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 Jim
A
20-year-old female business major sought counseling because her father, Jim,
age 50, (B) was arrested by local
police outside a bar about 70 miles from his home in western Kansas. According
to the police report, he was drunk, attempted to provoke a fight with several
bar patrons, made lewd and lascivious remarks to two women inside, and seemed
confused about his whereabouts and purpose. At the jail, he seemed stuporous,
apathetic, and barely capable of communicating. After repeatedly refusing to answer
the officers’ questions, he was transferred to the state hospital for
observation. (1)
Gradually,
the sad story of Jim’s childhood unfolded in therapy. He had been the third of
seven children. His mother was hardworking but died when Jim was 11; his father
was a drifter and periodic drunkard who died when Jim was 10. The younger
siblings became wards of the state and were eventually placed in foster care.
Jim, however, ran away when he was 14, wandering from town to town across
Kansas, occasionally staying with relatives until he became so disruptive he
was thrown out. In the meantime, he sampled any illicit drug he could lay his
hands on. (C)
At
18, Jim enlisted in the Navy, lying about his history of substance abuse. He
found the structure stifling and greatly resented taking orders, getting up
early day after day, and being forced to be respectful to those in authority. Within
18 months, he was court-martialed for assaulting an officer and being
intoxicated while on duty. After a brief stint in the brig, he was handed a
dishonorable discharge. (2) Upon release, he took up residence in a
rundown part of Kansas City, working irregularly as a dishwasher and cook. (6)
Between jobs, he admitted that he
sometimes mugged vulnerable elderly women “for fun” and as a means of securing
rent money. (1)
At
age 30, he met and married an apparently histrionic female barely 20 years old,
who occasionally worked as a prostitute to support her own pattern of heroin
addiction. Jim tried heroin but found it nauseating and decided to stick with
rock cocaine. Together they lived miserably for three years. Their only child
was born six months into the marriage. After a particularly brutal marital
fight that left the wife with a broken arm and fractured skull (5) and
Jim with a month’s sentence in jail, Jim’s wife left him for a new boyfriend,
though they were never legally divorced.
Over
the next few years, Jim became more heavily involved in drug related crime.
Drifting from Kansas City to St. Louis to Memphis and finally to New Orleans,
he began dealing drugs in earnest. Eventually arrested in a sting operation, he
agreed to turn state’s evidence in exchange for a reduced sentence of five years.
(1)
His
relationship with his daughter has been one of broken promises and disappointments. On the rare occasions he would breeze into town, he
would make grand promises to her that he had transformed his life and was going
to try to win custody of her. He would then describe all of the gifts he was
going to buy her and the blissful life they would lead together. He would then
disappear just as quickly as he had entered, once stealing her new bike and
another time persuading her to steal a ring from her mother’s bureau drawer.
(2) No matter how desperately she
wanted him to love her, he seemed incapable of showing her any affection or
feeling.
Currently,
Jim has been paroled for four years and again lives on the outskirts of a small
Kansas town. He prefers not to bother people and likes to be left alone. About
once a year, however, he goes on a binge, spending most of his money, brawling,
and landing in jail. He is known by the judge and the local police, who now
consider him more as an annoying nuisance than a major threat to society. He is
usually confined in the county jail for about a month, after which he is
released to alleviate overcrowding. (4) Between these sprees, he is typically sober.
DSM-IV Criteria
(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.
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