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The False Perception of Antisocial Personality Disorder

Starting in the early years of psychology and psychiatry, psychopathy and sociopathy have gained notoriety as being cold-hearted and ruthless disorders. By looking at what representation that is readily available in the media, versus studies and documented cases which are harder to procure, it is easy to see why there are misinformed opinions held by the genral public. With social media being the driving force of the misrepresentation and mislabeling of ASPD Gen Z and Gen Alpha have been given false information and poor representation of antisocial personality disorder. 

Antisocial personality disorder is, “a mental disorder in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others.” (MFMER, 2019). It is classified by the American Psychological Association as a cluster B personality disorder which also “includes antisocial, borderline, histrionic and narcissistic personality disorders. Individuals with these disorders often appear dramatic, emotional, or erratic.” (American Psychological Association 2013). The term Antisocial Personality Disorder first appeared in 1980 the Diagnostic and Statistical Manual for Mental Disorders Volume III (DSM- III). By creating the diagnosis of ASPD, Robert Spitzer who was tasked with the reorganization and restructure of the DSM, chose to group together the preexisting sociopathic personality disorder and the newly contrived psychopathic personality disorder. Though in the current version of the DSM, DSM-V, both are umbrellaed under the diagnosis of antisocial personality disorder, Mental health experts are pushing to separate the two disorders and reinstate them as separate personality disorders because of the varying diagnostic criteria (American Psychological Association 2013). 

  Psychopathy itself first rose to the forefront of psychology in the mid 20th century, but in the mid 19th century French physician Philippe Pinel described individuals with psychopathy as “insane” but “without delirium.”  (Perez, 2012). He went on to describe those with the disorder as, “having a characteristic lack of restraint, and as those whose behavior was marked by complete remorselessness for their actions” (Perez, 2012). Individuals with the disorder were later described by Hervey Cleckley as being charming and astute, but also lacking in emotional depth. Unlike psychopathy, sociopathy had been included in the DSM-I; the diagnosis at the time consisted of antisocial, sexual deviation, and dissocial reactions. When the DSM-II was published the diagnosis moved away from more antisocial behaviors and instead shifted towards sadistic and sexual deviant behaviors. When sociopathy and psychopathy joined as one, the criteria diagnoses leaned more towards the sociopathy criteria than the psychopathy (Houser, 2015), while in modern day diagnosis it tends to be the opposite. 

While DSM-III's diagnostic criteria for ASPD revolved around the psychopathic component, the 2013 verson of DSM-V focuses on the sociopathic component. DSM-V criteria for the diagnosis of antisocial personality disorder is as follows: 

“A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following: 

Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest. 

Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 

Impulsivity or failure to plan ahead. 

Irritability and aggressiveness, as indicated by repeated physical fights or assaults. 

Reckless disregard for safety of self or others. 

Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations. 

Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another. 

The individual is at least age 18 years. 

There is evidence of conduct disorder with onset before age 15 years. 

The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder. “ 

(American Psychiatric Association, 2013) 

Because the diagnostic criteria for ASPD in the DSM-V, diagnosing an individual under the age of 18 can be complex. Often markers will be prominent in adolescent before the ages of 18 and will more than likely be diagnosed with a conduct disorder because of the antisocial symptoms. Diagnosis of adults with antisocial personality disorder can be equally as difficult for two reasons. The first being misdiagnosis, professionals may give a diagnosis of antisocial personality disorder because an individual might fit the criteria for psychopathy, even if the individual does not fit the criteria for ASPD (Houser, 2015). The second being that by the age of 18 it is assumed that a substantial portion of the undiagnosed adults are incarcerated or in the criminal justice system. Because very few adolescents with conduct disorders choose to be tested for ASPD only an estimation can be made as to what percent of the genral United States population has the personality disorder. In a study published in 2007 by the Journal of The American Academy of Psychiatry and Law, data was presented the study from all five of Connecticut's adult jails. The study consisted of a sample size of 508 incarcerated individuals, 307 of being male and 201 being female, the data conclusion showed that 39.5% of the studied males were found to have ASPD and 27.9% of all females studied presented with ASPD (Trestman, 2007). It is estimated that 50% of prison population in the USA have a diagnosis of ASPD, well less than the 1/6th of the general USA population with a diagnosis of ASPD. 

ASPD is challenging to treat, as normally a combination of psychotherapy and medication is required. When utilizing psychotherapy professionals will likely use either Cognitive Behavior Therapy or Psychodynamic Psychotherapy. Cognitive Behavior Therapy can help to bring to light negative behaviors and thought patterns, while giving alternative replacements two negative patterns. Psychodynamic Psychotherapy revolves around the subconscious tension in an individual psyche. While Psychotherapy is not always effective, its success is dependent on the individual's attitude toward it, as many with this disorder do not believe that they need help or that they even have ASPD. Other forms of therapy can be utilized such as anger management and counseling but those are not always effective (Mayo Foundation for Medical Education and Research, 2019). ASPD though uncurable, treatment could help to lessen the individual manifestations of antisocial behavior and can often be managed by the previously mentioned therapies and medications. 

Today's generations are presented many different claims of ASPD. Many of the perspectives coming from social media, influencers, and large Hollywood productions that focuses on turning a profit. Because of this, illness both physical and mental, are romanticized by the media and forced to fit a created narrative that best suits the creator's agenda. For example, creators on apps such as Tik Tok, YouTube, and twitch are being labeled as Psychopaths for presenting negative behavioral patterns. More recently in a YouTube documentary produced by Shane Dawson in titled “the mind of Jake Paul”, Dawson mongers fear around youtuber Jake Paul's controversial past and behaviors that have been deemed “psychopathic” or “sociopathic” by the YouTube community (Dawson, 2018). Because of productions like Dawson’s, the main representation of ASPD is negative and projects poorly on the personality disorder.  

The issue behind this newly arising problem with social media influencers is their prominence in our society and the accumulation of affluence. Many of the social media stars on the receiving end of the harmful sociopath or psychopath accusations are marketing their videos or projects towards adolescences. The old adage of monkey see monkey do is exceedingly notable when it comes to children. Children are observational learners for the most part and gain a lot of their behaviors from watching parents, their favorite TV shows, or YouTubers. When children observe negative and dangerous behaviors that are gratified by increase in popularity or affluence, they are more likely to mirror those behaviors. For that reason, when YouTube and other social media platforms market games or TV shows that put forward violence or negative behavior to children, it can shift already learned behaviors and increase a child's likelihood to follow the negative behavioral patterns shown by their favorite influencers. Parents and guardians need to pay closer attention to what media is being consumed by children and adolescents as at a young age child are very impressionable and are easily swayed. 

          A creative outlet is important as it allows for individuals to express themselves in any way that they choose. With the growth of social media websites and the growth of Hollywood this has become more apparent in the immense impact that these massive platforms have. When we label celebrities or social media stars with outdated terms such as psychopath or a sociopath, we are the ones contributing to the toxic culture and responsible for spreading detrimental ill-informed opinions on another human being. There's no way to know if an influencer, social media star or celebrity is diagnosed with any mental illness, unless there is an actual diagnosis from a licensed psychologist or psychiatrist.  

Additionally, the misinformation and uninformed opinions  

Another reason this is such an issue is the lack of knowledge of the public towards ASPD and other cluster B personality disorders in general. For the general population, the only information readily available on antisocial personality disorder is what can be gleaned from movies, YouTube videos, or documentaries. While some forms of media can be informative, such as documentaries or articles produced by credited sources, more often than not readily available material such as YouTube videos and TV shows are rarely credible. They present a false idea of mental health and those who suffer from mental disorders. But human beings are excited by what is unknown known to them and with the outpouring of Hollywood's manufactured, ideas and agendas it would appear to the everyday viewer that what they are seeing on the big screen is how the disorder manifests. Thus continuing the cycle of misinformation and misrepresentation.   

  ASPD has gone through many changes have been made to the definition and the diagnostic criteria, the misrepresentation has both psychopathy and sociopathy has been present since the very beginning. Sociopathy and psychopathy are similar, both affect the individual differently and required different treatments. Because of this it is the hope of many in the mental health community that ASPD will be dissolved in a coming version of the DSM and sociopathy and psychopathy restored to their respective positions as separate disorders. After taking a look at what representations of ASPD are readily available to the public there is no confusion as to why the current generation is being led astray. I believe the best way to remedy the issues with antisocial personality disorder and the misrepresentation of it in media and social media like is through education. Educating and giving a platform to those with the actual disorder and those licensed to treat the disorder will allow us to dispel toxic stereotypical opinions and the romanticization of a high-risk and unpredictable disorder. 

References 

American Psychiatric Association. (2013). Cautionary statement for forensic use of  

DSM-5. In Diagnostic and statistical manual of mental disorders (5th ed.). doi:10.1176/appi.books .9780890425596.744053 

CM;, G. (2017, July). Social Media Use and Conduct Problems in Emerging Adults. 

Dawson, S. (Director). (2018, September 25). The Mind of Jake Paul [Video file]. Retrieved from https://www.youtube.com/watch?v=9bpkr91p2xY 

Houser, M. C. (2015). A HISTORY OF ANTISOCIAL PERSONALITY DISORDER IN THE DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL ILLNESS AND TREATMENT FROM A REHABILITATION PERSPECTIVE (Unpublished master's thesis). Southern Illinois University Carbondale. doi:OpenSIUC 

Mayo Foundation for Medical Education and Research, (2019, December 10). Antisocial personality disorder.  

Perez, P.R. (2012). The etiology of psychopathy: A neuropsychological  

perspective. Aggression and Violent Behavior 17, 519–522 

Pickersgill, M. (2012). Standardising antisocial personality disorder:  

The social shaping of a psychiatric technology. Sociology of Health & Illness 34(4), 544-559. doi: 10.1111/j.1467-9566.2011.01404.x 

Trestman, R., Ford, J., Zhang, W., & Wiesbrock, V. (2007, December 01). Current and Lifetime Psychiatric Illness Among Inmates Not Identified as Acutely Mentally Ill at Intake in Connecticut's Jails.  

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The Debate for the Right to Die

This paper deals with subjects that are potently triggering, if you are easily triggered by death please do not read.

               For many terminally ill patients a miserable and dejected end of life plan was the only option. But with policies such as the death with dignity act and the minuscule legalization of physician assisted suicides in a few states, there has been an apparent light in the dark for the terminally ill. The debate of wither it is a right of the people or a moral sin is widespread and appears to be endless. With many policies, appeals, acts and, members of the medical and science community, the fight for the right to die continues. But as it is a constant ethical and moral debate between doctors, patients, and lawmakers Death with dignity is one of the only saving graces for individuals who wish control over their remaining years.  

                In 1993 a businessman named Alvin Snyder, two attorneys named Eli Stutsman and Mark Trinchero, a doctor Peter Goodwin and a nurse Mariam Coppens started a political committee called Orgon Right to Die. The purpose of this committee was to pen and pass the Organ Death with Dignity act. In 1994 campaigning started for the death with dignity act that was later passed with a little over a 50% voter approval rate. By passing the Organ Right to Die act patients with terminal illnesses in Oregon where able to take part in physician assisted suicide. The passing of the act made Oregon the 1st state to allow physician assisted suicide, (History of the Death with Dignity act, 2020). many different acts and appeals stemmed from the passing of the Oregon Right to Die act some of the first followers being those form Maine and Vermont. between 2004 and 2014 in nationwide expansion of the act was beginning. This was started with a terminal brain cancer patient who ended up moving to Oregon so they could take advantage of be death with dignity act. The life and story of the patient change the physician assisted suicide movement and allowed for greater access by the expansion of set movement. Because of the previously mentioned patient policy reform began in a state-by-state basis and success in rewriting and remaking old laws and policies that outdated. But due to varying opinions and ethical debates very few states have actually legalized physician assisted suicide. (History of the Death with Dignity act, 2020)

                         Though the majority of U.S. states have strict laws against physician assisted suicides, some states have passed acts allowing this kind of services to be provided for chronically ill patients. A few of these states being Washington, Colorado, California, Hawaii and D.C. Most of which have different laws or acts protecting this service. For example, Colorado operates under the End of Life Options Act, that was instated in 2016 but did not take effect until 2017. The End of life Options Act of Colorado has strict criteria for physician assisted suicide, the criteria being:

A prognosis of six months or less;

Mental capacity to make an informed decision;

Residency in Colorado; and

Has requested and obtained a prescription for medical aid-in-dying medication.

(Colorado End of Life Options Act 2019)

               Most authorize states share similar criteria to the previously mentioned criteria and many have further rules for eligibility of individuals and the execution of the actual assisted suicide. Currently only 10 states allow PAS most of which are under different acts then the death with dignity act Some of which being the Elizabeth Whitefield End of Life Options Act; 2021 from New Mexico, the Aid in Dying for the Terminally Ill Act; 2019 from New Jersey, and the Patient Choice and Control at the End of Life Act; 2013 from Vermont. ((Death with dignity acts - states that allow assisted death 2021).  

               Though many questions are raised physician assisted suicide the main question raised by physician assisted suicide (PAS) is the ethical dilemma behind the actual act itself. Is physician assisted suicide Ethical? Should any one group decide your fate or should a chronically ill person have the right to decide when they have fought hard and long enough? upon further research into the ethical side of physician assisted suicide I found two main camps and no real middle ground. One being for assisted suicide and one being decidedly against. Though each individual is allowed their own opinion it is important to remember what the law States and what is allowed under the law. As though you might believe one thing it might not fall in line with what is legal. This is of course prevalent when it comes to the death with dignity debate as there are very few states that have legalized PAS and many that It is still illegal and period

               For the side in favor of PAS there is no ethical dilemma nor is there reason for hesitation when it comes to penning and passing death with dignity acts. Having the right to choose what happens at the end of your life weather you are suffering or not is extremely important, just as it is in your young adult life. Most of those in favor of PAS believe it is the right of the people to decide when they die and how they die, they believe it is there constitutional right. By not allowing death with dignity acts and PAS in certain states it limits the options of the people, If States and lawmakers chose to take a harm reduction standpoint on this debate, and allowed better education of the options to terminally ill patients there is a chance that they might see a reduction in the suicide and self-injury rate per state to state. The words to best explain this side of the argument belong to Dr. Kevorkian who said, “I didn’t do it to end the life. I did it to end the suffering the patient is going through. The patient is obviously suffering. What’s a doctor supposed to do, turn his back?” (Jack Kevorkian, MD - Euthanasia 2019). Not only do these words truly explain how the medical and science communities feel about PAS, but also the patients who choose this path, or would choose it given the choice.

               For the side opposing physician assisted suicide there are two main arguments presented by the Medical and Science communities. Those being that legalizing PAS is the path toward euthanasia and the moral dilemma physicians licensed to carry out PAS will face. These dilemmas are voiced in an article published by the journal of Oncology in 2017. The author describes how, “PAS is much less about physical pain and suffering than it is about the desire to have the control to end one’s life”, and how, “PAS is a slippery slope toward the practice of euthanasia”, (Reasons to Reject Physician Assisted Suicide/Physician Aid in Dying 2017). The author raises a few good questions here, f for instance if physician assisted suicide were to be made legal in every state would the process be abused? And is PAS the beginnings of euthanasia? On top of the concerns presented by the Medical and Science communities, many religious beliefs and followers do not believe in PAS as it is a direct violation to their beliefs. An example of this is teachings of the Catholic Church, some groups apart of the Catholic church, such as Father William P. Saunders wrote in an articular for the Catholic Herald, would go as far as to write, “with PAS, they (physicians) now formally are cooperating with the evil of taking of a person’s life.” (The Catholic Church's teaching on assisted suicide, 2018).

                Regardless of ones own opinion on the physician assisted suicide or death with dignity acts there is ample amount of both good and bad representation in the media. From TV shows two actual historical cases death with dignity and physician assisted suicide continuously receives a bad rap. A good example of this is Jack Kevorkian, nicknamed Dr. Death, who was an American pathologist who whole heartedly believed in PAS and Death with dignity to the point of taking matters into his own hands. In 1998 Kevorkian was arrested for willingly euthanizing a man with Lou Gehrig's disease, he was tried for the one death, even though it is believed he assisted in over 130 euthanasians which he conduced in his van. When news broke of what Kevorkian had done it caused wide sweat panic as well as controversy. Similarly to the issues raised with the Kevorkian case the media continues to glorify and shame character who take part in this kind of ‘Angle of death’ behaviors and actions creating a twisted opinion based on falsified information of the death with dignity and PAS agenda.

               Regardless any ethical or moral debate, in my opinion it is the right of the people to have control over their lives and bodies. Similar to the pro life vs pro choice I believe that if it's my body it should be my choice. And in the end if somebody really wants something, in this case to end their suffering, they will find a way to do it. Whether it be an a law sanctioned medical facility full of sterile medical grade tools or in the woods or ones home they will find a way. Because as humans wouldn't force an animal to suffer, but we readily allow terminally ill people with no foreseeable chance of cure, be forced to live out a painful existence that brings no good or joy to them. To me that is the ethical debate, not whether or not a doctor is allowed to euthanize an already dying  patient, but rather if a lawmaker can choose whether or not a painful and thankless existence should be forced upon any one human being.  

                                                     References

History of the Death with Dignity act. (2020, July 15).            

Colorado End of Life Options Act. (2019, August 19).

Death with dignity acts - states that allow assisted death. (2021, March 30)

Jack Kevorkian, MD - Euthanasia. (2019, December 18).  

O’Rourke. (2017, August 29). Reasons to Reject Physician Assisted Suicide/Physician Aid in Dying.  

SAUNDERS, F. (2018, October 25). The Catholic Church's teaching on assisted suicide.