The anxieties and discord within my tiny world and the world at large have felt heavier as of late. Thus, my words do not flow today with the relative ease that they have under different conditions. (To be clear, I’m fine. Perhaps I am just more sensitive to the energies and emotions of others.)
I recently learned about “adulthood antisocial behavioral syndrome”. If you’re familiar with the definition of antisocial personality disorder, it’s essentially that without the requirement for conduct disorder before the age of 15. (If you’re not familiar with antisocial personality disorder, allow me to refer you to my 2013 post (!) that describes the condition.)
The prevalence of these two conditions (derived from surveys of the general public) surprised me: In the United States, about 4% of the population have antisocial personality disorder, and a striking 20% apparently have adulthood antisocial behavioral syndrome. If the prevalence is 20%, should we consider that a disorder? (Is that why it’s called a “syndrome”?) That means if you invite four of your friends over to your home, one person in that group has adulthood antisocial behavioral syndrome. (Maybe it’s you!)
For many reasons (it’s exhausting, I have insufficient data, I can’t do anything to help, etc.), I avoid the intellectual exercise of considering what psychiatric conditions certain public figures may have. That being said, regardless of who is President and which political party has the majority, it is common in psychiatric education to note that there are people in power who likely have antisocial personality disorder. These individuals just haven’t gotten caught (or have the resources to avoid punishment… or there are institutional factors that protect them).
But, for “fun”, let’s run the numbers. If 4% of the US population meet criteria for antisocial personality disorder, that means
- four Senators and
- 17 House Representativies
demonstrate a “pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years”. (I’ll let you discuss amongst yourselves as to the identities of these individuals.) There are 15 Cabinet members and nine Supreme Court justices, so the chances are low that one person in either one of those groups has antisocial personality disorder.
If 20% of the US population meet criteria for adulthood antisocial behavioral syndrome, that means
- 20 Senators
- 87 House Representatives
- one Supreme Court justice and
- three Cabinet members
demonstrate a “pervasive pattern of disregard for and violation of the rights of others”… but did not do so before the age of 15.
The paper that describes the survey also notes that these two antisocial conditions are
highest among male, white, Native American, younger, and unmarried respondents, those with high school or less education, lower incomes, and Western residence
When we consider mass shootings (most certainly an antisocial behavior) in the US, most of them were committed by men… but also note that the vast majority of men don’t ever kill people.
The odds ratio for Native Americans struck me: What does that mean? Is this simply due to the low numbers of Native Americans in this country (i.e., small numbers inflate percentages)? What are the other confounders?
And what about the contexts? Aren’t there occasions when antisocial behaviors are adaptive? If someone threatens your life on a routine basis, is it (1) unreasonable to lie, (2) put your safety at risk when you try to escape the situation, and (3) perform poorly at work due to the stress in your life? You only need to meet three criteria to receive a diagnosis of antisocial personality disorder.
I’m also curious about the prevalences of adulthood antisocial behavioral syndrome in other countries. Does a 20% prevalence in the US mean anything? Do we demonstrate more antisocial behaviors than others on this planet? Maybe this is just human nature?
Some people say that intellectualization is a mature defense mechanism. I’ll let you decide if this post is simply a manifestation of whatever unconscious conflict roils in my psyche.
Maria Yang, MD 