Subtypes of ASPD.

heresjohnny

I never knew that Antisocial Personality Disorder had different subtypes, but it does make sense that it would.     These are Millon’s ten subtypes of ASPD (antisocial personality disorder).   Theodore Millon was a psychologist who specialized in personality disorders and subdivided them into various subtypes.   (In a future article, I’ll write a post about his Borderline Personality Disorder divisions.)

This was a post I found on Psychforums (in the ASPD forum).  I don’t know who wrote it, so I can’t give credit to the original source, only a link to where I found it.

In the post I found, the the term “psychopath” is used, but I think these types more properly describe people with ASPD, most who are sociopaths (an acquired condition due to trauma that may also involve brain dysfunction), not psychopaths (a condition of the brain you are born with that has nothing or little to do with early trauma).   There are also pro-social psychopaths (though all psychopaths lack a conscience), and none of these types seem very pro-social to me.  So even though many psychopaths may fit these subtypes, I think it’s misleading so I took out the term “psychopath” in the subheads.

Unprincipled 

Activities kept near or at the boundaries of the law; stereotyped social roles; con man, charlatan, fast-talking used car salesman.Expansive fantasies and exaggerated sense of self-importance.Willing to take advantage of and humiliate those who leave themselves open to deceit.

May cultivate persuasiveness or charm as a means of getting others to lower their guard, but sees all prosocial behaviour as ultimately self-serving.

Contemptuous of “the system”; working “the system” to avoid punishment seen as just “part of the game“.

Covetous 

Sees self as wrongfully deprived of life’s necessities, leading to envy and resentment.

Compensates by taking what he or she is entitled to as a means of revenging wrong and restoring “karmic balance” in life.

Sees self as a victim of external forces, misunderstood by others and by society.

Manipulates others as a meaning of proving own superiority, as well as avenging attributions of worthlessness.

Smug and contemptuous toward victims, who may be viewed as pawns in the larger game.

Prone to ostentatious displays of conspicuous consumption.

Risk-Taking 

Chronic underarousal leads to risk-taking as means of “feeling alive”.

Fails to realize the consequences of risk-taking; believes that social rules are unnecessarily confining of own sense of adventure.

Eschews normal desire for safety as evidence of cowardice.

Proves own mettle as a means of proving self-esteem and worthiness to self and others.

Disingenuous 

Superficial sociability (or even seductiveness) hides an impulsive, moody and resentful core.

Emotionally labile, prone to excitement-seeking, stimulus-dependant behaviour, lacking in forethought, with a high potential for painful consequences.

Rationalizes and projects blame onto others when attempts to solicit attention go awry.

Spineless

Aggression not intrinsically rewarding; psychopathic acts intended to others that the psychopath is not weak.

Has first-strike mentality; strikes whenever own fearfulness peaks (perhaps in episodes of panic), regardless of objective degree of threat.

Experiences fantasies of vulnerability; sees others as sadistic or exploiting.  [my note–I’m not sure what “fantasies of vulnerability” would refer to]

Abrasive 

Prefers to be overtly contentious, confrontational, antagonistic rather than indirectly manipulative.

Expects hostility from others, and pre-empts insults with own abrasiveness.

Prefers to escalate arguments; experiences pleasure by frustrating others, making them back down.

Inherently oppositional to any form of emotional control; seeks to break constraints simply because they exist.

Tyrannical 

Realizes pleasure through total control of others.

Employs violence instrumentally, to force perceived opponents to cower or submit.

Projects image of power or brutality; supports self-image of power and superiority by inflicting pain and suffering, if not power.

Explosive 

Low frustration threshold, resulting in episodes of uncontrollable rage and violent attack.

Episodes may be instantaneous reaction to frustration or perceived insult, and thus may be perceived by others as random and unprovoked.

Malevolent

Hateful, destructive defiance of values of social life.

inherently distrustful, ruthless, cold-blooded, revengeful, punitive.

Malignant 

Often isolated, paranoid, with ruminative fantasies of power and revenge.

Sees others as inherently persecutory or treacherous.

Uses hostility as a means of armoring self, forcin adversaries to take issue and withdraw.

http://www.psychforums.com/antisocial-personality/topic95961.html

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Psychopathy may not be what you think.

gearhead

I’ve been doing some reading about psychopathy and have found out some surprising things. I always was a little confused as to how psychopathy differed from sociopathy and have used those terms interchangeably on this blog due to my confusion. I’ve also used the term interchangeably with Antisocial Personality Disorder (ASPD) and sometimes even malignant narcisissm. It turns out it’s probably something completely different from the other three disorders and may not even be a disorder at all!

Before you start laughing, hear me out.

It all started with this colorful, humorous description someone wrote on a forum I’ve been active on, describing how a Psychopath differs from a Narcissist:

When I picture a Psychopath, I think of someone who at bedtime bounces around from one thing to the next, essentially a high-energy, happy person. When I picture a Narc at bedtime, I imagine someone wearing long pajamas and a nightcap (yes, a nightcap), walking around a 19th Century house, holding a candle, checking for ghosts.

At first I thought this was a weird (but funny) analogy. But it really isn’t. According to psychologist Theodore Millon, Primary Psychopathy is something you are born with and is not due to abuse, unlike NPD or ASPD. Studies have shown that the limbic system (emotional center) of primary psychopaths is simply less active than in normal people. So they don’t experience empathy or have a conscience regardless of how they were raised, but they also don’t have very deep emotions in general.

Millon

Because they lack deep emotions, primary psychopaths tend to be fearless risk takers. They also aren’t moody because they don’t experience anxiety or depression the way others do–if they experience those states at all. But psychopathy has become associated with sociopathy and/or ASPD or malignant narcissism because a born psychopath may be more prone to developing personality disorders than the normal population, if they are abused. Because they don’t have the capacity to develop a conscience or empathy, if they do develop a personality disorder, it’s likely to be Antisocial Personality Disorder, where the right of others are callously violated. That’s why so many psychopaths are also antisocial and dangerous.

But there is nothing wrong with the cognitive functioning of a psychopath. They are able to learn the difference between right and wrong, and if they do not develop a personality disorder, theoretically they can choose to do what’s right. Only the limbic system is impaired, so any decisions a true psychopath makes are cognitively based. Emotion simply doesn’t play into it at all. They do “whatever works.” They lack a conscience because conscience is emotion- or shame-based, and a psychopath isn’t capable of much emotion in general.

So a primary psychopath can theoretically be a good person who is just extremely unemotional and only uses logic and reason to make decisions. Unlike narcissists, who actually have deep emotions but have turned all their emotions inward toward themselves and require “supply” to bolster their fragile egos, a non-disordered psychopath has no need for supply. They simply don’t care what anyone thinks. What you think is simply not something that even occurs to them. In contrast, a narcissist cares very much what you think and falls apart like wet toilet paper if supply in the form of approval or adoration is not forthcoming.

Primary psychopathy seems analogous to the Myers-Briggs ESTJ (Extroverted/Sensing/Thinking/Judging) personality type. In other words, a psychopath is an outgoing, sensation seeking, hedonistic thinker who happily jumps around from activity to activity like someone jacked up on Red Bull, yet they don’t have ADHD either because the J(udging) aspect means their high level of activity always has a goal or purpose. Such a person would be easily bored (which could also lead to antisocial behavior), never worry about things or experience (or even understand) guilt, and unafraid to try and experience new things. Their lack of emotionality would suit them well for the business world. In fact, people who have become very successful in business tend to score high in psychopathic traits.

two-brains

While many high level executives do abuse the rights of others and callously close entire departments and treat their employees like so many pieces in a chess game (whatever works, right?), because psychopaths can tell the difference between right and wrong, some will try to do the right thing just the same. The difference is, they are using cognition rather than emotion to back any prosocial decisions.

Looked at this way, primary psychopathy may not be a disorder at all but a personality variation. Of course, the term “psychopathy” has negative connotations because most of us associate it with antisocial criminals, shady con artists, and serial killers. And in fact many of them are, but not all.

Sociopathy differs from primary psychopathy because (according to Millon, above), it’s antisocial behavior that may develop in a person with ASPD or NPD and is always due to abuse somewhere in the person’s past. A primary psychopath can become a sociopath if they become disordered, and that’s where you would find the serial killers and criminals (and these people usually have ASPD). But a sociopath isn’t always (or even usually) a psychopath. Sociopaths who aren’t psychopathic are usually very malignant narcissists (high spectrum NPD + ASPD) or sometimes even Borderlines, and they differ from psychopaths because there is no logic or rational thinking behind their antisocial or destructive behaviors, only unhealthy, toxic emotion. They seem to have no empathy because all their empathy–and most of their other emotions except anger–are turned inward toward themselves. The false self is what they present to others instead of their real emotions. Narcissists have plenty of empathy but it’s all for themselves–that’s why they are prone to wallowing in self pity. A psychopath would never wallow in self pity. They simply don’t care what you think.

Are BPD and complex PTSD the same disorder?

age_3_1961_2
Me at age 3 in the zone. Was the template for my BPD already laid down?

Ruji, a new commenter on this blog, made an interesting observation–that BPD should be divided into at least two subtypes: Empathy Challenged/Character Disordered (closer to NPD/ASPD) and Highly Sensitive Person with Emotional Dysregulation (closer to the type I have, although at different times in my life or when extremely stressed I have displayed the more character-disordered subtype). I agree with her. Ruji’s idea is remarkably similar to The World Health Organization’s two subtypes of BPD:

1. F60.30 Impulsive type
At least three of the following must be present, one of which must be (2):

–marked tendency to act unexpectedly and without consideration of the consequences;
–marked tendency to engage in quarrelsome behavior and to have conflicts with others, especially when impulsive acts are thwarted or criticized;
–liability to outbursts of anger or violence, with inability to control the resulting behavioral explosions;
–difficulty in maintaining any course of action that offers no immediate reward;
–unstable and capricious (impulsive, whimsical) mood.

2. F60.31 Borderline type
At least three of the symptoms mentioned in F60.30 Impulsive type must be present [see above], with at least two of the following in addition:

–disturbances in and uncertainty about self-image, aims, and internal preferences;
–liability to become involved in intense and unstable relationships, often leading to emotional crisis;
–excessive efforts to avoid abandonment;
–recurrent threats or acts of self-harm;
–chronic feelings of emptiness.
–demonstrates impulsive behavior, e.g., speeding, substance abuse

Psychologist Theodore Millon has gone even further, proposing that BPD should be divided into four subtypes:

1. Discouraged (including avoidant features): Pliant, submissive, loyal, humble; feels vulnerable and in constant jeopardy; feels hopeless, depressed, helpless, and powerless.

2. Petulant (including negativistic features) Negativistic, impatient, restless, as well as stubborn, defiant, sullen, pessimistic, and resentful; easily slighted and quickly disillusioned.

3. Impulsive (including histrionic or antisocial features) Capricious, superficial, flighty, distractible, frenetic, and seductive; fearing loss, becomes agitated, and gloomy and irritable; potentially suicidal.

4. Self-destructive (including depressive or masochistic features) Inward-turning, intropunitively angry; conforming, deferential, and ingratiating behaviors have deteriorated; increasingly high-strung and moody; possible suicide.

Millon’s Types 1 and 4 would correspond to the Highly Sensitive Person/Emotional Dysregulation type mentioned above (and therefore closer to the Avoidant/Dependent PDs); Type 2 sounds very much like NPD; and Type 3 seems closer to ASPD or Histrionic PD.

complex_ptsd
BPD symptoms are almost identical to those of Complex PTSD.

There are so many diverse–almost opposite–symptoms that can appear with this disorder that one person with BPD can be very different from the next. In fact, you can take 10 borderlines and they will all seem very different from each other, with barely any similarities in their behavior at all. One will be shy, fearful and retiring, never making waves, acting almost like an Aspie or an Avoidant; while another may break the law, lie constantly, and act obnoxious and rage whenever things don’t go their way. A borderline could be your raging boss who drinks too much and ends every annual Christmas party with one of his infamous rages, or it could be the sweet and pretty schoolteacher who goes home every night and cuts herself. She could be the come-hither seductress or the nerdy computer programmer. He may have few or no friends or a great many.

This diversity is not the case with the other personality disorders, which have more cohesiveness in the symptoms their sufferers display. So I wonder–is BPD really a personality disorder at all? Does it even exist, or is it really just a group of trauma-caused symptoms the experts in their ivory towers stuck in a single box called “BPD” because they didn’t know how else to classify them?

In fact, all these diverse subtypes have one thing in common–they are all very similar or identical to the symptoms of someone with complex PTSD (C-PTSD). People with C-PTSD are often misdiagnosed as Borderlines because their behaviors can be just as baffling and manipulative, and both disorders also include dissociative, almost psychotic episodes. Extrapolating from that, I wonder if ALL borderlines actually have C-PTSD.

Earlier today I posted an article outlining 20 signs of unresolved trauma, and I was struck by how similar these were to the symptoms of BPD. And there is also this article that Ruji just brought to my attention that also describes how remarkably similar the two disorders are, but that the idea of fear of abandonment (which is recognized as the root cause of BPD) is not recognized as a factor in causing PTSD and that may be part of why they have been kept separate.

The BPD label, like any Cluster B label, is very damaging to its victims because of the “evil and character-disordered” stigma it carries. One psychologist has even included us, along with narcissists, among the “People of the Lie”!

Yes, it’s true some borderlines do act a lot like people with NPD or even Malignant Narcissism or ASPD, but most probably do not, and are really much more similar to people with Avoidant or even Dependent personality disorders, which hurt the sufferer more than anyone else. But if you have a BPD label, people start backing away from you slowly due to the stigma. Therapists are reluctant to treat you because they assume you will be either difficult and hateful in therapy sessions, or will never get better. Insurance companies won’t pay claims where there is a BPD diagnosis, because it’s assumed there is no hope for you. I’ve had this problem when I’ve tried to get therapy. I remember one therapist who I had seen for the intake session, who told me he needed to obtain my psychiatric records before we could proceed. The session had gone smoothly and I felt comfortable with him. A few days later I received a phone call and was told he did not treat “borderline patients” and wished me luck. So that’s the kind of thing we’re up against if we’ve had the BPD label slapped on us.

Also, as an ACON blogger who works with a lot of victims of narcissistic abuse, my BPD label sometimes makes people wary of me and they begin to doubt that my motives here are honest. At first I was reluctant to talk about my “Cluster B disorder” here, because I knew it might be a problem for some ACONs, who think borderlines are no better than narcissists. But I eventually decided that to hide it away like an embarrassing family secret would be misleading so I “came out” about having BPD (I never actually lied about it, but played it down in the beginning and rarely mentioned it). I’m glad I fessed up, but there have been a few people who left this blog after I came out about it or began to doubt my motives. So there’s that stigma and it’s very damaging.

Both C-PTSD and Borderline PD are caused by trauma. Both are complex defensive reactions against future abuse and both involve things like splitting, dissociation, psychotic episodes, self-destructiveness, wild mood swings, and behavior that appears to be narcissistic and manipulative.

The way I see it, the only real difference between C-PTSD and BPD is that the traumatic event or abuse happened at an earlier age for someone with BPD, perhaps during toddlerhood or infancy, while all forms of PTSD can happen at a later age, even adulthood. But the symptoms and defense mechanisms used to avoid further trauma are the same for both.