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NURB 4130 Antisocial Personality Lecture Notes
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- Northwestern State University Of Louisiana
This is a comprehensive and detailed note on;Antisocial, Disruptive, Impulse Control, and Conduct Disorders Outline.
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Antisocial Personality and Disruptive, Impulse Control and Conduct Disorders (29) Introduction
A. Pts w/ personality d/os often have challenging relationships w/ health care professionals. Reasonable
requests met w/ resistance or stubborn refusal to comply by pt. Ex: epileptic pt w/ personality d/o rejects
advice to stay on antileptic meds despite consequences.
Antisocial Personality Disorder
A. ASPD is a pervasive/persistent pattern of disregard for, and violation of the rights of others occurring
since age 15 years.
B. Dx given to individuals 18 years or older who fail to follow society’s rules-that is, they do not believe
that society’s rules are made for them and are consistently irresponsible.
C. For many, there is evidence of a conduct disorder before the age of 15 years. The term psychopath or
sociopath, a person w/ tendency toward antisocial and criminal behavior w/ little regard for others, is
often used to describe the behaviors of ppl w/ ASD.
D. Ex: Danny explains that rules are made to be broken (wait, is this fucking play about Caden?)
Clinical Course and Dx Criteria for ASD
A. ASD has a chronic course, but antisocial behaviors tend to diminish later in life, particularly after
age of 40. ASD ppl are arrogant and self-centered and feel privileged and entitled. Self-serving and
exploit and seek power over others. Can be interpersonally engaging and charming which is
mistaken for genuine concern for others. In reality, they lack empathy; unable to express
compassion; tend to be intensive, callous, and contemptuous of others. Deceit and manipulation for
selves or pleasure are central features. Behavior impulsively and interpersonally irresponsible.
B. Perform acts for grounds of arrest-destroy property, harassment, stealing or pursuing other illegal
occupations. Act hastily/hurriedly/spontaneously, are temperamentally aggressive and shortsighted,
and fail to plan ahead or consider other alternatives. Do not adapt to social standards of community.
Lack sense of personal obligation to fulfill social/financial responsibility (being a spouse, parent,
friend, employee, etc.) Lack remorse for transgression/wrongdoing.
C. Openly and flagrantly/blatantly violate laws ending up in jail. Some end up in a niche in community
that rewards their competitive tough behavior (military, politics.)
Epidemiology & Risk Factors
A. Males w/ etoh use d/o and those from substance use clinics, prisons, or other forensic settings have
highest rates. Adverse socioeconomic (poverty) or sociocultural (migration) factors also assoc w/
higher prevalence.
B. Gender difference exist in how s/s manifest. more men than women 2:1.
C. Age of onset: to be dx, person must be at least 18 years and must have exhibited 1 or more
childhood behavioral characteristics of conduct d/o before 15 yrs (aggression to ppl/animals,
destruction of property, deceitfulness/theft, or serious violation of rules). Increased likelihood of
ASD in adulthood if there was early onset conduct d/o (before 10yrs) as well as childhood ADHD
dx.
D. Ethnicity & culture: found in all cultures. In NW Alaska termed kunlangeta meaning “his mind
knows what to do, but he doesn’t do it.” In southwest Nigeria, termed arankan to mean “a person
who always goes his own way regardless of others, who is uncooperative, full of malice and
bullheaded.” No tx according to shamans in both cultures. In USA, odds greater among men, Native
Americans vs nonhispanic whites, less than 65, previously married, w/ high school education, and
incomes less $70K. less prevalent among Asian/Pacific Islander and Hispanics.
Comorbidity
, A. ASPD assoc w/ other MI such as mood, anxiety, and other personality d/o as well as alcohol and
drug abuse. Important to assess whether pt has engaged in illegal activities at times other than
when pursuing/using substances.
Etiology
A. Biologic Theories:
1. Neuropsychological factors and arousal levels. Early MRI show ppl w/ ASPD failed to
activate limbic-prefrontal circuit (amygdala, orbitofrontal cortex, insula, and anterior
cingulate) during fearful situations. Findings support neural basis of fearlessness. Impairment
in moral judgment assoc w/ dysfx in prefrontal cortex. Emotional distance, aggression, and
impulsivity assoc w/ neural dysfx
B. Psychological Theories: strong relationship btwn ASPD & difficult temperament. Btwn ID, Ego,
and Superego, the super ego is underdeveloped and ego is blossoming.
1. Temperament neurobiologically determined. Is predisposition on how we express feelings
and actions and is evident in early life & remains stable. Ex: baby relaced/calm/sleep a lot
and others alert/startled easily/cry more/sleep less. Difficult temperaments are common in
ASPD and are often basis of aggression and impulsivity. Temperament: person’s
characteristic intensity, rhythmicity, adaptability, energy expenditure, and mood. Difficult
temperament: characterized by intense emotional and psychologic reactivity w/ poor self-
regulation. 4 key behaviors-aggression, inattention, hyperactivity, and impulsivity.
Explanations is that unsatisfactory attachments early in relationships lead to ASPD behavior
in life. Attachment, attaining, and retaining interpersonal connection to significant person,
begin at birth. ASDP ppl there is a failure to make/sustain stable attachments in early
childhood leading to avoidance of future attachments. Risk factors for dysfx attachments-
parental abandonment or neglect, loss of a parent/caregiver, and physical/sexual abuse.
C. Social Theories: come from chaotic families w/ alcoholism and violence were norm. victims of
abuse/neglect, live in foster homes more likely to be victimized by ASPD behaviors especially
aggression. Child abuse and growing up w/ domestic violence increases risk.
Teamwork and Collaboration
A. Tx difficult and involves helping pt alter their schema. Meds don’t tx ASPD but are RX for
comorbidities (depression, anxiety, impulsivity). Overall tx goals are to develop a nursing sense of
attachment and empathy for ppl/situation and to live w/in society norms.
B. Rarely seek mental health care for ASPD but rather tx for depression, substance abuse,
uncontrolled anger, or forensic-related probs. Many committed to MH care by court order or result
of ultimatum (choice btwn losing jjob, expulsion, divorce, etc). pt’s lack good insight/motivation
for change making it hard to work w/ them and they don’t view behavior as problematic.
Priority Care Issues
A. Although can be charming, can become verbally/physically abusive if expectations not met.
Protection of other pts and staff priority. Often persuasive and complimentary but use divisive
statements such as “you are the only one who understands me, how can you work w/ these jerks,
you are the only nice nurse.” Do not engage/support this interaction b/c you may inadvertently set
up dysfx group dynamics w/ staff members. Remain objective in interax and avoid compromising
situations such as granting special favors/privileges. They use charm/cunningness/seduction to
impress/manipulate other to get what they want.
Nursing Management: Assessment
A. Biologic/Physical Health: self-care not usually an issue and doesn’t impair physical fx. Consider
physical effects of chronic co-existing substance use d/o.
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