Fisher Kristy A., Torrico Tyler J., Hany Manassa, Doerr Chaddie
Aventura Medical Center
Consilient Interventional Healthcare
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. 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. 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. Substance abuse has been found to show a significant correlation to the diagnosis of antisocial personality disorder, while education and intelligence displays a negative correlation, with a higher prevalence of ASPD amongst those with lower IQs and reading levels . Research shows reductions in the prevalence rate with increasing age in criminal populations,[11] as well as epidemiological samples. Changes in personality traits with age and increased mortality with the behavior of ASPD have been hypothesized to justify this age-dependent alteration.[12]
反社会型人格障碍（ASPD）是一种根深蒂固且僵化的功能失调性思维过程，其特点是专注于社会不负责任行为，表现为剥削性、违法犯罪行为且毫无悔意。漠视和侵犯他人权利是这种人格障碍的常见表现，其症状包括不遵守法律、无法持续稳定就业、欺骗、为个人利益操纵他人以及无法建立稳定关系。《精神疾病诊断与统计手册》（DSM - 5）将所有十种人格障碍分为三个集群（A、B和C）。反社会型人格障碍属于B类的4种障碍之一，B类还包括边缘型、自恋型和表演型人格障碍。所有这些障碍的特征都是与他人进行戏剧性、情绪化且不可预测的互动。反社会型人格障碍是唯一一种在童年期无法诊断的人格障碍。在18岁之前，患者必须在15岁之前被诊断患有品行障碍（CD），才能符合反社会型人格障碍的诊断标准。许多研究人员和临床医生对这一诊断提出质疑，担心它与包括精神病态在内的其他障碍有显著重叠。然而，其他人则反驳说，精神病态只是反社会型人格障碍的一种亚型，表现更为严重。最近的文献指出，尽管反社会型人格障碍是一种异质性结构，可细分为多个具有许多相似之处且常合并出现但并非同义的亚型，但必须从生物学和认知角度对反社会型人格障碍患者进行特征描述，以确保更准确的分类和适当的治疗。据估计，一般人群中反社会型人格障碍的终生患病率在1%至4%之间。由于15岁之前品行障碍的初始诊断这一预测因素，这种假设可能相当宽泛，因为品行障碍并不总是得到恰当评估。性别分布倾向于男性，男性被诊断为反社会型人格障碍的可能性是女性的3至5倍，一般人群中男性患病率为6%，女性为2%。研究发现物质滥用与反社会型人格障碍的诊断有显著相关性，而教育程度和智力则呈负相关，智商和阅读水平较低者中反社会型人格障碍的患病率更高。研究表明，犯罪人群以及流行病学样本中，患病率随年龄增长而降低。有人假设，人格特质随年龄的变化以及反社会型人格障碍行为导致的死亡率增加可以解释这种与年龄相关的变化。
