Abstract
Currently, the Antisocial Personality Disorder (ASPD) is at the far right of a continuum in regard to Cluster B personality disorders. Since a hundred years ago the psychotic core / the psychotic potential, due to a lack of reality testing, above a certain threshold, was brought into question. At least transitory psychotic decompensations certainly arise, as we referred to in this presentation. We refer in this paper to theoretical and clinical exemplification on a patient in the “Prof. Dr. Alex. Obregia” Psychiatric Hospital in Bucharest, who is under prolonged hospitalization, subject to certain articles of the Code of Criminal Procedure concerning compulsory admission and treatment, as a result of committing a potentially antisocial act. Explanatory perspective is based on the Treaty of Psychodynamic Psychiatry by Glen O. Gabbard, the primitive functioning of this woman raising suspicion of a personality disharmony located at the border between narcissistic (in the malign sense of the word) and anti-sociality. Explanatory concepts bring into discussion the primitive mental functioning, the immaturity of the defense mechanisms and of the thought and the behavior, characteristics of following type: projective identification, Self grandly designed, narcissistic collusion, flas Self, twinning, capacity to feel unconsciously the pulsating movements of the other, transferential – countertransferential dynamic. The aspect of adequacy / temporary loss of contact with reality, the dimension of the intelligence and the intellect of this patient, assessing antisocial acts and their consequences, the possibility to function socially or not, and the quality of the compensatory resources must not be omitted. The study has an explanatory evaluating perspective with comparative implications and rich literature references.
Highlights
The Antisocial Personality Disorder (ASPD) is at the far right of a continuum in regard to Cluster B personality disorders
This paper wants to underline the main point in the general approach of Anti-Social Personality Disorder (ASPD), which is the fact that, situated at the edge, a personality with narcissistic traits of malignant intensity is equivalent to the structuring of that personality in an Antisocial type of disorder, in which the psychotic core isn’t expressly emphasized, but an erratic behavior is intercepted, a maladapted behavior to the requirements of reality, a kind of hidden psychosis, just below the surface
There is a specialized research literature, such as a study made on 137 cocaine dependent women [10], of which more than a quarter were diagnosed with ASPD after the DSM criteria, projecting personality traits such as: irresponsibility; impulsivity; lack of realistic, longterm goals; promiscuous sexual behavior; early behavioral problems; parasitic lifestyle; insensitivity and lack of empathy; shallow affect, lack of remorse; susceptibility to boredom, grandiose sense of selfappreciation
Summary
This personality disorder has a prevalence of approximately 4% of the general population. There is a pervasive pattern of disregard for and violation of the rights of others occurring since the age of 15, as is indicated by three (or more) of the following: failure to comply with social norms about legal behavior, as indicated by repeatedly committing acts that constitute grounds for arrest; unfairness, indicated by lying repeatedly, use of alibis, manipulating others for personal profit or pleasure, impulsivity or failure to plan ahead; irritability and aggressiveness; reckless negligence to his safety or that of others; considerable irresponsibility; lack of remorse. Clinicians may overlook the diagnosis in women due to sex role stereotypes; a seductive and manipulative woman that exhibits significant antisocial activity is most likely labeled as hysterical, histrionic or borderline This tendency to mistakenly diagnose women with antisocial behavior is changing, as the social freedoms they enjoy are growing, and more of them change their lifestyle to traditionally male models. That is why it is stated that the dissocial disorder diagnosis “cannot be set before the age of 18” [1]
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