Co-author: Belinda Sng Qi Rong
The 2019 film ‘Joker’ garnered public interest due to its portrayal of brutal violence. Many have speculated that the Joker is a psychopath or has antisocial personality disorder (ASPD) due to the violent crimes portrayed in the movie. ASPD is often featured in psychological thriller films, where the character commits gruesome crimes and feels no remorse for them. While there are some truths in such presentations, they are often dramatised as extremes. These media misrepresentations of ASPD contribute to misunderstandings toward the general population of individuals with ASPD. In reality, while ASPD encompasses a range of psychopathological behaviour, often impulsive and under-justified, not all individuals with ASPD commit violent crimes.
What does ASPD look like?
ASPD features a pervasive pattern of disregard for and violation of the rights of others characterised by:
Failure to conform to social norms. Displaying behaviour such as destroying property, stealing, pursuing illegal occupations.
Deceitful and manipulative for personal profit or pleasure. Repeated lying, use of aliases, or conning others.
Patterns of impulsivity or failure to plan ahead. Sudden changes in jobs or relationships.
Tendency to engage in reckless behaviour. Disregards the safety of themselves and others. Display behaviour like recurrent speeding, driving while intoxicated, and multiple accidents in terms of driving behaviour.
Consistent difficulty in maintaining commitments. Repeated failure to sustain consistent work behaviour or honour financial obligation.
Difficulty feeling remorse or empathy. Indifference or superficial reasoning (i.e. ‘life is unfair’) to other’s downfall.
ASPD has an approximate prevalence of 3% in men and 1% in women. Individuals diagnosed with ASPD may have had a history of conduct disorder before the age of 18. Conduct disorder encompasses a range of emotional and behavioural symptoms centralising an array of self-serving behaviours at the expense of others. Without intervention, these childhood behaviours can become hardwired automatic responses to perceived threats, elevating in severity.
Causes of ASPD
While researchers are still trying to pinpoint the exact cause of APSD, we do know that it is likely caused by a combination of biological, psychological, and environmental factors.
Biological / genetic:
Abnormalities in the brain, specifically the prefrontal and anterior cingulate cortex may contribute to impulsivity, irresponsibility, poor decision-making, and deficient emotional information processing in individuals with ASPD. deficits in the amygdala, hippocampus, and superior temporal gyrus may contribute to difficulties complying with social rules, deficiency in moral judgement, and insensitivity to the threat of punishment.
Dopamine, commonly known as the ‘feel good chemical’, impacts our mood and motivation levels. High levels of dopamine are found to be linked with higher levels of aggression and poorer impulse control. This may explain the tendency for individuals with ASPD to engage in violent and reckless behaviour.
Serotonin, similarly, impacts our mood, anger, and aggression. Low levels of serotonin were also found to be linked to increased irritability, impulsivity and aggression. These factors all contribute to poorer emotional control. A study done by Menahem suggested that aggression combined with poor emotional control can interfere with one’s ability to interpret the intentions and actions of others. An individual who tends to respond in aggression is likely to also perceive the intentions and actions of others to be aggressive.
Environmental / social:
Recurrent traumatic childhood experiences are one of the strongest contributors to the development of conduct disorder (before the age of 18) and ASPD. Traumatic childhood experiences include child abuse or neglect, as well as instability within the family system. Individuals who have had an unsafe childhood, whereby they experienced or witnessed violent behaviours within their family, have a higher likelihood of modelling after aggressive behaviours that they have observed.
Psychological
Researchers have also drawn links between ASPD and an insecure-dismissive attachment style. An insecure-dismissive attachment is likely to be developed as a result of childhood abuse or neglect. When the primary caregiver is unavailable most of the time or acts as a source of distress for the infant, the child may feel unsafe and fearful, not having the opportunity to learn to self-soothe. The same view of the world and relationships may accompany the individual into adulthood, where they tend to feel undeserving of love or concern from others. As such, the lowered self-worth and anger may translate into acting out similar patterns of abusive behaviour.
Treatment options
As the symptoms of ASPD stem from both chemical imbalances in the brain as well as adverse childhood experiences, a combination of medication and psychotherapy could help individuals better manage their behaviour.
Medication
Medication can help to manage the symptoms of ASPD. Antidepressants can help balance serotonin levels to reduce low moods and aggression. Antipsychotics can reduce instances of violent or aggressive behaviours. Mood stabilisers can be prescribed to manage severe changes in mood that may precede aggressive behaviours.
Psychotherapy
Psychotherapy can help individuals to process early childhood experiences and behaviours modelled after our caregivers, and understand how they impact the way we perceive the world, as well as influence the way we behave or react to events. In therapy, the therapist probes into and validates these experiences, exploring how they have shaped one’s pattern of thought and behaviour. Processing these experiences and associated memories facilitates changes in the way we perceive past, present and future experiences, as well as the way we respond to them. Individuals with ASPD tend to have past traumatic experiences which makes them more prone to respond with aggression. As such, therapy is generally aimed at helping the individual to gain greater insight into their behaviour and the origins of their adapted pattern of thought, thereby facilitating pro-social changes in the way they interpret and respond to events.
Barriers to treatment
While there are a vast number of treatment options available, it may, however, be challenging to treat ASPD. The pattern of doubt and uncertainty likely experienced during childhood through adulthood coupled with mistrust of others, can interfere with the treatment process. The traumatic experiences they have been through are likely to have impacted them to prioritise self-protection over connecting with others. Individuals with ASPD may hence find difficulty in complying with treatment.
As with most other disorders, ASPD exists on a spectrum. This means that not all individuals with ASPD will commit impulsive acts of violence. Furthermore, the diagnosis of ASPD does not exempt one from criminal charges. While criminal behaviour is non-excusable, it is worth keeping in mind that these perpetrators may too, at some point of their lives, have been victims of trauma and abuse. Behind the angry facade, is someone who possibly had a difficult childhood.
Interesting reads
https://www.todayonline.com/singapore/five-years-jail-man-who-set-his-familys-flat-yishun-fire
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3920596/