may occur in combination with symptoms of schizophrenia schizo-affective disorder. Agitated depression and mixed depressive anxiety neurosis are easily mistaken for pure anxiety states. Antisocial personality disorder may be confused with mania.

Mental disorder in offenders

Because of the difficulty of obtaining representative samples of offenders in the community, surveys on mental disorder among offenders have mainly been done on those in prison. The prevalence of mental disorder among prisoners, whether remanded or sentenced, is much higher than in the community. Figures have obviously varied between different populations studied, but a fifth of women prisoners and a third or more of male prisoners have antisocial personality disorder prisoners were 10 times likelier than the general population to have

Criminality and violence in psychiatric patients

There is an excess of offending, including violence, among those with mental disorder. However, antisocial personality disorder and substance misuse are stronger risk factors than mental illnesses such as schizophrenia. The bulk of offending in general, and violence in particular, has nothing to do with mental illness. A recent study, for example (Fazel and Grann, 2006), found that about 5 per cent of violent crimes were committed by those with psychosis (which has a prevalence of about 1 per cent) the association was stronger in females.

Diagnosis and Prognosis

This method implies a system of diagnostic levels that are used for increasing refinement. Diagnostic understanding is developed from broader levels to deeper, latent dimensions. Thus, the diagnosis starts with a problematic behavior that may be specified as a clinical syndrome such as a phobia, sexual disturbance, or compulsion. If manifestations of anxiety are associated with these symptoms, a neurotic level of difficulty such as an anxiety disorder or obsessive-compulsive disorder can be specified. Underlying this level is the character formation in which the symptom is embedded. At this point the diagnosis is addressed to the character organization that produces symptomatic outgrowths. If there is a stable, deeply ingrained maladaptive pattern, a personality disorder can be specified for example, a schizoid or passive-aggressive personality disorder.

Partnership and Adult Lifestyle

If the delinquent behaviour persists into adulthood, this may indicate an antisocial personality disorder or the more narrowly defined psychopathy (Hare, 1995, 2001). In these cases, deviant behaviour is very hard to modify (Losel, 1998). Such chronic delinquents often have difficulties in forming stable intimate relations or they chose partners that have similar problems (Quinton et al., 1993). Although most criminal careers fade out after the age of 40, other difficulties such as alcoholism, chronic unemployment, psychiatric problems and violence in the family often continue (Farrington, 1989). Such lifestyles, and the inheritance of genetic information create, in turn, developmental risks for the next generation. But, again, this is not necessarily a closed cycle and depends on interactions with protective factors and mechanisms.

Equivalence Of Computeradministered Tests And Traditional Methods

Interview Schedule (C-DIS) and a clinician-administered Structural Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders-Third Edition-Revised (DSM-III-R SCID) to evaluate 173 clients. They reported the congruence between the two instruments to be acceptable except for substance abuse disorders and antisocial personality disorder, in which the levels of agreement were poor. The C-DIS was able to rule out the possibility of comorbid disorders in the sample with approximately 90 accuracy.

Inadequate Personality

Closely allied to both the dependent and passive-aggressive personalities is the inadequate personality disorder. Although no longer recognized as a specific entity in DSM-IV nomenclature, it is nevertheless included here because its frequent occurrence gives it more than historical interest. The major feature of this diagnosis involves a profound underresponse in virtually every aspect of the person's functioning. This includes underresponsiveness in relationships, school, jobs, and sexual functioning. Associated with underresponse are traits such as strong feelings of inadequacy and inferiority, a weepy sentimentalism which often emerges in the context of melodramatic events, and an inappropriate sobriety with respect to authority relationships. Although such persons may demonstrate high intelligence, excellent reading skills, and well-developed levels of conceptualization, performance skills and self-assurance are extremely limited.

Alcohol and related disorders

Alcoholism is defined as alcohol seeking and consumption behavior that is harmful. Long-term and uncontrollable harmful consumption can cause alcohol-related disorders that include antisocial personality disorder, mood disorders (bipolar and major depression) and anxiety disorders. Antisocial personality disorder Disorder characterized by behavior pattern of disregard for others' rights. People with this disorder often deceive and manipulate, or their behavior might include aggression to people or animals or property destruction, for example. This disorder has also been called sociopathy or psychopathy.

Sources of Anxiety in the Personality

A diagnosis of antisocial personality can be made if qualities of immaturity, underdeveloped superego, and magical thinking are prominent. Other character or personality diagnoses that avoid anxiety include obsessive-compulsive and borderline personalities - Passive-aggressive persons express negativism and withholding

Defenses Used to Manage Individual Emotions

This frequently used mechanism is designed primarily to manage the emotion of anger. The subject directs blame, anger, and aggression to less threatening substitute figures so that these emotions, associated judgments, and behaviors are not focused on the real, more threatening target. A frequent manifestation of displacement is a recurrent belligerence toward authorities representing a displacement of resentment toward parental figures to whom an expression of anger would have been highly threatening. Passive-aggressive and dependent persons, in their reluctance to express hostility directly, typically utilize displacement.

Defenses and the Report

Several diagnostic implications involving the use of particular defense mechanisms were pointed out in the definitions of defense mechanisms. For example, the use of denial is typical of those with a histrionic syndrome. The constellation of defenses consisting of intellectualization, isolation, and undoing, often in conjunction with rationalization and sublimation, is characteristic of obsessives and compulsives. The use of displacement is typical of passive-aggressive persons. Compensation in patients with depression and narcissistic disturbances also is frequently found because bolstering or maintenance of self-esteem is a major need for them. Utilization of projection is typical of persons with paranoid inclinations in which hostility and aggressive motivations are overly ascribed to others. Splitting in the borderline diagnosis and regression among psychopathic, antisocial, or impulsive types are other examples of defense mechanisms that typically are seen in specific diagnoses....

Risk Factors

Frequently comorbid with other psychiatric and medical diagnoses, are the most commonly found diagnoses in psychological autopsy studies of completed suicides for both men and women, across all age groups Substance abuse and behavioral disorders, such as antisocial personality and conduct disorder, are found in much larger proportions in adolescent suicides than in older suicides, which are dominated


The most prevalent was antisocial personality disorder. All subjects had impulse control disorder and a paraphilia, but it is not clear how many of the offenders in the study had a diagnosis of pedophilia or other specific paraphilias. In another recent study, Raymond et al. (25) found that 93 of individuals with pedophilia had at least one lifetime comorbid axis I diagnosis. Highest were comorbid mood and anxiety disorders. There was high co-occurrence of alcohol and cannabis use disorders, and 60 had comorbid personality disorders, in particular obsessive-compulsive, antisocial, avoidant, and narcissistic. Contrary to commonly held assumptions, there was a relatively low incidence 23 of antisocial personality disorder.

Mental Disorders

The fact that more women than men are treated in mental health clinics and psychiatric hospitals would lead one to believe that the rate of mental illness is higher among women than among men. This appears to be the case with respect to some, but certainly not all, mental disorders. Women tend to be more vulnerable to anxiety disorders, depression, and eating disorders, and they probably have a higher rate of attempted suicide than men. On the other hand, boys are more likely than girls to stutter, to be hyperactive, and to develop other conduct or behavioral disorders (Myers, 1995). As adults, they are more likely to become alcoholics and or substance abusers and to develop antisocial personalities (Unger, 1979). Men also commit more crimes than women, and crimes of violence in particular (U.S. Department of Justice, 1996). Finally, substantially more men than women, and especially older white men, succeed in committing suicide (Singh et al., 1996).

Offending behaviour

Causes of offending behaviour are predominantly social and environmental, rather than psychiatric. Conduct disorder in children ('juvenile delinquency') often persists into adulthood as criminality and or antisocial personality. Criminality tends to run in families. Twin and adoption studies indicate some specific genetic component of this inheritance, and up to half of antisocial behaviour may have a genetic basis. However, other factors such as coming from a large impoverished family, poor parenting, a culture of criminal behaviour in the neighbourhood and school, and low intelligence are thought to be of greater influence.

Conduct disorder

Conduct Disorder Symptoms

Youngsters who show symptoms (most often aggression) before age 10 may also exhibit oppositional behavior and peer relationship problems. When they also show persistent conduct disorder and then develop adult antisocial personality disorder, they should be distinguished from individuals who had no symptoms of conduct disorder before age 10. The childhood type is more highly associated with heightened aggression, male gender, oppositional defiant disorder, and a family history of antisocial behavior. a behavioral disorder. One study with adopted children in the mid-1990s looked at the relationship between birth parents with antisocial personality disorder, and adverse adoptive home environments. When these two adverse conditions occurred, there was significantly increased aggressiveness and conduct disorder in the adopted children. That was not the case if there was no indication of antisocial personality disorder in the birth parents. This finding has important implications for...


Epidemiological surveys using a variety of diagnostic criteria estimate a prevalence of 10 to 15 of at least one personality disorder within the general population (Mattia & Zimmerman, 2001). The diagnosis is more commonly made in younger people (25 to 44 years). The sex ratio varies according to the specific disorder for example, women are more likely to be diagnosed with borderline personality disorder (BPD) whereas most individuals diagnosed with antisocial personality disorder are men. Unsurprisingly, both prisons and psychiatric hospitals have a particularly high prevalence of personality disorder. Within the former this has been estimated to be as high as 78 Singleton, Meltzer & Gatward (1998), while figures for the latter range from one-third to two-thirds. The role of personality disorder in psychological morbidity is also significant in general practice. In a one-year prevalence study of 'conspicuous psychiatric morbidity' in patients attending two general practices in...

Bias and Base Rates

Similarly, psychologists assessing prison inmates, among whom antisocial personality disorder is commonly found, may be more likely to expect and diagnose this disorder than they would if they were working with similar data in a university counseling center.

Joel Paris

Personality disorders are common, and they cause serious morbidity (Skodol et al., 2002). Several studies suggest these disorders have an overall prevalence of about 10 (Samuels et al., in press Weissman, 1993). Although there is little research on the community prevalence of specific categories, a recent survey (Samuels et al., in press) indicates that antisocial personality is the most common category in community populations. Unfortunately, we lack good epidemi-ological data on cross-cultural differences in the community prevalence of personality disorders.


In nonpsychotic diagnoses, withdrawal and avoidance may derive instead from the patient's characterological manner of achieving security by living with reduced interpersonal contact. For instance, this may occur in the schizoid character disorder in which the individual demonstrates a bland, aloof quality rather than a strange quality. Withdrawal during the interview may also be observed in an extremely passive patient with dependent or passive-aggressive qualities as main features of character disorder withdrawal.