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Psychopath Hopeful Breakthroughs: Oxytocin, Schema Therapy, Reciprocal Altruism (Literature Review)

Uploaded 1/20/2024, approx. 35 minute read

The video you are about to watch has caused me enormous distress, cognitive dissonance, decompensation, disintegration and constipation. Not necessarily in this order.

And the reason is it's a hopeful video.

It's a review of five studies recently published which deal with antisocial personality disorder including its most extreme form colloquially known as psychopathy or sociopathy.

Psychopathy and sociopathy are not recognized clinical terms in the diagnostic and statistical manual but they describe a manifestation or a portion of the antisocial personality disorder spectrum and for the first time in many many years there's hope.

The thing is this, I don't do hope.

My videos are bleak, doom, gloom, hopelessness, helplessness and when I'm forced to follow the evidence to a path of light and hopefulness I feel bad, I feel hopeless and who the heck am I?

My name is Sam Wagner.

I am the hopeless author of Malignant of Love and Narcissism. Revisited the bleak former professor of psychology in Southern Federal University in Rostovand on Russia and currently on the faculty of CEAPs, Commonwealth Institute for Advanced Professional Studies, Cambridge United Kingdom, Toronto Canada and an outreach campus in Lagos, Nigeria and if this didn't drive you to despair, depression and disintegration wait till you listen to this or watch this video.

A video about hope, hope for a diagnosis that hitherto was considered untreatable, incurable, hopeless.

Most practitioners avoid psychopaths, avoid people with antisocial personality disorder because we don't have any treatment modality, any intervention that has even a minimal effect on psychopaths while we can and do often modify the behaviors of narcissists.

We are able to reduce abrasive and antisocial behaviors in narcissistic personality disorder.

Even this minor modicum of accomplishment is denied us when we deal with psychopaths.

Psychopaths are incorrigible.

They are immutable.

They are like rocks.

Practitioners just give up on psychopaths.

In prison, psychopaths go through evaluation, they go through mock therapeutic treatment, but really everyone fully expects them to relapse.

Crime rate among criminals is extremely high.

People with antisocial personality disorder who are not criminals, which is the vast majority of the population of psychopaths, the vast majority are actually not criminals.

You can find them in various settings such as corporate structures, in the army, in medicine and so on and so forth, but they are not criminals.

Even in this case, they don't change until late in life, until their 40s and 50s.

Now there's new information about this as well.

Stay tuned.

What are the latest breakthroughs when it comes to antisocial personality disorder and psychopathy based on the latest studies?

Antisocial personality disorder.

There's a debate.

Is it a mental illness at all?

Or is it just a lifestyle choice or a personality style?

Define authority known as consummationness, recklessness, rejection of laws and mores and regulations or any imposition from the outside, constant power play, goal orientation, using other people, instrumentalizing them or trampling of them on the way to obtaining the goal.

These are all personality choices or personality features, but when put together, do they constitute a mental illness?

Your humble servant does not think so.

I don't consider antisocial personality disorder a personality disorder at all or a mental illness of any kind. I think the folks in the 19th century got it more right, got it more accurately than we do. They called psychopathy a moral insanity, a character defect, a social insanity or social dysfunction.

They didn't regard antisocial or psychopaths as mentally ill.

And I don't think they are.

The current thinking, the current emerging thinking is that antisocial personality disorder is some kind of cognitive distortion. It is a dysfunctional thought process.

Now, we have a cognitive distortion in narcissism, in narcissistic personality disorder, and it's known as grandiosity.

Grandiosity distorts the narcissist's ability to perceive reality properly.

The narcissist deforms, reframes, reshapes and rewrites reality in order to uphold and buttress an inflated, fantastic self-image.

Similarly, someone with antisocial personality disorder has a cognitive distortion, a dysfunctional thought process focused on socially exploitative behavior.

And typically antisocial personality disorder is characterized by a lack of remorse for these behaviors, hurting other people, using other people, leveraging their vulnerabilities, abusing them, instrumentalizing them in order to obtain goals.

All these are considered legitimate.

It's a dog eat dog world.

It's a jungle out there.

They would have done it to you as a psychopath.

The psychopathic thought process is they would have done it to me had I not done it to them first.

So it's a cognitive distortion.

Actually, it's a misperception of reality.

And we all know that antisocial personality disorder is one of the four personality disorders in the cluster B.

This clustering of personality disorders has survived well into the fifth edition text revision of the Diagnostic and Statistical Manual published only two years ago.

Nothing has changed.

The DSM is still stuck somewhere 25 years ago.

The situation is much better with the competitor for the DSM, the International Classification of Diseases published by the World Health Organization, where there is a single personality disorder with a variety of traits such as such as dissociality in the case of psychopaths and narcissists.

But within cluster B, we have the erratic, dramatic disorders.

We have narcissistic, borderline, histrionic and antisocial.

The thing is that thousands of studies over the last 150 years have linked environmental factors and adverse childhood experiences to the emergence of antisocial personality disorder and psychopathy in adulthood neglect, physical abuse, even to some extent, sexual abuse, although sexual abuse usually translates into borderline personality disorder.

Among quite a few psychopaths, we find sexual abuse in psychopathy or antisocial personality disorder is highly comorbid with narcissistic and borderline personality disorder.

In other words, within the same patient, we often diagnose antisocial, narcissistic and borderline personality disorder, the same patient.

Now, we know that genetic factors play a huge role in the development of antisocial personality disorder.

Estimates of heritability range from 38% to a whopping 69%.

It's even much more pronounced than in borderline personality disorder, according to some studies.

Childhood psychopathology, known as conduct disorder, also strongly correlates to the development of antisocial personality disorder.

A small majority of children diagnosed with conduct disorder go on to become antisocial adults.

Now, we don't know what is the prevalence of antisocial personality disorder in the general population because exactly like narcissists, psychopaths are not very keen on therapy, to put it gently.

Psychopaths also like narcissists are grandiose.

They deny that anything is wrong with them.

It is society that is malformed.

It is other people who are responsible for the antisocial choices, decisions and behaviors.

He is innocent, is pure, is a driven snow.

So it's very difficult to estimate the prevalence of antisocial personality disorder in the general population.

But we think that 6% of men and 2% of women suffer from antisocial personality disorder.

So yes, to this very day, antisocial personality disorder is more preponderant, more common among men than among women.


Now, that is not the case in narcissistic personality disorder and borderline personality disorder where women caught up with men.

And today, half of all narcissists and half of all borderlines are women or men.

So with psychopathy, still the vast majority of psychopaths, about 60, 70% of psychopaths are men.

And women psychopaths are typically borderlines.

So they are secondary psychopaths.

They're not primary psychopaths.

They're not what is known as factor one psychopaths.

They are factor two psychopaths.

Factor one and factor two are elements in the main test we have to diagnose psychopaths known as the PCLR developed by Robert Hare.

It has huge deficiencies and flaws as a clinical test, but it's proven to be a valid test to a large extent.

Now, one last thing.

The importance of early intervention in all class to be personality disorders is cannot be overestimated.

It's critical to intervene early on.

We can diagnose borderline personality disorder at age 12.

We can diagnose narcissistic personality disorder at about age 18 and I think maybe 16.

We can diagnose contact disorder in children as young as nine and sometimes four.

So early intervention is crucial.

Unfortunately, there aren't many pharmacological treatment options.

Psychopharmacology of class to be personality disorder is extremely underdeveloped and so is brain imaging and so is the genetics of, for example, narcissism.

So we are still missing many critical pieces in the puzzle.


One recent study aims to plug a mini hole in the dike or the dam of class to be personality disorders, especially antisocial personality disorder.

And that is a study of inter-nasal oxytocin.

Does it benefit patients with antisocial personality disorder?

Does it reduce amygdala hyper-reactivity to images of emotional phases?

That was the question posed by the study.

So it was a double-blind, randomized placebo-controlled study and it aimed to address the question whether oxytocin normalizes levels of hyper-reactivity to emotional phases in amygdala among people with antisocial personality disorder.

Now you can find all the bibliography, all the references in the description and as usual, shockingly, the description is under the video.

Get it?

Get it?

Some of you.

Not all.

Okay.

So, we know that the amygdala is hyper-reactive to emotional phases in aggression-prone individuals.

Aggression-prone individuals have a problem with the amygdala in situations which involve emotions.

No.

When administered oxytocin, the situation has changed.

The oxytocin seemed to have reduced the signal in aggression-prone individuals, reduced the hyper-reactivity that is anger-related.

So it seems that oxytocin somehow ameliorated or mitigated not only the anger but the brain's reaction to anger.

While in psychopaths, the brain is hyperactive, goes out of control in a way, oxytocin was able to reassert control, reestablish the equivalent of impulse control.

The researchers performed functional magnetic resonance imaging, fMRI, after treatment with intranasal synthetic oxytocin and placebo.

There was a control group with placebo.

And then what they did, after they've administered the intranasal oxytocin, they exposed the test subjects, they exposed them to an emotional classification task.

They asked them, they showed them faces and they asked them, "Is this face angry? Is this face fearful? Is this face happy?" and so on and so forth.

They found that oxytocin reduced right amygdala hyperactivity to angry faces.

In participants with antisocial personality disorder.

So in the absence of oxytocin, people with antisocial personality disorder react dramatically to anger in other people.

When they confront or are faced with angry people, they become super violent, super aggressive.

And oxytocin seemed to have somehow placed this reaction under control by reducing activity in the right side of the amygdala and the effects were larger in women, even in, I mean, the effects were even larger in women.

And there's a conclusion that women with antisocial personality disorder might benefit from oxytocin treatment for reactive aggression much more than men.

Just a bit of good news, especially in borderline actually.

When borderlines switch from borderline self state to a secondary psychopathic self state, when they decompensate, they are about to act out, become aggressive or violent or reckless or perhaps an intranasal dose of oxytocin can prevent the disaster from happening and reestablish impulse control.

Now another study tried to correlate antisocial personality disorder in young adults between the ages of 18 and 29 years and the capacity to focus on tasks, focus on an agenda, things to do.

Now this is a bit ironic because psychopathy, one of the defining features of psychopathy is that it is goal oriented.

But the psychopath's problem is that while the goal remains fixed and clear and unambiguous and unequivocal and the psychopath pursues the goal relentlessly and callously and mercilessly, trampling on people, killing people if needed need be, you know, on the way to obtaining the goal, the psychopath has a problem with managing tasks, it is a problem to break the goal down to a variety of steps and then pursue this algorithm to its end.

It's not that psychopaths are not self efficacious, psychopaths are actually highly self efficacious.

It's as they have a bit of a problem in some aspects of processing tasks.

Adaptive behavior requires the ability to focus on a current task and to protect it from distraction, from other intervening tasks.

So adaptive behavior requires not to engage in multitasking but to focus on a single task and this is known as cognitive stability.

But another requirement is the ability to rapidly switch to another task in light of changing circumstances.

So on the one hand, you need to pursue a task without getting distracted, without losing your focus, being able to direct all your attention to obtaining the outcome, the required or desired outcome and so on.

So this is cognitive stability.

On the other hand, if your environment changes and presents new challenges or even threats, you need to possess the ability to switch from a given task to another task, more conducive to survival and to functioning and this is known as cognitive flexibility.

Truly a well adopted person possesses both cognitive stability and cognitive flexibility, the ability to shift attention between tasks, between attributes of a stimulus, between responses, between perspectives, between strategies.

The best description of best analysis of cognitive flexibility you can find in the work of Miyaki and Zalazo over the last 20 years.

Now this recent study that I'm reviewing here examined issues of cognitive flexibility across a range of psychiatric disorders in young adults between the ages of 18 and 29.

It used a validated computerized trans-diagnostic flexibility paradigm and we're not going to do this.

The specific measures of interest were total errors, total mistakes on an intra-extra dimensional task.

So the ability to shift between sets of tasks and the shift performance that reflected the ability to move attention away from one stimulus dimension to another stimulus dimension.

In short, how alert are you to the environment?

When you're pursuing your task, are you then totally blind and oblivious, deaf and dumb and mute, unable to digest, unable to absorb information from the environment to change and to react to it on the fly?

If you have this problem, you have a problem with cognitive flexibility.

Some people, for example, people with autism spectrum disorder, have this problem. They're focused on tasks and nothing that's happening around them, nothing, distracts them, nothing changes their trajectory.

Even if they're put at risk, they would still pursue the task.

And so cognitive flexibility is a major hallmark of health.

Now remember that the narcissist and the psychopath suffer from cognitive distortions. The narcissist has an impaired reality testing. The psychopath doesn't have an impaired reality testing, but he has a cognitive distortion that relates to the world at large.

In other words, the psychopath's cognitive distortion has to do with his or her internal working model and theory of mind, while the narcissist's cognitive distortion has to do with reality testing.

So the narcissist misperceived reality and the psychopath misperceived reality, but for very different reasons.

The psychopath's misperception of reality doesn't amount to a problem with reality testing because it has to do with internal features, with the way he perceives other people, with the way he understands society and how it works, with his expectations regarding choices and decisions of other people, and so on and so forth.

In short, the psychopath is very pessimistic when it comes to other people, assumes the worst, always adheres to the worst case scenario and allows the worst case scenario to dictate his decisions and choices.

So participants with antisocial personality disorder demonstrated deficits of small effect size on tasks, as well as small effect size deficits for extra-dimensional errors.

I will explain. These results indicate that deficits in cognitive flexibility are pretty common in antisocial personality disorder, but not deficits in cognitive stability.

And this is exactly what we know about psychopaths.

They pursue a goal. They're almost autistic in their pursuit of a goal. They are cognitively stable. They're able to pursue a goal. They're able to design a strategy in order to obtain the goal, and then they're able to pursue this strategy efficaciously.

But their ability to shift away from the goal, to say, well, you know, I'm giving up on the goal. I'm moving on. I'm trying something else. I am attempting something new. Their ability to give up on a goal is close to zero. They're like these dogs, you know, that lock their jaws and never let go.

People, whatever they call. I mean, they just can't let go. They don't have cognitive flexibility. Even as the environment around them changes, they're still going to pursue the goal.

So a psychopath would be committed a crime, and then there's police all over the place, and he would still continue to commit the crime. Even though there are policemen around, they're pointing guns at the psychopath, he would still continue to commit the crime. Even though he had been warned numerous times, even though he knows what he's doing might lead to adverse consequences or low consequences, it nothing matters. His goal orientation, his cognitive stability is such that it overpowers his ability to change course, to redefine goals, to let go. He has no cognitive or little cognitive flexibility.

And in this study, researchers also found that participants with post-traumatic stress disorder, PTSD, and with depression have elevated total errors on the task with moderate effect sizes.

So in addition to participants with antisocial personality disorder, those with binge eating disorder, obsessive compulsive disorder, OCD, and generalized anxiety disorder, GAD, they also showed small effect sizes. Participants with antisocial personality disorder, people with depression, gambling disorder, OCD, social anxiety disorder, and substance dependence had small effect size deficits.

And this suggests, to translate this to English for you, it suggests that cognitive flexibility deficits, the inability to change course, to react to the environment, to adapt. These deficits occur across various mental disorders, and they may result or lead to substance abuse.

But it's important to understand that people with antisocial personality disorder are impaired when it comes to cognitive flexibility exactly like people who are depressed, people who are addicted, people who have OCD, people who have social anxiety disorder.

Indeed, today we link psychopathy with anxiety. And I have videos dedicated to this, how actually the psychopath suffers from anxiety disorder and substance dependence.

Antisocial personality disorder, therefore, when it comes to goal orientation and the pursuit of goals, is one of a family of disorders.


How to tackle psychopaths? What to do with them when they come to therapy?

When an narcissist comes to therapy, a very common mistake is to treat the narcissist as an adult.

The therapist attempts, ridiculously, the therapist attempts to strike a bargain with the narcissist, a therapeutic alliance, a contract with a narcissist who is four years old.

The attempt to apply adult treatment modalities and the elements of adult treatment modalities, such as therapeutic alliance to narcissist, is idiotic. I have no other words to worry for it.

Instead, we should use child psychology. 100% child psychology with narcissists coupled with trauma therapies, because narcissism is a post-traumatic condition.

Now, child psychology does not have therapeutic agreements or alliances or contracts because children are incapable of contracting. And this is the root cause of the failure of all treatment modalities bar none when it comes to narcissists.

The attempt to treat them with the respect and boundaries, which are common among adults. They're not adults, they're children.

What about psychopaths? How to treat? What to do with psychopaths? What approach is most recommended or appropriate for patients with antisocial personality disorder and the history of trauma?

This kind of trauma that causes mistrust, hostile attribution biases, externalized aggression. What do we do with these patients?

So there's a theory called reciprocal altruism. Reciprocal altruism was best described by drivers. This is a kind of altruism that occurs between unrelated individuals, individuals who are not members of the same family, so they don't share the same gene pool.

The assumption in reciprocal altruism is that if you're good to me now, I'll be good to you in the future. There's a kind of credit system. If you do me good, if you help me in a time of need, I remember this and you will have credit with me. And I'll reciprocate when you're in a time of need. There will be a kind of repayment, or at least a promise of repayment of the altruistic act in the future.

Drivers again described it in 1971.

Now there are usually debates about this. Hamilton says we don't need to call it reciprocal altruism, we should call it reciprocity because everything, every human relationship has to do with reciprocity. Every human relationship is transactional.

I'll not go into all this right now, although it's a fascinating topic for a future video. But it's one way to approach the treatment of people with antisocial personality.

But before we go there, the problem with antisocial personality disorder is the heterogeneity of the population. We slap the diagnosis of antisocial personality disorder on millions of people. People in prison, chief executive officers, surgeons, surgeons in hospitals, I mean they're all antisocial, they're all psychopaths. And this is a huge problem because the population is heterogeneous and you can't capture all of it with a single diagnosis.

Add to this the polythetic problem in the Diagnostic and Statistical Manual, where only five of nine criteria are enough to diagnose and so consequently you can have two people with the same diagnosis and they share only one clinical criteria, one diagnostic criteria. They have nothing else in common, they're actually diametrically opposed, they have one thing in common. So it's a huge mess.

The diagnostic landscape for antisocial personality disorder is an enormous mess and no wonder there are huge debates about for example in the inclusion of psychopathy in the Diagnostic and Statistical Manual.

Robert Hare, Babiak and others are advocates of this but the committees of the Diagnostic and Statistical Manual over the last 40 years have rejected this. They don't accept it because of the heterogeneity.


Okay, there's a recent framework in the study of antisocial personality disorder that uses reciprocal altruism theory and it proposes three pathways along which psychopaths can benefit from different modes of clinical therapy focused on specific behaviors and treatment goals and so on.

The framework of reciprocal altruism theory therefore allows for heterogenation incorporates a vast arena of clinical features, traits and so on so forth because it's a generalized theory. It's not linked intimately with a single diagnosis but it affords a canvas upon which we can paint the various antisocial landscapes.

So for patients with antisocial personality disorder and a history of trauma that causes mistrust, hostile attribution biases, externalized aggression, there is what is called pathway number one.

Pathway number one includes eye movement desensitization and reprocessing therapy, EMDR, and EMDR enhances empathy for victims and reduces problem behavior in samples of both youths and adults.

Schema therapy and some forms of cognitive behavior therapy may also be appropriate for this subset of patients with antisocial personality disorder and it's not surprising. These are patients who developed antisocial personality disorder because they have been traumatized and they have learned the wrong lessons about humanity.

People are evil, people are out to get you, people will hurt you, so they developed defensively compensatory antisocial personality disorder.

In short, their antisocial personality disorder, antisocial personality, psychopathy which is coupled with trauma is a facade, is nothing but a shell, an act, a theotically. It's like trying to frighten people away by saying, "Hey, I'm a psychopath, don't mess with me."

So this is a veneer, it's skim deep and it's much easier to penetrate with techniques such as EMDR and schema therapy and the results there are very promising.

But there are other groups of antisocial personality disorder, as I said, it's heterogeneous. So for patients with antisocial personality disorder and a history of trauma that causes mistrust, hostile attribution biases, externalized aggression, there is what is called pathway number one.

Pathway number one includes eye movement desensitization and reprocessing therapy, EMDR, and EMDR enhances empathy for victims and reduces problem behavior in samples of both youths and adults.

Schema therapy and some forms of cognitive behavior therapy may also be appropriate for this subset of patients with antisocial personality disorder and it's not surprising. These are patients who developed antisocial personality disorder because they have been traumatized and they have learned the wrong lessons about humanity.

People are evil, people are out to get you, people will hurt you, so they developed defensively compensatory antisocial personality disorder.

In short, their antisocial personality disorder, antisocial personality, psychopathy which is coupled with trauma is a facade, is nothing but a shell, an act, a theotically. It's like trying to frighten people away by saying, "Hey, I'm a psychopath, don't mess with me."

So this is a veneer, it's skim deep and it's much easier to penetrate with techniques such as EMDR and schema therapy and the results there are very promising.

But there are other groups of antisocial personality disorder, as I said, it's heterogeneous.


So for patients with antisocial personality disorder and a history of trauma that causes mistrust, hostile attribution biases, externalized aggression, there is what is called pathway number one.

Pathway number one includes eye movement desensitization and reprocessing therapy, EMDR, and EMDR enhances empathy for victims and reduces problem behavior in samples of both youths and adults.

Schema therapy and some forms of cognitive behavior therapy may also be appropriate for this subset of patients with antisocial personality disorder and it's not surprising. These are patients who developed antisocial personality disorder because they have been traumatized and they have learned the wrong lessons about humanity.

People are evil, peopleare out to get you, people will hurt you, so they developed defensively compensatory antisocial personality disorder.

In short, their antisocial personality disorder, antisocial personality, psychopathy which is coupled with trauma is a facade, is nothing but a shell, an act, a theotically. It's like trying to frighten people away by saying, "Hey, I'm a psychopath, don't mess with me."

So this is a veneer, it's skim deep and it's much easier to penetrate with techniques such as EMDR and schema therapy and the results there are very promising.

But there are other groups of antisocial personality disorder, as I said, it's heterogeneous.

So for patients with antisocial personality disorder and a history of trauma that causes mistrust, hostile attribution biases, externalized aggression, there is what is called pathway number one.

Pathway number one includes eye movement desensitization and reprocessing therapy, EMDR, and EMDR enhances empathy for victims and reduces problem behavior in samples of both youths and adults.

Schema therapy and some forms of cognitive behavior therapy may also be appropriate for this subset of patients with antisocial personality disorder and it's not surprising. These are patients who developed antisocial personality disorder because they have been traumatizedtheir eyes cognitively to the need to reduce risky behaviors by not risky behaviors, such as novelty seeking or thrill seeking or recklessness.

So we teach them to control impulses and to reduce risky choices and decisions.

That's the maximum that can be done.


Now, numerous studies have shown over the decades, maybe even the centuries, because psychopathy is the oldest diagnosis, by the way.

Numerous studies have shown that psychopathy tends to ameliorate and mitigate over the years. When the psychopath reaches 40, 50 years of age, at least psychopathic behaviors, if not psychopathic traits, psychopathic behaviors diminish. They're reduced.

Psychopaths mellow with age. They become much more normative. They become much more conforming to social mores and conventions and norms. They become much more accepting of the law and so on, the law abiding.

So this happens to psychopaths in their 40s and 50s, similar to borderline. Same thing happens with borderline. It's kind of spontaneous remission. This has been the common wisdom, but there's been a recent meta-analysis that kind of upended the apple cart or rocked the boat or whatever metaphor suits your mood right now.

This meta-analysis stated that dimensional rank order stability for antisocial personality disorder criteria was high compared to other personality disorders.

Now, what is dimensional rank order stability? It is the extent that certain traits are maintained over time.

Simple. So this meta-analysis looked at the question, are the traits of psychopaths stable over the lifespan? Are they maintained over time?

But pay attention. Not behaviors, traits. There's a big difference. You can maintain the same traits and yet your behavior changes so dramatically that you lose the diagnosis.

Now, this is the case with the majority of people with borderline personality disorder beyond the age of 45. They maintain critical traits, psychodynamics and other psychological elements of borderline personality disorder, but they lose so many behaviors.

So many behaviors change that they are not, it's no longer possible to diagnose them with borderline personality disorder.

And these are known as subclinical borderline.

So the same applies to psychopathy. No one has ever claimed that psychopaths lose the traits of psychopathy. They are no longer psychopaths. They are suddenly people loving and empathic and amazing and compassionate and affectionate. No one made this ridiculous claim.

Of course, a psychopath is a psychopath is a psychopath for life. The same applies to the narcissist by the way. No one makes these claims.

The claim made in multiple studies regarding the psychopath was a psychopath changes his behaviors when he crosses the critical threshold of 40 or 50 years old, changes his behaviors, become a member of society, let's say, sublimates if you wish, but his traits remain the same. His convictions, his worldview remains the same. His personality style remains the same. None of these changes.

And so this meta analysis supports this contention. It seems that the extent the certain traits were maintained over time was high in antisocial personality disorder, even when compared to other personalities.

So I'm going to read to you an excerpt from the study from an initial pool of 1473 studies. 40 were included in our analysis covering 38,432 participants.

Wow, so many psychopaths. It's worrying. 56.7% of them maintain the diagnosis of any personality disorder. 45.2% maintain the diagnosis of borderline personality disorder over at least one month.

Not very impressive.

Findings on the dimensional mean level stability indicate that most personality disorder criteria significantly decreased from baseline to follow up, except for antisocial personality disorder, obsessive compulsive personality disorder, and schizoid personality disorder criteria.

So in all other personality disorder, there's been a decrease in the expression of traits or in the existence of traits in all other personality disorder. This includes narcissistic and borderline from baseline. But the exceptions were antisocial, obsessive compulsive, and schizoid.

In these three personality disorders, the traits remained relatively stable.

Findings on the dimensional rank order stability suggested moderate estimates, except for antisocial personality disorder criteria, which were found to be high.

In other words, stable, stable over the period of the study.

Of the studies, findings indicate that both personality disorders and personality disorder criteria were only moderately stable, although between study heterogeneity was high.

And stability self-dependent on several methodological factors.

What about the dimensional mean level stability findings?

Let me translate to English yet again.

Dimensional mean level stability means the extent that absolute personality score levels change over time or don't change over time. They're stable over time.

So the dimensional mean level stability, the extent again, the extent that absolute personality score levels change, these studies showed that except for antisocial personality disorder criteria, most other personality disorder criteria, and that includes narcissistic and borderline significantly decreased from baseline to follow up.

Patients with other personality disorder diagnosis were not much more likely than patients with antisocial personality disorder to maintain the diagnosis.

In short, antisocial schizoid and obsessive compulsive are the worst. They seem to be lifelong. The traits don't change, ameliorate or mitigate.

So what to do about all this mess? There is a new ray of light, schema therapy, one of my favorites. I'm very much in favor of CBT, schema therapy, transactional analysis.

So it's one of my favorites. EMDR is efficacious. I know this is sufficient, but I can't wrap my mind around eye movements. I mean, it looks to me like witchcraft.

So there was a trial. The question was how effective was schema therapy compared with treatment as usual for violent, impatient offenders with antisocial personality disorder, violent criminals, violent psychopaths.

So there was a trial and it aimed to test the cooperative long-term effectiveness of schema therapy.

Schema therapy is an evidence-based psychotherapy for personality disorders in general. And so they compared schema therapy with treatment as usual for impatient, violent offenders, as I said.

Now the patients showed moderate to large improvements in outcomes, which is pretty amazing. I think it's the first study that I'm aware of that shows any change whatsoever when it comes to violent psychopaths.

But there's a caveat there. Violent psychopaths are cunning and sharp. They may tailor their reaction. They may cheat or deceive the researchers and the therapists.

As simple as that, they may simply put on an act of getting better, of changing, of reforming. They do it all the time in probation boards and parole boards. I mean, everyone knows.

So I can't really trust these outcomes because they involve psychopaths.

But it's still not easy to pull off. Schema therapy was superior to treatment as usual for personality disorder symptoms and rehabilitation. And it had a small to moderate advantage in multiple secondary outcomes.

And in improving traits such as self-regulation and self-control, which protect against recidivism, schema therapy patients also moved through rehabilitation more rapidly.

And this wraps up this extremely painful episode for me, because this video makes the claim that there is hope. And I hate, I hate to break it to you, that there is hope for the treatment of antisocial personality disorder and psychopathy. It upends my world. It challenges my beliefs. And you know, now I'm really, really depressed.


Oh God, this is really bad. Okay, Shoshani, I hope you survived this video. I haven't.

And see you next time.

If you enjoyed this article, you might like the following:

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Professor Sam Vaknin discusses the topic of promiscuity, its various causes, and its connection to mental health disorders. He delves into the psychological and behavioral aspects of promiscuity, including its association with narcissism, psychopathy, and dissociation. He also explores the impact of promiscuity on intimate relationships and societal changes. The presentation provides a comprehensive analysis of the complex and multifaceted nature of promiscuity.


Personality Disorders: Child's Defense Against Madness (Schizotypy and Neoteny)

Professor Sam Vaknin discusses the relationship between schizotypy and personality disorders. He explains that schizotypy is a spectrum that includes both positive and negative traits, such as creativity, cognitive disorganization, and impaired reality testing. He suggests that there are two types of psychopaths: primary psychopaths who are grandiose and impulsive, and secondary psychopaths who have access to emotions and empathy but are low on narcissism. He also explains that schizotypy is not a mental illness but a personality theory that suggests that everyone has some degree of disorganization and chaos.


Borderline Girl, Interrupted (Rebecca Ray's "Pure")

Professor Sam Vaknin discusses the book "A Certain Age" by Rebecca Ray, praising it as a masterpiece that provides insight into the formation of borderline personality disorder in adolescence. He reads excerpts from the book and comments on them, highlighting the pathogenesis of borderline personality disorder, precocious sexuality, dissociation, and the internal struggles of individuals with this disorder. He emphasizes the transactional mindset, external locus of control, and the use of fantasy as a defense mechanism. The discussion also touches on self-harming behaviors, lying, and the need for external validation in individuals with borderline personality disorder.


Narcissistic Women vs. Borderline Women vs. Narcissistic Men

Professor Sam Vaknin discusses the differences between men and women when it comes to personality disorders. He states that there is little difference between male and female narcissists in terms of their psychodynamics, but their behaviors may differ due to societal and cultural expectations. Within the same diagnosis, the variation between men and women is low, but the variation between diagnoses is much higher. Vaknin also notes that the Diagnostic and Statistical Manual (DSM) is gender-neutral in its language, but some claims within it can be seen as sexist.


Loving the Borderline in Her Fantasy

Professor Sam Vaknin discusses the love life, sexual fantasies, and relationships of borderline women, as well as the connection between borderline personality disorder and promiscuity. He delves into the origins and manifestations of the disorder, including its link to childhood trauma and heredity. Vaknin also explores the impact of these dynamics on relationships and the potential for resonance or exacerbation of pathologies in such pairings.


Sadist: The Pleasure of Your Pain, the Anguish of Your Pleasure (and Narcissist)

Professor Sam Vaknin discusses sadistic personality disorder and its manifestations in individuals. He delves into the removal of sadistic personality disorder from the Diagnostic and Statistical Manual and the motivations behind sadistic behavior in narcissists. He also provides insights into the intersection of sadism and narcissism, as well as the impact of sadistic behavior on victims.


Shy/Quiet Borderline “Diagnosis”, Reality vs. Phantasy/Fantasy

Professor Sam Vaknin discusses the book "A Little Life" and emphasizes the importance of relying on scientific evidence rather than personal anecdotes. He rejects the proposed diagnosis of "shy or quiet borderline" and explains the differences between narcissistic and borderline fantasies. He also delves into the psychodynamics of narcissistic and borderline personality disorders, highlighting their distinct etiologies and behaviors.


Introverted, Shy, or Schizoid?

Professor Sam Vaknin discusses the differences between shyness, avoidant personality disorder, schizoid personality disorder, introversion, homophobia, social anxiety, and anxiety disorder. He explains that mental health practitioners often conflate these constructs because they rely on observable phenomena rather than etiology and psychodynamics. He then focuses on the difference between introversion and schizoid personality disorder, stating that introverts are deliberate, slow, guarded, paranoid, and skeptical, and are never impulsive. The professor also notes that anxiety plus impulsivity equals psychopathy, while anxiety plus avoidance equals introversion. Finally, he distinguishes between shyness, introversion, and other related personality traits, emphasizing that these personality traits have distinct motivational forces and lead to different personal and peer reactions.


Covert Borderline, Classic Borderline - Psychopaths?

Professor Sam Vaknin discusses the proposed new mental health diagnosis of covert borderline, which is more typical of men. He compares and contrasts the covert borderline with the classic or dysregulated borderline. Both types have mood lability and emotional dysregulation, but the classic borderline dissociates from emotions, while the covert borderline rationalizes emotions and becomes a primary psychopath. Many anti-racism activists are covert narcissists and covert borderlines who obtain indirect attention and self-gratification through their activism.

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