A Case of Antisocial Personality Disorder
By: THEODORE MILLON
et al.
Notes:
(1) Numbers mark aspects of the case most consistent with DSM
criteria as follow, and
do not necessarily indicate that the
case “meets” diagnostic criteria in this respect.
(2) Patient's name has been changed in respect to confidentiality,
and name mentioned is not of a real existent person.
Case of Toni
Toni presented for therapy as mandated by court order. She
was recently charged with disturbing the peace, after a fight with her neighbor escalated into punching and
shouting, and with possession of narcotics with intent to sell (4).
People in her apartment building describe her as “impossible
to get along with, with a real chip on her shoulder.” She puts forward an image of provocation
and challenge that the
other residents find intimidating. She dresses the part well, with a black leather
jacket, numerous body piercings, and tattoos on every knuckle. Her hostility and penchant for
lying about every
detail from the important to the insignificant make history-taking difficult. When asked
what started the fight that led to her latest arrest, she replies, “Cause I don’t take
anybody’s shit.”
Although Toni is only 23 years old (B),
her tough exterior and hard lifestyle make her appear much older. She scoffs
when asked about her religious affiliation: “Jesus don’t love nobody, or at
least he don’t love me. The only religion I have is ‘do unto others before they
do unto you.’” Her
police record corroborates this life philosophy (1). It includes multiple arrests for possession,
theft, and prostitution.
Toni is known by a variety of different names throughout the city, some based
on stolen identities
of real people and some purely invented. She has a collection of driver’s licenses and
social security cards that help her set up lines of credit across town. She proudly boasts that
she has perfected the art of obtaining huge lines of credit in electronics
stores based on
false identities and then selling the goods for quick cash (2).
Toni is the middle of five children, including two
stepchildren, and she does not maintain contact with any of her siblings. Her
father died when
she was 5 years old under mysterious conditions, possibly drug-related. Her stepfather paid
little attention to the children and worked away from home most of the time. Discipline was
administered sporadically
and violently by her mother, who would often explode in alcohol-induced rages. During these
episodes, Toni usually ran away and stayed overnight with friends, until things “cooled
down.”
As the interview moves on, Toni clearly states that she has entered therapy only to avoid prison time for trying to sell cocaine to an undercover cop. She is quick to rationalize and blame others for her current plight: “The apartment was my boyfriend’s. I just knew where the stuff was. That cop was a good actor cause I thought he would kill me if I hadn’t sold it to him.” To hear her tell it, she was an innocent victim, just in the wrong place at the wrong time (2).
The quality of her home life appears to have deteriorated as
the years went on. Her school attendance became irregular when her
mother took an
early morning job at a bakery near their home to pay the bills. With no one at home to monitor
her behavior, Toni found it much more interesting to spend the day at the riverfront than
at school.
Eventually, she began using marijuana and then selling it casually as a means
of supporting her own habit. Robbing strangers, usually women, at knifepoint was something
she did “a couple of times a month.” (C)
By the time she was 15, her visits home became infrequent,
which Toni attributes to her mother’s explosive temper. By the time she was 18, she had been
arrested three times, once for possession, once for shoplifting, and once for animal abuse
when she lit a
stray cat on fire with hairspray and a cigarette lighter.
When asked if she feels guilty for any of this, she says, “No way,
no one ever felt
guilty for what they did to me.”(7) She admits to heroin use and occasional needle sharing and
says she is not afraid of HIV. “Whatever happens, happens, you know.”(5)
When asked about her family of origin, Toni states, “Don’t
have one, don’t need one!” When asked how she supports herself, she
says with a smirk, “I
get by.” In fact, she has never held a job for more than three weeks. “I’m not the kind of
person that can get up in the morning and be somewhere on time,” she says, “and
besides, who could make it on what they want to give you? I am looking for
bigger and better
things.”(6)
DSM-IV Criteria
A. There is a pervasive pattern of
disregard for and violation of the
rights of others occurring since
age 15 years, as indicated by
three (or more) of the following:
(1) failure to conform to social norms with respect to lawful behaviors 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 safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior
or honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated,
or stolen from another
B. The individual is at least age 18 years.
C. There is evidence of Conduct Disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.
(1) failure to conform to social norms with respect to lawful behaviors 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 safety of self or others
(6) consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior
or honor financial obligations
(7) lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated,
or stolen from another
B. The individual is at least age 18 years.
C. There is evidence of Conduct Disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.
References
(1)
Personality Disorders in Modern Life, second edition, 2000, 2004 by John Wiley
& Sons, Inc.
(2)Diagnostic and Statistical Manual of Mental Disorders,
Fourth Edition. Copyright
1994 American Psychiatric Association.
No comments:
Post a Comment