Antisocial Personality Disorder, APD: Sociopath Lacks Conscience

Mar 17, 2011
Jill Stefko

APDs Wear a Mask of Normalcy - fedegrafo

The Diagnostic and Statistical Manual, DSM IV TR, used by mental professionals to diagnose, lists criteria for the APD. Read portraits of two sociopaths.

The DSM IV TR, published by the American Psychiatric Association in 2000, the fifth revision of the manual first published in 1952, classifies psychiatric disorders. While not specifically mentioned in the DSM IV TR, the hallmark of the APD is having no conscience.

APD: A Personality Disorder

APD is a Cluster B Personality Disorder. People in this category continually disregard and violate the rights of others. They have patterns of inner experiences and behaviors that deviate from their society’s norms. Their cognition – viewing and interpreting themselves, people and events and affectivity – appropriateness of response, are abnormal. Interpersonal functioning and impulse control are affected.

APD: DSM IV TR Criteria

There’s an omnipresent pattern of disregard for and violation of the other’s rights, exhibited by the behavior of people, at least eighteen-years-old, that’s not caused by another psychiatric disorder or substances, as evidenced by at least three criteria:

Nonconformance to social norms, including crime
Repeated pathological lying, and taking advantage of others for egocentric pleasure and/or profit
Impulsiveness or failure to plan ahead
Irritability and aggressive behavior that may include physical attacks
Reckless disregard for theirs and other people’s safety
Irresponsibility which may include failure to maintain acceptable job performance and/or other obligations
No remorse, being indifferent to or rationalizing, hurting and abusing others

Portraits of Two APDs

One of the reference books I used when I wrote my doctoral thesis and this article was the text book for my one of my classes, Abnormal Psychology, Ephraim Rosen & Ian Gregory, (W. B. Saunders Company, 1965). When psychopath and sociopath were the words used for this disorder, the difference between the two was that the former commits crimes.

Pseudonyms are used for confidentiality. Joe is a thirty year old male who owns several rental properties. He’s glib, charming, a pathological liar, uses pity parties, highly manipulative, blames others for situations he created and intimidates people. Some of his tenants have had no heat in two or more of their rooms, no hot water for months, have windows that don’t lock, broken fans and windows that don’t shut. Joe blamed the people who built the house and the city inspector for these conditions. According to him, the inspector didn’t tell him about some of them when he bought the property. He blamed tenants for creating the problems and tried to intimidate them. He whined that he was overworked and taken advantage of.

Joe knew about some housing standard violations and city codes before leases were signed and said nothing until after tenants moved in. When they brought violations to his attention, he promised he would make repairs to comply. He didn’t. A building inspector, who found eighteen violations in one of the apartments, sent Joe a letter stating that he had to comply by a specified date. Joe refused. The only recourse the tenant had was to move.

Joe lied to authorities to avoid being held responsible for violations he created. “Tenants wouldn’t allow him access to make repairs.” “The apartment was so dirty that workers refused to make repairs.” To date, Joe fits the former definition of the sociopath because he has not been arrested.

Lu fits the former definition of the psychopath. Her behavior is similar to Joe’s, with the exception that she was arrested for, as newspaper headlines proclaimed, stealing drugs from dead people. She was a registered nurse who worked as a medical examiner for the coroner’s office. Lu took prescription medication, including Fenatyl patches, from death scenes. She overdosed on Fenatyl and was rushed to an emergency room. The EMTs found the patches and other prescription medication that she stole. The emergency room doctor reported this to the coroner, as required by law. The coroner, legally, terminated her employment as an independent contractor.

Lu and her husband wanted to sue the ER doctor and hospital for reporting her to the coroner; the coroner, for wrongful termination. She claimed that she had hypoglycemia and the incident wasn’t an overdose. She said was allowed to take the medications home to study them and that there was no disposal facility. The proper procedure was to account for the drugs and flush them down the toilet or have them transported to existing hazardous waste facilities. Lu received ARD, her husband divorced her and she, later, died from a possible drug overdose.

APDs: Is There a Solution?

There is no successful way to treat APDs. The major problem is that, for treatment to work, the clients have to recognize they have a problem. APDs have no conscience and are content remaining the way they are.

ECT, Electroconvulsive Therapy, and medication have been effective for some patients: ineffective or detrimental for others.

Three types of therapies used to treat the APD are behavioral and cognitive and psychotherapy. Behavioral psychologists theorize sociopathic behavior is learned during childhood and APDs can be taught to change their behavior. In cognitive therapy, the therapist tries to understand the APD’s thoughts and feelings and teaches the client skills needed to change behavior. Psychotherapists believe the APDs’ behavior is caused by a childhood traumatic experience and try to find this in their subconscious to bring it to the conscious and release it. Sometimes, a combination of all three methods is used. These have worked for some APDs.

It’s possible for the APD to outgrow the disorder.

I gave a talk about personality disorders. A woman told us that her grandson was diagnosed with APD and asked if there was a cure. I wished I could have told her that there was. Another woman in the audience was a counselor who attended the talk to earn a CEU, continuing education unit. She introduced herself, agreed with me and added some of her experiences in response to the woman’s question. The best advice we could offer was to recognize the problem and deal with the young man for what he was. Hopefully, one day, an effective treatment will be discovered for APDs.