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Antisocial Personality Disorder: Diagnosis and Treatment Research Paper

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Updated: Sep 4th, 2021


In the past thirty years, a great deal has been learned about antisocial Behavior. It is known that most types of antisocial behavior tend to be inter-related, in the sense that people who commit one type have an elevated probability of also committing other types. Hence, it is plausible to assume the existence of an antisocial syndrome, and that most types of antisocial acts basically reflect the same underlying theoretical construct, which might be termed an “antisocial personality”.

However, less is known about the development of the antisocial syndrome, and especially about developmental sequences of antisocial acts, or the extent to which one type of act facilitates or is a stepping stone to other types. Also, little is known about the developmental course of careers of antisocial behavior: about ages of onset, probability of persistence or escalation, frequency of different acts at different ages, duration of problems, or ages of desistance (Hugues, 2006).

Many research projects focus on only one type of antisocial act, such as crime or drug use. More researchers should aim to measure a wide variety of different types of acts and hence the full antisocial syndrome. While precise definitions of antisocial personality disorder (APD)/, and cut-off points between normal and pathological, change over time, the constituent acts are well known. They include property crimes, violent crimes, drug use, heavy drinking, drunk or reckless driving, sexual promiscuity or risky sex behavior, divorce/ separation or unstable sexual relationships, spouse or partner abuse, child abuse or neglect, an unstable employment history, debts, dependence on welfare benefits, heavy gambling, heavy smoking, and repeated lying and conning (Frederick, 2006).

Associated personality features include impulsiveness and a lack of planning, selfishness and egocentricity, callousness and a lack of empathy, a lack of remorse or guilt feelings, low frustration tolerance and high aggressiveness. There is a great deal of continuity and stability over time in antisocial behavior, but also a great deal of change in absolute levels of behavioral manifestations.

According to Martin (2006) “conduct disordered children have a relatively high probability of becoming antisocial adults, suggesting that the antisocial syndrome typically arises in childhood and persists into adulthood”. However, there are many dropouts: most conduct-disordered children do not develop APD, for example. The boundary between childhood and hood is artificial, since there is no sign of discontinuity at age 18. There is also intergenerational transmission of antisocial behavior from parents to children, and antisocial behavior is highly concentrated in certain families and individuals.

However, little is known about the precise mechanisms that underlie this intergenerational transmission. A key issue is whether APD and psychopathy are different in kind or in degree from antisocial behavior in general. To the extent that the differences are primarily in degree, all the findings in this paper about early prevention of antisocial behavior will apply to APD and psychopathy as well. However, to the extent that the differences are primarily in kind, this will not necessarily be true.

Risk and Protective Factors

Prevention methods should be based on knowledge about risk and protective factors. Numerous risk factors have been identified for different types of antisocial behavior, but there has been insufficient research on risk factors for the antisocial syndrome in general or for APD or psychopathy. It is unclear how far risk factors are the same for all types of antisocial acts. Important risk factors include conduct disorder, hyperactivity-impulsivity-attention deficit, low intelligence and attainment, inconsistent or harsh discipline, poor parental supervision, divorce/ separation of parents, and socio-economic deprivation (Hugues, 2006).

However, little is known about the influence of these risk factors on different stages of antisocial careers such as onset, persistence, escalation, duration or desistance, or about the independent, interactive or sequential effects of risk factors. Little is known about precise causal mechanisms that might link risk factors and antisocial behaviors, and relatively little is known about protective factors that are not merely at the opposite end of the scale to a risk factor. More research is needed on the effects of life events (e. g. getting married, getting a job, moving house) on the course of development of antisocial behavior, using within-individual analyses in which each person is followed up before and after the life event (Frederick, 2006). Similarly, more research is needed on whether risk factors for antisocial behavior are similar or different for males and females and for the major racial and ethnic groups.

Early Prevention

A key choice is between primary prevention targeted on the whole community and secondary prevention targeted on high-risk children and families. Both approaches have advantages and disadvantages. An advantage of secondary prevention is that scarce treatment resources can be targeted on the people who are most in need. According to John (2002) a disadvantage of secondary prevention is that identifying children and families as high risk may have stigmatizing effects and may prejudice co-operation from the community. It might perhaps be argued that primary prevention is likely to be most useful in preventing antisocial behavior, while secondary prevention may be most useful in preventing syndromes of APD and psychopathy. (Hugues, 2006) Most is known about the primary prevention of antisocial behavior, and that is the main concern of this paper. A number of promising methods of preventing types of antisocial behavior have been identified, including intensive home visiting in pregnancy and infancy, preschool intellectual enrichment programs, parent training, interpersonal skills training, peer influence resistance strategies and anti-bullying programs in schools.

Multiple component programs that include several of these elements seem particularly promising. However, there have been few well-designed evaluations of these programs, especially in relation to APD or psychopathy, and the effectiveness of Communities that Care has not yet been established. It is important to be clear about what it is that the intervention ultimately hopes to achieve in terms of behavioral reduction.

Although a small number of individuals are responsible for a disproportionate amount of antisocial behavior, the population approach may ultimately lead to a greater reduction of antisocial behavior in the general population with greater overall benefits in cost reduction. A reduction in less frequent, but more serious, behaviors, which are more likely to be demonstrated by high-risk individuals, may not be achievable. The public may be less impressed by a reduction in more common behaviors such as vandalism and car theft than by less substantial reductions in robbery and serious assault. The importance of cost savings may not be a priority shared by all parties. Investigators should therefore be entirely clear at the outset regarding their goal of intervention in view of the differing expectations of sponsors of research, policy-makers, politicians and the public.


This paper brings together available knowledge about risk and protective factors and the effectiveness of early prevention methods for antisocial behavior. However, it also reveals important gaps in knowledge, especially about risk factors and early prevention methods for APD and psychopathy. In practice, most experimental interventions have been designed to test the effectiveness of a technology (e. g. parent training) rather than to test causal hypotheses (e. g. about the effect of different methods of parenting). Including experimental interventions in longitudinal studies encourages use of the experimental results to draw conclusions about causal effects on antisocial behavior.

In choosing interventions, there is a tension between selecting multiple component programs that have a greater probability of changing people but create difficulty in identifying the precise “active ingredient”, and single component programs with lesser impact but more clear-cut interpretation. Our preference is for multiple component programs, as the available evidence suggests greater probability of a successful impact in preventing antisocial behavior. If a multiple component program proved to be effective, it is always possible to carry out subsequent experiments designed to disentangle the effects of the different components.

We believe that the time is ripe to mount a major initiative such as this in order to significantly advance knowledge about the causes and prevention of antisocial behavior, APD and psychopathy in the new millennium. Whilst not a substitute, it should also inform a new generation of prospective, long-term, longitudinal studies which are also required.

Works Cited

  1. Hugues Herv, John C. Yuille. The Psychopath : Theory, Research, and Practice. Lawrence Erlbaum, 2006: 128-135
  2. Frederick Rotgers, Michael Maniacci. Antisocial Personality Disorder: A Practitioner’s Guide to Comparative. Springer Publishing Co., Inc. 2006, 78-81
  3. John B. Reid, Gerald R. Patterson. Antisocial Behavior in Children and Adolescents: A Developmental Analysis and Model for Intervention American Psychological Assoc, 2002: 54-60
  4. Martin Kantor. The Psychopathy of Everyday Life: How Antisocial Personality Disorder Affects All of Us. Praeger Publishers, 2006: 163-169
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