I want to bring you the latest, the bleeding edge, the cutting edge.
How appropriate about antisocial personality disorder.
First, a distinction.
Antisocial personality disorder is the official diagnosis in the Diagnostic and Statistical Manual in all its editions. There is no such thing as psychopathy in the manual.
The proposed construct of psychopathy has been mulled over, analyzed, considered, contemplated, dissected and you name it by multiple successive committees and all of them rejected it.
I happen to disagree. I agree with Robert Hare that there is an extreme end of the spectrum of antisocial personality disorder known as psychopathy. It should have a label of its own.
Because on the extreme end of antisocial personality disorder we have criminals, we have people whose lives are dedicated to hurting, damaging and ruining other people or to further their goals in completely socially condemned ways.
It is no wonder that Robert Hare gleaned most of his information from the prison population in the United States. He has been a prison psychologist.
Psychopathy. Sociopathy.
On the other hand, it is not a clinical entity. It is more media hype. It is not as nonsensical as empaths and emotional flashbacks but it is not very far.
Sociopathy is something so ill-defined that it does not find place in anything I do, not in my written texts and not in my videos.
I do not deal with media hype and self-styled expertise on YouTube.
Let me tell you the latest things we have learned in the past few years about antisocial personality disorder.
It is entrenched. It is very difficult to reverse although age seems to ameliorate it or at least the behaviors attend upon it.
It is a dysfunctional mental process and behavior. It focuses on delinquent socially exploitative and criminal activities in the extreme end of the spectrum as I have mentioned.
In other words, exactly like narcissistic personality disorder and to some extent borderline personality disorder and so on, it is a relational, as I keep saying in my videos in the past few years, these are not true mental illnesses because they describe relationship failures. They describe social deficiencies.
They used to call it in the 19th century and early 20th century a character flaw, a character defect or a character disorder.
So not really mental illness in the strict rigorous clinical sense.
Antisocial personality disorder is identified by a lack of remorse for actions that hurt and damage other people, harm them. Harming other people is perceived by psychopaths and antisocial is perceived as inevitable.
They even go as far as saying the victim asked for it. The victim should have been diligent and stupidity is a price.
So the victim blame and so on.
Antisocial personality disorder belongs of course to the cluster B, erratic or dramatic cluster of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, including in the fifth edition text revision along with borderline, narcissistic and histrionic personality disorder.
Lately, we are beginning to unify this disorder, to see the similarities, the extreme similarities.
For example, when the borderline acts out, she tends to display all the hallmarks of secondary psychopathy, fomulative two psychopathy, impulsive psychopathy.
And similarly, histrionic personality disorder can easily be reconceived and perfectly described as a form of psychopathy, despite the fact that the histrionic ostensibly has empathy.
And we are beginning to realize that the empathy of the borderline and the empathy of the histrionic fluctuate dramatically and in many cases disappear altogether in certain stressful life situations.
So there's a lot in common, a lot of common ground between antisocial personality disorder and the other cluster B personality disorders.
People with antisocial personality disorder struggle. It's a struggle. It's a difficult life because they're unable to form stable interpersonal relationships and the disorder consequently is linked to elevated rates of aggression, violence, accidents, suicide, and substance abuse. So we'll come to in a minute. Substance abuse actually has the highest, most significant correlation to the diagnosis of antisocial personality disorder. So when you see someone who is an alcoholic or a junkie, someone who habitually abuses, for example, cocaine, coke, or alcohol, this person is likely a psychopath, not a borderline, not a codependent, not a, you know, a narcissist even. In all likelihood, that's a person with antisocial personality disorder, albeit maybe with emotional dysregulation, factor two, or with grandiosity. So a kind of psychopathic narcissist. Psychopathy is intimately and extremely highly correlated with substance abuse. Intelligence and education on the other hand, show a negative correlation with antisocial personality disorder. There's a higher prevalence of antisocial people with antisocial personality disorder, a higher prevalence among people with lower reading scores and lower IQs, which explains why I'm not a psychopath, despite the documentary. Okay. The etiapatology, the reasons, the causes of antisocial personality disorder, etiapatology or the etiology remains unknown. We think that there are environmental factors at play and maybe genetic factors.
The various studies that estimate that psychopathy or antisocial personality disorder are anywhere between 38% to 69% heritable. In other words, the genetic component is anywhere between 40% and 70%.
But there, I've seen these studies, the samples are very small, and I'm not impressed.
Adverse childhood experiences, ACEs, for example, physical abuse, to a lesser extent, sexual abuse, neglect. They're the type of environmental factors that I've mentioned, and they do correlate with the development of antisocial personality disorder along an earlier diagnosis called childhood conduct disorder. So childhood conduct disorder, an attention deficit hyperactivity disorder, ADHD, are precursors of psychopathy or antisocial personality disorder in adults.
For example, among children diagnosed with conduct disorder, 40% of boys and 25% of girls go on and continue life. And then as adults, they meet the diagnostic criteria for antisocial personality disorder.
Now, what are these criteria that I keep mentioning?
In the DSM-5, the person is required to be above the age of 18 years. So you can't diagnose antisocial personality disorder in anyone younger than 18, anyone younger than 18 who tortures animals and kills, and I don't know what else he does, that's someone with conduct disorder.
So the evidence of conduct disorder, usually with onset at an age younger than 15 years, is a precursor to antisocial personality disorder.
Additionally, we must exclude the differential diagnosis and we must exclude schizophrenia and bipolar disorder, especially the manic phase, because they have antisocial elements. The person must show a pervasive pattern of disregard for and quoting disregard for and violation of the rights of others, which can be demonstrated by acting impulsively, failing to plan, disregarding the law, as indicated by repeatedly committing acts that are grounds for arrest, being deceitful, indicated by lying repeatedly, using aliases, or conning others for personal gain or pleasure, being easily provoked, aggressive, indicated by constantly getting into physical fights or assaulting others, recklessly disregarding their own safety or the safety of others, consistently acting irresponsibly, indicated by quitting a job with no plans for another job, not paying bills and so on and so forth, not feeling remorse, indicated by indifference to or rationalization of hurting others or mistreating them. This is the language of the Diagnostic and Statistical Manual 5 and regrettably it excludes many manifestations of antisocial personality disorder in daily life and among high functioning individuals.
I would recommend Martha Stout's book The Social Path Next Door. I would recommend anything written by Robert Hare and others.
So there are no current diagnostic modalities. This is very important to understand. There are no accepted standards for diagnosing antisocial personality disorder. We use anything from structured interviews and tests like the MMPI 2 and 3, but they are very weak instruments because psychopaths don't self-report honestly. They lie. They prevaricate.
So we also use neuroimaging, genetic testing, genetic testing, are like this, genetic testing in order to evaluate potential patterns and causes and abnormalities, especially in the brain.
Patients with antisocial personality disorder are at a higher risk of contracting certain viral infections and sexually transmitted infections associated with high risk behavior, including AIDS, HIV and hepatitis C, as well as increased mortality rates due to traumatic injuries, suicide, homicides and accidents. These are all tell-tale signs of someone with antisocial personality disorder.
I mentioned that we use neuroimaging. Electroencephalography is not used in patients with suspected antisocial personality disorder. It is though used in patients with antisocial behavior who are suspected to have autism spectrum disorder.
Seizures as well.
So we do use EEG, but not with antisocial personality disorder.
There were many attempts to identify the precise gene contributing to antisocial personality disorder. There's some mild evidence, emphasis on mild, that it may be a variation within a gene called AVPR1A in the 2P12 region of chromosome 2, a mouthful.
But genetic testing cannot yet help us to diagnose antisocial personality disorder sooner or to confirm specific mutations. So that's again a very weak instrument.
What about MRI? What about PET? What about functional MRI?
We do use this in cases of obsessive compulsive disorder because these tests do show increases in blood flow and metabolic activity in the orbitofrontal cortex, limbic structures, chordate and thalamus with a trend toward right-sided predominance in patients with OCD.
But they are not very useful with antisocial personality disorder.
The fact that we keep failing with neuroimaging, EEG, MRI, PET, that we keep failing to pinpoint a specific brain abnormality raises serious doubts about the claim that psychopathy is a brain disease akin to, shall we say, schizophrenia or even depression and bipolar.
It seems that the environmental, social, cultural, autobiographical component is overwhelming. And of course the brain reacts by rewiring itself. The brain is neuroplastic, but it doesn't mean that the brain abnormality is the cause.
I mean we have no studies of young brains in the making and how they become ostensibly or allegedly the brains of psychopaths. We don't have such a thing. Longitudinal studies.
A antisocial personality disorder is associated with a risk for pathological gambling. It's a mental disorder characterized by a pattern of continued gambling despite negative physical, psychological and social consequences. So it's a kind of addiction. Gambling combines risk-taking, thrill-seeking and addiction, which are the three core elements of psychopathy.
Psychopaths also suffer from anxiety disorders. Most psychopaths are anxious.
This is a complete reversal of our mythological or mythical image of the psychopath as fearless.
Psychopath is not fearless. He is reckless and he cannot control his or her impulses. So impulse control and recklessness imitate or appear to be fearlessness, but they are not.
Psychopathy is actually highly anxious and a lot paranoid.
Psychopaths also commonly suffer from somatization disorders and abuse substances, as I mentioned.
Eating disorders on the other hand are much more likely to be found in people with borderline personality disorder and narcissistic personality disorder. Anorexia is actually quite common with NPD.
So antisocial personality disorder is not associated with eating disorders, but it is associated with suicide, which is another form of self-harm and self-destruction. Suicide is more common among patients with borderline personality disorder than among patients with antisocial personality disorder, but it's still in both cases much higher than in patients with narcissistic or histrionic personality disorder.
OCD, obsessive compulsive disorders, are not common in antisocial personality disorder because they are much more comorbid. They are much more typically associated with cluster C disorders.
Can we cure psychopathy or antisocial personality disorder with a miracle drug, psychedelics maybe or something? Does this silver bullet awaiting?
Well, there's none. No drugs are effective in treating antisocial personality disorder.
Of course, you could use medication to treat various behaviors to modify or modulate some facets in co-occurring conditions, for example, obsessive compulsive disorders on the rare occasions that it rears its ugly head, but there's no medicine or cure or pill for antisocial personality disorder or for narcissistic personality disorder or for borderline personality disorder.
Get off this wagon of nonsense. Psychedelics don't cure personality disorders. Cut the CRAP.
Second generation antipsychotics, resperin, for example, or quetiapine, these are used as first line therapy to address aggressive behavior. Anticonvulsants such as oxcarbasipine or carbamazepine, these anticonvulsants can be used to aid with impulsivity, but there are no psychological or psychotherapy strategies that have shown clear efficacy with these patients, not even group therapy. They are disruptive to other patients, actually, in group settings.
Drugs for ADHD, atomoxetine and aprepiline, they're often used to treat ADHD in ASPD. They're non-addictive and people with ASPD are at an elevated risk for addiction.
And for that reason, we never use Adderall or any other stimulants or addictive medication with this population of people with cluster B, actually, personality disorder, all of a tendency to addiction.
Anyone who abuses Adderall and also has cluster B personality disorder is likely to end up an addict, being an addict, an alcoholic or a junkie or something worse and is at an elevated risk of suicide. That's what we know.
Heather 2. Heather 2, look it up and see you tomorrow.