ANTISOCIAL PERSONALITY DISORDER: FACTS AND CAUSES

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?