The Antisocial Personality Disorder

Dear Dr. LeCrone:

I am just beginning my career as a nurse and love my work. With one exception, I feel confident about helping the patients that I come in contact with.

In this instance I seem to let patients manipulate me by lying, asking for special treatment by taking advantage of my compassion for them, and making me feel guilty when I’m not complying with their requests. I know that I am very trusting, somewhat naive, hate confrontation and a people pleaser, such as you described in a previous column.

One of my colleagues says that I have trouble dealing with patients who have antisocial personality disorders. Do you agree with her?

-A reader in N.Y

Dear Reader:

Let me talk a little about antisocial personality disorder (APD), and then let you arrive at your own conclusions.

APD is characterized by a number of problems including some of the following:

• Failure to conform to social norms or lawful behaviors.

• Deceitfulness, as indicated by repeated lying, or manipulating others for personal profit or pleasure.

• Irresponsibility, impulsivity or failure to plan ahead.

• Irritability and aggression, as indicated by repeated physical fights or assaults.

• Reckless disregard for safety of self or others.

• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

APD often beginning in adolescence as conduct disorders. APD sufferers, sometimes referred to as sociopaths, are often involved in substance abuse, legal problems and other antisocial behaviors.

Frequently coming from troubled childhood and adolescent beginnings,
APD suferers have no specific racial, gender, or socio-economic backgrounds. Many have, however, been victims of abuse, poor parenting, lack of education and poverty.

These people can be very charming, disarming and fabricators of convincing stories to achieve their goals. They can fool all but the most wary and experienced people.

Getting “burned” a few times, hopefully in relatively benign situations, can help people develop some of the instincts and gut hunches necessary to spot APD sufferers before you are taken advantage of.

Guilt and remorse are largely absent in antisocial personalities, along with their lack of insight and ability to profit from the consequences of their behavior. Changes in behavior are therefore difficult to accomplish. Many professionals share your struggle in dealing with these difficult people.

I hope that this information may help you identify and successfully deal with your patients.