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Antisocial personality disorder (APD) is a personality disorder which is often characterised by antisocial and impulsive behaviour. APD is generally (if controversially) considered to be the same as, or similar to, the disorder that was previously known as psychopathic or sociopathic personality disorder. Approximately 3% of men and 1% of women have some form of antisocial personality disorder (source: DSM-IV).

Although criminal activity is not a necessary requirement for the diagnosis, these individuals often encounter legal difficulties due to their disregard for societal standards and the rights of others. Therefore, many of these individuals can be found in prisons. However, it should be noted that criminal activity does not automatically warrant a diagnosis of APD, nor does a diagnosis of APD imply that a person is a criminal. It is hypothesized that many high achievers exhibit APD characteristics. This, however, brings much criticism upon the diagnostic criteria specified for those exhibiting Antisocial Personality Disorder and the PCL-R. Both of these tests depend upon the person in question being a criminal or having participated in criminal activities.

Research has shown that individuals with APD are indifferent to the possibility of physical pain or many punishments, and show no indications that they experience fear when so threatened; this may explain their apparent disregard for the consequences of their actions, and their lack of empathy when others are suffering.

The recent, controversial science of sociobiology attempts to explain animal and human behavior and social structures, largely in terms of evolutionarily stable strategies. For example, in one well-known 1995 paper by Linda Mealey, chronic antisocial/criminal behavior is explained as a combination of two such strategies.
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Diagnostic criteria (DSM-IV-TR)

The DSM-IV-TR, a widely used manual for diagnosing mental disorders (see also: DSM cautionary statement), defines anti-social personality disorder as a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

1. failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
3. impulsivity or failure to plan ahead
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults
5. reckless disregard for safety of self or others
6. consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor financial obligations
7. lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

The manual lists the following additional necessary criteria:

* The individual is at least age 18 years.
* There is evidence of Conduct Disorder with onset before age 15 years.
* The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.

Criticism of the DSM-IV criteria

The DSM-IV confound: some argue that an important distinction has been lost by including both sociopathy and psychopathy together under APD. As Hare et al write in their abstract, "The Axis II Work Group of the Task Force on DSM-IV has expressed concern that antisocial personality disorder (APD) criteria are too long and cumbersome and that they focus on antisocial behaviors rather than personality traits central to traditional conceptions", concluding, "... conceptual and empirical arguments exist for evaluating alternative approaches to the assessment of psychopathy .… our hope is that the information presented here will stimulate further research on the comparative validity of diagnostic criteria for psychopathy; although too late to influence DSM-IV". http://www.psych.utoronto.ca/~peterson/psy430s2001/Hare%20RD%20Psychopathy%20JAP%201991.pdf


Diagnostic criteria (ICD-10)

Dissocial Personality Disorder (F60.2), usually coming to attention because of a gross disparity between behaviour and the prevailing social norms, and characterized by:

* callous unconcern for the feelings of others;
* gross and persistent attitude of irresponsibility and disregard for social norms, rules and obligations;
* incapacity to maintain enduring relationships, though having no difficulty in establishing them;
* very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
* incapacity to experience guilt or to profit from experience, particularly punishment;
* marked proneness to blame others, or to offer plausible rationalizations, for the behaviour that has brought the patient into conflict with society.

There may also be persistent irritability as an associated feature. Conduct disorder during childhood and adolescence, though not invariably present, may further support the diagnosis.


Diagnostic criteria (PCL-R test)

In contemporary research and clinical practice, APD is most commonly assessed with the Hare Psychopathy Checklist- Revised (PCL-R), which is a clinical rating scale with 20 items. Each of the items in the PCL-R is scored on a three-point scale according to specific criteria through file information and a semi-structured interview. The items are as follows:

Factor 1: Aggressive narcissism

* Glibness/superficial charm
* Grandiose sense of self-worth
* Pathological lying
* Conning/manipulative
* Lack of remorse or guilt
* Shallow affect
* Callous/lack of empathy
* Failure to accept responsibility for own actions

Factor 2: Socially deviant lifestyle

* Need for stimulation/proneness to boredom
* Parasitic lifestyle
* Poor behavioral controls
* Early behavioral problems
* Lack of realistic, long-term goals
* Impulsivity
* Irresponsibility
* Juvenile delinquency
* Revocation of conditional release

Traits not correlated with either factor

* Promiscuous sexual behavior
* Many short-term marital relationships
* Criminal versatility

Score 0 if the trait is absent, 1 if it is possibly or partially present and 2 if it is present. The item scores are summed to yield a total score ranging from 0 to 40 which is then considered to reflect the degree to which they resemble the prototypical psychopath. A score higher than 30 supports a diagnosis of psychopathy. Forensic studies of prison populations have reported average scores of around 22 on PCL-R; control "normal" populations show an average score of around 5.

A note of caution: the test must be administered by a trained mental health practitioner under controlled conditions for it to have any validity.


Portrayal of psychopaths in the media

Psychopaths in popular fiction and movies generally possess a number of standard characteristics which are not necessarily as common amongst real-life psychopaths. The traditional "Hollywood psychopath" is likely to exhibit some or all of the following traits which make them ideal villains.

* High intelligence, and a preference for intellectual stimulation (music, fine art etc.)
* A somewhat vain, stylish, almost "cat-like" demeanor
* Prestige, or a successful career or position
* A calm, calculating and always-in-control attitude

It is this last feature which is probably most at odds with the typical real-life psychopath: an individual with APD is much more likely to be impulsive, disorganised and short-tempered rather than the smooth-talking, self-disciplined character portrayed by Anthony Hopkins or Kiefer Sutherland.

In popular culture, "psychopath" is often used interchangeably with "serial killer" (such as the characters in slasher films) though the terms are not synonymous. It is, however, true that most serial killers are also sociopaths.



Psychopathy's Relationship with Other Mental Disorders

Psychopathy, as measured on the PCL-R, is negatively correlated with all DSM-IV Axis I disorders except substance-abuse disorders. Psychopathy is most strongly correlated with DSM-IV antisocial personality disorder. PCL-R Factor 1 is correlated with narcissistic personality disorder and histrionic personality disorder. PCL-R Factor 2 is particularly strongly correlated to antisocial personality disorder and criminality.

PCL-R Factor 2 is associated with reactive anger, anxiety, increased risk of suicide, criminality, and impulsive violence. PCL-R Factor 1, in contrast, is associated with extraversion and positive affect. Factor 1, the so-called core personality traits of psychopathy, may even be beneficial for the psychopath (in terms of nondeviant social functioning).


A Three-Factor Model of Psychopathy

Cooke and Michie eliminated criteria related to criminal incarceration and juvenile delinquency and statistically analyzed three factors of psychopathy.

Arrogant/Deceitful Interpersonal Style

* Glibness/superficial charm
* Egocentricity/Grandiose sense of self-worth
* Pathological lying
* Conning/Manipulative

Deficient Affective Experience

* Lack of remorse or guilt
* Callous/Lack of empathy
* Shallow affect
* Failure to accept responsibility for own actions

Impulsive/Irresponsible Behavioral Style

* Need for stimulation/Proneness to boredom
* Parasitic lifestyle
* Lack of realistic, long-term goals
* Impulsivity
* Irresponsibility

Corporate Psychopathy

The Corporation, a documentary exploring the psyche of the corporation, came to the conclusion that if the corporation can be regarded as a person, rather than a legal entity, as it is under United States law, its personality would meet all of the DSM-IV requirements for being a psychopath (such as conning others for profit and recklessness).