ANTI SOCIAL PERSONALITY DISORDER :

NEUROPSYCHIC UNDERSTANDING,
CALLOUS UNEMOTIONAL TRAITS, EMPATHY, REINFORCEMENT
LEARNING
Presented By Himani Sharma
Clinical Psychologist
CRR No. A73770
Index

 Conduct Disorder & ASPD

 What it looks like
 Causes
 Prevalence
 Reinforcement Learning
 Empathy
 Neuropsychological Correlates of Violence
 Researches
 Treatment
 Conclusion
 References
Conduct Disorder
 Repetitive, persistent pattern of dissocial,
aggressiveness.
 It can lead to dissocial Personality disorder
 Adverse psychosocial environment
 Symptoms can be divided in 4 categories :
 Aggressive
 Deceitful
 Destructive
 Violation of Rules
ASPD
.
General Criteria for Personality Disorder (ICD-10) Code F60

A diagnosis of any specific personality disorder (including

ASPD) requires that the disturbing behavior pattern:
 Is enduring and of long duration.

 Is pervasive and clearly maladaptive to a broad range

of personal and social situations.

 Has begun in childhood or adolescence and continued

into adulthood.
 Leads to considerable personal distress (sometimes

apparent late in the disorder).

 Is usually, but not always, associated with significant

occupational and social performance problems

Antisocial Personality Disorder
 ICD 10 - F60.2 Dissocial personality
disorder Personality disorder

 (a)Callous unconcern for the feelings of others;

 (b)Gross and persistent attitude of irresponsibility and

disregard for social norms, rules and obligations;

 (c)Incapacity to maintain enduring relationships, though

having no difficulty in establishing them;

 (d)Very low tolerance to frustration and a low threshold for

discharge of aggression, including violence;

 (e)Incapacity to experience guilt or to profit from

experience, particularly punishment;

 (f)Marked proneness to blame others, or to offer plausible

rationalizations, for the behaviour that has brought the

patient into conflict with society.
There may also be persistent irritability as an associated
feature. Conduct disorder during childhood and adolescence,
though not invariably present, may further support the
Continued . . .

Personality disorders, usually come to attention

because of a gross disparity between behavior and the
prevailing social norms, and characterized by:

• Unconcern for others

• Gross and persistent attitude of irresponsibility and disregard for
social norms, rules and obligations
• Incapacity to maintain enduring relationships, though having no
difficulty in establishing them
• Very low tolerance to frustration and a low threshold for discharge of
aggression, including violence
• Incapacity to experience guilt or to profit from experience,
particularly punishment
• Marked proneness to blame others, or to offer plausible
rationalizations, for the behavior that has brought the patient into
conflict with society.
• There may also be persistent irritability as an associated feature
Psychological Picture
Trait/Feature Description Reference
Emotional coldness;
inability to recognize or
Lack of empathy Dehghani (2023)
respond to others’
emotions
Habitual lying,
manipulation, use of Patrick et al. (2009);
Deceitfulness
aliases, and conning Dehghani (2023)
others
Acting on urges without
Impulsivity thinking of the Patrick et al. (2009)
consequences
Repeated physical fights,
Aggressiveness irritability, or abusive Dehghani (2023)
behavior
Charismatic but shallow
Superficial charm interpersonal style often Patrick et al. (2009)
used manipulatively
Irregular work history,
financial negligence,
Irresponsibility Dehghani (2023)
failure to honor
commitments
Prevalences

Population Prevalence Estimate Reference

(%)
General (lifetime) 0.2–5.0 Cambridge, 2022
Males (general) 3.9–5.8 Coid, 2003
Females (general) 0.5–1.9 Black, 2015
Prisoners (men) 47–55 Fazel & Danesh, 2002
Prisoners (women) 21–31 Fazel & Danesh, 2002
Prisoners (recent
13.5–27.5 Elsevier, 2024
study)
• High vulnerability among clinical population &
substance use populations.
Prevalences continue ….. Gender
Differences
 4:1 for boys to girls, as 8–16% of boys and 3%
of girls aged 4–16 years old
 Boys aged 10 to 20, prevalence is highest at
10 , decreases thereafter.
 For girls, midteens represents a peak.
 Longitudinal study :
 Age of onset bears a relationship to the seriousness
of ASPD and other disorders in adulthood.
 Childhood is associated with adult criminal
behaviour, violence, substance abuse than
adolescent onset(Moffitt et al., 2002).
 76% males & 30% female, by the age of 30, had
history of CD, and either criminal record or
 Etiology / Causes
 Neurobiological
 reduced right temporal lobe volume
 reduced serotonin and cortisol levels ( reduced activation of HPA
axis )
 Genetics
 externalizing behaviors were highly heritable (70%) (Deater-
Deckard et al., 1997).
 Correlations for aggressive behaviors between twins,(Kim-Cohen et
al., 2006)
 Monozygotic .75
 Dizygotic .45

 Environmental
 Chaotic family environment, chronically exposed to violence,
physical or sexual abuse, and neglect,
 Psychological
 Inflated, unstable, tentative view of self
Neurological Picture of

 Neurotransmitters
 Low level of plasma dopamine,
 Excessive DA activation in some prefrontal
circuits
 Dysfunctional Areas in Brain :
 Orbitofrontal–limbic motivation networks
 decreased gray matter in limbic brain structures
 Decreased left amygdala
 Signicantly high activity in right frontal brain
while resting in aggressive children (EEG)
Reinforcement Learning

 Conduct Problems(CP) is associated with abnormal

reward and punishment processing (P.J. Frick et. Al.).
 Children with high values on CP & Callous
Unemotional(CU) conditions demonstrated a decreased
sensitivity to punishment, while those with high values
on CP only showed an increased sensitivity to
punishment(k. A. Fanti et. Al).
 A study “a door-opening-paradigm” found a response
perseveration in participants with CP, irrespective of
consequences(W. Matthys et. al.).
 In a rewarded continuous performance task, decreased
activation in the right OFC was found though
neuroimagining study(K. Rubia [Link] ).
Empathy
 Limited affective empathy but intact cognitive
empathy( S. L. Sebestian et. Al.)
 A study with healthy adults revealed an association
between stronger activation of the anterior insula,
orbitofrontal cortex (OFC), amygdala, and ACC, and
dominance of affective empathy( C.L. Cox et. Al).
 Hypo-responsivity of the amygdala(CU traits
mediate the activation pattern)
 Children with low CU traits : over-reactivity to negative
stimuli
 Children with high CU traits : reduced activity in the
amygdala and dorsal ACC
Increased Risk of Violence: Neurobiology
and Psychology

 Overactive behavioral activation system (BAS)

and underactive behavioral inhibition system
(BIS)
 Variations in stress-regulating mechanisms
 Structural and functional brain abnormalities in
amygdala, prefrontal cortex, anterior cingulate,
and insula
 Low cortical arousal and low reactivity of the
autonomic nervous system
 This leads to fearlessness, poor response to
punishment
Continued . . .
 Early findings suggest three neural
systems are involved:
 Subcortical neural systems
 Aggressive behavior - dysfunction in the
integrated functioning of brain circuits involving
the amygdala
 Prefrontal cortex
 Decision-making circuits and socioemotional
information processing circuits
 Frontoparietal regions
 Emotions and impulsive motivational urges
 Researches :
Author Sample Ag Methods Results
e
Bauer and CD group vs. age 15-20 EEGs during oddball Participants with CD and younger
Hesselbrock matched control task than 16.5 years exhibited reduced
(1999a) community sample P300 brain wave in the posterior
region of the brain. Participants with
CD and older than 16.5 years
displayed reduced P300 brain wave in
the frontal region of the brain
Bauer and Community sample 15-20 EEGs during a Stroop An elevated number of conduct
Hesselbrock task problems was associated with
(1999b) reduced P300 brain wave amplitude.
This reduction was related to the
“rules violation” subtype of CD, but
not the aggression subtype.
Bauer and CD group vs. age 14-20 EEGs during Reduced P300 brain wave amplitude
Hesselbrock 2001 matched controls memorization task within CD group.
community sample requiring active
responses

Bauer and Grouped by CD 14-19 EEGs during auditory Participants with a history of rules
Hesselbrock 2003 subtype community stimulus response task violations exhibited reduced P300
sample boys only brain wave amplitude.
Kruesi et al. CD group vs. age 9-20 MRI scans Reduced right temporal lobe and right
(2004) matched controls temporal grey matter volume within
Community Sample CD group
Sterzer, et al. CD group vs. age 9-15 EEGs during passive Reduced activation in the left
(2005) matched controls viewing of negative amygdale and deactivation of the
clinical sample boys pictures ACC within CD group.
only
Patrick et al. Community sample 15 EEGs during visual Association between reduced P300
(2006) boys only oddball task brain wave amplitude and general
externalizing behaviors factor. Boys
only When scores on the more
general externalizing factor were
controlled during analyses, the link
Fearlessness theory (Raine, 1993)

 Low autonomic nervous system activity

among individuals with CD marks
fearlessness, without association of
negative repercussions, they do not learn
to inhibit antisocial behaviors.

 Recent meta-analyses study, indicates that

low resting HR and increased heart rate
reactivity are associated with conduct
problems among children and adolescents
(Lorber, 2004; Ortiz & Raine, 2004)
Stimulation-seeking theory

 Low physiological arousal causes an

unpleasant internal state.
 Antisocial individuals seek external
sources of stimulation to increase their
physiological arousal to an optimal level
(Raine, Venables, & Mednick, 1997;
Quay, 1965).
Researches
 Poor parent child relationship characterizez
many cases of CD (Kazdin & Whitley, 2003).
 Familes of CD experience more than average
amount of negative life events, have fewer
social support, involved in chronic conflict with
others in community(Jaffee et al., 2003).
 70% of children with CD also have other
diagnosis(Hemphill, 1996).
 Young firesetters have single parent, or
typically father is absent for longer
period(Gaynor 2002).
Assessments

 Hare Psychopathy Checklist–Revised

(PCL-R)
 Personality Diagnostic Questionnaire-4+
(PDQ-4+) self report
 Minnesota Multiphasic Personality
Inventory (MMPI)
 International Personality Disorder
Examination (IPDE) (DSM 5 & ICD 10)
 Millon Clinical Multiaxial Inventory
 Treatment

 Pharmacotherapy
 Family Therapy
 Problem solving Skill Management Training
 Parent Management Training
 Interventions in Schools

 Comprehensive two-pronged approach

includes
 Early intervention/prevention programs
 Ongoing interventions
 Conclusion

Conduct disorder is part of behavioral and emotional

disorders with onset usually occurring in childhood and
adolescence, range of behavior from violating rights of
others to being destructive, manipulative and aggressive.
CD is comorbid with other mental illness. Its hard for
them to learn from their mistakes, they have poor
inhibitory neural control, they have poor interpersonal
relationships, specially emotional understanding. CD can
develop as an ASPD individual. It can not be cured but it
can be handled in a better way through learning better
problem solving skills on individuals part and even
his/her parents part through training and therapy.
 References
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Kelly, The balance between feeling and knowing: affective and
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[Link]
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better of two evils? Evidence that children exhibiting continuous
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on opposite directions on physiological and behavioral measures of
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[Link]
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 References

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 Poorly regulated anger is predictive of conduct problems (Cole et al.,
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