Consult-Liaison Education Medicine

Personality Disorders (VI): Where Does the Antisocial Variety Come From?

Now that we know how the DSM defines antisocial personality disorder, let’s see what the literature[1. Unfortunately, there isn’t a lot of data for many psychiatric conditions and phenomena. This frustrates clinicians and patients alike.] says about its causes.

One paper that argues that children whose mothers are experiencing depression are more likely to demonstrate antisocial behaviors. This is a “nurture” proposal, as mothers experiencing depression may not have more difficulties with the role of parenting. This can result in more stress for the family.[2. This, along with many of the other studies discussed here, harkens back to the “schizophrenogenic mother“, which is controversial.]

The authors also argue that genetics accounts for about one-third of the association between mother and child antisocial behaviors. This is the “nature” proposal, as the data suggests that treating depression in mothers alone does not prevent the development of antisocial behaviors.

Do note that the study looked at kids at ages five and seven. We have no idea how many of these kids ultimately demonstrate symptoms consistent with conduct disorder. Recall that a diagnosis of conduct disorder (by age 15) must precede a diagnosis of antisocial personality disorder (earliest at age 18).

Here’s a paper that discusses childhood spanking and a possible relationship with antisocial behavior. (Again, this paper does not comment on the the development of conduct disorder.) The authors interviewed parents and asked them if they spanked their children in the past week. According to the paper, the more parents spanked their children, the more likely the children were to develop antisocial behaviors. The authors conclude, “When parents use corporal punishment to reduce [antisocial behaviors], the long-term effect tends to be the opposite.”

It’s not clear if the interview also screened for other events occurring in the home, including substance use, violence between the parents/caregivers, education, etc.

There’s evidence that children who “experienced substantiated child abuse and/or neglect from 1967 to 1971 in a Midwestern metropolitan county area” were, as adults, significantly more likely to demonstrate symptoms of antisocial personality disorder. These diagnoses came from a two-hour interview… which, again, generally isn’t how personality disorders are diagnosed in clinical practice. (Rarely do psychiatrists get two hours with clients and, as previously noted, personality disorders are usually diagnosed after working with a client over time.)

Here’s an argument that male children born to women with severe nutritional deficiency were more likely to develop antisocial personality disorder. The authors concluded that the risk was highest if the mother experienced “nutritional deficiency” (famine) during the first and second trimesters.

During famine and war, there are numerous relevant factors that may affect this: People can get really ill (dysentery, tuberculosis, etc.). People experience both physiological and psychological stress during these times. It may not be nutritional deficiency alone that results in antisocial personality disorder. (Furthermore, the results of this paper would suggest that populations in North Korea and Somalia should have a higher incidence of antisocial personality disorder, which does not appear to be the case.)

So, hopefully, we now have more empathy for individuals with antisocial traits or personality disorder. They often had crappy things happen to them while they were growing up. As a result of their personal histories, could they have developed ways of coping that may have worked well in the past, but don’t work so well now (and may instead be construed as antisociety)?

Next: What can we do about this? How can we help these individuals?