PERSONALITY DISORDER DSM IV 301.70
there is no widely accepted effective method of treating sociopathic
personality types. They
tend to be very manipulative during treatment and tend to lie and cover
up personal faults in themselves and have little insight into their
behavior patterns. They
tend to exhibit short-term enthusiasm for treatment, particularly after
an incident which has brought them into contact with society or the law,
however, once this anxiety is relieved and reduced, they frequently drop
out of treatment and fall back into the same sociopathic patterns that
brought them into treatment initially.
In most cases, the prognosis remains unfavorable throughout the
An Antisocial Personality Disorder is not just a medical term for criminality. It describes a long term pervasive personality disorder that is very resistant to treatment. Suicide, alcoholism, vagrancy, social isolation are common among these individuals, but there is a remarkable lack of anxiety or depression for situations in which these emotions are usually expected. In spite of their run-ins with the law, they usually present a very charming and normal facade. Dynamically, these individuals remain fixed in earlier levels of development. Usually there is parental rejections and/or indifference and needs for satisfaction and security are not met. As a result, psychoanalytic theory holds that the ego which controls impulses between conscience and impulses is underdeveloped. Behavior is usually id directed due to this lack of ego strength, a result is a need for immediate gratification. An immature superego allows the individual to pursue gratification regardless of the means and without experiencing any of the feelings of guilt. Functioning has been implicated as an important doctrine in determining whether an individual develops this disorder. Usually the following circumstances are predisposed factors:
problem 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
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.
Therapy 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
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 which 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