Personality disorders, which have persistent behaviors and internal experiences that deviate significantly from the expectations of the culture in which the individual lives, are a continuous pattern that manifests itself in two or more of the areas of cognition, affect, interpersonal functioning, and impulse control, inflexible, and encompasses a wide variety of personal and emotional states. This continuous pattern causes clinically significant distress or impairment in social, occupational, or other important areas.
When we look at the characteristics of AUD in general, it is seen that the conduct disorder that starts at an early age has turned into antisocial behaviors in adult life; it is stated that these people have weak behavioral control, lack conscience and empathy, and behave irresponsibly, manipulatively and deceitfully. They see themselves as grandiose and are self-centered. They have a superficial charm, but fail to deliver on long-term personal promises. They are impulsive and angry.
Checkley’s (1976) definition of psychopathy is as follows:
1. Superficial charm and good intelligence.
2. Absence of delusions or unrealistic thoughts
3. Absence of psychoneurotic symptoms
5. Lying, insincerity
6. Absence of remorse and shame
8. Lack of learning from experience and poor judgment
9. Pathological selfishness and inability to love
10. A general lack of many emotional responses
11. Lack of insight
12. Irresponsibility in interpersonal relationships
13. Fantastic behavior (sometimes with alcohol and substance use)
14. Rare suicidal behavior
15. Unrequited sex life
16. Failure to draw a life plan.
Etiology of Antisocial Personality Disorder (APD)
1. Psychological Factors
Psychological factors related to the etiology of APD are handled by psychodynamic and psychoanalytic theories, learning theories and cognitive theories. Both psychoanalytic and psychodynamic theories link APD to a deficiency or pathology in the development of the superego. Psychoanalytic theorists argue that antisocial personality stems from pathological grandiosity as in narcissistic personality, and that there are angry introjections especially in APD. Accordingly, due to the parent’s neglect or abuse of the child, the child internalizes the image of a hostile parent and finds the parent unreliable and hostile. When this situation is combined with the absence of a loving mother object, the basic feeling of trust cannot be formed and a fixation occurs in the separation-individuation process.
Due to the aforementioned process, the child cannot gain object continuity.
Kernberg (2000) sees APD, which he calls “malignant narcissism syndrome” or “antisocial personality disorder”, as a typical narcissistic personality disorder, and treats the disorder as pathological object relations and superego pathology. According to Kernberg, deficiencies or pathologies occur in the superego development of these people due to the absence of a constant relationship with the caregiver or the traumatic experiences in childhood.
2. Cognitive Approaches
The cognitive-behavioral formulation of the disorder reveals that these individuals engage in some self-serving cognitive distortions. These are respectively find excuses(where wanting or wanting to avoid something legitimizes behavior), thinking is belief(believing that thoughts and feelings are always true), personal rigidity(believing that one’s choices are always good and correct), accepting feelings as evidence(don’t think they’re right because they feel their behavior is right) about the decisions of others thinks their opinions are unimportantand low probability of outcome(a person’s belief that undesirable things will not happen or will not concern him) are the distortions revealed by cognitive approaches.
According to cognitive-behavioral approaches, beliefs about oneself and others underlie the person’s transmitted cognitions. These people perceive themselves as loners, strong and autonomous people, and they see the world as cruel, powerful and a place where they can be deceived at any time. Their perceptions of others are that others are manipulative, exploitative, powerless and frail. Therefore, individuals with APD believe that they should take care of themselves and be more aggressive than others, otherwise they will be manipulated by others. (Beck and Freeman, 1990).
Another core belief is that they are always right; so they don’t feel the need to question their behavior. Again, due to their distrust of others, they do not receive advice or guidance regarding their past, present, or future behavior. Because they focus only on the present, they cannot predict the future consequences of their behavior (Beck & Freeman, 1990).
3. Learning Approaches
From the point of view of the learning approach, it is seen that individuals with APD do not learn the conditioned fear responses, so they have difficulties in learning the fear and avoidance reactions for the reduction of fear. In addition, individuals with APD may be operantly conditioned to aggressive behaviors due to the traumatic experiences they are exposed to during the early stages of their lives. When it is remembered that people with APD have fears that they will be persecuted and deceived by others, it has been suggested that their hostile, oppositional, manipulative behavior serves as a negative reinforcer to reduce the likelihood of the above-mentioned negative expectations being realized, and thus serves to perpetuate the disorder (Millon & Everly, 1985).
4. Attachment Theory
Attachment theory has an important place in the handling of APD as well as in the explanation of many psychopathologies. The attachment experience established with the primary caregiver affects the child’s representations of self and others, as well as the thinking and behavior strategies related to attachment. At this point, negative experiences such as loss or abuse may cause the child to develop negative representations of self and others, or to develop a set of thought and behavioral strategies that predispose the child to psychopathology.
It is known that experiences disrupting the attachment relationship, such as long-term separations with caregivers, father’s antisocial or deviant behavior, or mother’s lack of warmth and neglect, are associated with APD.
A study by Zanarini (1989) shows that 89% of individuals with APD have experienced long-term separations from their caregivers at some point in their childhood, and most of them have been subjected to physical abuse or strict disciplinary practices. Other studies show that individuals with APD have dismissive or fearful attachment styles, which indicate that they have not established a secure attachment experience.
5. Psychosocial Factors
When psychosocial factors are evaluated in general, research findings indicate that people with APD are mostly from low socioeconomic level and from rural areas; that they migrated to cities or abroad and lived under difficult conditions in undeveloped suburbs; they come from disorganized, fragmented, chaotic families with widespread family conflicts, alcoholism, gambling, delinquency, and overbeating parents; have suffered sexual and physical abuse and neglect in their childhood and adolescence; it is seen that these people have stories of parental loss/separation from parents and emotional deprivation especially in the first years of life (Türkçapar, 2002).
It is seen that parental attitudes have a very important role in psychosocial factors. Accordingly, factors such as parents’ hostile attitudes, inadequate role models (the absence of an authority figure at home or the fact that the parents did not guide the child very little), inconsistent disciplinary behaviors, abusive behaviors, and reinforcement of the child’s anger behaviors interact with biological predispositions and play an important role in the development of the disorder. Patterson, 2002).
Another factor related to parental attitudes that plays a role in the etiology is related to the influence of parents in the process of acquiring “competence”, which is generally thought of as the opposite of antisocial behavior. It has been understood that parenting characteristics such as control, discipline, closeness and positive reinforcement are associated with variables such as academic ability, good peer relations and self-esteem, which indicate the acquisition of competence. On the other hand, the above-mentioned parenting styles prevent individuals with APD from gaining competence.
Research results indicate that sexual, emotional and physical abuse and neglect experienced in childhood are the most important factors that play a role in the etiology of APD along with many other disorders. It is known that physical and emotional abuse is associated with lower scores on intelligence tests, less empathy, cognitive impairments (deficit), higher depression, and difficulties in relationships with family and peers. It is also reported that abused children are much more aggressive towards their peers, and some of them “become abusive” while they are victims.
Approaches that provide explanations for the etiology of personality disorders in general, and AUD in particular, have gravitated towards a biopsychosocial and holistic framework over time.
It is seen that these approaches approach the disorder with a perspective that integrates with object relations and attachment theories, including explanations for interpersonal relations, and make a cognitive-interpersonal formulation.