Antisocial Personality Disorder is characterized by a gross disregard for the rights of others, as well as probably frequent violations of others’ rights. These behaviors typically develop into a recognizable pattern occurring in early- to mid-adolescence and continuing into adulthood. Diagnostic criteria require a minimum of three “symptoms” from a list of seven (DSM-IV-Tr, p.706):
1. Failure to conform to social norms (e.g.disrespect for the law, repeated arrests)
2. Deceitfulness (e.g. lying, conning others for personal gain)
3. Impulsivity or failure to plan ahead
4. Irritability and aggressiveness (e.g.repeated fights or assaults)
5. Reckless disregard for safety of self or others
6. Consistent irresponsibility (e.g. failure to maintain a steady job, failure to honor financial obligations)
7. Lack of remorse (e.g. indifference, rationalizes hurting, mistreating, or stealing from others)
Additionally, for an official diagnosis the individual should be at least 18 years of age at the time of assessment, there may be evidence of a conduct disorder prior to age 15, and the antisocial behavior should not occur exclusively during the course of schizophrenia or a manic episode (DSM-IV-Tr, p.706).
Borderline Personality Disorder
Borderline Personality Disorder is characterized by a noted instability in interpersonal relationships, self-image, affect, and impulsivity beginning in early adulthood. There are nine listed “symptoms” or diagnostic criteria, of which five or more must be present at the time of assessment for an official diagnosis (DSM-IV-Tr, p.710):
1. Frantic efforts to avoid abandonment (real or imagined) [this does not include suicidal of self-mutilating behaviors]
2. A pattern of unstable and intense relationships (often traversing from extreme idealization to extreme devaluation)
3. Identity disturbance (unstable self-image or sense of self)
4. Impulsivity in at least two area that are potentially self-damaging (e.g. sex, spending, substance abuse, binge eating, driving)
5. Recurrent suicidal behaviors, gestures, threats, or self-mutilation
6. Affective instability from marked reactivity of mood (e.g. irritability, anxiety, dysphoria)
7. Chronic feelings of emptiness
8. Inappropriate, intense anger or difficulty controlling anger (e.g. frequent temper displays, constantly angry, physical fights)
9. Transient, stress-related paranoia or severe dissociative symptoms
Possible Bias or Evolutionary Origins in Gender Disparity
While Antisocial Personality Disorder (ASPD) is frequently seen as being diagnosed more often in males, and Borderline Personality Disorder diagnosed more often in females which is far greater than the ASPD gender disparity, there is research to suggest that this disparity may be more likely due to bias on the part of the assessing psychologists, or perhaps more specifically a bias in the diagnostic criteria. There is also research that suggests “Mother Nature” factors that may lead to the gender disparity.
Evolutionarily speaking, women who were more cautious, fearful of potential dangers, and participated in less risk-taking behaviors likely survived to procreate. ASPD diagnostic criteria basically include a sense of fearlessness and participation in various risky behaviors and activities, which may indicate a possible reason for it’s infrequent diagnosis in women. Whereas BPD is basically characterized by anxious and fearful behaviors and patterns, particularly the abandonment focus, which all could play a role in whether or not a female prehistoric ancestor survived. If you’re a prehistoric woman, regardless of whether you’ve selected wisely for your mate, if he abandons you your survival may be in jeopardy. Also, females more often than not display less aggressive personality and behavior patterns which may also contribute to the gender disparity.
Cultural Differences in Personality Disorder Diagnosis
Cross-culturally, some behaviors are widely supported and praised, which may lead to confusion with cross-culturally affected personality disorder assessments, including assessments of individuals from varied regions within a culture. For example, the DSM-IV-Tr states that ASPD appears to be associated with low socioeconomic status (SES) and urban settings. In some individuals, the diagnostic criteria may mistakenly fit what seems to be ASPD but is actually more of a protective survival strategy (DSM-IV-Tr, p. 704). With regard to BPD, careful evaluation of the emotional instability should be performed to ensure that there is not another cause aside from a personality disorder. For example, confusion or conflict in the individual’s sexual orientation, social pressures, anxiety-provoking choices, substance abuse, or existential dilemmas, among other possibilities, may contribute to the observable behaviors.
Problems for Forensic Psychologists
For forensic psychology professionals it is important to remember that there may be significant bias in the diagnostic criteria that leads one to an ASPD diagnosis over some other personality disorder, or the same for BPD. Additionally, diagnostic criteria are widely available to the general public and careful attention should be given to the consistency of behavior patterns in individuals being assessed, especially in legal settings. Disturbances in one’s thinking are not necessarily a free ticket from criminal responsibility.
Additionally, individuals presenting with ASPD and BPD can be manipulative, convincing of their “remorse” or their desire to “get better” only to turn around and continue their disordered behaviors. It is rare to find an individual presenting with ASPD who understands they’re “in the wrong” and need intervention or help. Individuals presenting with BPD are far more likely to be distressed from their behaviors and thought patterns and seek or accept help. Considering the overly biased diagnosis of BPD in women, and the typical concept of men not wanting help, this could also contribute to the gender disparity.
References:
Barlow, D., Durand, M. (2009). Abnormal Psychology: An Integrative Approach.
American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Illnesses.
Leedom, L. (2007). Gender bias against men in diagnosis of sociopathy.
