The video below is the Antisocial Behavior section from Part 1 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything they need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 1, click here.
Transcript of DSM-5 EPPP Lecture Video: Antisocial Behavior
Antisocial Behaviors are defined as activities that disregard societal norms or standards of appropriate behavior, and that violate the rights of others.
They have the potential for serious harm to others. Breaking the law, manipulating others for personal gain or amusement, lying, lack of concern for the well-being or feelings of others, and acts of violence are just a few examples of Antisocial Behaviors.
A major subdivision of Antisocial Behavior (ASB) involves (a) “overt” ASB (e.g., fighting, verbally confronting another, etc.) vs. (b) “covert” ASB (e.g., stealing, destroying property, lying).
This distinction is related to a continuum of such behavior patterns, with noncompliance and defiance located at the midpoint of this continuum.
Antisocial Behavior is a prominent feature in some mental disorders such as Antisocial Personality Disorder and Conduct Disorder. Antisocial Behavior that is not due to a mental disorder can be a focus of clinical attention as evidenced by the inclusion in the DSM-5 inclusion of V codes for Adult Antisocial Behavior and Child or Adolescent Antisocial Behavior (APA, 2013).
There is a huge number of risk factors for developing antisocial tendencies in childhood or adolescence; it is typically a combination of risk factors that best predicts the development of ASB. These risk factors can be categorized into three domains: individual factors, family or societal factors, and school-based factors.
Individual risk factors include the inability to regulate emotions, the need for instant gratification, impulsivity, substance use, lower levels of intelligence, associating with deviant peers, alienation or rejection by peers, a seeming imperviousness to punishment or punitive cues, and low–frustration tolerance.
Family or societal factors include disruptions in caregiving (e.g., placement in foster care), poor supervision, inconsistent or punitive discipline styles, insecure attachment, deep family conflict, witnessing or experiencing maltreatment, and the presence of guns or drugs in the environment.
School-based factors include being categorized as needing special education, lack of attachment to teachers or motivation to achieve, academic failure, low morale (among both teachers and students), disliking school, and associating with deviant peers (either by choice or, for example, being grouped with deviant peers for the purposes of punishment or special education).
A prominent finding is that ASB is best predicted by combinations of risk factors, including interactions between different levels of such risk processes.
Moffitt (1993) summarized the work of many investigators and originally theorized that there are two courses of Antisocial Behavior: life-course and adolescent-limited. The two can be distinguished by age of onset, duration of symptoms, and types of offenses. In life-course Antisocial Behavior, antisocial patterns begin in childhood, and a wide range of offenses are carried out, including victim-oriented crimes, with a high likelihood of persistence past adolescence.
Adolescent-limited offenses are typically related to the expression of independence and are often related to symbols of adult privilege; there is little or no childhood history of disruption or ASB. Still, adolescent forms of Antisocial Behavior may be quite extreme, and recent evidence reveals that adolescent-onset forms may not always desist after the teenage years.
Evidence now exists for a third subtype of conduct disorder, called childhood-limited, in which severe early-onset forms of aggression and antisocial activities abate by adolescence. Children with childhood-limited subtype do not engage in Antisocial Behavior in adulthood but often become depressed, anxious, socially isolated, and financially dependent on others as they develop (Moffitt, Caspi, Harrington & Milne, 2002, as quoted by Moffitt et al., 2008). Finally, it is rare to find individuals with a sudden adult-onset Antisocial Behavior (in the absence of earlier developmental precursors), unless drug use or a head injury is present.
According to recent research using self-report sources of information, 30 percent to 40 percent of males and 16 percent to 32 percent of females have committed a serious violent act by age 17. Although most juvenile offenders do not commit their first serious act of violence until adolescence, those juveniles who display extremely violent behavior prior to puberty are more likely to engage in high levels of violence, commit a large number of violent acts, and demonstrate persisting violent behavior into adulthood (Hersen, 2007).
In fact, child-onset types (with such high likelihood of persistence into a life-course pattern) typically show a constellation of multiple risk factors, including difficult temperament, insecure attachment to caregivers, poor verbal skills, intensive family conflict (and family histories of paternal Antisocial Behavior and maternal depression), maltreatment/abuse, poor early peer relationships, and academic failure.
Behaviorally based treatments (e.g., systematic reward programs for families; cognitive-behavioral anger management treatments for youths themselves) have been shown effective for child and early adolescent forms of antisocial behavior.
For adolescents, research has shown that the most effective treatment for juvenile offenders with Antisocial Behavior is Multi-Systemic Therapy (MST). MST works not only with the identified youth but intensively with the involvement of the family and the community. Therapists, who are on call 24/7 and who work in multiple settings with the youth and family, promote pro-social peer association and recreation, help families to access community-based services, teach effective parental discipline and other parenting skills, aid in the creation of an extended support system, and improve performance in both school and work.
FLASHCARD:
Antisocial Behavior (ASB)
- Can be subdivided into overt (physical or verbal aggression) or covert (stealing, property destruction, lying) components
- Noncompliance at the midpoint of the continuum
- Involves behavior violating legal or social norms, with the potential for serious harm to others
- May appear in Oppositional Defiant Disorder, Conduct Disorder, or adult Antisocial Personality Disorder
Risk factors
- Many risk factors identified, divisible into individual, family-social, and school-related categories
- Children with persistent patterns of ASB are likely (but not inevitably) to persist with escalating actions into adolescence and beyond; they typically have multiple risk factors for ASB
- Adolescent-onset youth have fewer risk factors and tend to desist once adolescence ends (though many long-term negative consequences can emanate from adolescent-onset behaviors)
Adult onset is rare
Treatment
- Behaviorally based interventions (parent management training; anger management) are optimal for children and early adolescents
- Multi-Systemic Therapy (MST) has been rigorously tested in adolescents with ASB, appreciably reducing recidivism. Therapist on call 24/7, work in multiple settings with the youth and family, promote pro-social peer association and recreation, help families to access community-based services, teach effective parental discipline and other parenting skills, aid in the creation of an extended support system, and improve performance in both school and work.
Questions:
What is more true regarding Antisocial behavior?
Answers:
A. It is characterized by negativistic, hostile, and defiant behavior such as actively disobeying directions of parents or other caregivers.
B. It is characterized by aggression toward people or animals, destruction of property, deceitfulness, theft, and serious rule violations.
C. It is characterized by overt and covert antisocial behavior.
D. It is a prevalent pattern of disregard for and infraction of other’s rights.
Rationale: The correct answer is C. Antisocial Behavior (ASB) involves overt Antisocial Behavior (e.g., fighting, verbally, confronting another, etc.) and “covert” Antisocial behavior (e.g., stealing, destroying properly, lying). Though A, B, and D may be true, the characteristics may change depending on the person. Answer C is true because it is more general and true for every case.