Антисоциальное расстройство личности: симптомы, диагностика и риски
Antisocial personality disorder
Расстройство личности: антисоциальное поведение, отсутствие эмпатии, импульсивность, агрессия. Симптомы до 15 лет. Причины, диагностика и возрастные особенности.
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Содержание
Введение
Психическое расстройство. Антисоциальное расстройство личности (АСПР или АПР) – это расстройство личности, характеризующееся ограниченной способностью к эмпатии и устойчивой тенденцией к пренебрежению или нарушению прав других. Другие значимые симптомы включают импульсивность, безрассудное поведение (включая злоупотребление психоактивными веществами), отсутствие раскаяния после причинения вреда другим, лживость, безответственность и агрессивность. Для постановки диагноза симптомы АСПР должны проявляться до 15 лет. Антисоциальное поведение часто начинается до 8 лет, и почти в 80% случаев первые симптомы развиваются к 11 годам. Распространенность АСПР возрастает у людей в возрасте от 24 до 44 лет и часто снижается у людей в возрасте от 45 до 64 лет. АСПР чаще встречается у мужчин, чем у женщин. Критерии диагностики расстройств личности изложены в пятой главе Международной классификации болезней (МКБ) и в Диагностическом и статистическом руководстве по психическим расстройствам Американской психиатрической ассоциации (DSM). Дисоциальное расстройство личности (ДРП) – это альтернативный термин для обозначения того же расстройства, используемый в Международной статистической классификации болезней и проблем со здоровьем (МКБ). Оба расстройства также называют психопатией или социопатией; однако некоторые исследователи проводят различие между понятиями антисоциального расстройства личности и психопатии, утверждая, что психопатия пересекается с АСПР, но отличается от него.
Mental health condition
Antisocial personality disorder (ASPD or APD) is a personality disorder characterized by a limited capacity for empathy and a long term pattern of disregard or violation of the rights of others. Other notable symptoms include impulsivity, reckless behavior (including substance abuse), a lack of remorse after hurting others, deceitfulness, irresponsibility, and aggressive behavior. Symptoms of ASPD must be present before the age of 15 to receive a diagnosis. Antisocial behaviours often have their onset before the age of 8, and in nearly 80% of ASPD cases, the subject will develop their first symptoms by age 11. The prevalence of ASPD increases in people aged 24 to 44 and often decreases in people aged 45 to 64. ASPD is more common in males than females. Criteria for diagnosing personality disorders are listed in the fifth chapter of the International Classification of Diseases (ICD) and in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM). Dissocial personality disorder (DPD) is another term for the same general disorder used in the International Statistical Classification of Diseases and Related Health Problems (ICD). Both have been referred to as psychopathy or sociopathy; however, some researchers have drawn distinctions between the concepts of antisocial personality disorder and psychopathy, with many arguing that psychopathy overlaps with but is distinguishable from ASPD.
Симптомы и поведение
Из-за склонности к безрассудству и импульсивности пациенты с антисоциальным расстройством личности (АРЛ) подвержены повышенному риску злоупотребления наркотиками и алкоголем. АРЛ наиболее часто ассоциируется с зависимостью, среди других расстройств личности. У людей с АРЛ повышен риск употребления наркотиков, заболеваний, передающихся через кровь, ВИЧ, более короткий период ремиссии и неправильного использования лекарственных препаратов, принимаемых внутрь, вследствие их склонности к зависимости. Они также чаще злоупотребляют психоактивными веществами или становятся зависимыми в молодом возрасте. Наряду со злоупотреблением психоактивными веществами, пациенты с АРЛ подвержены большему риску развития игровой зависимости. Антисоциальное расстройство личности связано с повышенным уровнем импульсивности, суицидальности и безответственного поведения, что обычно приводит к повышенному уровню агрессивного поведения, домашнего насилия, незаконного употребления наркотиков, постоянного гнева и насильственных преступлений. Такое поведение обычно негативно сказывается на их образовании, отношениях или работе. Наряду с этим, распространены рискованные сексуальные действия, такие как наличие нескольких сексуальных партнеров, посещение проституток, непоследовательное использование презервативов, обмен секса на наркотики и частый незащищенный секс. Их импульсивное поведение обычно ставит под угрозу их собственную безопасность и безопасность окружающих. Пациенты с АРЛ склонны описывать эмоции с амбивалентностью и испытывают повышенные состояния эмоциональной холодности и отстраненности. У людей с АРЛ или проявляющих антисоциальное поведение, часто бывает хроническая скука. Они могут испытывать такие эмоции, как счастье и страх, менее отчетливо, чем другие. Возможно также, что они могут испытывать такие эмоции, как гнев и разочарование, чаще и яснее, чем другие эмоции. У людей с АРЛ может быть ограниченная способность к эмпатии, и они могут быть больше заинтересованы в собственной выгоде, независимо от вреда другим. Они могут не считаться с моралью, социальными нормами или правами других. Люди с АРЛ могут проявлять высокомерие, пренебрежительное и негативное отношение к другим, испытывать ограниченное сожаление о своих вредных поступках и проявлять безжалостное отношение к тем, кому они причинили вред. Они также могут обладать полностью сохранной теорией разума, то есть способностью приписывать психические состояния себе и другим, но при этом иметь сниженную способность понимать, как агрессивное действие может повлиять на другого человека. Эти факторы могут способствовать агрессивному и преступному поведению, а также дефициту эмпатии. Несмотря на это, они могут быть хорошо развиты в области социального познания, то есть способности обрабатывать и хранить информацию о других людях, что может способствовать увеличению способности манипулировать ими. АРЛ широко распространено среди заключенных. Нападение и другие насильственные преступления – наиболее частые обвинения. Тестостерон – это гормон в мозге, который играет важную роль в агрессивности. Например, у преступников, совершивших насильственные преступления, уровень тестостерона, как правило, выше, чем у обычных людей. Эффект тестостерона ослабляется кортизолом, который способствует когнитивному контролю импульсивных тенденций. Поджоги и уничтожение чужого имущества также являются поведенческими проявлениями, часто связанными с АРЛ. Наряду с другими поведенческими проблемами, у многих людей с АРЛ в юности наблюдалось расстройство поведения, характеризующееся повсеместным паттерном насильственного, преступного, непокорного и антисоциального поведения. Хотя проявления поведения варьируются по степени, люди с этим расстройством личности обычно эксплуатируют других вредными способами для собственной выгоды или удовольствия, испытывая ограниченное сожаление и часто манипулируя и обманывая других. Некоторые делают это, прикрываясь поверхностным обаянием, другие – запугиванием и насилием. Люди с антисоциальным расстройством личности могут намеренно проявлять безответственность, поскольку они склонны обвинять других, когда им трудно признать свои ошибки, часто пытаясь перенаправить внимание со своего вредного поведения на кого-то или что-то другое.
Due to their tendencies toward recklessness and impulsivity, patients with ASPD are at a higher risk of drug and alcohol abuse. ASPD is most likely to be associated with addiction, among other personality disorders. Individuals with ASPD are at a higher risk of illegal drug usage, blood borne diseases, HIV, shorter periods of abstinence, and misuse of oral administrations as a consequence of their tendency towards addiction. They are also more likely to abuse substances or develop an addiction at a young age. Along with substance abuse, patients with ASPD are at a greater risk of developing a gambling addiction. Antisocial personality disorder has been associated with higher levels of impulsivity, suicidality, and irresponsible behavior, usually resulting in heightened levels of aggressive behavior, domestic violence, illegal drug use, pervasive anger, and violent crimes. This behavior usually has negative effects on their education, relationships, or jobs. Alongside this, risky sexual behaviors such as having multiple sexual partners, seeing prostitutes, inconsistent use of condoms, trading sex for drugs, and frequent unprotected sex are also common. Their impulsive behavior will usually jeopardize their own safety and the safety of others. Patients with ASPD tend to describe emotions with ambivalence and experience heightened states of emotional coldness and detachment. Individuals with ASPD, or who display antisocial behavior, may often experience chronic boredom. They may experience emotions such as happiness and fear less clearly than others. It is also possible that they may experience emotions such as anger and frustration more frequently and clearly than other emotions. People with ASPD may have a limited capacity for empathy and can be more interested in benefiting themselves regardless of harm to others. They may have no regard for morals, social norms, or the rights of others. People with ASPD may display arrogance, think lowly and negatively of others, have limited remorse for their harmful actions, and have a callous attitude toward those they have harmed. They may also display a perfectly intact theory of mind, or the ability to attribute a mental state to oneself and others, but have an impaired ability to understand how another individual may be affected by an aggressive action. These factors might contribute to aggressive and criminal behavior as well as empathy deficits. Despite this, they may be adept at social cognition, or the ability to process and store information about other people, which can contribute to an increased ability to manipulate others. ASPD is highly prevalent among prisoners. Assault and other violent crimes are the most common charges. Testosterone is a hormone in the brain that plays an important role in aggressiveness. For instance, criminals who have committed violent crimes tend to have higher levels of testosterone than the average person. The effect of testosterone is counteracted by cortisol, which facilitates the cognitive control of impulsive tendencies. Arson and the destruction of others' property are also behaviors commonly associated with ASPD. Alongside other conduct problems, many people with ASPD had conduct disorder in their youth, characterized by a pervasive pattern of violent, criminal, defiant, and anti social behavior. Although behaviors vary by degree, individuals with this personality disorder will typically exploit others in harmful ways for their own gain or pleasure, with limited compunction, and frequently manipulate and deceive other people. While some do so with a façade of superficial charm, others do so through intimidation and violence. Individuals with antisocial personality disorder may deliberately show irresponsibility because they tend to place blame on others when they have difficulty internally acknowledging their faults, often by attempting to redirect attention away from their harmful behavior and onto someone else or something else.
Причины
Расстройства личности обычно вызываются сочетанием и взаимодействием генетических и средовых факторов. Генетически, это врожденные темпераментальные склонности, определяемые генетически обусловленной физиологией. Средово, это социальный и культурный опыт человека в детстве и подростковом возрасте, включающий в себя семейную динамику, влияние сверстников и социальные ценности. По словам профессора Эмили Симонов из Института психиатрии, психологии и нейронаук, существует множество факторов, которые постоянно связаны с антисоциальным расстройством личности, таких как: гиперактивность и расстройство поведения в детстве, преступность во взрослом возрасте, более низкие показатели IQ и проблемы с чтением. Наиболее тесная связь между этими факторами и антисоциальным расстройством личности наблюдается при детской гиперактивности и расстройствах поведения. Кроме того, дети, растущие с предрасположенностью к антисоциальному расстройству личности и взаимодействующие с другими детьми с девиантным поведением, с большей вероятностью получат этот диагноз в дальнейшем. Как и при многих других расстройствах, генетика играет роль в развитии этого состояния, но среда оказывает на него неоспоримое влияние.
Personality disorders are usually caused by a combination and interaction of genetic and environmental influences. Genetically, it is the intrinsic temperamental tendencies as determined by their genetically influenced physiology. Environmentally, it is a person's social and cultural experiences in childhood and adolescence encompassing their family dynamics, peer influences, and social values. According to professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience, there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores, and reading problems. The strongest relationship between these variables and ASPD are childhood hyperactivity and conduct disorder. Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD. Like many disorders, genetics play a role in this disorder, but the environment holds an undeniable role in its development.
Генетическая
Исследования генетических ассоциаций при антисоциальном расстройстве личности свидетельствуют о том, что АРЛ имеет некоторую, а возможно, и выраженную генетическую основу. Распространенность АРЛ выше среди людей, состоящих в родственных связях с теми, кто страдает этим расстройством. Исследования близнецов, направленные на разделение генетических и средовых факторов, выявили значительное генетическое влияние на антисоциальное поведение и расстройства поведения. Среди конкретных генов, которые могут быть вовлечены, особо перспективным в корреляции с АРЛ представляется ген, кодирующий моноаминоксидазу А (МАО А) – фермент, расщепляющий моноаминовые нейротрансмиттеры, такие как серотонин и норадреналин. Различные исследования, изучающие связь гена с поведением, показали, что варианты гена, приводящие к снижению выработки МАО А (например, аллели 2R и 3R в промоторной области), ассоциированы с агрессивным поведением у мужчин. На эту связь также влияют негативные переживания в раннем детстве: дети с вариантом низкой активности (MAOA L), пережившие неблагоприятные обстоятельства, более склонны к развитию антисоциального поведения, чем дети с вариантом высокой активности (MAOA H). Даже при исключении влияния факторов окружающей среды (например, эмоционального насилия) сохраняется небольшая связь между MAOA L и агрессивным и антисоциальным поведением. Еще одним геном, представляющим интерес в контексте антисоциального поведения и личностных черт, является ген, кодирующий серотониновый транспортер (SLC6A4), который активно исследуется в связи с другими психическими расстройствами. Исследования генетических ассоциаций показали, что короткий аллель "S" связан с импульсивным антисоциальным поведением и АРЛ у заключенных. Однако исследования психопатии выявили, что длинный аллель "L" связан с фактором 1 психопатии, описывающим ее основные аффективные (например, отсутствие эмпатии, бесстрашие) и межличностные (например, грандиозность, манипулятивность) расстройства личности. Это позволяет предположить существование двух различных форм расстройства: одна связана с импульсивным поведением и эмоциональной дерегуляцией, а другая – с хищнической агрессией и аффективными нарушениями. В исследовании ассоциации в масштабах генома, опубликованном в 2016 году, были идентифицированы и другие генные кандидаты для АРЛ. Некоторые из этих генных кандидатов общие для синдрома дефицита внимания и гиперактивности, который часто сопутствует АРЛ. Исследование показало, что у людей с четырьмя мутациями на 6-й хромосоме вероятность развития антисоциального расстройства личности на 50% выше, чем у тех, у кого этих мутаций нет.
Research into genetic associations in antisocial personality disorder suggests that ASPD has some or even a strong genetic basis. The prevalence of ASPD is higher in people related to someone with the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behavior and conduct disorder. In the specific genes that may be involved, one gene that has shown particular promise in its correlation with ASPD is the gene that encodes for Monoamine oxidase A (MAO A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norepinephrine. Various studies examining the gene's relationship to behavior have suggested that variants of the gene resulting in less MAO A being produced (such as the 2R and 3R alleles of the promoter region) have associations with aggressive behavior in men. This association is also influenced by negative experiences early in life, with children possessing a low activity variant (MAOA L) who have experienced negative circumstances being more likely to develop antisocial behavior than those with the high activity variant (MAOA H). Even when environmental interactions (e. g. emotional abuse) are taken out of the equation, a small association between MAOA L and aggressive and antisocial behavior remains. The gene that encodes for the serotonin transporter (SLC6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behavior and personality traits. Genetic association's studies have suggested that the short "S" allele is associated with impulsive antisocial behavior and ASPD in the inmate population. However, research into psychopathy find that the long "L" allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e. g. lack of empathy, fearlessness) and interpersonal (e. g. grandiosity, manipulativeness) personality disturbances. This is suggestive of two different forms of the disorder, one associated more with impulsive behavior and emotional dysregulation, and the other with predatory aggression and affective disturbance. Various other gene candidates for ASPD have been identified by a genome wide association study published in 2016. Several of these gene candidates are shared with attention deficit hyperactivity disorder, with which ASPD is often comorbid. The study found that those who carry four mutations on chromosome 6 are 50% more likely to develop antisocial personality disorder than those who do not.
Гормоны и нейротрансмиттеры
Травматические события могут приводить к нарушению стандартного развития центральной нервной системы, что может вызывать выброс гормонов, способных изменить нормальные паттерны развития. Одним из нейротрансмиттеров, который изучался у лиц с антисоциальным расстройством личности (АРЛ), является серотонин, также известный как 5-HT. Хотя было показано, что пониженные уровни серотонина могут быть связаны с АРЛ, существуют также данные о том, что снижение функции серотонина тесно коррелирует с импульсивностью и агрессией в различных экспериментальных условиях. Импульсивность связана не только с нарушениями метаболизма 5-HT, но может быть наиболее важным психопатологическим аспектом, связанным с такой дисфункцией. Соответственно, DSM классифицирует "импульсивность или неспособность к планированию" и "раздражительность и агрессивность" как два из семи подкритериев категории А диагностических критериев АРЛ.
Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development. One of the neurotransmitters that has been discussed in individuals with ASPD is serotonin, also known as 5HT. While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5HT metabolism but may be the most essential psychopathological aspect linked with such dysfunction. Correspondingly, the DSM classifies "impulsivity or failure to plan ahead" and "irritability and aggressiveness" as two of seven sub criteria in category A of the diagnostic criteria of ASPD.
Неврологические
Антисоциальное поведение может быть связано с рядом неврологических дефектов, таких как черепно-мозговая травма. Антисоциальное поведение ассоциируется с уменьшением объема серого вещества в правом линзовидном ядре, левой инсуле и фронтополярной коре. Увеличение объема серого вещества наблюдается в правой веретенообразной извилине, нижней теменной коре, правой поясной извилине и постцентральной коре. Интеллектуальные и когнитивные способности часто оказываются нарушенными или сниженными у людей с антисоциальным расстройством личности (АРЛ). Вопреки распространенному стереотипу о "психопатическом гении", антисоциальное расстройство личности связано со снижением общего интеллекта и специфическим снижением отдельных аспектов когнитивных способностей. Эти дефициты также встречаются в общих выборках населения с антисоциальными чертами и у детей с предрасположенностью к антисоциальному расстройству личности. Люди, проявляющие антисоциальное поведение, как правило, демонстрируют снижение активности в префронтальной коре. Эта связь более заметна при функциональной нейровизуализации, чем при структурной. Префронтальная кора участвует во многих исполнительных функциях, включая подавление импульсов, планирование, оценку последствий действий и различение между добром и злом. Однако некоторые исследователи ставят под вопрос, связано ли уменьшение объема в префронтальных областях с антисоциальным расстройством личности, или же это результат сопутствующих расстройств, таких как злоупотребление психоактивными веществами или жестокое обращение в детстве. Кроме того, остается открытым вопрос о том, является ли эта связь причинно-следственной, то есть вызывает ли анатомическая аномалия психологическую и поведенческую аномалию, или наоборот. Одно исследование показало, что у лиц с психопатией (ЦСП) значительно более высокий уровень антисоциальности, психопатии, арестов и судимостей по сравнению с контрольной группой.
Antisocial behavior may be related to a number of neurological defects, such as head trauma. Antisocial behavior is associated with decreased grey matter in the right lentiform nucleus, left insular, and frontopolar cortex. Increased volumes of grey matter have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post central cortex. Intellectual and cognitive ability is often found to be impaired or reduced in the ASPD population. Contrary to stereotypes in popular culture of the "psychopathic genius", antisocial personality disorder is associated with reduced overall intelligence and specific reductions in individual aspects of cognitive ability. These deficits also occur in general population samples of people with antisocial traits and in children with the precursors to antisocial personality disorder. People that exhibit antisocial behavior tend to demonstrate decreased activity in the prefrontal cortex. This association is more apparent in functional neuroimaging as opposed to structural neuroimaging. The prefrontal cortex is involved in many executive functions, including behavior inhibitions, planning ahead, determining consequences of action, and differentiating between right and wrong. However, some investigators have questioned whether the reduced volume in prefrontal regions is associated with antisocial personality disorder, or whether they result from co morbid disorders, such as substance use disorder or childhood maltreatment. Moreover, it remains an open question whether the relationship is causal, i. e., whether the anatomical abnormality causes the psychological and behavioral abnormality, or vice versa. One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.
Стиль воспитания
Стиль воспитания может напрямую влиять на то, как дети переживают и развиваются в юности, и может оказать влияние на диагностику расстройства антисоциальной личности (РАЛ). Четыре стиля воспитания демонстрируют основные подходы к воспитанию детей и их последствия, которые формируют личность во взрослой жизни.
Parenting styles can directly affect how children experience and develop in their youth, and can have an impact on a child's diagnosis of ASPD. The four parenting styles demonstrate the main approaches to raising children and their outcomes that lead into adulthood. Authoritarian Authoritarian parenting styles involve stricter rules than any other parenting style, with greater consequences if rules are disobeyed. Authoritarian parents set high expectations for their children that may cause the children to later develop rebellious behavior, low self esteem, aggression, and resentfulness. Permissive Permissive parenting styles involve a more relaxed attitude towards rules that are less enforced than any other parenting style. Permissive parents tend to allow more freedom for children to make their own decisions which can lead to impulsivity, lack of self control, and a lack of acknowledgment of boundaries later in life. Neglectful Neglectful parenting styles tend to have little to no rules for children to follow, and may even withhold basic needs required for child development. Parents who display neglectful behavior are less involved than any other parenting style and can cause children to develop mental health issues, withdrawal from emotions, and delinquent behavior. Authoritative Authoritative parenting styles involve guidelines and expectations as well as support and understanding. Authoritative parents tend to have more balance within their parenting style compared to the other parenting styles, and parent in a way that lets children understand not only what the rules are, but why they are important. Individuals who were raised by authoritative parents tend to be more self confident, responsible, successful, and have a greater chance of developing positive coping skills. Having a healthy, safe, stable/consistent, understanding, and attentive parenting style in an environment with positive role models and influences at home as well as out in the community help to ensure more positive behavior for children and an overall decrease in ASPD symptoms.
Авторитарный стиль воспитания предполагает более строгие правила, чем при любом другом стиле, с более серьезными последствиями за их нарушение. Авторитарные родители предъявляют высокие требования к своим детям, что может привести к развитию бунтарства, низкой самооценки, агрессии и обиды.
Parenting styles can directly affect how children experience and develop in their youth, and can have an impact on a child's diagnosis of ASPD. The four parenting styles demonstrate the main approaches to raising children and their outcomes that lead into adulthood. Authoritarian Authoritarian parenting styles involve stricter rules than any other parenting style, with greater consequences if rules are disobeyed. Authoritarian parents set high expectations for their children that may cause the children to later develop rebellious behavior, low self esteem, aggression, and resentfulness. Permissive Permissive parenting styles involve a more relaxed attitude towards rules that are less enforced than any other parenting style. Permissive parents tend to allow more freedom for children to make their own decisions which can lead to impulsivity, lack of self control, and a lack of acknowledgment of boundaries later in life. Neglectful Neglectful parenting styles tend to have little to no rules for children to follow, and may even withhold basic needs required for child development. Parents who display neglectful behavior are less involved than any other parenting style and can cause children to develop mental health issues, withdrawal from emotions, and delinquent behavior. Authoritative Authoritative parenting styles involve guidelines and expectations as well as support and understanding. Authoritative parents tend to have more balance within their parenting style compared to the other parenting styles, and parent in a way that lets children understand not only what the rules are, but why they are important. Individuals who were raised by authoritative parents tend to be more self confident, responsible, successful, and have a greater chance of developing positive coping skills. Having a healthy, safe, stable/consistent, understanding, and attentive parenting style in an environment with positive role models and influences at home as well as out in the community help to ensure more positive behavior for children and an overall decrease in ASPD symptoms.
Разрешающий стиль воспитания характеризуется более расслабленным отношением к правилам, которые применяются менее строго, чем при любом другом стиле. Разрешающие родители склонны предоставлять детям больше свободы в принятии собственных решений, что может привести к импульсивности, недостатку самоконтроля и неспособности признавать границы в дальнейшей жизни.
Parenting styles can directly affect how children experience and develop in their youth, and can have an impact on a child's diagnosis of ASPD. The four parenting styles demonstrate the main approaches to raising children and their outcomes that lead into adulthood. Authoritarian Authoritarian parenting styles involve stricter rules than any other parenting style, with greater consequences if rules are disobeyed. Authoritarian parents set high expectations for their children that may cause the children to later develop rebellious behavior, low self esteem, aggression, and resentfulness. Permissive Permissive parenting styles involve a more relaxed attitude towards rules that are less enforced than any other parenting style. Permissive parents tend to allow more freedom for children to make their own decisions which can lead to impulsivity, lack of self control, and a lack of acknowledgment of boundaries later in life. Neglectful Neglectful parenting styles tend to have little to no rules for children to follow, and may even withhold basic needs required for child development. Parents who display neglectful behavior are less involved than any other parenting style and can cause children to develop mental health issues, withdrawal from emotions, and delinquent behavior. Authoritative Authoritative parenting styles involve guidelines and expectations as well as support and understanding. Authoritative parents tend to have more balance within their parenting style compared to the other parenting styles, and parent in a way that lets children understand not only what the rules are, but why they are important. Individuals who were raised by authoritative parents tend to be more self confident, responsible, successful, and have a greater chance of developing positive coping skills. Having a healthy, safe, stable/consistent, understanding, and attentive parenting style in an environment with positive role models and influences at home as well as out in the community help to ensure more positive behavior for children and an overall decrease in ASPD symptoms.
Пренебрегающий стиль воспитания предполагает отсутствие правил или их минимальное количество, а также возможное необеспечение базовых потребностей, необходимых для развития ребенка. Родители, проявляющие пренебрежение, наименее вовлечены в воспитание и могут спровоцировать развитие у детей проблем с психическим здоровьем, эмоциональную отстраненность и делинквентное поведение.
Parenting styles can directly affect how children experience and develop in their youth, and can have an impact on a child's diagnosis of ASPD. The four parenting styles demonstrate the main approaches to raising children and their outcomes that lead into adulthood. Authoritarian Authoritarian parenting styles involve stricter rules than any other parenting style, with greater consequences if rules are disobeyed. Authoritarian parents set high expectations for their children that may cause the children to later develop rebellious behavior, low self esteem, aggression, and resentfulness. Permissive Permissive parenting styles involve a more relaxed attitude towards rules that are less enforced than any other parenting style. Permissive parents tend to allow more freedom for children to make their own decisions which can lead to impulsivity, lack of self control, and a lack of acknowledgment of boundaries later in life. Neglectful Neglectful parenting styles tend to have little to no rules for children to follow, and may even withhold basic needs required for child development. Parents who display neglectful behavior are less involved than any other parenting style and can cause children to develop mental health issues, withdrawal from emotions, and delinquent behavior. Authoritative Authoritative parenting styles involve guidelines and expectations as well as support and understanding. Authoritative parents tend to have more balance within their parenting style compared to the other parenting styles, and parent in a way that lets children understand not only what the rules are, but why they are important. Individuals who were raised by authoritative parents tend to be more self confident, responsible, successful, and have a greater chance of developing positive coping skills. Having a healthy, safe, stable/consistent, understanding, and attentive parenting style in an environment with positive role models and influences at home as well as out in the community help to ensure more positive behavior for children and an overall decrease in ASPD symptoms.
Авторитетный стиль воспитания сочетает в себе установление правил и ожиданий с поддержкой и пониманием. Авторитетные родители демонстрируют больше баланса в своем подходе, чем при других стилях, и воспитывают детей таким образом, чтобы они понимали не только, какие существуют правила, но и почему они важны. Люди, воспитанные авторитетными родителями, как правило, более уверены в себе, ответственны, успешны и имеют больше шансов развить позитивные стратегии преодоления трудностей.
Parenting styles can directly affect how children experience and develop in their youth, and can have an impact on a child's diagnosis of ASPD. The four parenting styles demonstrate the main approaches to raising children and their outcomes that lead into adulthood. Authoritarian Authoritarian parenting styles involve stricter rules than any other parenting style, with greater consequences if rules are disobeyed. Authoritarian parents set high expectations for their children that may cause the children to later develop rebellious behavior, low self esteem, aggression, and resentfulness. Permissive Permissive parenting styles involve a more relaxed attitude towards rules that are less enforced than any other parenting style. Permissive parents tend to allow more freedom for children to make their own decisions which can lead to impulsivity, lack of self control, and a lack of acknowledgment of boundaries later in life. Neglectful Neglectful parenting styles tend to have little to no rules for children to follow, and may even withhold basic needs required for child development. Parents who display neglectful behavior are less involved than any other parenting style and can cause children to develop mental health issues, withdrawal from emotions, and delinquent behavior. Authoritative Authoritative parenting styles involve guidelines and expectations as well as support and understanding. Authoritative parents tend to have more balance within their parenting style compared to the other parenting styles, and parent in a way that lets children understand not only what the rules are, but why they are important. Individuals who were raised by authoritative parents tend to be more self confident, responsible, successful, and have a greater chance of developing positive coping skills. Having a healthy, safe, stable/consistent, understanding, and attentive parenting style in an environment with positive role models and influences at home as well as out in the community help to ensure more positive behavior for children and an overall decrease in ASPD symptoms.
Здоровый, безопасный, стабильный/последовательный, понимающий и внимательный стиль воспитания в среде с позитивными образцами для подражания и влиянием как дома, так и в обществе способствует более позитивному поведению детей и общему снижению симптомов РАЛ.
Parenting styles can directly affect how children experience and develop in their youth, and can have an impact on a child's diagnosis of ASPD. The four parenting styles demonstrate the main approaches to raising children and their outcomes that lead into adulthood. Authoritarian Authoritarian parenting styles involve stricter rules than any other parenting style, with greater consequences if rules are disobeyed. Authoritarian parents set high expectations for their children that may cause the children to later develop rebellious behavior, low self esteem, aggression, and resentfulness. Permissive Permissive parenting styles involve a more relaxed attitude towards rules that are less enforced than any other parenting style. Permissive parents tend to allow more freedom for children to make their own decisions which can lead to impulsivity, lack of self control, and a lack of acknowledgment of boundaries later in life. Neglectful Neglectful parenting styles tend to have little to no rules for children to follow, and may even withhold basic needs required for child development. Parents who display neglectful behavior are less involved than any other parenting style and can cause children to develop mental health issues, withdrawal from emotions, and delinquent behavior. Authoritative Authoritative parenting styles involve guidelines and expectations as well as support and understanding. Authoritative parents tend to have more balance within their parenting style compared to the other parenting styles, and parent in a way that lets children understand not only what the rules are, but why they are important. Individuals who were raised by authoritative parents tend to be more self confident, responsible, successful, and have a greater chance of developing positive coping skills. Having a healthy, safe, stable/consistent, understanding, and attentive parenting style in an environment with positive role models and influences at home as well as out in the community help to ensure more positive behavior for children and an overall decrease in ASPD symptoms.
Культурные влияния
Социокультурный подход в клинической психологии рассматривает расстройства как подверженные влиянию культурных факторов; поскольку культурные нормы значительно различаются, психические расстройства (такие как антисоциальное расстройство личности – ASPD) воспринимаются по-разному. Роберт Д. Хэр предположил, что зафиксированный рост случаев ASPD в Соединенных Штатах может быть связан с изменениями в культурных нормах, которые, в свою очередь, оправдывают поведенческие тенденции многих людей с этим расстройством. Хотя наблюдаемый рост может быть частично обусловлен расширением (и злоупотреблением) диагностическими методами, учитывая разделение, предложенное Эриком Берном, между людьми с активным и латентным ASPD – последние удерживаются от девиантного поведения благодаря приверженности внешним источникам контроля, таким как закон, традиционные устои или религия – предполагается, что разрушение общих стандартов может освободить людей с латентным ASPD от их прежнего социально одобряемого поведения. Скандально известный клинический психиатр Пьер Эдуард Карбоно утверждал, что проблема принудительной госпитализации по решению суда заключается в высокой вероятности ошибочной диагностики ASPD. Он считает, что возможность ошибочно диагностировать и принудительно лечить препаратами человека, не страдающего ASPD, но получившего этот диагноз, может иметь катастрофические последствия. Однако, игнорировать возможность недиагностирования ASPD и наблюдать за тем, как пациент остается без лечения из-за недостатка убедительных доказательств влияния культурных или средовых факторов, психиатр не должен; и, по его словам, необходимо "действовать осторожно".
The sociocultural perspective of clinical psychology views disorders as influenced by cultural aspects; since cultural norms differ significantly, mental disorders (such as ASPD) are viewed differently. Robert D. Hare suggested that the rise in ASPD that has been reported in the United States may be linked to changes in cultural norms, serving to validate the behavioral tendencies of many individuals with ASPD. While the rise reported may be in part a byproduct of the widening use (and abuse) of diagnostic techniques, given Eric Berne's division between individuals with active and latent ASPD – the latter keeping themselves in check by attachment to an external source of control like the law, traditional standards, or religion – it has been suggested that the erosion of collective standards may serve to release the individual with latent ASPD from their previously prosocial behavior. Controversial clinical psychiatrist Pierre Édouard Carbonneau suggested that the problem with legal forced admittance is the rate of failure when diagnosing ASPD. He contends that the possibility of diagnosing and coercing a patient into prescribing medication to someone without ASPD, but is diagnosed with ASPD, could be potentially disastrous. But the possibility of not diagnosing ASPD and seeing a patient go untreated because of a lack of sufficient evidence of cultural or environmental influences is something a psychiatrist must ignore; and in his words, "play it safe".
Расстройства поведения
Хотя антисоциальное расстройство личности – это психическое расстройство, диагностируемое во взрослом возрасте, его истоки лежат в детстве. Критерии DSM-5 для антисоциального расстройства личности (АРЛ) требуют, чтобы у индивида наблюдались поведенческие проблемы, проявляющиеся к 15 годам. Примерно 25–40% подростков с расстройством поведения (РП) впоследствии получают диагноз АРЛ во взрослом возрасте. Расстройство поведения – это расстройство, диагностируемое в детстве, которое сопоставимо с характеристиками, наблюдаемыми при АРЛ. Оно характеризуется повторяющимся и стойким паттерном поведения, при котором ребенок нарушает основные права других или общепринятые нормы, соответствующие его возрасту. Дети с этим расстройством часто демонстрируют импульсивное и агрессивное поведение, могут быть бесчувственными и лживыми, неоднократно совершать мелкие правонарушения (например, кражи или вандализм) или вступать в драки с другими детьми и взрослыми. РП отличается от оппозиционно-вызывающего расстройства (ОВР) тем, что дети с ОВР не совершают агрессивных или антисоциальных действий по отношению к другим людям, животным или имуществу, хотя многие дети с диагнозом ОВР впоследствии получают диагноз РП. На основании возраста, в котором проявляются симптомы, выделяют два варианта развития РП. Первый вариант называется «ранним детским типом» и возникает, когда симптомы расстройства поведения проявляются до 10 лет. Этот вариант часто связан с более устойчивым течением жизни и более выраженным поведением, а дети в этой группе демонстрируют более высокий уровень симптомов СДВГ, нейропсихологических дефицитов, больше академических проблем, повышенную дисфункцию семьи и более высокую вероятность агрессии и насилия. Второй вариант называется «подростковым типом» и возникает, когда расстройство поведения развивается после 10 лет. По сравнению с ранним детским типом, наблюдается меньшее нарушение различных когнитивных и эмоциональных функций, и подростковый вариант может ремитировать к взрослой жизни. Помимо этой дифференциации, DSM-5 предоставляет спецификатор для бесчувственного и безэмоционального межличностного стиля, который отражает характеристики, наблюдаемые при психопатии, и считается детским предшественником этого расстройства. По сравнению с подростковым подтипом, ранний детский подтип имеет тенденцию к худшему исходу лечения, особенно если присутствуют бесчувственные и безэмоциональные черты.
While antisocial personality disorder is a mental disorder diagnosed in adulthood, it has its precedent in childhood. The DSM 5's criteria for ASPD require that the individual have conduct problems evident by the age of 15. About 25–40% of youths with conduct disorder will be diagnosed with ASPD in adulthood. Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD. It is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age appropriate norms are violated by the child. Children with the disorder often display impulsive and aggressive behavior, may be callous and deceitful, may repeatedly engage in petty crime (such as stealing or vandalism), or get into fights with other children and adults. CD is distinct from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, or property, though many children diagnosed with ODD are subsequently re diagnosed with CD. Two developmental courses for CD have been identified based on the age at which the symptoms become present. The first course is known as the "childhood onset type" and occurs when conduct disorder symptoms are present before the age of 10. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of aggression and violence. The second course is known as the "adolescent onset type" and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood onset type, less impairment in various cognitive and emotional functions are present, and the adolescent onset variety may remit by adulthood. In addition to this differentiation, the DSM 5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent onset subtype, the childhood onset subtype tends to have a worse treatment outcome, especially if callous and unemotional traits are present.
Психопатия
Психопатия обычно определяется как расстройство личности, характеризующееся, в частности, антисоциальным поведением, сниженной способностью к эмпатии и раскаянию, а также плохим контролем поведения. Психопатические черты оцениваются с помощью различных инструментов измерения, включая Контрольный список психопатии, разработанный канадским исследователем Робертом Д. Хэром (PCL-R). "Психопатия" не является официальным названием диагноза в DSM или МКБ; это также не официальное название, используемое какими-либо другими крупными психиатрическими организациями. Однако в DSM и МКБ указывается, что их антисоциальные диагнозы иногда называют (или включают то, что подразумевается под) психопатией или социопатией. Работа американского психиатра Херви Клекли по психопатии послужила основой для диагностических критериев РАСП, и в DSM говорится, что РАСП часто называют психопатией. В соответствии со спецификатором, аффективные и межличностные характеристики сравнительно подчеркиваются по сравнению с поведенческими компонентами. Исследования показывают, что даже без спецификатора "с психопатическими чертами" эти критерии Раздела III точно отражают аффективные и межличностные особенности психопатии, хотя спецификатор расширяет охват аспектов межличностных отношений и образа жизни PCL-R. Однако эти конструкции не признаются в DSM или МКБ.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Подтипы:
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Кочевые антисоциальные (включая шизоидные и избегающие черты) – Дрейфующие, бродяги, скитальцы; авантюристы, странствующие бродяги, бродяги; обычно легко адаптируются в сложных ситуациях, проницательны и импульсивны. Настроение колеблется между обреченностью и непобедимостью.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Злонамеренные антисоциальные (включая садистские и параноидальные черты) – Враждебные, язвительные, злобные, порочные, садистские, злокачественные, жестокие, обидчивые; ожидают предательства и наказания; жаждут мести; грубые, бесчувственные, бесстрашные; лишены чувства вины; многие опасные преступники, включая серийных убийц.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Корыстные антисоциальные (включая негативистские черты) – Хищнические, завистливые, неудовлетворенно жаждущие; враждебные и властные; завистливые, жадные; получают больше удовольствия от отнимания, чем от обладания.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Рискованные антисоциальные (включая истерические черты) – Бесстрашные, предприимчивые, смелые, отважные, дерзкие, бесшабашные; безрассудные, опрометчивые, беспечные; не пугаются опасности; стремятся к рискованным предприятиям.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Защищающие репутацию антисоциальные (включая нарциссические черты) – Должны восприниматься как непогрешимые, нерушимые, неукротимые, грозные, неприкосновенные; нетерпимы к сомнениям в их статусе; чрезмерно реагируют на оскорбления.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
В другом месте Миллон выделяет десять подтипов (частично перекрывающихся с вышеперечисленными) – корыстные, рискованные, злонамеренные, тиранические, злокачественные, неискренние, взрывные и абразивные, – но конкретно подчеркивает, что "число 10 нисколько не является особенным. Таксономии могут быть представлены на разных уровнях детализации".
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Эффективное лечение РАСП еще более усложняется из-за невозможности проведения сравнительных исследований психопатии и РАСП из-за различных диагностических критериев, различий в определении и измерении результатов, а также акцента на лечении заключенных, а не лиц, находящихся на свободе. Из-за очень низкой или отсутствующей способности к раскаянию люди с РАСП часто не имеют достаточной мотивации и не видят последствий антисоциальных действий. Исследования показали, что амбулаторная терапия, скорее всего, не будет успешной, но степень, в которой люди с РАСП полностью невосприимчивы к лечению, может быть преувеличена. Большинство лечения проводится для лиц, находящихся в системе уголовного правосудия, в рамках их заключения. Лица с РАСП могут оставаться на лечении только по требованию внешнего источника, например, условий условно-досрочного освобождения. Психотерапия, также известная как "разговорная" терапия, может помочь в лечении пациентов с РАСП. Также исследуется схема-терапия как метод лечения РАСП. В обзоре Чарльза М. Бордуина подчеркивается сильное влияние мультисистемной терапии (МСТ), которая потенциально может улучшить ситуацию. Однако для этого требуется полное сотрудничество и участие всех членов семьи. Некоторые исследования показали, что наличие РАСП не существенно мешает лечению других расстройств, таких как злоупотребление психоактивными веществами, хотя другие исследования предоставили противоречивые данные. Терапевты, работающие с лицами с РАСП, могут испытывать значительные негативные чувства по отношению к пациентам с обширной историей агрессивного, эксплуататорского и оскорбительного поведения. Вместо того чтобы пытаться развить у этих людей совесть, что чрезвычайно сложно, учитывая природу расстройства, терапевтические методы направлены на рациональные и утилитарные аргументы против повторения прошлых ошибок. Эти подходы фокусируются на ощутимой, материальной ценности просоциального поведения и воздержания от антисоциального поведения. Однако импульсивный и агрессивный характер людей с этим расстройством может ограничить эффективность этой формы терапии.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Использование лекарств при лечении антисоциального расстройства личности изучено недостаточно, и ни одно лекарство не одобрено FDA для конкретного лечения РАСП. Кокрановский обзор 2020 года исследований, посвященных использованию фармацевтических препаратов у пациентов с РАСП, в котором восемь исследований соответствовали критериям отбора для обзора, пришел к выводу, что имеющихся данных недостаточно для вынесения рекомендаций относительно использования фармацевтических препаратов при лечении различных проблем, связанных с РАСП. Тем не менее, психиатрические препараты, такие как антипсихотики, антидепрессанты и стабилизаторы настроения, могут использоваться для контроля симптомов, таких как агрессия и импульсивность, а также для лечения расстройств, которые могут сопутствовать РАСП и для которых показаны лекарства.
Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls. Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL R). "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy. American psychiatrist Hervey Cleckley's work on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy. Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components. Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL R. However, these constructs are not recognized in the DSM or ICD. Subtype Features Nomadic antisocial (including schizoid and avoidant features) Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility. Malevolent antisocial (including sadistic and paranoid features) Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers. Covetous antisocial (including negativistic features) Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having. Risk taking antisocial (including histrionic features) Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures. Reputation defending antisocial (including narcissistic features) Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights. Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special Taxonomies may be put forward at levels that are more coarse or more fine grained." Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated. Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment. Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD. Schema therapy is also being investigated as a treatment for ASPD. A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members. Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use, although others have reported contradictory findings. Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors. Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy. The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD. A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD. Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co occur with ASPD for which medications are indicated.
Прогноз
У мальчиков почти в два раза чаще выявляются все диагностические критерии антисоциального расстройства личности (АРЛ), чем у девочек (40% против 25%), и они часто начинают демонстрировать симптомы расстройства в более раннем возрасте. Дети, у которых симптомы не проявляются до 15 лет, практически никогда не развивают АРЛ в дальнейшем. Когда их ловят на чем-то неправомерном, они часто кажутся невозмутимыми и не проявляют никаких эмоций по поводу последствий. В результате неспособности устанавливать и поддерживать здоровые отношения из-за недостатка навыков межличностного общения, люди с АРЛ могут оказаться в сложных ситуациях, таких как развод, безработица, бездомность и даже преждевременная смерть в результате самоубийства. У них также наблюдается более высокий уровень совершения преступлений, пик которого приходится на конец подросткового возраста, и они часто совершают преступления большей тяжести в более молодом возрасте, когда им впервые ставят диагноз. Основываясь на данных исследования, исследователи пришли к выводу, что агрессия у пациентов с АРЛ в основном импульсивна, хотя имеются и долгосрочные свидетельства спланированной агрессии.
Boys are almost twice as likely to meet all of the diagnostic criteria for ASPD than girls (40% versus 25%) and they will often start showing symptoms of the disorder much earlier in life. Children that do not show symptoms of the disease through age 15 will almost never develop ASPD later in life. When they are caught doing something wrong, they often appear to be unaffected and unemotional about the consequences. As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide. They also see higher rates of committed crime, reaching peaks in their late teens and often committing higher severity crimes in their younger ages of diagnoses. Based on the evidence in the study, the researchers concluded that aggression in patients with ASPD is mostly impulsive, though there are some long term evidences of pre meditated aggressions.
Эпидемиология
Оценочная пожизненная распространенность антисоциального расстройства личности (АСРЛ) среди населения в целом составляет от 1% до 4%, со смещением в сторону 6% среди мужчин и 2% среди женщин. Распространенность АСРЛ еще выше в определенных группах населения, таких как тюрьмы, где преобладают насильственные преступники. Было установлено, что распространенность АСРЛ среди заключенных составляет чуть менее 50%. Аналогично, распространенность АСРЛ выше среди пациентов, проходящих лечение по поводу злоупотребления алкоголем или другими наркотиками (АДН), чем в общей популяции, что указывает на связь между АСРЛ и злоупотреблением АДН и зависимостью. Исследование, проведенное на 31 молодом человеке из Сан-Франциско и 56 молодых людей из Чикаго, показало, что 84% и 48% бездомных соответственно соответствовали диагностическим критериям АСРЛ. Другое исследование бездомных показало, что у 25% участников диагностировано АСРЛ. У людей с АСРЛ повышен риск самоубийства. Дети людей с АСРЛ также находятся в группе риска. Некоторые исследования показывают, что негативный или травматический опыт в детстве, возможно, в результате выбора, который может сделать родитель с АСРЛ, может быть предиктором делинквентного поведения в дальнейшей жизни ребенка.
The estimated lifetime prevalence of ASPD amongst the general population falls within 1% to 4%, skewed towards 6% men and 2% women. The prevalence of ASPD is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. It has been found that the prevalence of ASPD among prisoners is just under 50%. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) use treatment programs than in the general population, suggesting a link between ASPD and AOD use and dependence. A study on 31 youths of San Francisco and 56 youths in Chicago found that 84% and 48% of the homeless met the diagnostic criteria for ASPD respectively. Another study on the homeless found that 25% of participants had ASPD. Individuals with ASPD are at an elevated risk for suicide. Children of people with ASPD are also at risk. Some research suggests that negative or traumatic experiences in childhood, perhaps as a result of the choices a parent with ASPD might make, can be a predictor of delinquency later on in the child's life.
История
Первая версия DSM в 1952 году включила социопатическое расстройство личности. Эта категория предназначалась для людей, которых считали "больными прежде всего с точки зрения общества и соответствия преобладающей среде, а не только с точки зрения личного дискомфорта и отношений с другими людьми". Выделялись четыре подтипа, называемые "реакциями": антисоциальная, диссоциальная, сексуальная и зависимость. Антисоциальная реакция включала людей, которые "постоянно попадают в неприятности" и не извлекают из этого уроков, не проявляя "лояльности", часто бесчувственных и безответственных, со способностью "рационализировать" свое поведение. Категория была описана как более конкретная и ограниченная, чем существующие концепции "конституционального психопатического состояния" или "психопатической личности", которые имели очень широкое значение; более узкое определение соответствовало критериям, предложенным Герви М. Клекли начиная с 1941 года, в то время как термин "социопат" был введен Джорджем Партриджем в 1928 году при изучении раннего влияния окружающей среды на психопатов. Партридж обнаружил корреляцию между антисоциальным психопатическим расстройством и пережитым в раннем детстве отвержением со стороны родителей. В DSM II 1968 года категории были пересмотрены, и "антисоциальная личность" была включена в список десяти расстройств личности, но описывалась схожим образом и применялась к людям, которые являются: "в основном не социализированными", постоянно конфликтуют с обществом, не способны на значительную лояльность, эгоистичными, безответственными, не способны испытывать вину или учиться на прошлом опыте и склонны обвинять других и рационализировать свои действия. В предисловии к руководству содержатся "специальные инструкции", в том числе: "Антисоциальная личность всегда должна быть охарактеризована как легкая, умеренная или тяжелая". В DSM II предупреждалось, что наличие в анамнезе правовых или социальных проступков само по себе недостаточно для постановки диагноза, и что сначала следует исключить "групповую делинквентную реакцию" детства или подросткового возраста или "социальную дезадаптацию без явного психического расстройства". Диссоциальный тип личности в DSM II был отнесен к "диссоциальному поведению" для людей, которые являются хищниками и занимаются более или менее преступной деятельностью, такой как рэкет, нечестные азартные игры, проституция и наркоторговля (DSM I классифицировал это состояние как социопатическое расстройство личности, диссоциальный тип). Позже он вновь появился как название диагноза в руководстве МКБ, разработанном ВОЗ, впоследствии названном диссоциальным расстройством личности и считающимся приблизительно эквивалентным диагнозу ASPD. В DSM III 1980 года был включен полный термин "антисоциальное расстройство личности", и, как и в случае с другими расстройствами, был составлен полный перечень симптомов, ориентированных на наблюдаемое поведение, для повышения согласованности диагностики между разными психиатрами ("надежность между оценщиками"). Список симптомов ASPD основан на исследовательских диагностических критериях, разработанных на основе так называемых критериев Фейнера 1972 года, и во многом приписывается влиятельным исследованиям социолога Ли Робинс, опубликованным в 1966 году как "Дети, выросшие в девиантном поведении". Однако Робинс ранее уточнила, что, хотя новые критерии, касающиеся проблем поведения в детстве, были получены из ее работы, она и соавтор исследования, психиатр Патрисия О'Нил, получили диагностические критерии, которые они использовали, от мужа Ли, психиатра Эли Робинса, одного из авторов критериев Фейнера, который использовал их в рамках диагностических интервью. В DSM IV сохраняется тенденция к поведенческим антисоциальным симптомам, при этом отмечается, что "этот тип также называют психопатией, социопатией или диссоциальным расстройством личности", и в резюме "Сопутствующие признаки" вновь включены некоторые основные черты личности из старых диагнозов. В DSM 5 используется тот же диагноз - антисоциальное расстройство личности. В "Карманном справочнике по диагностике DSM 5" предполагается, что человек с ASPD может проявлять "психопатические черты", если у него или нее "отсутствует тревога или страх и присутствует смелый и эффективный стиль межличностного общения".
The first version of the DSM in 1952 listed sociopathic personality disturbance. This category was for individuals who were considered " ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals." There were four subtypes, referred to as "reactions": antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood. The DSM II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize. The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers (DSM I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis. The DSM III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up". However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews. The DSM IV maintained the trend for behavioral antisocial symptoms while noting, "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM 5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM 5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".