WHAT IS ANTISOCIAL PERSONALITY DISORDER?
Antisocial Personality Disorder
APD and the serial bully
I estimate that around 1 person in 30 (approximately 2 million) in the UK exhibits the profile of the serial bully whose behaviour is congruent with many of the diagnostic criteria for Antisocial Personality Disorder. Some serial bullies meet sufficient clinical criteria to merit the label psychopath.
Although mental health professionals are not all in agreement, the emphasis of antisocial personality disorder is, as the name implies, on the antisocial acts committed by the individual. Psychopaths, on the other hand, are diagnosed more according to personality traits, eg lack of remorse, lack of guilt, lack of conscience, etc. Whilst many psychopaths meet the diagnostic criteria for antisocial personality disorder, not all do; similarly, not all people with antisocial personality disorder meet the criteria for a psychopath.
I use the term psychopath for an individual with many of the characteristics of Antisocial Personality Disorder who is dysfunctional and violent and who expresses their violence physically (eg assault, damage to property, etc); I use the term sociopath (socialised psychopath) for an individual with many of the characteristics of Antisocial Personality Disorder who expresses their violence psychologically (eg constant criticism, sidelining, exclusion, undermining etc). Psychopathic APD people are usually, but not exclusively, associated with low socio-economic status and urban settings and tend to be of lower intelligence. Sociopaths are usually highly intelligent, have higher socio-economic status and often come from "normal", "nice", "middle-class" families.
When diagnosing a Personality Disorder, it is usual to find that the characteristics of the disorder are not regarded as problematic by the person themselves. This fits well with the serial bully's apparent lack of insight into their behaviour and the effect of their behaviour on others. However, this apparent lack of insight is more selective than it appears.
The estimate of 3% for males and 1% for females amongst the general population comes from the Prevalence for Antisocial Personality Disorder in DSM-IV, the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. However, most of the research on Antisocial Personality Disorder has been undertaken with people who are physically violent, as these people have come to the attention of the authorities (police, welfare agencies, doctors, psychiatrists, etc) through their recognised (physically) antisocial behaviour. They have committed criminal, arrestable offences. I believe relatively little research has been undertaken with people who are psychologically violent but rarely physically violent; these people tend to commit non-criminal, non-arrestable offences.
People who are physically violent tend to have low self-esteem, low intelligence and low self-discipline; people who are psychologically violent tend to have low self-esteem, high self-discipline and high intelligence. I suspect that around 2-3% of both males and females are psychologically violent - in addition to the DSM-IV estimate of 3% (males) and 1% (females) for physically violent people.
Until recently, psychologically violent people in the workplace were regarded as tough managers or difficult characters or (by subordinates) as a pain in the butt. These attitudes are changing as the dysfunction, inefficiency, cost, and severe psychiatric injury these people's behaviour causes is revealed (click to see effects of bullying on health, the psychiatric injury PTSD, and the cost of bullying to industry and taxpayers).
Listed below are the diagnostic criteria for antisocial personality disorder which I believe to be relevant to the serial bully. Links to related personality disorders follow. The information is provided not to diagnose, but to aid the recognition and understanding of aggressive and dysfunctional behaviour. An individual may exhibit traits of more than one personality disorder. Bear in mind that psychiatrists themselves are not unanimous on the existence, content, and diagnosis of personality disorders.
The DSM-IV Diagnostic Criteria for Antisocial Personality Disorder include:
A. A pervasive pattern of disregard for and violation of the rights of others occurring since the age of 15 years as indicated by at least three of:
1. failure to conform to social norms with respect to lawful behaviours as indicated by repeatedly performing acts that are grounds for arrest;
2. deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure;
3. impulsivity or failure to plan ahead;
4. irritability and aggressiveness, as indicated by repeated physical fights or assaults;
5. reckless disregard for the safety of self or others;
6. consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations;
7. lack of remorse, as indicated by being indifferent to or rationalising having hurt, mistreated, or stolen from another.
B. The individual is at least 18 years of age.
C. There is evidence of Conduct Disorder with onset before age 15 years.
D. The occurrence of antisocial behaviour is not exclusively during the course of Schizophrenia or a Manic Episode.
Physical violence is currently a prerequisite. However...
A. There's a lot of anecdotal evidence to suggest that people who are bullies as adults were bullies at school; this is where they learnt to bully, and learnt they could get away with it.
A1. The serial bully is unable and unwilling to act within the bounds of society, whilst insisting everyone else does. In the UK, there is a legal precedent (since March 1997, the case of a school-age girl in Wakefield) that bullying - verbal intimidation with no physical contact - constitutes common assault and is therefore now a criminal offence. Most of the offences committed by the serial bully are non-criminal and therefore non-arrestable; click here for a list.
A2. The serial bully is a practised liar with a Jekyll and Hyde nature who gains gratification from bullying others. The serial bully will select and bully any person whom he or she believes is a threat to them (the threat is of exposure of the bully's inadequacy) and whose exposure would threaten the bully's job, promotion prospects and standing within the hierarchy.
A3. The serial bully acts randomly and impulsively, and chooses to not be able to remember what they said, did or committed to more than 24 hours ago; the serial bully cannot think or plan ahead more than 24 hours and consequently lives forever in the present.
A4. The serial bully regularly shows impatience and irritability, especially when questioned or called to account, and then becomes aggressive; a psychological assault usually follows. See denial.
A5. The serial bully has a cavalier attitude to Health and Safety; when the target's symptoms reach the stage that other people begin to ask questions, the bully plays the mental health trap to abdicate and deny responsibility for their behaviour.
A6. The serial bully rarely stays in one position long and there is no loyalty to anyone except him or herself. Misappropriation of budgets is common to most cases involving a serial bully. The serial bully often has a poor credit rating.
A7. The serial bully shows no remorse, for he or she gives the appearance of not having a conscience. In truth, the conscience is selectively switched off. The serial bully always blames others as a means of avoiding accepting responsibility for their behaviour and the effect it has on others.
B. The serial bully in the workplace is always over 18.
C. Adult serial bullies were invariably bullies at school.
D. The bully is usually in a position of responsibility and therefore not exhibiting schizophrenia or manic behaviour; if they were, they would be relieved of their responsibility, especially for managing staff.
Diagnosis of such an individual is a challenge; how do you deal with a person who is a compulsive liar with a Jekyll and Hyde nature, is charming and glib, excels at deception and evasion of accountability, especially when that person's superiors behave in a similar manner, give him or her glowing reports, and deny everything?
HOW IS BULLYING DIAGNOSE AS BORDERLINE PERSONALITY DISORDER?
We usually think of bullies as big, scary men. We don't imagine that they could take the form of small, spiteful women. Most of us have observed that in grade school and high school, bullies come in both sexes, but we still tend to think of them as physically intimidating, physically threatening males.
In reality, there's a type of emotional bully who is far more dangerous and destructive than any physical one. The physical bully is usually a person who was bullied themselves as a child by someone bigger and stronger. They take out their hurt and angry feelings on peers who appear smaller and weaker than them. There are various effective ways of dealing with these types which I won't get into, here.
The emotional bully is a different creature. This person usually has a condition known as Borderline Personality Disorder, or BPD, which is characterized by a number of different signs and symptoms. Those with milder cases have terrible fears of abandonment, chronic feelings of emptiness and a habit of pushing away those who'd love or help them.
Those with a more severe and destructive form of the condition suffer from wide swings of mood, self-destructive behaviors, various addictions, excessive, uncontrollable anger and extreme touchiness. These people take offense at things which normal people would never consider to be a slight, and they are quick to exact vengeance.
Anyone who has had the misfortune of dealing with someone from the latter group knows how far this type of person will go in satisfying their need for revenge. Paradoxically, in their quest for so-called "justice" these Borderline individuals are the real ones causing damage, as opposed to the person who supposedly "wronged" them.
The word "Borderline" was originally used to describe this condition because some of the ideas these people entertain are so irrational and some of their beliefs are so unrealistic and rigidly fixed that they seem nearly psychotic. This condition, when severe, is considered to be on the borderline of insanity.
Individuals who have a milder version of the disorder can do very well in therapy. They can function fairly well in their lives and they tend not to make too much trouble for themselves or others. More severely affected individuals tend to be "trouble-makers" who engage in self-mutilation and/or interfere destructively in other people's lives.
They pit people against each-other, which is technically known as "splitting," and they cause a lot of suffering in the people they live and work with. They are manipulative, passive-aggressive, unreasonable, stubborn, erratic and highly impulsive. They get under people's skin. If you frequently find yourself talking with your co-workers about a colleague or supervisor who makes many of you incredibly angry and frustrated, this person most likely has Borderline Personality Disorder.
BPD individuals can be so full of rage that they go to extreme lengths to "punish" those who they feel have caused them some sort of offense. This can take the form of legal threats, attempts at blackmail, stalking and other types of harassment. The so-called offenses they are reacting to are virtually always imagined, but the angry, vengeful feelings of these disturbed individuals are very real.
Unfortunately, people with severe BPD are prone to keep escalating a situation if the other person tries to stand up for themselves. In their troubled mind, they perceive the person's self-defense as an offense against them. Sometimes, the best way of dealing with such an individual is to end all contact with them. This might mean changing jobs, moving to a new home or giving up certain hobbies or activities. It seems like a drastic response, but "Hell hath no fury like a Borderline scorned."
Our courts are burdened enough these days, and in reality, are vastly deficient when it comes to understanding and addressing the legal ramifications of mental disorders. Until such time as there are legal protections for the type of bullying and harassment that is so typical of the very ill BPD person, it's up to us to become less of a target to these people by withdrawing ourselves from contact with them and hoping that they don't keep pursuing their disturbed and destructive agenda.
Obviously, this is not to say that we shouldn't try to defend and protect ourselves from attacks to our safety and welfare, but that it's important to understand that individuals with BPD tend to be expert at using the legal system to their nefarious advantage. In their over-arching sense of vengeful entitlement they manipulate the legal system and use whatever legitimate and illegitimate means necessary to get back at those against whom they hold a grudge.
One consolation to their victims might be to recognize that people with severe BPD are deeply unhappy. They are incapable of forming normal, healthy attachments with others and their relationships are characterized by chronic conflict and frustration. They are constantly irritable and agitated but unable to soothe this malaise. They are as self-destructive as they are hurtful to others and they live lives of loneliness, alienation and meaninglessness.
If we are unfortunate enough to have had dealings with someone with a severe case of BPD, we can remind ourselves that however much they might have made us suffer, it was only temporary, whereas their unhappiness is never-ending. They are plagued by their paranoia, rage and vindictiveness. As much as I am wary of such individuals, I can't help but feel compassion for them, as one of the worst places to be in the universe is inside the troubled mind of someone with severe BPD.
Labels: Borderline disorder
WHAT IS AN OBSESSIVE COMPULSIVE DISORDER? WHAT ARE ITS RISK?
Obsessive Compulsive Disorder (OCD) is a serious emotional problem that involves:
Obsessions: Intense worries, thoughts, and images that pop into the mind and create a great deal of distress. Worries about becoming contaminated with germs are an example of a particularly common obsession.
Compulsions: Various behaviors or actions that temporarily reduce the distress obsessions cause. For example, people with contamination obsessions would be likely to wash their hands excessively to deal with their worries about becoming contaminated.
OCD can be fairly mild, but it’s quite common for it to be severe and substantially reduce the quality of life for those who have it. Sufferers often spend many hours a day carrying out their compulsions and feel helpless to do anything about their OCD. The good news is that OCD is highly treatable. The bad news is that a diagnosis of OCD often raises the risk of other emotional problems such as the ones that follow.
- Mood Disorders: Some studies have found that more than twenty-five percent of people who have OCD also have a disturbance in their moods. Left untreated, mood disorders can lead to serious problems. If you have intense feelings of sadness, low moods, fatigue, and/or feelings of worthlessness, it’s important to have it checked out. Conversely, if your moods become extremely high and are accompanied by things such as inflated self-esteem, rapid speech, excessive energy, decreased need for sleep, and/or excessive indulgences, that needs to be looked into as well.
- Anxiety Disorders: OCD has generally been thought to be a type of anxiety disorder although some professionals feel otherwise. In either event, problems with anxiety often go along with OCD. Signs of anxiety include avoidance of people, fears of losing control, intense fears, panic attacks, and tension.
- Attention Deficit Disorders (ADD): The various types of ADD often involve problems with attention, hyperactivity, and impulsivity. Additional problems include troubles staying focused, losing various items, forgetfulness, trouble remaining still, and talking without thinking. Those who have OCD are at increased risk of having ADD, but they also may merely “look” like they have ADD because their OCD requires much of their attentional resources. The good news here is that successful treatment of OCD sometimes results in an abatement of their ADD like symptoms.
- Substance Abuse: Given that OCD causes huge distress for many of its sufferers, it’s not surprising that some of them try abusing substances (alcohol, prescription drugs, and illegal drugs) to quell their anxiety and upset. Unfortunately, the relief provided by substances is fleeting. Treatment should be sought for both problems when they co-occur.
The bottom line is that if you have OCD, you probably feel great distress. That distress can escalate if you also have one or more additional emotional problems such as the ones discussed above. However, OCD as well as these accompanying problems can be alleviated by treatment that’s been designed and empirically validated for these issues.
Just a reminder—when you seek treatment for any of these problems, be sure to ask the mental health professional if he or she has experience and training in treating these disorders.
WHAT IS A BIPOLAR DISORDER?
Personality Disorders Misdiagnosed As Bipolar
For the past year, a debate has been raging regarding the misdiagnoses of bipolar disorder. New research seeks to clarify the initial findings by determining what the researchers believe is the appropriate diagnosis.
In the earlier study, investigators reported that fewer than half the patients previously diagnosed with bipolar disorder received an actual diagnosis of bipolar disorder after using a comprehensive, psychiatric diagnostic interview tool — Structured Clinical Interview for DSM-IV (SCID).
That is, an overdiagnosis of bipolar disorder was occurring. In this followup study, the researchers have determined the actual diagnoses of those patients.
Under the direction of lead author Mark Zimmerman, researchers discovered patients who received a previous diagnosis of bipolar disorder that was not confirmed by a SCID were significantly more likely to be diagnosed with borderline personality disorder as well as impulse control disorders.
The research involved the study of 82 psychiatric outpatients who reported that they received a previous diagnosis of bipolar disorder that was not later confirmed through the use of the SCID. The diagnoses in these patients were compared to 528 patients who were not previously diagnosed with bipolar disorder. The study was conducted between May 2001 and March 2005.
Zimmerman, who is also an associate professor of psychiatry and human behavior at The Warren Alpert Medical School of Brown University, says, “In our study, one quarter of the patients over-diagnosed with bipolar disorder met DSM-IV criteria for borderline personality disorder. Looking at these results another way, nearly 40 percent (20 of 52) of patients diagnosed with DSM-IV borderline personality disorder had been over-diagnosed with bipolar disorder.”
The results of the study also indicate that patients who had been overdiagnosed with bipolar disorder were more frequently diagnosed with major depressive disorder, antisocial personality disorder, post-traumatic stress disorder and eating and impulse disorders.
Zimmerman and colleagues note that “we hypothesize that in patients with mood instability, physicians are inclined to diagnose a potentially medication-responsive disorder such as bipolar disorder rather than a disorder such as borderline personality disorder that is less medication-responsive.”
In their previously published study that concluded bipolar disorder was overdiagnosed, they studied 700 patients. Of the 700 patients, 145 reported they had been previously diagnosed as having bipolar disorder; however, fewer than half of the 145 patients (43.4 percent) were diagnosed with bipolar disorder based on the SCID.
The authors state that the overdiagnosis of bipolar disorder can have serious consequences, because while bipolar disorder is treated with mood stabilizers, no medications have been approved for the treatment of borderline personality disorder. As a result, overdiagnosing bipolar disorder can unnecessarily expose patients to serious medication side effects, including possible impact to renal, endocrine, hepatic, immunologic and metabolic functions.
Zimmerman concludes, “Because evidence continues to emerge establishing the efficacy of certain forms of psychotherapy for borderline personality disorder, over-diagnosing bipolar disorder in patients with borderline personality disorder can result in the failure to recommend the most appropriate forms of treatment.”
WHAT IS VITAMIN D DEFICIENCY?
HOW WILL IT INCREASED RISK FOR CANCER AND AUTOMIMMUNE DISEASES?
A study has linked vitamin D deficiency with an increased risk for cancer and autoimmune diseases, such as rheumatoid arthritis MS, and lupus. Researchers found, through mapping vitamin D receptor binding throughout the human genome, that vitamin D deficiency is a major environmental factor in increasing the risk of developing these disorders.
And 70 percent of children and adults in the US are vitamin D deficient. The cause of deficiency is a combination of not enough sun exposure, and a diet low in vitamin D.
Hydroxychloroquine, or Plaquenil, and corticosteroids, which both can be prescribed for the treatment of rheumatoid arthritis, are among these. Even if you are taking one of these drugs, your doctor can adjust your vitamin D dose to correct the malabsorption.
You can ask your doctor for a simple blood test called, 25-hydroxy vitamin D test.
To increase your level of vitamin D through food, you should include more oily fish, such as salmon, mackerel and tuna. Egg yolks and mushrooms also provide vitamin D, or you could choose a cereal and milk fortified with vitamin D.
However, this is without sunblock in the summer, and it is not recommended to expose your skin to the sun without sunblock for long amounts of time. This can cause skin damage and increase your risk of skin cancer.
There is no one-size fits all solution for taking vitamin D, how much you need depends on how deficient you are, which medical condition you have, etc. It is usually recommended that you supplement by adding 1-2,000 IU of vitamin D per day.
This is because the liquid form has better absorption rates and are therefore recommended above vitamin D tablets. You can find liquid form in most health food stores.
Not only does vitamin D play a crucial role in the absorption of calcium, but it staves off osteoporosis, which can be a risk for people with RA. It also protects those susceptible to seasonal affective disorder from becoming depressed.
Vitamin D plays a role in managing musculoskeletal pain from rheumatoid arthritis and other diseases. It's common for people who live with chronic pain to have a vitamin D deficiency, and for doctors to routinely check their patients and offer Vitamin D supplements as part of the treatment plan.