Case Study

Research and various studies over many decades have shown that individuals with ASPD

are at an increased risk for involvement in criminogenic behavior (Holthouser & Bui, 2016). A

study developed by Trundle, Craig, & Stringer, 2017, analyzed the behaviors and life of one

male prisoner with ASPD and PDA, pathological demand avoidance. The purpose of this case

study was to not only differentiate between PDA and ASPD, but to also provide clinical findings

which could be useful in the successful risk management of individuals with ASPD who are

incarcerated.

Trundle, Craig, & Stringer, 2017, analyzed Mr. S, a 23-year-old white male serving a

four-year sentence for grievous bodily harm and robbery. He has a history of extreme violence

and rule violation, while in the community and during his incarceration. His first contact with the

police occurred when he was 12 years old, and he went on to have five court appearances before

the age of 18 for offences including domestic violence (Trundle, Craig, & Stringer, 2017). Mr. S

was chosen for this study and screening because he was referred by his offender manager to be

screened for ASPD due to his aggressive and antisocial behavior in custody. Mr. S scored eight

out of ten items, as well as scoring additional items for childhood difficulties, self-harm/suicide

attempts and challenging behavior, indicating the presence of ASPD traits (Trundle, Craig, &

Stringer, 2017).

Characteristics, Symptoms and Behaviors of Patient

Mr. S was analyzed for behavioral problems in childhood, evidence of ODD or CD in

adolescence, impulsivity, no sense of responsibility, low threshold for aggression, violent or

aggressive outburst, and disregard for rules and social norms. The individual’s results were

positive for every feature examined. Examples include numerous reports of aggressive and
violent behavior towards himself, other inmates and staff, and antisocial behavior from age 12

with repeated contact with police before age of 18. The patient also reported challenging and

aggressive behavior since the age of five.

Mr. S’s offender manager supported his referral of Mr. S for the study by describing his

difficult and violent behavior during his various incarcerations. Mr. S bullies other inmates

which has caused him to be unable to share a cell. He took another inmate hostage, threw boiling

water over another inmate, and threatened others on numerous occasions. He has punched staff,

thrown hot soup over staff and made threats of extreme violence. These instances occurred in

response to Mr. S being asked to do something, such as close his cell door or return to his cell

(Trundle, Craig, & Stringer, 2017). Mr. S has also displayed self-injurious behavior. He has

swallowed and chewed razor blades, made superficial cuts to his stomach, face and legs, and

attempted to hang himself with bed sheets. These actions happened in response to being

transferred to another area within the prison. Mr. S also has a poor attitude towards work. He

does not like to be challenged or told what to do. He indicated that previously his main form of

income was “robbing drug dealers”.

Mr. S’s parents reported that his behavior was angry, aggressive, and challenging since

he was five years old and that he became over-reliant on his mother (Trundle, Craig, & Stringer,

2017). According to various accredited sources in psychology, an ASPD diagnosis looks at

behavior starting at the age of 15 onwards, described by (DeLisi, et. al., 2018) as a pervasive

pattern of disregard for and violation of the rights of others occurring since age 15 years and

including three or more of the following indicators: failure to conform to social norms with

respect to lawful behaviors, deceitfulness, impulsivity, irritability and aggressiveness, reckless

disregard for safety of self or others, consistent irresponsibility, and lack of remorse. In Mr. S’s
case his behavior started ten years prior to the diagnosis age, at five years of age, which makes

for an interesting history for his ASPD diagnosis.

This case study sheds some light on what it is like for individuals with ASPD having to

navigate through the life of incarceration. There are many who do not understand the

characteristics and behaviors associated with ASPD and may stigmatize and attribute the violent

and dangerous behaviors such as the ones seen in Mr. S as noncompliant convicts who act

violently and viciously because they are dangerous and do not know any other way. While in

fact, the situations and certain activities are in fact triggering and extremely difficult for an

individual with ASPD to carry out without an immense amount of difficulty.

Literature Review

Using keywords and terms such as antisocial personality disorder, personality disorder,

living with ASPD, symptoms of ASPD, stigma, challenges, interventions, history. Sources from

the disciplines of nursing, mental health counseling, education, and psychology were examined

for the review of the literature of the living with antisocial personality disorder. The relevant

database which was utilized for the purpose of this essay is the Western Michigan University

Libraries which contains a wide range of research based articles, journals, as well as manuals,

books and dissertations. The extensive amount of different types of data and research within the

WMU Libraries allows for an in depth review of the literature on the concept of an individual’s

experience of what it is like living with ASPD.

The case study done by Trundle, Craig, & Stringer, 2017, which was used to describe

behaviors and characteristics of ASPD described the difficulties of everyday life for incarcerated

individuals with ASPD. They cited various well accredited sources, including research-based

sources which are well renowned, such as the American Psychiatric Association.
 Holthouser & Bui examined the tendencies, lifestyles, and analyzed interventions for

those living with ASPD (2016). This article also stressed the lack of data available regarding

treatment options for those living with ASPD and stated that it is crucial that more research

should be done.

The research done by Celarie and McDermott proved that ASPD is one of the highest

stigmatized personality disorders, and stressed that individuals living with ASPD feel the highest

sense of being misunderstood, and experience a lot of anxiety, fear, shame, anger, and

vulnerability throughout their lifetimes (2015). Perhaps if more people knew the results of this

research study’s results there would be less stigma towards those with ASPD.

Raypole published a study which depicts the harm that experienced stigma from others

causes individuals with ASPD who are trying to improve and get the help they need. This study

makes an important point about educating friends and family of people with ASPD regarding

what the disorder is and isn’t, and that it can be of variating symptoms and behaviors in each

individual (2019).

In 2016 Holthouser & Bui stressed the need for further studies and research that need to

be done to find successful treatments and therapies for those with ASPD who want to get better.

Luckily two years later Van Den Bosch, Rijckmans, Decoene, & Chapman (2018) found through

research that Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT),

Schema Focused Therapy (SFT), person centered psychotherapy, client centered psychotherapy,

psychodynamic psychotherapy, and Mentalization Based Treatment (MBT) are appropriate

interventions for individuals diagnosed with ASPD. These are important findings due the fact

that there is now data proving that multiple therapies exist for this population. They also did

further research to address the worry of whether SFT could be used in high security forensic
settings to reduce recidivism. Recidivism a tendency to relapse into a previous condition or mode

of behavior, (Merriam-Webster, 2019). The concern regarding the tendency of ASPD patients

after release from incarceration in high risk security settings to be reincarcerated was analyzed

and findings concluded that there was significantly reduced recidivism, further supporting the

use of SFT.

In order to understand a psychiatric disorder, we must first analyze its history and

understand its origin. The British Psychological Society examined the history of ASPD all the

way back to its start, in the 19th century when we did not have an understanding of ASPD (2010).

This article highlighted the important findings, years, and beginning of ASPD as a known

personality disorder from its very beginning, and discussed the importance for those with it of it

being named and discovered.

Two of the most asked questions that are asked by clinicians of any field when discussing

a disorder are, “What causes it?” and “How do we treat it?” Treatment has been widely

researched and studied for people wanting to improve their behavior. However, not much has

been discovered about the cause of development of ASPD. Harvard Health Publishing states that

there are many factors which contribute, including environmental, genetic, or biological factors

as well as the anatomy of the brain (2019). The anatomy of the brain as we know cannot be

altered, however it is important to know for research purposes that abnormalities in the frontal

lobe and volume changes are often seen with this disorder (Harvard Health Publishing, 2019).

While ADHD does not in any way cause or increase the risk of ASPD, according to Black, 2015,

a conduct disorder in children can be indicative of a person developing ASPD in childhood.

References

Holthouser, B., & Bui, N. H. (2016). Meditative interventions and antisocial personality
disorder. Counselling Psychology Quarterly, 29(3), 235–252. doi:
10.1080/09515070.2015.1026311

Trundle, G., Craig, L. A., & Stringer, I. (2017). Differentiating between pathological demand
avoidance and antisocial personality disorder: A case study. Journal of Intellectual
Disabilities and Offending Behaviour,  8(1), 13-27.
doi:http://dx.doi.org.libproxy.library.wmich.edu/10.1108/JIDOB-07-2016-0013
DeLisi, M., Drury, A. J., Caropreso, D., Heinrichs, T., Tahja, K. N., & Elbert, M. J. (2018).
Antisocial Personality Disorder With or Without Antecedent Conduct Disorder: The
Differences Are Psychiatric and Paraphilic. Criminal Justice and Behavior, 45(6), 902–
917. https://doi.org/10.1177/0093854818765593