Antisocial Personality Disorder (Nursing)

Kristy Fisher; Tyler Torrico; Manassa Hany

Antisocial Personality Disorder (Nursing)

Learning Outcome

Describe the clinical features of antisocial personality disorder
Summarize the treatment of antisocial personality disorder
Recall the outcomes of patients with antisocial personality disorder

Introduction

Antisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with no remorse. Disregard for and violation of the rights of others are common manifestations of this personality disorder, which displays symptoms that include failure to conform to the law, inability to sustain consistent employment, deception, manipulation for personal gain, and incapacity to form stable relationships.[1]

The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classifies all ten personality disorders into three clusters (A, B, and C). ASPD falls into 1 of 4 cluster-B disorders, which also includes borderline, narcissistic, and histrionic. All of these disorders characteristically demonstrate by dramatic, emotional, and unpredictable interactions with others.[2] Antisocial personality disorder is the only personality disorder that is not diagnosable in childhood. Before the age of 18, the patient must have been previously diagnosed with conduct disorder (CD) by the age of 15 years old to justify diagnostic criteria for ASPD.[1]

Many researchers and clinicians argue this diagnosis, with concerns of significant overlap with other disorders, including psychopathy. However, others counter that psychopathy is simply a subtype of ASPD, with a more severe presentation. Recent literature states that although a heterogeneous construct that can subdivide into multiple subtypes that share many similarities and are often comorbid but not synonymous, individuals with antisocial personality disorder must be characterized biologically and cognitively to ensure more accurate categorization and appropriate treatment.[3]

The estimated lifetime prevalence of ASPD amongst the general population falls within 1 to 4%.[4][5] Due to the predicting factor of the initial diagnosis of conduct disorder before the age of 15, this assumption can be quite broad as CD is not always evaluated properly.[6] Gender distribution tends to be skewed towards males, with 3 to 5 times more likelihood of being diagnosed with ASPD than females, with 6% men and 2% women within the general population.[7] Substance abuse has been found to show a significant correlation to the diagnosis of antisocial personality disorder,[8] while education and intelligence displays a negative correlation,[7][9] with a higher prevalence of ASPD amongst those with lower IQs and reading levels [10]. Research shows reductions in the prevalence rate with increasing age in criminal populations,[11] as well as epidemiological samples.[7] Changes in personality traits with age and increased mortality with the behavior of ASPD have been hypothesized to justify this age-dependent alteration.[12]

Nursing Diagnosis

Low self-esteem
Risk for self-harm or violence
Impairment in social interactions
Inability to cope

Causes

Although the precise etiology is unknown, both genetic and environmental factors have been found to play a role in developing antisocial personality disorder. Various studies in the past have shown differing estimations of heritability, ranging from 38% to 69%. Environmental factors that correlate to the development of ASPD include adverse childhood experiences (both physical and sexual abuse, as well as neglect) along with childhood psychopathology (CD and ADHD).[13]

Other studies stress the importance of both shared and non-shared environmental factors, including both family dynamics and peer relations on the development of antisocial personality disorder. Research has been focused on establishing the exact gene contributing to ASPD and much evidence is pointing toward the 2p12 region of chromosome 2 and variation within AVPR1A. Interactions of specific genes with the environment have been an area of study as well, with evidence of variation in the oxytocin receptor gene (OXTR) contributing to the broad ranges of behavior elicited in ASPD due to its effect on the influence of deviant peer affiliation.[14]

Assessment

Before performing a comprehensive psychiatric assessment of the patient, a careful history and physical examination is necessary. "The DSM-5 diagnostic criteria for Antisocial Personality Disorder

A pervasive pattern of disregard for and violation of the rights of others, since age 15 years, as indicated by three (or more) of the following:
- Failure to conform to social norms with respect to lawful behaviors, such as performing acts that are grounds for arrest.
- Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit.
- Impulsivity or failure to plan.
- Irritability and aggressiveness, often with physical fights or assaults.
- Reckless disregard for the safety of self or others.
- Consistent irresponsibility, failure to sustain consistent work behavior or honor monetary obligations.
- Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.
The individual is at least age 18 years.
Evidence of conduct disorder typically with onset before age 15 years.
The occurrence of antisocial behavior is not exclusively during schizophrenia or bipolar disorder."

Evaluation

No current diagnostic modalities, such as tests including serology, are currently accepted standards in diagnosing antisocial personality disorder. However, genetic testing and neuroimaging have been used to evaluate potential causes and patterns, respectively, with ASPD (see Etiology section above). Patients with ASPD are at a higher risk of contracting certain viral infections and sexually transmitted diseases associated with high-risk behavior, including hepatitis C and human immunodeficiency virus, as well as increased mortality rates due to accidents, traumatic injuries, suicides, and homicides.[15][16][17]

Medical Management

Although a multitude of interventions has been tested in the past, an appropriate algorithm fails to exist today. Literature suggests early treatment intervention with conduct disorder in children as the least costly and most effective with treating antisocial personality disorder.[18] However, certain psychopharmacology and psychotherapy have been used throughout literature, but due to the severity of potential harms in adulthood, intricate consideration is necessary when delineating a treatment course.[19]

Most of the needs of antisocial personality disorder are addressable in the outpatient setting. Hospitalization is not cost-effective as it provides little to no benefit to those with ASPD, and it is very costly. Also, the presence of those with ASPD in a psychiatric hospital disrupts the environment, thus affecting the treatment of other patients in need of therapeutic care. Hospitalization is reserved for treating co-occurring conditions or possible complications, such as substance intoxication/withdrawal or recent suicidal behavior.

Insufficient evidence exists to support any psychological intervention in adults with ASPD.[20] No pharmacological intervention has been shown to treat ASPD, but medications are highly recommended to treat co-occurring conditions. Aggressive behavior is treatable with second-generation antipsychotics as first-line therapy, including risperidone (2 to 4 mg/day), quetiapine (100 to 300 mg/day). Second and third-line therapies for aggression include selective serotonin reuptake inhibitors (SSRI), sertraline (100 to 200 mg/day) or fluoxetine (20 mg/day), and mood stabilizers, lithium, and carbamazepine (dosed at recommended levels for bipolar disorder), respectively. Anticonvulsants, such as oxcarbazepine and carbamazepine, can be used to aid with impulsivity. Buproprion and atomoxetine are often used to treat associated ADHD due to their non-addictive nature.

Nursing Management

Educate patient about the disorder
Assess behavior and mental status
Assess social interactions
Administer SSRIs if prescribed
Encourage patient to seek therapy
Teach patient self-care

Outcome Identification

Of those children with conduct disorder, 25% of girls and 40% of boys will meet the diagnostic criteria for antisocial personality disorder. Boys exhibit symptoms earlier than girls, who often only elicit these symptoms in puberty. Children who do not develop conduct disorder and progress to the age of 15 without antisocial behaviors will not develop ASPD. Childhood CD is a reliable prognosticator of adulthood ASPD.[1] The small percentage of adults with antisocial personality disorder who never met the criteria or never received an evaluation for CD, tend to have milder symptoms.[21]

Antisocial personality disorder, although a chronic condition with a lifelong presentation, has had moderations shown with advancing ages, with the mean remitted age of 35 years old. Those with less baseline symptomatology showed better-remitted rates. Studies in the past revealed remitted rates of 12 to 27% and 27 to 31% rates of improvement, but not remission. Crime rates and severity reflect this relation as well, with peak crime statistics in late teens and higher severity of crimes at younger ages. Those with later presentations of antisocial behavior showed less severe behavioral problems. Those who were either never imprisoned or imprisoned for longer periods displayed greater remission rates than those imprisoned for shorter periods. This finding indicated that short-term incarceration could be somewhat preventive for future antisocial behavior.[1]

Coordination of Care

The diagnosis, categorization, and management of antisocial personality disorder is quite complex and multifaceted, often only presenting after inflicting harm. People with antisocial personality disorder run a risk of incarceration due to the violent and deceitful nature of the behaviors elicited in ASPD. Hospitalization provides no benefit to a patient with ASPD and can actually create a disruptive hospital environment to others who truly require hospitalization for therapeutic purposes.

Health Teaching and Health Promotion

Antisocial personality disorder is one of the best-documented diseases in all of the literature pertaining to psychiatry, including etiology, epidemiology, pathophysiology, neuroanatomy, heritability, and interventional treatment. However, an established treatment algorithm and specialized psychopharmacology currently fail to exist.
Better preventative measures are necessary as many of those with ASPD may only be assessed upon incarceration after the harm has already occurred. One is not apt to seek help for ASPD symptomatology. Many only seek assistance for co-occurring mental disorders or only present for court-mandated assessments.
Even with the remission rates in advanced ages, ASPD causes much turmoil to the patient and the patient’s surrounding community. The lives of those with ASPD remain negatively impacted even after remission.

Risk Management

Many individuals diagnosed with antisocial personality disorder remain a burden to their families, coworkers, and closely associated peers, such as neighbors, despite becoming less troublesome with age. Mental health comorbidities and associated addictive disorders, as well as higher mortality rates due to suicides and homicides, only add to this burden. Most of those who improve with age remain unable to re-claim their lost prospects, including education, domestication, and employment. Those patients who did show remission were more likely to have spousal or family ties, with better social support.[1]

Details

References

[1]

Clark DA, Donnellan MB, Robins RW. Antisocial Traits, Negative Emotionality, and Trajectories of Relationship Quality in Mexican-Origin Couples. Journal of personality disorders. 2020 Aug:34(4):459-479. doi: 10.1521/pedi_2019_33_410. Epub 2019 Aug 12 [PubMed PMID: 31403390]

[2]

Mohan L, Yilanli M, Ray S. Conduct Disorder. StatPearls. 2024 Jan:(): [PubMed PMID: 29261891]

[3]

Junewicz A, Billick SB. Conduct Disorder: Biology and Developmental Trajectories. The Psychiatric quarterly. 2020 Mar:91(1):77-90. doi: 10.1007/s11126-019-09678-5. Epub [PubMed PMID: 31768912]

[4]

Gelhorn HL, Sakai JT, Price RK, Crowley TJ. DSM-IV conduct disorder criteria as predictors of antisocial personality disorder. Comprehensive psychiatry. 2007 Nov-Dec:48(6):529-38 [PubMed PMID: 17954138]

[5]

Sagar R, Patra BN, Patil V. Clinical Practice Guidelines for the management of conduct disorder. Indian journal of psychiatry. 2019 Jan:61(Suppl 2):270-276. doi: 10.4103/psychiatry.IndianJPsychiatry_539_18. Epub [PubMed PMID: 30745702]

[6]

Coid J, Ullrich S. Antisocial personality disorder is on a continuum with psychopathy. Comprehensive psychiatry. 2010 Jul-Aug:51(4):426-33. doi: 10.1016/j.comppsych.2009.09.006. Epub 2009 Dec 21 [PubMed PMID: 20579518]

[7]

Hare RD, Neumann CS. Psychopathy as a clinical and empirical construct. Annual review of clinical psychology. 2008:4():217-46. doi: 10.1146/annurev.clinpsy.3.022806.091452. Epub [PubMed PMID: 18370617]

[8]

Charland LC. Science and morals in the affective psychopathology of Philippe Pinel. History of psychiatry. 2010 Mar:21(81 Pt 1):38-53 [PubMed PMID: 21877429]

[9]

Kendler KS. Philippe Pinel and the foundations of modern psychiatric nosology. Psychological medicine. 2020 Dec:50(16):2667-2672. doi: 10.1017/S0033291720004183. Epub 2020 Nov 20 [PubMed PMID: 33213600]

[10]

Crego C, Widiger TA. Cleckley's psychopaths: Revisited. Journal of abnormal psychology. 2016 Jan:125(1):75-87. doi: 10.1037/abn0000130. Epub 2015 Nov 30 [PubMed PMID: 26618655]

[11]

Lilienfeld SO, Watts AL, Smith SF, Patrick CJ, Hare RD. Hervey Cleckley (1903-1984): Contributions to the study of psychopathy. Personality disorders. 2018 Nov:9(6):510-520. doi: 10.1037/per0000306. Epub 2018 Aug 6 [PubMed PMID: 30080062]

[12]

First MB, Yousif LH, Clarke DE, Wang PS, Gogtay N, Appelbaum PS. DSM-5-TR: overview of what's new and what's changed. World psychiatry : official journal of the World Psychiatric Association (WPA). 2022 Jun:21(2):218-219. doi: 10.1002/wps.20989. Epub [PubMed PMID: 35524596]

[13]

Hopwood CJ, Thomas KM, Markon KE, Wright AG, Krueger RF. DSM-5 personality traits and DSM-IV personality disorders. Journal of abnormal psychology. 2012 May:121(2):424-32. doi: 10.1037/a0026656. Epub 2012 Jan 16 [PubMed PMID: 22250660]

[14]

Tackett JL, Silberschmidt AL, Krueger RF, Sponheim SR. A dimensional model of personality disorder: incorporating DSM Cluster A characteristics. Journal of abnormal psychology. 2008 May:117(2):454-9. doi: 10.1037/0021-843X.117.2.454. Epub [PubMed PMID: 18489222]

[15]

DeLisi M, Drury AJ, Elbert MJ. The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Comprehensive psychiatry. 2019 Jul:92():1-6. doi: 10.1016/j.comppsych.2019.04.001. Epub 2019 Apr 30 [PubMed PMID: 31079021]

[16]

Sanchez-Roige S, Gray JC, MacKillop J, Chen CH, Palmer AA. The genetics of human personality. Genes, brain, and behavior. 2018 Mar:17(3):e12439. doi: 10.1111/gbb.12439. Epub 2017 Dec 29 [PubMed PMID: 29152902]

[17]

Réale D, Reader SM, Sol D, McDougall PT, Dingemanse NJ. Integrating animal temperament within ecology and evolution. Biological reviews of the Cambridge Philosophical Society. 2007 May:82(2):291-318 [PubMed PMID: 17437562]

[18]

Svrakic DM, Cloninger RC. Epigenetic perspective on behavior development, personality, and personality disorders. Psychiatria Danubina. 2010 Jun:22(2):153-66 [PubMed PMID: 20562740]

[19]

Gescher DM, Kahl KG, Hillemacher T, Frieling H, Kuhn J, Frodl T. Epigenetics in Personality Disorders: Today's Insights. Frontiers in psychiatry. 2018:9():579. doi: 10.3389/fpsyt.2018.00579. Epub 2018 Nov 19 [PubMed PMID: 30510522]

[20]

Wan L, Zha R, Ren J, Li Y, Zhao Q, Zuo H, Zhang X. Brain morphology, harm avoidance, and the severity of excessive internet use. Human brain mapping. 2022 Jul:43(10):3176-3183. doi: 10.1002/hbm.25842. Epub 2022 Mar 25 [PubMed PMID: 35332975]

[21]

Gocłowska MA, Ritter SM, Elliot AJ, Baas M. Novelty seeking is linked to openness and extraversion, and can lead to greater creative performance. Journal of personality. 2019 Apr:87(2):252-266. doi: 10.1111/jopy.12387. Epub 2018 Jun 11 [PubMed PMID: 29604214]

[22]

Frank GKW, Shott ME, Sternheim LC, Swindle S, Pryor TL. Persistence, Reward Dependence, and Sensitivity to Reward Are Associated With Unexpected Salience Response in Girls but Not in Adult Women: Implications for Psychiatric Vulnerabilities. Biological psychiatry. Cognitive neuroscience and neuroimaging. 2022 Nov:7(11):1170-1182. doi: 10.1016/j.bpsc.2021.04.005. Epub 2021 Apr 17 [PubMed PMID: 33872764]

[23]

Brennan PA, Mednick SA. Genetic perspectives on crime. Acta psychiatrica Scandinavica. Supplementum. 1993:370():19-26 [PubMed PMID: 8452051]

[24]

Guze SB, Wolfgram ED, McKinney JK, Cantwell DP. Psychiatric illness in the families of convicted criminals: a study of 519 first-degree relatives. Diseases of the nervous system. 1967 Oct:28(10):651-9 [PubMed PMID: 6051292]

[25]

Krueger RF, Hicks BM, Patrick CJ, Carlson SR, Iacono WG, McGue M. Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. Journal of abnormal psychology. 2002 Aug:111(3):411-24 [PubMed PMID: 12150417]

[26]

Rosenström T, Ystrom E, Torvik FA, Czajkowski NO, Gillespie NA, Aggen SH, Krueger RF, Kendler KS, Reichborn-Kjennerud T. Genetic and Environmental Structure of DSM-IV Criteria for Antisocial Personality Disorder: A Twin Study. Behavior genetics. 2017 May:47(3):265-277. doi: 10.1007/s10519-016-9833-z. Epub 2017 Jan 21 [PubMed PMID: 28108863]

[27]

Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW, Taylor A, Poulton R. Role of genotype in the cycle of violence in maltreated children. Science (New York, N.Y.). 2002 Aug 2:297(5582):851-4 [PubMed PMID: 12161658]

[28]

Nielsen DA, Goldman D, Virkkunen M, Tokola R, Rawlings R, Linnoila M. Suicidality and 5-hydroxyindoleacetic acid concentration associated with a tryptophan hydroxylase polymorphism. Archives of general psychiatry. 1994 Jan:51(1):34-8 [PubMed PMID: 7506517]

[29]

da Cunha-Bang S, Knudsen GM. The Modulatory Role of Serotonin on Human Impulsive Aggression. Biological psychiatry. 2021 Oct 1:90(7):447-457. doi: 10.1016/j.biopsych.2021.05.016. Epub 2021 May 25 [PubMed PMID: 34266672]

[30]

Scarpa A, Raine A. Psychophysiology of anger and violent behavior. The Psychiatric clinics of North America. 1997 Jun:20(2):375-94 [PubMed PMID: 9196920]

[31]

Leppla I, Fishman D, Kalra I, Oldham MA. Clinical Approach to Personality Change Due to Another Medical Condition. Journal of the Academy of Consultation-Liaison Psychiatry. 2021 Jan-Feb:62(1):14-21. doi: 10.1016/j.psym.2020.08.003. Epub 2020 Sep 12 [PubMed PMID: 33190792]

[32]

Neugebauer R, Hoek HW, Susser E. Prenatal exposure to wartime famine and development of antisocial personality disorder in early adulthood. JAMA. 1999 Aug 4:282(5):455-62 [PubMed PMID: 10442661]

[33]

Wakschlag LS, Lahey BB, Loeber R, Green SM, Gordon RA, Leventhal BL. Maternal smoking during pregnancy and the risk of conduct disorder in boys. Archives of general psychiatry. 1997 Jul:54(7):670-6 [PubMed PMID: 9236551]

[34]

Newlin E, Weinstein B. Personality disorders. Continuum (Minneapolis, Minn.). 2015 Jun:21(3 Behavioral Neurology and Neuropsychiatry):806-17. doi: 10.1212/01.CON.0000466668.02477.0c. Epub [PubMed PMID: 26039856]

[35]

Shapiro D. Theoretical reflections on Wilhelm Reich's Character Analysis. American journal of psychotherapy. 2002:56(3):338-46 [PubMed PMID: 12400201]

[36]

Di Giuseppe M, Perry JC. The Hierarchy of Defense Mechanisms: Assessing Defensive Functioning With the Defense Mechanisms Rating Scales Q-Sort. Frontiers in psychology. 2021:12():718440. doi: 10.3389/fpsyg.2021.718440. Epub 2021 Oct 15 [PubMed PMID: 34721167]

[37]

Reti IM, Samuels JF, Eaton WW, Bienvenu OJ 3rd, Costa PT Jr, Nestadt G. Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection. Acta psychiatrica Scandinavica. 2002 Aug:106(2):126-33 [PubMed PMID: 12121210]

[38]

Luntz BK, Widom CS. Antisocial personality disorder in abused and neglected children grown up. The American journal of psychiatry. 1994 May:151(5):670-4 [PubMed PMID: 8166307]

[39]

Egami Y, Ford DE, Greenfield SF, Crum RM. Psychiatric profile and sociodemographic characteristics of adults who report physically abusing or neglecting children. The American journal of psychiatry. 1996 Jul:153(7):921-8 [PubMed PMID: 8659615]

[40]

Brewer AJ, Saunders R, Fearon P, Fonagy P, Cottrell D, Kraam A, Pilling S, Simes E, Anokhina A, Butler S. Antisocial cognition as a mediator of the peer influence effect and peer selection effect in antisocial adolescents. European child & adolescent psychiatry. 2022 Jan:31(1):177-187. doi: 10.1007/s00787-020-01695-1. Epub 2020 Dec 16 [PubMed PMID: 33330952]

[41]

Monahan KC, Steinberg L, Cauffman E. Affiliation with antisocial peers, susceptibility to peer influence, and antisocial behavior during the transition to adulthood. Developmental psychology. 2009 Nov:45(6):1520-30. doi: 10.1037/a0017417. Epub [PubMed PMID: 19899911]

[42]

Shao R, Wang Y. The Relation of Violent Video Games to Adolescent Aggression: An Examination of Moderated Mediation Effect. Frontiers in psychology. 2019:10():384. doi: 10.3389/fpsyg.2019.00384. Epub 2019 Feb 21 [PubMed PMID: 30846962]

[43]

Wiegman O, van Schie EG. Video game playing and its relations with aggressive and prosocial behaviour. The British journal of social psychology. 1998 Sep:37 ( Pt 3)():367-78 [PubMed PMID: 9738313]

[44]

Chen MJ, Miller BA, Grube JW, Waiters ED. Music, substance use, and aggression. Journal of studies on alcohol. 2006 May:67(3):373-81 [PubMed PMID: 16608146]

[45]

Moran P. The epidemiology of antisocial personality disorder. Social psychiatry and psychiatric epidemiology. 1999 May:34(5):231-42 [PubMed PMID: 10396164]

[46]

Black DW, Gunter T, Loveless P, Allen J, Sieleni B. Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of life. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists. 2010 May:22(2):113-20 [PubMed PMID: 20445838]

[47]

Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, Pickering RP. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. The Journal of clinical psychiatry. 2004 Jul:65(7):948-58 [PubMed PMID: 15291684]

[48]

Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF. Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. The Journal of clinical psychiatry. 2005 Jun:66(6):677-85 [PubMed PMID: 15960559]

[49]

Neumann CS, Hare RD. Psychopathic traits in a large community sample: links to violence, alcohol use, and intelligence. Journal of consulting and clinical psychology. 2008 Oct:76(5):893-9. doi: 10.1037/0022-006X.76.5.893. Epub [PubMed PMID: 18837606]

[50]

Simonoff E, Elander J, Holmshaw J, Pickles A, Murray R, Rutter M. Predictors of antisocial personality. Continuities from childhood to adult life. The British journal of psychiatry : the journal of mental science. 2004 Feb:184():118-27 [PubMed PMID: 14754823]

[51]

Raine A. Autonomic nervous system factors underlying disinhibited, antisocial, and violent behavior. Biosocial perspectives and treatment implications. Annals of the New York Academy of Sciences. 1996 Sep 20:794():46-59 [PubMed PMID: 8853591]

[52]

Dolan M. Psychopathy--a neurobiological perspective. The British journal of psychiatry : the journal of mental science. 1994 Aug:165(2):151-9 [PubMed PMID: 7953028]

[53]

Raine A, Venables PH, Williams M. Relationships between central and autonomic measures of arousal at age 15 years and criminality at age 24 years. Archives of general psychiatry. 1990 Nov:47(11):1003-7 [PubMed PMID: 2241502]

[54]

Moffitt TE, Lynam D Jr. The neuropsychology of conduct disorder and delinquency: implications for understanding antisocial behavior. Progress in experimental personality & psychopathology research. 1994:():233-62 [PubMed PMID: 8044205]

[55]

Dolan MC. What imaging tells us about violence in anti-social men. Criminal behaviour and mental health : CBMH. 2010 Jul:20(3):199-214. doi: 10.1002/cbm.771. Epub [PubMed PMID: 20549783]

[56]

Goyer PF, Andreason PJ, Semple WE, Clayton AH, King AC, Compton-Toth BA, Schulz SC, Cohen RM. Positron-emission tomography and personality disorders. Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology. 1994 Feb:10(1):21-8 [PubMed PMID: 8179791]

[57]

Raine A, Lencz T, Bihrle S, LaCasse L, Colletti P. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Archives of general psychiatry. 2000 Feb:57(2):119-27; discussion 128-9 [PubMed PMID: 10665614]

[58]

Robins LN, Price RK. Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project. Psychiatry. 1991 May:54(2):116-32 [PubMed PMID: 1852846]

[59]

Andreasen NC, Rice J, Endicott J, Reich T, Coryell W. The family history approach to diagnosis. How useful is it? Archives of general psychiatry. 1986 May:43(5):421-9 [PubMed PMID: 3964020]

[60]

Black DW, Baumgard CH, Bell SE. The long-term outcome of antisocial personality disorder compared with depression, schizophrenia, and surgical conditions. The Bulletin of the American Academy of Psychiatry and the Law. 1995:23(1):43-52 [PubMed PMID: 7599370]

[61]

Dinwiddie SH, Cottler L, Compton W, Abdallah AB. Psychopathology and HIV risk behaviors among injection drug users in and out of treatment. Drug and alcohol dependence. 1996 Dec 2:43(1-2):1-11 [PubMed PMID: 8957138]

[62]

Goldstein RB, Dawson DA, Chou SP, Ruan WJ, Saha TD, Pickering RP, Stinson FS, Grant BF. Antisocial behavioral syndromes and past-year physical health among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. The Journal of clinical psychiatry. 2008 Mar:69(3):368-80 [PubMed PMID: 18348594]

[63]

Ellis D, Collis I, King M. Personality disorder and sexual risk taking among homosexually active and heterosexually active men attending a genito-urinary medicine clinic. Journal of psychosomatic research. 1995 Oct:39(7):901-10 [PubMed PMID: 8636922]

[64]

Henry BF. Treating Gang-Involved Patients: Embodied Trauma & How to Heal from Life on the Street. Professional development (Philadelphia, Pa.). 2019 Fall:22(2):3-10 [PubMed PMID: 32577076]

[65]

Raspa RF, Cusack J. Psychiatric implications of tattoos. American family physician. 1990 May:41(5):1481-6 [PubMed PMID: 2333825]

[66]

Clark LA. Assessment and diagnosis of personality disorder: perennial issues and an emerging reconceptualization. Annual review of psychology. 2007:58():227-57 [PubMed PMID: 16903806]

[67]

Campbell K, Clarke KA, Massey D, Lakeman R. Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. International journal of mental health nursing. 2020 Oct:29(5):972-981. doi: 10.1111/inm.12737. Epub 2020 May 19 [PubMed PMID: 32426937]

[68]

Dao TK, Prevatt F, Horne HL. Differentiating psychotic patients from nonpsychotic patients with the MMPI-2 and Rorschach. Journal of personality assessment. 2008 Jan:90(1):93-101. doi: 10.1080/00223890701693819. Epub [PubMed PMID: 18444100]

[69]

Sellbom M, Ben-Porath YS, Lilienfeld SO, Patrick CJ, Graham JR. Assessing psychopathic personality traits with the MMPI-2. Journal of personality assessment. 2005 Dec:85(3):334-43 [PubMed PMID: 16318573]

[70]

Falkenbach DM, Reinhard EE, Zappala M. Identifying Psychopathy Subtypes Using a Broader Model of Personality: An Investigation of the Five Factor Model Using Model-Based Cluster Analysis. Journal of interpersonal violence. 2021 Aug:36(15-16):7161-7184. doi: 10.1177/0886260519831388. Epub 2019 Mar 2 [PubMed PMID: 30827139]

[71]

Frick PJ. Early Identification and Treatment of Antisocial Behavior. Pediatric clinics of North America. 2016 Oct:63(5):861-71. doi: 10.1016/j.pcl.2016.06.008. Epub [PubMed PMID: 27565364]

[72]

Weinberg I, Ronningstam E. Dos and Don'ts in Treatments of Patients With Narcissistic Personality Disorder. Journal of personality disorders. 2020 Mar:34(Suppl):122-142. doi: 10.1521/pedi.2020.34.supp.122. Epub [PubMed PMID: 32186986]

[73]

Bateman A, O'Connell J, Lorenzini N, Gardner T, Fonagy P. A randomised controlled trial of mentalization-based treatment versus structured clinical management for patients with comorbid borderline personality disorder and antisocial personality disorder. BMC psychiatry. 2016 Aug 30:16(1):304. doi: 10.1186/s12888-016-1000-9. Epub 2016 Aug 30 [PubMed PMID: 27577562]

[74]

Coccaro EF, Kavoussi RJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Archives of general psychiatry. 1997 Dec:54(12):1081-8 [PubMed PMID: 9400343]

[75]

Müller-Oerlinghausen B, Lewitzka U. Lithium reduces pathological aggression and suicidality: a mini-review. Neuropsychobiology. 2010:62(1):43-9. doi: 10.1159/000314309. Epub 2010 May 7 [PubMed PMID: 20453534]

[76]

Barratt ES, Stanford MS, Felthous AR, Kent TA. The effects of phenytoin on impulsive and premeditated aggression: a controlled study. Journal of clinical psychopharmacology. 1997 Oct:17(5):341-9 [PubMed PMID: 9315984]

[77]

Huband N, Ferriter M, Nathan R, Jones H. Antiepileptics for aggression and associated impulsivity. The Cochrane database of systematic reviews. 2010 Feb 17:2010(2):CD003499. doi: 10.1002/14651858.CD003499.pub3. Epub 2010 Feb 17 [PubMed PMID: 20166067]

[78]

Stanford MS, Helfritz LE, Conklin SM, Villemarette-Pittman NR, Greve KW, Adams D, Houston RJ. A comparison of anticonvulsants in the treatment of impulsive aggression. Experimental and clinical psychopharmacology. 2005 Feb:13(1):72-7 [PubMed PMID: 15727506]

[79]

Corrigan PW, Yudofsky SC, Silver JM. Pharmacological and behavioral treatments for aggressive psychiatric inpatients. Hospital & community psychiatry. 1993 Feb:44(2):125-33 [PubMed PMID: 8432495]

[80]

Cowdry RW, Gardner DL. Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Archives of general psychiatry. 1988 Feb:45(2):111-9 [PubMed PMID: 3276280]

[81]

Diamond D, Yeomans F, Keefe JR. Transference-Focused Psychotherapy for Pathological Narcissism and Narcissistic Personality Disorder (TFP-N). Psychodynamic psychiatry. 2021 Summer:49(2):244-272. doi: 10.1521/pdps.2021.49.2.244. Epub [PubMed PMID: 34061655]

[82]

Kernberg OF. An overview of the treatment of severe narcissistic pathology. The International journal of psycho-analysis. 2014 Oct:95(5):865-88. doi: 10.1111/1745-8315.12204. Epub 2014 Jun 6 [PubMed PMID: 24902768]

[83]

Ritter S, Platt LM. What's New in Treating Inpatients With Personality Disorders?: Dialectical Behavior Therapy and Old-Fashioned, Good Communication. Journal of psychosocial nursing and mental health services. 2016 Jan:54(1):38-45. doi: 10.3928/02793695-20151216-03. Epub [PubMed PMID: 26760134]

[84]

Sansone RA, Sansone LA. Responses of mental health clinicians to patients with borderline personality disorder. Innovations in clinical neuroscience. 2013 May:10(5-6):39-43 [PubMed PMID: 23882440]

[85]

Parth K, Datz F, Seidman C, Löffler-Stastka H. Transference and countertransference: A review. Bulletin of the Menninger Clinic. 2017 Spring:81(2):167-211. doi: 10.1521/bumc.2017.81.2.167. Epub [PubMed PMID: 28609147]

[86]

Knaak S, Mantler E, Szeto A. Mental illness-related stigma in healthcare: Barriers to access and care and evidence-based solutions. Healthcare management forum. 2017 Mar:30(2):111-116. doi: 10.1177/0840470416679413. Epub 2017 Feb 16 [PubMed PMID: 28929889]

[87]

Edershile EA, Wright AGC. Fluctuations in grandiose and vulnerable narcissistic states: A momentary perspective. Journal of personality and social psychology. 2021 May:120(5):1386-1414. doi: 10.1037/pspp0000370. Epub 2020 Oct 22 [PubMed PMID: 33090821]

[88]

Scott KM,de Vries YA,Aguilar-Gaxiola S,Al-Hamzawi A,Alonso J,Bromet EJ,Bunting B,Caldas-de-Almeida JM,Cía A,Florescu S,Gureje O,Hu CY,Karam EG,Karam A,Kawakami N,Kessler RC,Lee S,McGrath J,Oladeji B,Posada-Villa J,Stein DJ,Zarkov Z,de Jonge P, Intermittent explosive disorder subtypes in the general population: association with comorbidity, impairment and suicidality. Epidemiology and psychiatric sciences. 2020 Jun 23; [PubMed PMID: 32638683]

[89]

Bateman A, Fonagy P. Comorbid antisocial and borderline personality disorders: mentalization-based treatment. Journal of clinical psychology. 2008 Feb:64(2):181-94. doi: 10.1002/jclp.20451. Epub [PubMed PMID: 18186112]

[90]

Jemal M, Tessema W, Agenagnew L. Cluster B personality disorders and its associated factors among psychiatric outpatients in Southwest Ethiopia: institutional-based cross-sectional study. BMC psychiatry. 2022 Jul 26:22(1):500. doi: 10.1186/s12888-022-04143-3. Epub 2022 Jul 26 [PubMed PMID: 35883168]

[91]

Trull TJ, Widiger TA. Dimensional models of personality: the five-factor model and the DSM-5. Dialogues in clinical neuroscience. 2013 Jun:15(2):135-46 [PubMed PMID: 24174888]

[92]

Black DW. The Natural History of Antisocial Personality Disorder. Canadian journal of psychiatry. Revue canadienne de psychiatrie. 2015 Jul:60(7):309-14 [PubMed PMID: 26175389]

[93]

Black DW, Monahan P, Baumgard CH, Bell SE. Predictors of long-term outcome in 45 men with antisocial personality disorder. Annals of clinical psychiatry : official journal of the American Academy of Clinical Psychiatrists. 1997 Dec:9(4):211-7 [PubMed PMID: 9511944]

[94]

Burt SA, Donnellan MB, Humbad MN, Hicks BM, McGue M, Iacono WG. Does marriage inhibit antisocial behavior?: An examination of selection vs causation via a longitudinal twin design. Archives of general psychiatry. 2010 Dec:67(12):1309-15. doi: 10.1001/archgenpsychiatry.2010.159. Epub [PubMed PMID: 21135331]

[95]

Boot K, Wiebenga JXM, Eikelenboom M, van Oppen P, Thomaes K, van Marle HJF, Heering HD. Associations between personality traits and suicidal ideation and suicide attempts in patients with personality disorders. Comprehensive psychiatry. 2022 Jan:112():152284. doi: 10.1016/j.comppsych.2021.152284. Epub 2021 Oct 26 [PubMed PMID: 34763292]

[96]

De Wit-De Visser B, Rijckmans M, Vermunt JK, van Dam A. Pathways to antisocial behavior: a framework to improve diagnostics and tailor therapeutic interventions. Frontiers in psychology. 2023:14():993090. doi: 10.3389/fpsyg.2023.993090. Epub 2023 Feb 9 [PubMed PMID: 36844347]

[97]

Cramer V, Torgersen S, Kringlen E. Personality disorders and quality of life. A population study. Comprehensive psychiatry. 2006 May-Jun:47(3):178-84 [PubMed PMID: 16635645]

[98]

James J. Dealing with drug-seeking behaviour. Australian prescriber. 2016 Jun:39(3):96-100. doi: 10.18773/austprescr.2016.022. Epub 2016 Jun 1 [PubMed PMID: 27346918]

[99]

Collins TN, Avondoglio JB, Terry LM. Correctional psychopharmacology: pitfalls, challenges, and victories of prescribing in a correctional setting. International review of psychiatry (Abingdon, England). 2017 Feb:29(1):34-44 [PubMed PMID: 27670976]

[100]

Apeldoorn S, Chavez R, Haschemi F, Elsherif K, Weinstein D, Torrico T. Worsening psychosis associated with administrations of buspirone and concerns for intranasal administration: A case report. Frontiers in psychiatry. 2023:14():1129489. doi: 10.3389/fpsyt.2023.1129489. Epub 2023 Feb 17 [PubMed PMID: 36873224]

[101]

Mezher AW, McKnight CA, Caplan JP. Buspirone Abuse: No Safe Haven. Psychosomatics. 2019 Sep-Oct:60(5):534-535. doi: 10.1016/j.psym.2018.12.008. Epub 2018 Dec 23 [PubMed PMID: 30685117]

[102]

Stassinos GL,Klein-Schwartz W, Bupropion "Abuse" Reported to US Poison Centers. Journal of addiction medicine. 2016 Sep-Oct [PubMed PMID: 27504927]

[103]

Stall N, Godwin J, Juurlink D. Bupropion abuse and overdose. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne. 2014 Sep 16:186(13):1015. doi: 10.1503/cmaj.131534. Epub 2014 Apr 28 [PubMed PMID: 24778361]

[104]

Jahnsen JA, Widnes SF, Schjøtt J. Quetiapine, Misuse and Dependency: A Case-Series of Questions to a Norwegian Network of Drug Information Centers. Drug, healthcare and patient safety. 2021:13():151-157. doi: 10.2147/DHPS.S296515. Epub 2021 Jul 21 [PubMed PMID: 34321931]

[105]

Sansone RA, Sansone LA. Is seroquel developing an illicit reputation for misuse/abuse? Psychiatry (Edgmont (Pa. : Township)). 2010 Jan:7(1):13-6 [PubMed PMID: 20386631]