Antisocial

Overview

“Antisocial” in the context of psychology and psychiatry refers to a pattern of disregard for the rights and wellbeing of others. While it might be used casually to refer to introverted dispositions or self-isolating behavior, the [[diagnostic-and-statistical-manual-of-mental-disorders|Diagnostic and Statistical Manual of Mental Disorders]] lays out specific criteria for Antisocial Personality Disorder that manifest before the age of 15 outside of episodic co-occurring disorders:

• Failure to conform to social norms and lawful behaviors

• Deceitfulness through lying for personal gain

• Impulsivity or failure to plan ahead

• Irritability & Aggressiveness including physical assaults

• Reckless disregard for safety for oneself or others

• Consistent irresponsibility such as a failure to maintain a work ethic or meet agreed-upon obligations

• lack of remorse through indifference or rationalization

Individuals diagnosed with ASPD are almost 8 times more likely to develop substance use disorders as the general population, though this shouldn’t be taken to mean that most people with substance use disorders have antisocial personality traits. Instead, psychologists consider that someone with ASPD and substance dependence are both part of an externalizing spectrum of vulnerabilities around behavioral control. Those on the externalizing spectrum are more likely to express their negative feelings outwardly through actions rather than inwardly through depression or anxiety. Both disorders are connected to impaired or reduced activity in the prefrontal cortext that’s responsible for judgment and self-control, which then amplifies short-term rewards over long-term consequences. They’re also related through low serotonin levels that fuel irritability and impulsivity that can drive a desire for instant relief despite consequences. ASPD often features a low baseline for emotional activation that presents as boredom or feelings of emptiness.

A 2012 twin study found that the genetic risks of ASPD have two dimensions:

• disinhibition factor: this measures a genetic predisposition towards impulsivity and novely-seeking behaviors that heavily overlaps with substance use disorders

• agressive-disregard factor: this measures a genetic predisposition towards irritability and a lack of empathy that can result in physical outbursts

Other twin studies find that the factors involved in the causes of antisocial behaviors shift dramatically based on age. When under 15, twins experiencing juvenile delinquency show that shared environments through family dynamics, community trauma, and socioeconomic status play a big role in the behaviors that meet the ASPD criteria. In early adulthood however, the influence of shared family environments declines almost entirely while genetic factors and environmental factors such as specific trauma or peer groups are seen as more dominant drivers. In short, we might expect teens to act out impulsively and destructively in response to a traumatic environment, but whether that baseline continues into adulthood depends a lot on genetic factors and individual trauma. It has similar heritability to conditions like bipolar disorder and schizophrenia.

Commentary

Frank Cotton, The Hellbound Heart

[[the-hellbound-heart|The Hellbound Heart]] by Clive Barker can be interpreted as a depiction of an extreme case of unmanaged ASPD told through the lens of Gothic transgression. I’ve elsewhere given an interpretation of the character of Frank Cotton that compares his desire to experience something transcendental beyond what normal earthly sensations can provide to compulsive substance use to experience any change at all to in intolerable present state. Frank can also be seen as a stereotypical case of ASPD, as we find out that, unlike his twin brother, even as a teenager he lacked the baseline rewards from ordinary life, which compelled him to try riskier and more hedonistic options to feel something. At the same time, there’s a strong stigma attached to ASPD that can deter individuals with it from seeking treatment to the benefit of both themselves and the society they are antisocial within. Cognitive therapies addressing ASPD often reframe an individual’s approach rather than their desires, so even though they may have the desire to do something illegal for personal gain, they can pause and reason that other legitimate avenues to personal gain can be more sustainable. It appeals to rational self-interest rather than attempting to frame a disregard for others as a cognitive distortion to be challenged. With characters like Frank, it can be easy to dismiss those with ASPD as born rotten, especially when heritability studies are interpreted to mean someone was doomed to be destructive rather than at-risk.