Psychological health

What Antisocial Personality Disorder Looks Like in Late Life

Older people’s inability to engage in antisocial behavior may seem self-evident. After all, don’t people move away as they get older? Aren’t older individuals more likely to accept traditional society’s limits on propriety simply because they have had more time to become familiar with these standards of behavior?

In fact, if you stop and think about the ages of the criminal figures portrayed in the media, it can be hard to come up with any examples where the offender is even over the age of 40. You might even have to go back to the classic 1979 movie, go in styleStarring George Burns, Art Carney, and Lee Strasberg. TV series with psychopathic characters, like any of the law and order, They rarely feature aging characters other than those serving as prosecutors or investigators.

Does all this mean that criminality, or its diagnostic counterpart, antisocial personality disorder, actually fades away in the last years of life? According to Kathryn Holzer of the University of Washington School of Medicine and colleagues (2021), it is plausible that the so-called “criminal energy” theory (Vaugn & DeLisi, 2018) applies and that those with antisocial personality disorder simply run out.

However, there is another explanation you might consider. These individuals may be present all the time, but they fall short of current diagnostic criteria, and most are strongly inclined towards behaviors that are evident in young adults. As the University of Washington researchers note, “the development of DSM [Diagnostic and Statistical Manual] The criteria for ASPD (Antisocial Personality Disorder) have been strongly influenced by research with younger rather than older adults… These studies are still considered among the most prominent in the field” (p. 445). Has this inadvertently misleading approach led to Failed to detect antisocial personality disorder that may still actually be present in the older population?

Some Diagnostic Considerations

Before getting to this question about possible age bias in the criteria for antisocial personality disorder, it is important to remind yourself of the fact that antisocial personality disorder and psychopathy are two different entities, and both are distinct from criminal behavior. People with a mental disorder do not necessarily act by committing antisocial behaviors, and as a result, they will be less likely to be imprisoned than individuals diagnosed with antisocial personality disorder, and not all criminals meet the criteria for that disorder.

A second diagnostic consideration concerns the incidence of mood disorders and substance use disorders in older adults with antisocial personality disorder. As a result, clinicians treating their elderly patients with these co-occurring disorders may focus less on the antisocial behaviors that accompany or can mask these conditions.

“A true crime wave in itself”

As a background to their investigation, the authors drew from a case (DeLisi et al., 2020) of “Mr. Z.” a 77-year-old white man with a long history of antisocial behavior that included multiple murders, both in and out of prison. This “true crime wave” meets the criteria for antisocial personality disorder as well as paranoid personality disorder, along with many forms of substance use disorder. He did not stop his violence and drug use until his 80s, and “until then, his rehabilitation was deemed too risky” (p. 445).

As this case illustrates, it is possible that the elderly, as the authors note, continue to have a “very active” career as criminals. The question is, could they receive a new diagnosis later in life based on the criteria for antisocial personality disorder?

What do the symptoms of antisocial personality disorder look like in the elderly?

To answer the question of whether the diagnostic criteria for antisocial personality disorder have an inherent age bias, the University of Washington authors began by drawing on the National Epidemiological Survey of Alcohol and Related Conditions III or NESARC-III. The authors used the Nationally Recognized Scale of Antisocial Behaviors (AUDADIS-5) to compare responses from a sample of 11,755 younger adults (18–34) matched with 14,738 adults aged 50 and over.

The broad nature of AUDADIS-5 allowed the research team to determine whether an individual exhibited ‘ASPD pathology’ by showing elevated scores across the entire scale. As examples, AUADIS-5 asked participants to rate themselves on the frequency of behaviors such as “intentionally hurting an animal” or “often scaring people into doing things.”

Read the main character

If an individual meets the criterion for demonstrating antisocial personality disorder according to the entire tool, the next question will be whether to select for this disease in items specific to the criteria for an antisocial personality disorder diagnosis. As it turns out, it wasn’t. Older adults with ASPD were less likely to endorse key diagnostic indicators, specifically:

  1. Failure to comply with standards of legal conduct as evidenced by the repetition of acts that constitute grounds for arrest.
  2. Irritability and aggressiveness as evidenced by repeated physical fights or assaults.
  3. Persistent irresponsibility as evidenced by repeated failure to maintain consistent business behavior or to meet financial obligations.

Based on these findings, it appears that older adults who have not been diagnosed with antisocial personality disorder, in fact, lack the “criminal energy” to engage in physically demanding actions that may lead to arrest. However, the authors note that it is still “possible for older adults with antisocial personality disorder to continue to cause disruption and create conflict in their lives” (p. 449). These individuals may act in irritable and even aggressive ways toward fellow residents and staff in nursing homes. Perhaps those living in the community may commit these antisocial acts towards family members, neighbors, and friends.

As the authors noted, it is also possible that an older antisocial person whose disorder has not been detected may be misdiagnosed as having a cognitive disorder that affects their ability to inhibit aggressive behavior. Undiagnosing antisocial personality disorder for these individuals can have important practical consequences. They can continue to bring harm to those around them without anyone realizing that their behavior represents a mental disorder, or they may receive inappropriate medical treatment or be placed in an institution.

Outperforming older adults with antisocial personality disorder

What if you have been cheated on or have been cheated on by an older adult who may have undiagnosed antisocial personality disorder? Without realizing it, you can easily hand your money or possessions over to someone who seems to be constantly growing because of their age. They may have a “great” investment opportunity to offer you or a “need” to help them pay for medication, rent, or transportation. Indeed, as Holzer et al. Suggestive, this individual may have learned to use different intimate techniques commonly associated with narcissism, such as manipulation and manipulation.

Since many people assume that older adults lack “criminal energy,” that is, physical strength or agility, it is easy to miss the possibility that a gray-haired person might be able to engage in other behaviors that can leave you dazed. Consider three diagnostic criteria for individuals with antisocial personality disorder who are accredited to a lower degree than their younger counterparts and use them as a guide.

to summarise, From a clinical point of view, knowing that antisocial personality disorder can persist in people you believe “originated” from can benefit from a mental health perspective. In your own life, you may not know ‘Mr. Z.’, but you protect yourself by becoming wise with his less severe counterparts.

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