Antisocial Personality Disorder Treatment

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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Personality Disorders

Generally, antisocial personality disorder (APD) is the most prevalent personality disorder associated with alcoholism when samples from public treatment centers are studied, and borderline personality disorder (BPD) is the most common disorder in studies from private treatment facilities. In a private psychiatric hospital sample, 57 of substance-abusing patients met DSM-III-R criteria for a personality disorder with BPD being the most commonly occurring personality disorder (Nace, Davis, & Gaspari, 1991).

Cognitive Vulnerabilitystress Interaction And Prospective Development Of Depression

When evaluating personality dysfunction using the dimensional scores, the HR group was rated higher than the LR group for Cluster A paranoid and schizotypal dimensions, Cluster B borderline, histrionic, and narcissistic dimensions, and Cluster C avoidant, dependent, obsessive-compulsive, and passive-aggressive dimensions. Schizoid, antisocial, and sadistic personality dysfunction were the only personality dimensions on which no significant risk group differences were found. The strength of these findings is bolstered by the fact that, except for the narcissistic, passive-aggressive, and self-defeating dimensions, these HR-LR differences remained after statistically controlling for the participants' depressive symptom levels, based on their BDI scores. In addition, the risk group differences in the lifetime prevalence of episodic unipolar depressive disorders (major, minor, and HD) reported by Alloy et al. (2000) remained after statistically controlling for the effects of personality...

Categorical Personality Disorders

The Cluster B personality disorders (antisocial, borderline, narcissistic, and histrionic), as described in DSM-IV, demonstrate elevated rates of SUDs (Mors & Sorensen, 1994). Conversely, in patients with SUDs, there is an elevated rate of Cluster B personality disorders, and multiple-substance-dependent patients are more likely to be diagnosed with Cluster B personality disorders than non-multiple-substance-dependent subjects (Skinstad & Swain, 2001). For example, in 370 patients with heterogenous SUDs, Rounsaville and colleagues (1998) found that 57 had an DSM-III-R personality disorder diagnosis, of which 45.7 were Cluster B, including 27 with antisocial personality disorder (ASPD) and 18.4 with borderline personality disorder (BPD). Antisocial Personality Disorder

Treatment Considerations

Sonality disorder, antisocial personality disorder and risk-taking among heroin users Findings from the Australian Treatment Outcome Study (ATOS). Drug Alcohol Depend, 74, 77-83. Leal, J., Ziedonis, D., & Kosten, T. (1994). Antisocial personality disorder as a prognostic factor for pharmacotherapy of cocaine dependence. Drug Alcohol Depend, 35, 31-35.

Pathological Gambling and Other Behavioral Addictions

Studies consistently find that patients with PG have high rates of lifetime mood (60-76 ), anxiety (16-40 ), and personality (87 ) disorders, particularly antisocial personality disorder (Black & Moyer, 1998 Crockford & el-Guebaly, 1998). Elevated rates of CB, compulsive sexual behavior, and intermittent explosive disorder have also been found (Black & Moyer, 1998).

Psychiatric Comorbidity And Sequelae

More than one-half of all cocaine abusers meet criteria for a current psychiatric diagnosis and nearly three-fourths for a lifetime psychiatric diagnosis (Ziedonis, Rayford, Bryant, Kendall, & Rounsaville, 1994). The most common comor-bid psychiatric diagnoses among cocaine abusers include alcohol dependence, affective disorders, anxiety disorders, and antisocial personality disorder (Kleinman et al., 1990 Marlowe, Husband, Lamb, & Kirby, 1995 Mirin, Weiss, Griffin, & Michael, 1991 Rounsaville et al., 1991 Weiss, Mirin, Griffin, Gunderson, & Hufford, 1993). For most cocaine users, co-occurring psychiatric disorders (including agoraphobia, alcohol abuse, alcohol dependence, depression, posttraumatic stress disorder (PTSD), simple phobia, and social phobia) precede cocaine use (Abraham & Fava, 1999 Shaffer & Eber, 2002). Attention-deficit hyperactivity disorder (ADHD) is an important comor-bid condition. In a large longitudinal study, approximately 21 of adults with...

Types of Assessment Measures

Strong evidence for validity of the CAPS was also provided by Weathers et al. (1999), who found that the CAPS total severity score correlated highly with other measures of PTSD (Mississippi Scale .91 MMPI-PTSD Scale .77 the number of PTSD symptoms endorsed on the SCID .89 and the PTSD Checklist PCL .94). As expected, correlations with measures of antisocial personality disorder were low (.14-.33). Weathers et al. (1999) also found strong evidence for the diagnostic utility of the CAPS, using three CAPS scoring rules for predicting a SCID-based PTSD diagnosis. The rule having the closest correspondence to the SCID yielded a sensitivity of .91, specificity of .84, and efficiency of .88, with a kappa of .75, indicating good diagnostic utility (see Weathers et al., 1999, for a detailed discussion of different scoring rules and their implications).

Reliability and Validity of Clinical Diagnosis

In a study of more than 200 adults at risk of AIDS, multiple diagnoses of personality disorder were recorded for most individuals with any DSM-III-R Axis II diagnosis. Almost half of the subjects with a diagnosis in one personality cluster also had a concurrent diagnosis in another cluster (Jacobsberg, Francis, & Perry, 1995). A study of the comorbidity of alcoholism and personality disorders in a clinical population of 366 patients also obtained comparable findings. There was extensive overlap between Axis I disorders and personality disorders, as well as among personality disorders themselves (Morgenstern, Langenbucher, Lubouvie, & Miller, 1997). In another study of 118 gay men conducted to investigate the stability of personality disorder, it was reported that diagnoses of personality disorders had low stability over a 2-year period (Johnson et al., 1997). A study of seventy-eight adult outpatients with attention deficit hyperactive disorder evaluated by standard tests showed...

Behavior

The third component of a comprehensive psychological assessment pertains to determining the degree to which the individual's behavioral characteristics are related to substance abuse. Behavioral adjustment can be characterized in both microenvironment (e.g., family and friends) and macroenvironment (e.g., work, community, and school). Importantly, behavioral disposition, such as antisocial personality disorder, mitigates optimal functioning in a variety of social contexts. The point to be emphasized is that behavioral adjustment is the product of the interaction between the individual and the particular context. A behavioral characteristic (e.g., aggressiveness) can be adaptive in one context and maladaptive in another context.

Child Psychiatry

Conduct disorder pediatric form of antisocial disorder. Look for lire setting, cruelty to animals, lying, stealing, and or fighting. As adults, patients often have antisocial disorder. Note Conduct disorder is required to make a diagnosis of antisocial personality disorder in adults.

Course

Of the personality disorders, antisocial personality disorder is the most commonly diagnosed and can be seen in as many as 25 of opioid abusers seeking treatment this is noted in men the vast majority of the time (Brooner et al., 1997). It is inaccurate to assume that drug-seeking behavior learned during years of addiction is responsible for the high percentage of antisocial personalities among opioid addicts. Antisocial personality disorder can be reliably diagnosed historically in most individuals at a young age, prior to the onset of opioid dependence. The relationship between opioid abuse and antisocial personality is complicated and appears to be influenced by a non-sex-linked genetic factor. When antisocial personality and opioid dependence are found together, the treatment course is frequently challenging, and the overall outcome is poor with regard to adequate length of time in treatment, relapse, criminal behavior during treatment, and ability...

Epidemiology

The two largest U.S. psychiatric epidemiological studies to date, the Epidemiologic Catchment Area (ECA) study (Regier et al., 1990) and the more recent National Comorbidity Survey (NCS Kessler et al., 1996) demonstrate that co-occurring SUDs and psychiatric disorders are prevalent in community populations. Methodological advancements of the NCS included an expanded scope of the community sample (e.g., the ECA sampled from within five U.S. communities, whereas the NCS sampled nationally representative households), and an advanced version of the Diagnostic and Statistical Manual of Mental Disorders (i.e., DSM-III-R American Psychiatric Association, 1987 ). Also, while both studies surveyed most of the more common psychiatric disorders, the ECA did not include posttraumatic stress disorder (PTSD), whereas the NCS did. Neither epidemiological survey included Axis II disorders other than antisocial personality disorder (ASPD). Despite these limitations and differences between the two...