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1. Can you please explain the research findings regarding antisocial personality disorder in terms of its causes and symptoms?

Research findings suggest a specific pattern of symptoms associated with antisocial personality disorder in terms of both symptoms and causes of the disorder. A common misconception is that antisocial personality disorder refers to people who have poor social skills. The opposite is often the case. Instead, antisocial personality disorder is characterized by a lack of conscience. People with this disorder are prone to criminal behavior, believing that their victims are weak and deserving of being taken advantage of. They tend to lie and steal. Often, they are careless with money and take action without thinking about consequences. They are often aggressive and are much more concerned with their own needs than the needs of others. http://www.4degreez.com/misc/disorder_information2.html

Some of the symptoms of antisocial personality disorder are similar to other disorders (see below), which the clinician will need to rule out in order to make an accurate diagnosis.

Symptoms -

There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 18 years, as indicated by three (or more) of the following:
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.

Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure impulsivity or failure to plan ahead.

Irritability and aggressiveness, as indicated by repeated physical fights or assaults
reckless disregard for safety of self or others.

Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

The individual is at least 18 years old (under 18 diagnoses with Conduct Disorder). There is evidence of Conduct Disorder with onset before age 15 years and the occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode http://www.psychnet-uk.com/clinical_psychology/criteria_personality_antisocial.htm

Associated Features -
Depressed Mood.
Addiction.
Dramatic or Erratic or Antisocial Personality.
Differential Diagnosis -
Some disorders have similar symptoms. The clinician, therefore, in her diagnostic attempt has to differentiate against the following disorders, which need to be ruled out to establish a precise diagnosis.
Substance-Related Disorder;
Schizophrenia
Manic Episode
Narcissistic Personality Disorder
Histrionic Personality Disorder
Borderline Personality Disorders
Paranoid Personality Disorder
Adult Antisocial Behavior.

Causes -
The cause of antisocial personality disorder is unknown, but biological or genetic factors may play a role. The incidence of antisocial personality is higher in people who have an antisocial biological parents. Although the diagnosis is limited to those over 18 years of age, there is usually a history of similar behaviors before age 15, such as repetitive lying, truancy, delinquency, and substance abuse. This disorder tends to occur more often in men and in people whose predominant role model had antisocial features.

Twin studies have confirmed the hereditability of antisocial behaviour in adults and shown that genetic factors are more important in adults than in antisocial children or adolescents where shared environmental factors are more important. (Lyons et a1. 1995)

Cadoret et al (1995) studied the family environment as well as the parentage of adoptees separated at birth from parents. Antisocial Personality Disorder in the biological parents predicted antisocial disorder in the adopted away children. However, adverse factors in the adoptive environment (for example, "marital problems or substance abuse) independently predicted adult antisocial behaviors. http://www.psychnet-uk.com/clinical_psychology/criteria_personality_antisocial.htm

So, individuals with an Antisocial Personality Disorder show a lack of concern toward the expectations and rules of society and usually frequently become involved in at least minor violations of the rules of society and the rights of others. A popular term for this type of individual is "sociopath". Although the diagnosis is limited to those persons over eighteen years of age, it usually involves a history of antisocial behavior before the age of fifteen. The individual often displays a pattern of lying, truancy, delinquency, substance abuse, running away from home and may have difficulty with the law. As an adult, the person often commits acts that are against the law and/or fails to live up to the requirements of a job, financial responsibility, or parenting responsibilities. They tend to have difficulty sustaining a long-term marital relationship and frequently are involved in alcohol and drug abuse. http://www.accg.net/antisocial.htm Causes are unknown, but research suggest both biological and social factors may play a part. Effective treatment is also limited for this disorder.

2. Could you explain the research on the effectiveness of various types of psychotherapy, and on the effectiveness of psychotherapy in general?

Treatment for antisocial personality disorder includes various types of psychotherapy, with some being more effective than others. In general, psychotherapy is not that effective for this disorder however. For example,

a. Counseling and Psychotherapy

Effective treatment of antisocial behavior and personality is limited. Group psychotherapy can be helpful. If the person can develop a sense of trust, individual psychotherapy or cognitive behavioral therapy can also be beneficial. There is no research that supports the use of medications for direct treatment of antisocial personality disorder, though.

Effective psychotherapy treatment for this disorder is limited. It is likely, though, those intensive, psychoanalytic approaches are inappropriate for this population. Approaches that reinforce appropriate behaviors and attempting to make connections between the person's actions and their feelings may be more beneficial. Emotions are usually a key aspect of treatment of this disorder. Patients often have had little or no significant emotionally-rewarding relationships in their lives. The therapeutic relationship, therefore, can be one of the first ones. This can be very scary for the client, initially, and it may become intolerable. A close therapeutic relationship can only occur when a good and solid rapport has been established with the client and he or she can trust the therapist implicitly.

b. Pharmacotherapy [See Psychopharmacology Section ]:

Medications should only be utilized to treat clear, acute and serious Axis I concurrent diagnoses. No research has suggested that any medication is effective in the treatment of this disorder.

c. Self-Help [See Self-Hep Section ]

Self-help methods for the treatment of this disorder are often overlooked by the medical profession because very few professionals are involved in them. Groups can be especially helpful for people with this disorder, if they are tailored specifically for antisocial personality disorder. Individuals with this disorder typically feel more at ease in discussing their feelings and behaviors in front of their peers in this type of supportive modality. http://www.psychnet-uk.com/clinical_psychology/criteria_personality_antisocial.htm

Interesting, antisocial personality disorder is much more prevalent in males than females. If present in females, it usually occurs at the onset of puberty. In males the onset is usually earlier on in childhood. Behaviors can diminish somewhat after the age of thirty when the individual seems to "mellow out" and learns more effective ways of staying within the system. Clients tend to be very manipulative and lack motivation for change. They very rarely seek therapy voluntarily and they are usually forced into therapy through some involvement with the law or other aspects of their life. History also reveals significant impairment in social, marital, and occupational functioning. Therapists relate that these clients tend to lack emotional attachment to others. They tend to be personable, charming, and engaging and are usually above average in intelligence. This demeanor, however, is often a pretense intended to deceive others and facilitate the exploitation of others. Emotional reactions tend to be extreme and these individuals tend to lack concern for other people's feelings, be preoccupied with their own interests, and tend to have grandiose expressions of their own importance. Insight and judgment are usually poor as is their responsiveness to therapy.

In general, psychotherapy should focus on helping the individual develop a trusting relationship with other significant people in their lives; children, spouses, etc. The client also needs to learn healthy ways to deal with anxiety and learn to postpone or defer gratification of impulses as a positive step toward developing a more mature and socially more positive way of interacting with others. Focus should also be on promoting development of alternate constructive methods of interacting with others rather than manipulation for self-gain. Progress should be measured in terms of self-control and use of appropriately assertive rather than aggressive behaviors to gain desired responses. Anxiety and frustration also need to be recognized and diminished and the client also needs to focus on appropriate means of management of these two emotions that tend to cause the greatest conflict with authority and others. Response to therapy is usually very poor, tends to be long term. However, most of these clients do discontinue therapy prematurely and only remain if forced or coerced which further complicates effectiveness of treatment. http://www.accg.net/antisocial.htm