Criminal Minds (2005-2010)
Hands-down the most disturbing of personality disorders is Antisocial Personality Disorder (ASPD). Many mainstream TV dramas base the content of their shows on people with ASPD – Criminal Minds, Bones, Law and Order, The CSI Series, and the list goes on….
In psychiatry, the meaning of antisocial is not the same as the layman’s term used often to describe the shy and sort of awkwardly charming introvert who embarrasses easily. Think Micheal Cera in Superbad or Juno, or any of his other roles. Instead, antisocial refers to people who are sociopaths or psychopaths. They lack a moral compass and have utter disregard for social norms. These people are entitled, deceitful, and remorseless of any type of wrongdoing. They lie, con, and cheat – not the type of person you’d want to meet on Match.com! Their inability, or refusal, to abide by rules and laws may give rise to criminal behavior and consequently overcrowded prisons – more than 80% of inmates are ASPDs. Unlawful acts can vary widely from vandalism, petty theft, and identity fraud to arson, rape, and killing sprees. They can be an acquaintance, co-worker, or even a friend or relative. Not all ASPDs are violent criminals, but Ted Bundy, Jeffrey Dahmer, and Charles Manson have been described as some of the most notorious and infamous ones.
Currently in psychiatry, per our bible the DSM-IV, there isn’t a distinction between a sociopath and a psychopath (pending revision). Although they’re both diagnosed as ASPD, and occasionally used interchangeably, some experts believe they are separate entities. A key difference between a sociopath versus a psychopath seems to be related to the underlying cause of their behavior, which summons the nature versus nurture argument. Sociopaths are thought to have been shaped by an invalidating and traumatic upbringing, whereas psychopaths are born emotionally and morally deficient. The latter is hard-wired differently from the get-go. Thus, fearlessness and stimulation-seeking are seen at an early age. Imaging studies have shown brain abnormalities implicated in emotional detachment and physiologic responses characteristic of psychopathic behavior.
ASPDs tend to possess superficial charm and allure, which serves them well in manipulating others for personal gain. Their bodies may be covered with ostentatious tattoos. This is, of course, not an absolute sign of an ASPD; otherwise, I can’t imagine what it’d be like to be NBA Commish David Stern, given the growing prevalence of tattooed bodies in the league. Also of note, a juvenile history consisting of the triad of bedwetting, fire-setting, and animal cruelty seems to be a harbinger of violent criminal behavior.
Clinically, ASPDs don’t seek treatment for their symptoms per se as they don’t see anything wrong with their antisocial behavior. They typically present for psychiatric treatment in the context of prescription drug-seeking, substance abuse problems, malingering - feigning an illness to get something they want – and violent behavior. Unfortunately, there is no demonstrated effective mental health intervention for treating ASPD itself. Thus, the criminal justice system becomes their de facto treatment system. Somewhat reassuringly, it has been observed that antisocial behavior in ASPDs attenuates over time, particularly beginning in their late 30s.
Many TV watchers become enthralled by crime drama shows like an unsuspecting victim is drawn to an antisocial’s charm and deceit. Entertaining and seemingly preposterous as the shows may be, the reality is that people with antisocial personality disorder do exist and live amongst us. The next time you feel captivated by someone’s charisma, yet feel like you’re being manipulated, follow your gut instinct and change the channel.