Personality Disorders: Causal Factors of ASPD

Biological Factors

Research on the biological factors of Antisocial Personality Disorder (ASPD) has focused on both genetic and psychological factors. The concordance rate of genetic predisposition shows a higher evident rate among identical twins than in fraternal twins for ASPD. Adoption study conclusions are similar, too. When researchers compared criminal records of men who were adopted, the rate of criminality was almost twice as high when the biological father had a criminal record and the adoptive father did not—a clear sign of genetic predisposition.

The clue to genetic predisposition factors of antisocial behaviour in individuals could be the relative absence of anxiety and guilt, which seems to characterize Antisocial Personality Disorder. According to many researchers' beliefs, the psychological basis for the disorder may be a dysfunction in the brain structures governing emotional arousal and behavioral self-control. This can result in impulsive behaviour and a clinically under-aroused state; impairing avoidance learning, causing boredom, and encouraging a search for excitement. According to psychological basis, children and adults alike with antisocial behaviour patterns tend to have lower heart rates, particularly under stress.

MRIs of antisocial individuals have shown subtle neurological deficits in their prefrontal lobes—the seat of executive function; which are planning, reasoning, and behavioral inhibition; such neurological deficits are associated with a reduction of autonomic activity. This supports a long-suspected idea of severely antisocial individuals being wired differently at a neurological level, causing them to respond with less arousal and a greater sense of impulsiveness to pleasurable and unpleasurable stimuli alike.

Psychological & Environmental Factors

According to psychodynamic theorists, antisocial personalities are individuals with no conscience. Psychoanalytic theorists believe that such individuals lack anxiety and guilt because they did not develop an adequate superego. The absence of a well-developed superego causes reduction of the restraints on the identity, resulting in impulsive behaviour. Inadequate identification with appropriate adult figures is thought to cause these individuals' failure to develop a strong superego because these figures weren’t either physically or psychologically available to the child. Supporting this position, the absence of the father from home has a higher related incidence of antisocial symptoms in children, even with socioeconomic status equated.

Cognitive theorists believe that an important feature of antisocial individuals is their consistent failure in thinking about—or to anticipate the long-term negative consequences—of their acts. This results in impulsive behaviour, with thought only of their wants of the moment. From this perspective, the key to preventing these individuals from getting themselves into trouble is to help them develop cognitive control (executive function) necessary to think before acting. Learning through modelling can play an important role too.

Many antisocial personalities come from homes of aggressive and inattentive parents. Such parents become role models for aggressive behaviour and disregard for others' needs. Another important environmental factor is exposure to deviant peers. Antisocial children often learn some of their deviant behaviour from peer groups that help model antisocial behaviour and reinforce it with social approval. When environmental factors are combined with a possible genetic predisposition for antisocial behaviour, it clearly encourages a pattern of deviant behaviour.

According to the learning explanations of some biological theorists, it suggests that individuals with antisocial behaviour lack impulse control. Learning theorists believe that the reason for poor impulse control in these individuals occur due to impaired ability to develop conditioned fear responses when they are punished. This results in a deficit of avoidance learning. Hans Eysenck said a person's ability to develop a conscience depended on that person’s ability to learn fear and inhibitory avoidance responses. Individuals who fail in these aspects will have less ability to inhibit their behaviour.

Clinical studies

In accordance with this hypothesis, Adrian Raine and his co-workers did a 14-year follow-up on males who had been subjected to classical conditioning at the age of 15, in which a soft tone had been used as the conditioned stimulus (CS) and a loud averse tone as the unconditioned stimulus (UCS). Conditioned fear was measured by the participant’s skin conductance response when the CS occurred after a number of pairings with the loud UCS. According to the research findings, the men who accumulated a criminal record by the age of 29 had shown poorer conditioning at the age of 15 than those with no criminal record.

According to further studies, major damage to the grey and white matter in the prefrontal cortex, as well as autonomic deficits, can result in pseudo-psychopathic personality in patients with neurological disorders, but it is not known whether individuals with antisocial personality disorder in the community, with no discernible brain trauma, also have subtle prefrontal deficits.

When prefrontal grey and white matter volumes were assessed using structural magnetic resonance imaging in 21 community volunteers with ASPD; as well as in two control groups which comprised of 34 healthy subjects, 26 subjects with substance dependence, and 21 psychiatric controls. The autonomic activity of (skin conductance and heart rate) was assessed during a social stressor in which the participants gave a videotaped speech of their faults.

The ASPD group showed an 11 percent reduction of prefrontal grey matter volume in the absence of ostensible brain lesions and reduced autonomic activity during the stressor. These deficits were a prediction of group membership independent of psychosocial risk factors. These findings are said to be the first evidence of structural brain deficits in ASPD. This prefrontal structural deficit may underlie the low arousal, poor fear conditioning, lack of conscience, and decision-making deficits known to characterize antisocial behaviour.

Personality Disorders: Introduction to ASPD

People diagnosed with personality disorders exhibit stable, ingrained, inflexible and maladaptive thinking, feeling, and behavioural patterns. When encountered by situations where their typical pattern of behaviour does not work, their inappropriate coping skills are likely to intensify, causing their emotional controls to breakdown and unresolved conflicts to reemerge.

Personality disorders happen to be an important part of the DSM (Diagnostic and Statistical Manual of Mental Disorders) system due to the increased likelihood of them acquiring several Axis I (symptom) Disorders, particularly depression, anxiety, and substance abuse. They are also associated with a poorer recovery course from such disorders. Ann Mason and her coworkers followed anxiety patients for five years. They discovered that those who were diagnosed with additional personality disorders were 30 to 40 percent less likely to recover from their anxiety disorders.

There are ten personality disorders in the Axis II Disorders, which are divided into three clusters capturing important commonalities: dramatic and impulsive behaviours, anxious and fearful behaviours, as well as odd and eccentric behaviours.

In Europe and America, around 10 to 15 percent adults may have personality disorders. A study conducted in Norway on personality disorders has found that 13.4 percent of the condition equally distributed among both genders. The most frequently encountered were paranoid, histrionic, avoidant, and obsessive-compulsive personality disorders.

Among these personality disorders, the most destructive to society is Antisocial Personality Disorder.  Therefore, this disorder has got the most attention from clinicians and researchers over the years. A second personality disorder that attracts a great deal of attention is Borderline Personality Disorder.

Antisocial Personality Disorder (ASPD)

In the past, people with ASPD were referred to as 'sociopaths' or 'psychopaths': such terms are still in use today, though not for the purpose of formal diagnosis. In the 19th century, at times, such individuals were referred to as moral imbeciles. Individuals with Antisocial Personality Disorder are among the most inter-personally destructive and emotionally-harmful individuals. Men outnumber women by 3 to 1 according to diagnosis.

Individuals with Antisocial Personality Disorder show lack of conscience: they exhibit less guilt and anxiety, and tend to be impulsive and unable to delay gratification of their needs. They lack emotional attachment towards others. For example, a report from a person diagnosed with the disorder was as follows:

When I was in high school, my best friend died of leukaemia, and I went to his funeral. Everybody there was crying...but I suddenly realised that I didn't feel a thing. That night, I thought more about it and realised I wouldn't miss my parents if they were to die. I also realised that I didn't care for my siblings either. There was no one I cared for, but I didn't need any of them to begin with, so I rolled over and slept.

The lack of capacity to care about others may make antisocial individuals a danger to society. For example, murderers such as Ted Bundy, Charles Manson, and Jeffrey Dahmer failed to show remorse for the crimes they committed, or sympathy for their victims.

Behavioural contradictions

Antisocial individuals may often verbalise feelings and commitments with great sincerity, but their behaviours tend to indicate otherwise. They often appear to be very intelligent and charming. They also have the ability to rationalise their inappropriate behaviour, making it appear reasonable and justifiable. Consequently, they often tend to be virtuosos at manipulating others in order to talk their way out of trouble.

The aforementioned antisocial characteristics can be reflected in psychological test responses and in social behaviours. According to the Multiphasic Personality Inventory (MMPI) profile of Milwaukee killer Jeffrey Dahmer, over a period of three years, he killed and dismembered at least 17 male victims. He slept with the dead bodies, engaged in sexual acts with them, stored body parts in jars and cannibalised many of them. He was convicted for the serial murders, for which he was sentenced to 1,070 years in prison.

According to MMPI expert Alex B. Caldwell, several aspects of this profile can help explain Dahmer's bizarre and destructive behaviour. His extraordinary high score on the psychopathic deviate scale is a reflection of antisocial impulsiveness coupled with a total lack of capacity for empathy and compassion. In all likelihood, his victims were regarded as no more than objects to satisfy his perverse needs.

Depression-Anxiety Discrepancies

According to Caldwell, there was a marked discrepancy between the depression and psychasthenia (anxiety) scales, which is rarely seen on the MMPI, reflecting Dahmer's sense of being fated or doomed to repeat his acts until he's caught: the high depression score, together with an absence of fear that, in normal people, may inhibit murderous behaviour (the low psychasthenia score).

Even though his profile was an indication of his high levels of psychological disturbance, it also reflects Dahmer's ability to mask his pathology under the normal facade which he used for years to fool law enforcement officials. Dahmer's general demeanour looked so normal that despite the horrific acts and the level of psychopathology shown in his results, his plea of not guilty by reason of insanity was rejected by the jury. Instead, he was sent to prison, where he was murdered by another inmate.

Individuals with antisocial personalities tend to display a perplexing failure in response to punishment due to their lack of anxiety, making the threat of punishment not a reason to deter from engaging in self-defeating or illegal acts over and over. This results in some of them developing imposing prison records.

An individual has to be at least 18 years old to be diagnosed with antisocial personality disorder. However, there is a requirement of substantial diagnostic criteria before the age of 15, which includes acts of habitual lying, excessive drinking, use of drugs, theft, vandalism, early and aggressive sexual behaviour, and chronic rules violations at home and school. Thus, Antisocial Personality Disorder is the culmination of deviant patterns of behaviour typically beginning at childhood.

Causal Factors of Schizophrenia

Schizophrenia has long been a focus of research due to the seriousness of the disorder as well as the many years of anguish and incapacitation experienced by the patients. Predisposition to schizophrenia is high if an immediate family member has the disorder, but there are chances of developing Schizophrenia even without a family history of the disorder.

Biological factors

Genetic predisposition:

Strong evidence exists of genetic predisposition to schizophrenia, but some develop the disorder without family history. The more closely an individual is related to a person with the disorder, the higher the chances are of him developing it. According to studies, identical twins have a higher rate of developing the disorder than fraternal twins. Adoption studies show a higher concordance with biological parents than with adoptive parents.

But genetics is not the only cause; if it was, the concordance rate of schizophrenia in twins would be at 100 percent. Schizophrenia develops in adulthood. Men develop symptoms of schizophrenia in their late teens or early twenties, while women show symptoms of the disorder in their twenties or thirties. More subtle signs of the disorder maybe present earlier, such as poor performance in school, troubled relationships, and lack of motivation.

Brain abnormalities:

Brain scans of such individuals indicate a number of structural abnormalities. According to the Neurodegenerative Hypothesis, the destruction of neural tissue can cause schizophrenia. MRI studies have shown mild to moderate brain atrophy; a general loss or deterioration of neurons in the cerebral cortex and limbic system, together with enlarged ventricles (cavities containing cerebrospinal fluid).

The atrophy is centered in the brain region influencing cognitive process and emotion. This may explain the thought disorders and inappropriate emotions seen in such patients. Likewise, MRI images of the thalamus, which collects and routes sensory input to various parts of the brain, reveal abnormalities as well. This may help account for the disordered attention and perception reported by the patients whose cerebral cortex may be getting garbled with unfiltered information of the thalamus. These structural differences are more common in patients exhibiting negative symptoms.

Biochemical factors:

Dopamine, a major excitatory neurotransmitter, may play a key role in schizophrenia. According to the Dopamine Hypothesis, the symptoms of schizophrenia, specifically the positive symptoms, are produced by overactivity of the dopamine system in areas of the brain which regulate emotional expression, motivational behaviour, and cognitive function.

Individuals diagnosed with schizophrenia have more dopamine receptors on neuron membranes than non-schizophrenics. These receptors seem to be overactive to dopamine stimulation and additionally, the effectiveness of antipsychotic drugs used to treat this disorder are positively related to their ability to reduce dopamine-produced synaptic activity. Other neurotransmitter systems could be involved in this complex disorder, too. Considering the biochemical and brain findings concerning schizophrenia, it is not clear whether they cause the disorder or vice versa.

Psychological factors

Freud and other psychoanalytic thinkers' view of schizophrenia was that it is a retreat from unbeatable stress and conflict. To Freud, schizophrenia represented an example of an extreme defence mechanism of regression, in which such a person retreats to an earlier and more secure (even infantile stage) of psychological development, when faced with overwhelming anxiety. Other psychodynamic thinkers, focusing on the interpersonal withdrawal, which is an important feature of schizophrenia, tend to view the disorder as a retreat from an interpersonal world that’s too stressful to deal with.

Even though Freud’s explanation on regression hasn’t received much direct research support, the belief of stress as a causal factor is accepted today. Some cognitive theorists believe that people with schizophrenia have a defect in the attention mechanism which filters out irrelevant stimuli, making them feel overwhelmed by both internal and external stimuli and in turn, causing sensory input to become a chaotic flood, resulting in irrelevant thoughts and images flashing into consciousness. The stimulus overload produces distractability, thought disorganisation, and a sense of being overwhelmed by disconnected thoughts and ideas.

As one schizophrenic noted, “Everything seems to come pouring in at once…I can’t seem to keep  anything out” (Carson). The recent MRI findings on thalamic abnormalities described earlier may help explain how the stimuli overload could occur through a malfunction of the brain's switchboard.

Environmental factors

Stressful life events seem to play an important role in the emergence of schizophrenic behaviour. Two to three weeks preceding a 'psychotic break', when acute signs of schizophrenia appear, these events tend to cluster. Stressful life events seem to interact with such a person's personality or biological vulnerability factors. A highly-vulnerable individual may require just a small stressful event to reach the breaking point. In a study, psychotic and non-psychotic individuals rated their emotional responses as they encountered stressful events in their daily lives. The psychotic individuals' reactions to their stresses were more intense with negative emotions, suggestive of emotional overactivity being a vulnerability factor.

Family dynamics have for long been a prime suspect in the origins of this disorder, but the search for characteristics of a parent or family causing the disorder has largely been unsuccessful. Significantly, children with biologically normal parents who are raised by adoptive parents with the schizophrenic disorder do not show an increased risk of developing the disorder. Although schizophrenic individuals often are from families with problems, the nature of the seriousness of such problems is not different from those of which non-schizophrenics are raised.

This does not mean that family dynamics are unimportant; it may just mean that a person must have a biological vulnerability factor in order to be affected by stressful family events to such a degree. There is indeed evidence that this vulnerability factor may appear early in life. In a study conducted by researchers, pre-schizophrenic children and their non-schizophrenic brothers and sisters were analysed using home movies of schizophrenic children. Even at these early ages, sometimes a child as young as two years old seem to show more odd and uncoordinated movements and less emotional expressiveness, especially for positive emotions. These odd behavioural patterns may not just reflect a vulnerability factor, but may also help create environmental stress by evoking negative reactions from others.

Although researchers have had difficulty pinpointing family factors contributing to the initial appearance of this disorder, one finding is consistent of previously-hospitalised schizophrenics being more likely to relapse when returned to a home environment that is high in a factor called 'Expressed Emotion'. Expressed emotion involves high levels of criticism, hostility, and over-involvement. One review of 26 studies showed that within 9-12 months of returning home, an average relapse of 48% in patients with  families who were high in expressed emotion, compared with a relapse rate of 21% with families that were low in this factor.

However, before we conclude on high expressed emotions causing relapses in patients, there is a finding from another study worth noting; which are videotapes of actual interactions between patients and their families. Analysis of the videotapes revealed that families who were high in expressed emotion did indeed make more negative comments to patients when they engaged in strange behaviours, but they also showed these patients behaving around four times as many strange behaviours, clouding the issue of what causes what. Thus, high expressed emotion may be a cause of a response to these patients' disordered behaviours; because people with this disorder can be overly sensitive to stress and even mildly negative family reactions could trigger underlying biological vulnerabilities, resulting in a relapse.

Sociocultural factors 

Sociocultural factors are undoubtedly linked to schizophrenia. According to many studies, the highest prevalence of schizophrenia is found in lower socioeconomic populations.Why is this? Is schizophrenia caused due to poverty, or is it an affect of the disorder? Two views tend to give opposite answers. The Social Causation Hypothesis attributes the higher prevalence of schizophrenia  to the higher levels of stress experienced by low-income people, particularly in urban environments.

In contrast, the Social Drift Hypothesis proposes that with the development of schizophrenic disorder, these individuals' personal and occupational functions tends to deteriorate, causing them to drift down the socioeconomic ladder into poverty and migrate to economically depressed urban environments. Perhaps both social causation and social drift maybe at work, for the factors linking poverty, social and environmental stressors, as well as schizophrenia, are undoubtedly complex.

In contrast to most disorders, schizophrenia may be a culture-free disorder. According to a worldwide epidemiological study sponsored by the World Health Organisation, the prevalence of schizophrenia  is not dramatically different throughout the world. Researchers have, however, found that the likelihood of recovery is greater in developing countries than in the developed nations, such as North America and Western Europe. This may be due to stronger community orientation and greater social support extended to disturbed individuals in developing countries.

Schizophrenia reflects complex interactions among psychological, biological, and environmental factors and presents prominent causal factors identified by analysis. Some patients do well with treatment and live productive lives, while others continue to be symptomatic. As this disorder starts in early adulthood, these individuals can benefit from rehabilitation and help them develop management skills, complete education or vocational training, and hold onto a job. This helps with self-sufficiency in people afflicted with schizophrenia.

There is no cure for schizophrenia, but management of symptoms with medication, cognitive behavioural therapy, and supportive psychotherapy. Substance abuse is high in schizophrenic patients, owing to the misuse of drugs, which can make diagnosis harder.

Schizophrenia: The Split Mind

According to Hogarty, schizophrenia is the most bizarre and, in many ways, the most puzzling of all psychological disorders. It is also one of the most challenging disorders to treat effectively. Despite many theories and thousands of research studies, schizophrenia remains one of the least understood disorders.

Schizophrenic symptoms include severe disturbances in thinking, speech, perception, emotion, and behaviour. Schizophrenia is one of a family of psychotic disorders which involve a certain amount of loss of contact with reality and bizarre behaviours and experiences.

The term 'Schizophrenia' was introduced by Swiss psychiatrist Eugene Bleuler in 1911. It literally means 'split mind'. This has led people to confuse it with Dissociative Identity Disorder (Multiple Personality Disorder). However, when Bleuler came up with the term 'Schizophrenia', multiple personalities were not on his mind. What he intended to suggest was that certain psychological functions such as emotions, thoughts, or languages; which are usually integrated with one another; were somehow split apart or disconnected in patients with the disorder.

Characteristics of Schizophrenia

Diagnosis of schizophrenia is based on evidence that such a person misinterprets reality and exhibits disordered attention, thought or perception. In addition, this individual will withdraw from social interactions, communicate in strange or inappropriate ways, neglect personal grooming, and behave in a disorganised fashion.

Schizophrenic thoughts tend to be delusional at times, which consist of false beliefs sustained in the face of evidence that normally could be sufficient to destroy them. An individual with schizophrenia may tend to believe that his brain is being turned to glass by ray guns operated by his enemies from outer space (a delusion of persecution or that Jesus Christ is one of his special agents or a delusion of grandeur). During the period of recovery, a patient with schizophrenia described several aspects of thought disorders.

The most wearing aspects of this disorder are the fierce battles going on inside their heads with unresolvable conflicts. Their minds can divide on a subject, and the two parts can subdivide over and over again until they feel as if their minds are in pieces. At other times, they may feel like they are trapped inside their heads, banging against its walls in a desperate attempt to escape.

As individuals progress into schizophrenic condition, their perception becomes disorganised and their discarded thoughts tend to become more pronounced. Unwanted thoughts constantly tend to intrude their consciousness. Some patients experience hallucinations; false perceptions with a compelling sense of reality. Auditory hallucinations, which are typically voices speaking to such patients, are the most common, but visual and tactical hallucinations may occur, too. The following is an individual's description of his hallucinations:

As of recent, my mind has played tricks on me, creating people inside my head who come out at times to haunt and torment me. They surround me in rooms, hide behind trees and under the snow outside. They taunt me and scream at me while devising plans to break my spirit. The voices tend to come and go, but the people never leave and are always real.

The language of schizophrenic people is often disorganised and may contain strange words. A patient's language, at times, may contain word assassinations based on rhymes or other associations, rather than meaning. Consider the following conversation between a psychologist and a hospitalised  schizophrenic patient:

After two weeks, the psychologist said to the patient, "As you say, you are wired precisely wrong. But why won't you let me see the diagram?" The patient answered, "Never ever will you find the lever; the external lever which will sever me forever with my real, seal, deal, heel. It is not in my shoe, not even in the sole. It walks away." (Rosenhan &Seligman).

Schizophrenia can affect emotions in a number of ways. Many individuals with schizophrenia have Blunted Affect. Manifesting less sadness, joy, and anger than most people do. Others have a Flat Affect, showing almost no emotions at all. Their voices are monotonous, their faces impassive. Inappropriate Affect can occur, too, as in the following case:

The psychologist noted that the previous patient smiled when he felt uncomfortable, and more so when he was in pain. He cried during television comedies and seemed to be angry when justice was served. He got frightened when complimented by someone, and roared in laughter upon reading of a young child being burnt in a fire.

Subtypes of Schizophrenia

Schizophrenia has cognitive, emotional and behavioural facets that can widely vary from case to case. The Diagnostic and Statistical Manual of Mental Disorders differentiates among four major subtypes of schizophrenia.

• Paranoid Schizophrenia, whose most prominent features are delusions of persecution, making them believe that others want to harm them, and delusions of grandeur, which makes them believe that they are of enormous importance. Suspicion, anger or anxiety may company their delusions, and hallucinations are also possible. 

• Disorganised Schizophrenia, whose central features happen to be confusion and incoherence, together with severe deterioration of adaptive behaviours such as social skills, personal hygiene, and self-care. Their thought disorganisation, at times, is so extreme that it makes it hard to communicate with them. At times, their behaviour appears to be silly and childish, with emotional responses that are highly inappropriate. Individuals with disorganised schizophrenia are usually unable to function on their own.

• Catatonic Schizophrenia is characterized by striking motor disturbances which range from muscle rigidity to random or recitative movements. Individuals with repetitive schizophrenia, at times, alternate between stuporous states, in which they seem to be oblivious to reality, and agitated excited, during which they can be dangerous to others. During this stuporous state, they may exhibit waxy flexibility, in which their limbs can be moulded by another into grotesque positions, which can be maintained for hours.

Undifferentiated Schizophrenia is a category assigned to individuals who exhibit some symptoms and thought disorders of the above categories.

In addition to these categories, many health workers and researchers divide schizophrenia reactions into two main categories on the basis of two classes of symptoms. One type is characterised by a predisposition of positive symptoms, which are bizarre behaviours like delusions, hallucinations, and disordered speech and thinking. These symptoms are called positive in the account of them representing the pathological extremes of normal processes. The second type features are negative symptoms, which is the absence of normal reactions such as the lack of emotional expression, loss of motivation, and an absence of speech.

The distinction between positive and negative symptoms seem to be an important one. Researchers have found differences in brain functions in both schizophrenics with positive symptoms and primarily negative symptoms. These subtypes show differences in life history and prognosis, too. The negative feelings are likely to be associated with a long history of poor functioning prior to diagnosis, and a poor outcome following treatment.


Schizophrenia affects around 1 percent of the world's population and 1.2 percent of Americans have schizophrenia. Some who are not hospitalised barely function on their own.