53-2 What are the three clusters of personality disorders? What behaviors and brain activity characterize the antisocial personality?

The disruptive, inflexible, and enduring behavior patterns of personality disorders interfere with social functioning. These disorders tend to form three clusters, characterized by

A person with antisocial personality disorder is typically a male whose lack of conscience becomes plain before age 15, as he begins to lie, steal, fight, or display unrestrained sexual behavior (Cale & Lilienfeld, 2002). About half of such children become antisocial adults—unable to keep a job, irresponsible as a spouse and parent, and assaultive or otherwise criminal (Farrington, 1991). (These people are sometimes called sociopaths or psychopaths.) They may show lower emotional intelligence—the ability to understand, manage, and perceive emotions (Ermer et al., 2012). When the antisocial personality combines a keen intelligence with amorality, the result may be a charming and clever con artist—or even a fearless, focused, ruthless soldier, CEO, or politician (Dutton, 2012).

Despite their remorseless and sometimes criminal behavior, criminality is not an essential component of antisocial behavior (Skeem & Cooke, 2010). Moreover, many criminals do not fit the description of antisocial personality disorder. Why? Because they actually show responsible concern for their friends and family members.

Antisocial personalities behave impulsively, and then feel and fear little (Fowles & Dindo, 2009). Their impulsivity can have violent, horrifying consequences (Camp et al., 2013). Consider the case of Henry Lee Lucas. He killed his first victim when he was 13. He felt little regret then or later. He confessed that, during his 32 years of crime, he had brutally beaten, suffocated, stabbed, shot, or mutilated some 360 women, men, and children. For the last six years of his reign of terror, Lucas teamed with Ottis Elwood Toole, who reportedly slaughtered about 50 people he “didn’t think was worth living anyhow” (Darrach & Norris, 1984).

Antisocial personality disorder is woven of both biological and psychological strands. Twin and adoption studies reveal that biological relatives of people with antisocial and unemotional tendencies are at increased risk for antisocial behavior (Frisell et al., 2012; Tuvblad et al., 2011). No single gene codes for a complex behavior such as crime. Molecular geneticists have, however, identified some specific genes that are more common in those with antisocial personality disorder (Gunter et al., 2010). The genetic vulnerability of people with antisocial and unemotional tendencies appears as a fearless approach to life. Awaiting aversive events, such as electric shocks or loud noises, they show little autonomic nervous system arousal (Hare, 1975; van Goozen et al., 2007). Long-term studies have shown that their levels of stress hormones were lower than average when they were youngsters, before committing any crime (FIGURE 53.1). Three-year-olds who are slow to develop conditioned fears are later more likely to commit a crime (Gao et al., 2010). Other studies have found that preschool boys who later became aggressive or antisocial adolescents tended to be impulsive, uninhibited, unconcerned with social rewards, and low in anxiety (Caspi et al., 1996; Tremblay et al., 1994).

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Traits such as fearlessness and dominance can be adaptive. In fact, some argue that psychopaths and heroes are twigs off the same branch (Smith et al., 2013). If channeled in more productive directions, fearlessness may lead to star-level athleticism, adventurism, or courageous heroism (Poulton & Milne, 2002). One analysis of 42 American presidents showed that they scored higher than the general population on such traits as fearlessness and dominance (Lilienfeld et al., 2012). Consistent with evidence that such traits can run in families, two of the most fearless and dominant presidents were distant cousins with the same last name: Roosevelt. (Two of the least fearless and dominant presidents were a father and son, John Adams and John Quincy Adams.) Lacking a sense of social responsibility, the same disposition may produce a cool con artist or killer (Lykken, 1995).

Genetic influences, often in combination with child abuse, help wire the brain (Dodge, 2009). In people with antisocial criminal tendencies, the emotion-controlling amygdala is smaller (Pardini et al., 2013; Yang et al., 2010). The frontal lobes are also less active, as Adrian Raine (1999, 2005) found when he compared PET scans of 41 murderers’ brains with those from people of similar age and sex (FIGURE 53.2). This area of the cortex helps control impulses. The reduced activation was especially apparent in those who murdered impulsively. In a follow-up study, Raine and his team (2000) found that violent repeat offenders had 11 percent less frontal lobe tissue than normal. This helps explain why people with antisocial personality disorder exhibit marked deficits in frontal lobe cognitive functions, such as planning, organization, and inhibition (Morgan & Lilienfeld, 2000). Compared with people who feel and display empathy, their brains also respond less to facial displays of others’ distress, which may contribute to their lower emotional intelligence (Deeley et al., 2006).

A biologically based fearlessness, as well as early environment, helps explain the reunion of long-separated sisters Joyce Lott, 27, and Mary Jones, 29—in a South Carolina prison where both were sent on drug charges. After a newspaper story about their reunion, their long-lost half-brother Frank Strickland called. He explained it would be a while before he could come see them—because he, too, was in jail, on drug, burglary, and larceny charges (Shepherd et al., 1990). The genes that put people at risk for antisocial behavior also put people at risk for substance use disorders, which may help explain why these disorders often appear in combination (Dick, 2007).

Genetics alone do not tell the whole story of antisocial crime, however. In another Raineled study (1996), researchers checked criminal records on nearly 400 Danish men at ages 20 to 22. All these men either had experienced biological risk factors at birth (such as premature birth) or came from family backgrounds marked by poverty and family instability. The researchers then compared each of these two groups with a third biosocial group (people whose lives were marked by both those biological and social risk factors). The biosocial group had double the risk of committing crime (FIGURE 53.3). Similar findings emerged from a famous study that followed 1037 children for a quarter-century: Two combined factors—childhood maltreatment and a gene that altered neurotransmitter balance—predicted antisocial problems (Caspi et al., 2002). Neither “bad” genes alone nor a “bad” environment alone predisposed later antisocial behavior. Rather, genes predisposed some children to be more sensitive to maltreatment. Within “genetically vulnerable segments of the population,” environmental influences matter—for better or for worse (Belsky et al., 2007; Moffitt, 2005; Pluess & Belsky, 2013).

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With antisocial behavior, as with so much else, nature and nurture interact and the biopsychosocial perspective helps us understand the whole story. To explore the neural basis of antisocial personality disorder, neuroscientists are trying to identify brain activity differences in criminals who display symptoms of this disorder. Shown emotionally evocative photographs, such as a man holding a knife to a woman’s throat, criminals with antisocial personality disorder display blunted heart rate and perspiration responses, and less activity in brain areas that typically respond to emotional stimuli (Harenski et al., 2010; Kiehl & Buckholtz, 2010). They also have a larger and hyper-reactive dopamine reward system, which predisposes their impulsive drive to do something rewarding despite the consequences (Buckholtz et al., 2010; Glenn et al., 2010). Such data provide another reminder: Everything psychological is also biological.