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Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterized by a long-term pattern of disregard for, or violation of, the rights of others as well as a difficulty sustaining long term relationships.[3] A weak or nonexistent conscience is often apparent, as well as a history of rule-breaking that can sometimes lead to law-breaking, a tendency towards substance abuse,[3] and impulsive and aggressive behaviour.[4][5] Antisocial behaviors often have their onset before the age of 8, and in nearly 80% of ASPD cases, the subject will develop their first symptoms by age 11.[6] The Prevalence of ASPD peaks in people age 24 to 44 years old, and often decreases in people age 45 to 64 years.[6] In the United States, the rate of antisocial personality disorder in the general population is estimated between 0.2 and 3.3 percent.[7] However, settings can greatly influence the prevalence of ASPD. In a study by Donald W. Black MD, a random sampling of 320 newly incarcerated offenders found ASPD was present in over 35 percent of those surveyed.[8] Antisocial personality disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), while the equivalent concept of dissocial personality disorder (DPD) is defined in the International Statistical Classification of Diseases and Related Health Problems (ICD); the primary theoretical distinction between the two is that antisocial personality disorder focuses on observable behaviours, while dissocial personality disorder focuses on affective deficits.[9] Otherwise, both manuals provide similar criteria for diagnosing the disorder.[10] Both have also stated that their diagnoses have been referred to, or include what is referred to, as psychopathy or sociopathy. However, some researchers have drawn distinctions between the concepts of antisocial personality disorder and psychopathy, with many researchers arguing that psychopathy is a disorder that overlaps with but is distinguishable from ASPD.[11][12][13][14][15]

 

Antisocial personality disorder

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Antisocial personality disorder
Other namesDissocial personality disorder (DPD), sociopathy
SpecialtyPsychiatry
SymptomsPervasive deviancedeceptionimpulsivityirritabilityaggressionrecklessness, manipulation and callous and unemotional traits
Usual onsetChildhood or early adolescence[1]
DurationLong term[2]
Risk factorsFamily historypoverty[2]
Differential diagnosisConduct disorderNarcissistic personality disorderSubstance use disorderbipolar disorderborderline personality disorderschizophrenia, criminal behavior[2]
Frequency1.8% during a year[2]

Antisocial personality disorder (ASPD or infrequently APD) is a personality disorder characterized by a long-term pattern of disregard for, or violation of, the rights of others as well as a difficulty sustaining long term relationships.[3] A weak or nonexistent conscience is often apparent, as well as a history of rule-breaking that can sometimes lead to law-breaking, a tendency towards substance abuse,[3] and impulsive and aggressive behaviour.[4][5] Antisocial behaviors often have their onset before the age of 8, and in nearly 80% of ASPD cases, the subject will develop their first symptoms by age 11.[6] The Prevalence of ASPD peaks in people age 24 to 44 years old, and often decreases in people age 45 to 64 years.[6] In the United States, the rate of antisocial personality disorder in the general population is estimated between 0.2 and 3.3 percent.[7] However, settings can greatly influence the prevalence of ASPD. In a study by Donald W. Black MD, a random sampling of 320 newly incarcerated offenders found ASPD was present in over 35 percent of those surveyed.[8]

Antisocial personality disorder is defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), while the equivalent concept of dissocial personality disorder (DPD) is defined in the International Statistical Classification of Diseases and Related Health Problems (ICD); the primary theoretical distinction between the two is that antisocial personality disorder focuses on observable behaviours, while dissocial personality disorder focuses on affective deficits.[9] Otherwise, both manuals provide similar criteria for diagnosing the disorder.[10] Both have also stated that their diagnoses have been referred to, or include what is referred to, as psychopathy or sociopathy. However, some researchers have drawn distinctions between the concepts of antisocial personality disorder and psychopathy, with many researchers arguing that psychopathy is a disorder that overlaps with but is distinguishable from ASPD.[11][12][13][14][15]

Signs and symptoms[edit]

Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others.[4] Although behaviors vary in degree, individuals with this personality disorder will typically have limited compunction in exploiting others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people. While some do so through a façade of superficial charm, others do so through intimidation and violence.[16] They may display arrogance, think lowly and negatively of others, and lack remorse for their harmful actions and have a callous attitude towards those they have harmed.[4][5] Irresponsibility is a core characteristic of this disorder; most have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations, and people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.[4][5][17][18]

Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardize their own safety and the safety of others, which can place both themselves and other people in danger.[4][5][19] They are often aggressive and hostile, with poorly regulated tempers, and can lash out violently with provocation or frustration.[4][18] Individuals are prone to substance use disorders and addiction, and the non-medical use of various psychoactive substances is common in this population. These behaviors can in some instances lead such individuals into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behavior and criminal infractions stemming back to adolescence or childhood.[4][5][17][18]

Moderate to serious problems with interpersonal relationships are often seen in those with the disorder. People with antisocial personality disorder usually form poor or reduced attachments and emotional bonds, and interpersonal relationships often revolve around the exploitation and abuse of others.[4] They may have difficulties in sustaining and maintaining relationships, and some have difficulty entering them.[17]

Conduct disorder[edit]

While antisocial personality disorder is a mental disorder diagnosed in adulthood, it has its precedent in childhood.[20] The DSM-5's criteria for ASPD require that the individual have conduct problems evident by the age of 15.[16] Persistent antisocial behavior, as well as a lack of regard for others in childhood and adolescence, is known as conduct disorder and is the precursor of ASPD.[21] About 25–40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.[22]

Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD and is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. Children with the disorder often display impulsive and aggressive behavior, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism or get into fights with other children and adults.[23] This behavior is typically persistent and may be difficult to deter with threat or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population, and children with the disorder may also engage in substance use.[24][25] CD is differentiated from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, and property, though many children diagnosed with ODD are subsequently re-diagnosed with CD.[26]

Two developmental courses for CD have been identified based on the age at which the symptoms become present. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of aggression and violence.[27] The second is known as the "adolescent-onset type" and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood.[28] In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood-onset subtype, especially if callous and unemotional traits are present, tends to have a worse treatment outcome.[29]

Comorbidity[edit]

ASPD commonly coexists with the following conditions:[30]

When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[31] Alcohol Use Disorder is likely caused by lack of impulse and behavioral control exhibited by Antisocial Personality Disorder patients.[32] The rates of ASPD tends to register around 40-50% in male alcohol and opiate addicts.[33] However, it is important to remember this is not a causal relationship, but rather a plausible consequence of cognitive deficits as a result of ASPD.

Causes[edit]

Personality disorders are seen to be caused by a combination and interaction of genetic and environmental influences.[34] Genetically, it is the intrinsic temperamental tendencies as determined by their genetically influenced physiology, and environmentally, it is the social and cultural experiences of a person in childhood and adolescence encompassing their family dynamics, peer influences, and social values.[4] People with an antisocial or alcoholic parent are considered to be at higher risk. Fire-setting, and cruelty to animals during childhood are also linked to the development of antisocial personality. The condition is more common in males than in females, and among incarcerated populations.[34][16]

Genetic[edit]

Research into genetic associations in antisocial personality disorder suggests that ASPD has some or even a strong genetic basis. Prevalence of ASPD is higher in people related to someone afflicted by the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behavior and conduct disorder.[35]

In the specific genes that may be involved, one gene that has seen particular interest in its correlation with antisocial behavior is the gene that encodes for Monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and Norepinephrine. Various studies examining the genes' relationship to behavior have suggested that variants of the gene that results in less MAO-A being produced, such as the 2R and 3R alleles of the promoter region, have associations with aggressive behavior in men.[36][37] The association is also influenced by negative experience in early life, with children possessing a low-activity variant (MAOA-L) who experience such maltreatment being more likely to develop antisocial behavior than those with the high-activity variant (MAOA-H).[38][39] Even when environmental interactions (e.g. emotional abuse) are controlled for, a small association between MAOA-L and aggressive and antisocial behavior remains.[40]

The gene that encodes for the serotonin transporter (SCL6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behavior and personality traits. Genetic associations studies have suggested that the short "S" allele is associated with impulsive antisocial behavior and ASPD in the inmate population.[41] However, research into psychopathy find that the long "L" allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e.g. lack of empathy, fearlessness) and interpersonal (e.g. grandiosity, manipulativeness) personality disturbances.[42] This is suggestive of two different forms, one associated more with impulsive behavior and emotional dysregulation, and the other with predatory aggression and affective disturbance, of the disorder.[43]

Various other gene candidates for ASPD have been identified by a genome-wide association study published in 2016. Several of these gene candidates are shared with attention-deficit hyperactivity disorder, with which ASPD is comorbid. Furthermore, the study found that those who carry 4 mutations on chromosome 6 are 50 percent more likely to develop antisocial personality disorder than those who do not.[44]

Physiological[edit]

Hormones and neurotransmitters[edit]

Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development.[45] Aggressiveness and impulsivity are among the possible symptoms of ASPD. Testosterone is a hormone that plays an important role in aggressiveness in the brain.[46] For instance, criminals who have committed violent crimes tend to have higher levels of testosterone than the average person.[47][citation needed] The effect of testosterone is counteracted by cortisol which facilitates the cognitive control of impulsive tendencies.[48]

One of the neurotransmitters that has been discussed in individuals with ASPD is serotonin, also known as 5HT.[45] A meta-analysis of 20 studies found significantly lower 5-HIAA levels (indicating lower serotonin levels), especially in those who are younger than 30 years of age.[49]

While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5HT metabolism, but may be the most essential psychopathological aspect linked with such dysfunction.[50] Correspondingly, the DSM classifies "impulsivity or failure to plan ahead" and "irritability and aggressiveness" as two of seven sub-criteria in category A of the diagnostic criteria of ASPD.[51][16]

Some studies have found a relationship between monoamine oxidase A and antisocial behavior, including conduct disorder and symptoms of adult ASPD, in maltreated children.[52]

Neurological[edit]

Antisocial behavior may be related to head trauma.[53] Antisocial behavior is associated with decreased grey matter in the right lentiform nucleus, left insula, and frontopolar cortex. Increased volumes have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post central cortex.[54]

Intellectual and cognitive ability is often found to be impaired or reduced in the ASPD population.[55] Contrary to stereotypes in popular culture of the "psychopathic genius", antisocial personality disorder is associated with both reduced overall intelligence and specific reductions in individual aspects of cognitive ability.[55][56] These deficits also occur in general-population samples of people with antisocial traits[57] and in children with the precursors to antisocial personality disorder.[58]

People that exhibit antisocial behavior tend to demonstrate decreased activity in the prefrontal cortex. The association is more apparent in functional neuroimaging as opposed to structural neuroimaging.[59] The prefrontal cortex is involved in many executive functions, including behavior inhibitions, planning ahead, determining consequences of action, and differentiating between right and wrong. However, some investigators have questioned whether the reduced volume in prefrontal regions is associated with antisocial personality disorder, or whether they result from co-morbid disorders, such as substance use disorder or childhood maltreatment.[60] Moreover, it remains an open question whether the relationship is causal, i.e., whether the anatomical abnormality causes the psychological and behavioral abnormality, or vice versa.[60]

Cavum septi pellucidi (CSP) is a marker for limbic neural maldevelopment, and its presence has been loosely associated with certain mental disorders, such as schizophrenia and post-traumatic stress disorder.[61][62][63] One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.[63]

Environmental[edit]

Family environment[edit]

Many studies suggest that the social and home environment has contributed to the development of antisocial behavior.[45] The parents of these children have been shown to display antisocial behavior, which could be adopted by their children.[45] A lack of parental stimulation and affection during early development leads to high levels of cortisol with the absence of balancing hormones such as oxytocin which disrupts and overloads the child's stress response systems, which is thought to lead to underdevelopment of the child's brain that deals with emotion, empathy and ability to connect to other humans on an emotional level. According to Dr. Bruce Perry in his book The Boy Who Was Raised as a Dog, "the [infant's developing] brain needs patterned, repetitive stimuli to develop properly. Spastic, unpredictable relief from fear, loneliness, discomfort, and hunger keeps a baby's stress system on high alert. An environment of intermittent care punctuated by total abandonment may be the worst of all worlds for a child."[64]

Cultural influences[edit]

The sociocultural perspective of clinical psychology views disorders as influenced by cultural aspects; since cultural norms differ significantly, mental disorders such as ASPD are viewed differently.[65] Robert D. Hare has suggested that the rise in ASPD that has been reported in the United States may be linked to changes in cultural mores, the latter serving to validate the behavioral tendencies of many individuals with ASPD.[66]: 136  While the rise reported may be in part merely a byproduct of the widening use (and abuse) of diagnostic techniques,[67] given Eric Berne's division between individuals with active and latent ASPD – the latter keeping themselves in check by attachment to an external source of control like the law, traditional standards, or religion[68] – it has been suggested that the erosion of collective standards may indeed serve to release the individual with latent ASPD from their previously prosocial behavior.[66]: 136–7 

There is also a continuous debate as to the extent to which the legal system should be involved in the identification and admittance of patients with preliminary symptoms of ASPD.[69] Controversial clinical psychiatrist Pierre-Édouard Carbonneau suggested that the problem with legal forced admittance is the rate of failure when diagnosing ASPD. He contends that the possibility of diagnosing and coercing a patient into prescribing medication to someone without ASPD, but is diagnosed with ASPD, could be potentially disastrous. But the possibility of not diagnosing ASPD and seeing a patient go untreated because of a lack of sufficient evidence of cultural or environmental influences is something a psychiatrist must ignore; and in his words, "play it safe".[70]

ICD-10[edit]

The WHO's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), has a diagnosis called dissocial personality disorder (F60.2):[71][72]

It is characterized by at least 3 of the following:
  1. Callous unconcern for the feelings of others;
  2. Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
  3. Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
  4. Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
  5. Incapacity to experience guilt or to profit from experience, particularly punishment;
  6. Marked readiness to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.

The ICD states that this diagnosis includes "amoral, antisocial, asocial, psychopathic, and sociopathic personality". Although the disorder is not synonymous with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature.[72][73]

It is a requirement of the ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.[72]

Psychopathy[edit]

Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls.[15][74][75][76] Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL-R).[77] "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy.[15][71][76][78][79]

American psychiatrist Hervey Cleckley's work[80] on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy.[11][15] However, critics argue ASPD is not synonymous with psychopathy as the diagnostic criteria are not the same, since criteria relating to personality traits are emphasized relatively less in the former. These differences exist in part because it was believed such traits were difficult to measure reliably and it was "easier to agree on the behaviors that typify a disorder than on the reasons why they occur".[11][12][13][14][15]

Although the diagnosis of ASPD covers two to three times as many prisoners than the diagnosis of psychopathy, Robert Hare believes the PCL-R is better able to predict future criminality, violence, and recidivism than a diagnosis of ASPD.[11][12] He suggests there are differences between PCL-R-diagnosed psychopaths and non-psychopaths on "processing and use of linguistic and emotional information", while such differences are potentially smaller between those diagnosed with ASPD and without.[12][13]Additionally, Hare argued confusion regarding how to diagnose ASPD, confusion regarding the difference between ASPD and psychopathy, as well as the differing future prognoses regarding recidivism and treatability, may have serious consequences in settings such as court cases where psychopathy is often seen as aggravating the crime.[12][13]

Nonetheless, psychopathy has been proposed as a specifier under an alternative model for ASPD. In the DSM-5, under "Alternative DSM-5 Model for Personality Disorders", ASPD with psychopathic features is described as characterized by "a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviors (e.g., fraudulence)." Low levels of withdrawal and high levels of attention-seeking combined with low anxiety are associated with "social potency" and "stress immunity" in psychopathy.[23]: 765  Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components.[81]

Other[edit]

Theodore Millon suggested 5 subtypes of ASPD.[82][83] However, these constructs are not recognized in the DSM and ICD.

SubtypeFeatures
Nomadic antisocial (including schizoid and avoidantfeatures)Drifters; roamers, vagrants; adventurer, itinerant vagabonds, tramps, wanderers; they typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility.
Malevolent antisocial (including sadistic and paranoidfeatures)Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals, including serial killers.
Covetous antisocial (including negativistic features)Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having.
Risk-taking antisocial (including histrionic features)Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures.
Reputation-defending antisocial (including narcissisticfeatures)Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights.

Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk-taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special ... Taxonomies may be put forward at levels that are more coarse or more fine-grained."[66]: 223 

Treatment[edit]

ASPD is considered to be among the most difficult personality disorders to treat.[84][85][verification needed][86] Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community.[87] Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.[84] They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment.[88][verification needed] Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.[89]

Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment.[90] Those with ASPD may stay in treatment only as required by an external source, such as parole conditions.[86][verification needed] Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended.[84] There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.[91] Psychotherapy also known as talk therapy is found to help treat patients with ASPD.[92]Schema therapy is also being investigated as a treatment for ASPD.[93] A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However, this treatment requires complete cooperation and participation of all family members.[94] Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use,[95] although others have reported contradictory findings.[96]

Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors.[84] Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of even this form of therapy.[97]

The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD.[98] A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD.[99] Nonetheless, psychiatric medications such as antipsychoticsantidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.[citation needed][100][101]

Prognosis[edit]

According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores and reading problems.[102] The strongest relationship between these variables and ASPD are childhood hyperactivity and conduct disorder. Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD.[103][104] Like many disorders, genetics play a role in this disorder but the environment holds an undeniable role in its development.

Boys are twice as likely to meet all of the diagnostic criteria for ASPD than girls (40% versus 25%) and they will often start showing symptoms of the disorder much earlier in life.[105] Children that do not show symptoms of the disease through age 15 will not develop ASPD later in life.[105] If adults exhibit milder symptoms of ASPD, it is likely that they never met the criteria for the disorder in their childhood and were consequently never diagnosed. Overall, symptoms of ASPD tend to peak in late-teens and early twenties, but can often reduce or improve through age 40.[5]

ASPD is ultimately a lifelong disorder that has chronic consequences, though some of these can be moderated over time.[105] There may be a high variability of the long-term outlook of antisocial personality disorder. The treatment of this disorder can be successful, but it entails unique difficulties. It is unlikely to see rapid change especially when the condition is severe. In fact, past studies revealed that remission rates were small, with up to only 31% rates of improvement instead of remittance.[105] As a result of the characteristics of ASPD (e.g., displaying charm in effort of personal gain, manipulation), patients seeking treatment (mandated or otherwise) may appear to be "cured" in order to get out of treatment. According to definitions found in the DSM-5, people with ASPD can be deceitful and intimidating in their relationships.[106] When they are caught doing something wrong, they often appear to be unaffected and unemotional about the consequences.[106] Over time, continual behavior that lacks empathy and concern may lead to someone with ASPD taking advantage of the kindness of others, including his or her therapist.[106]

Without proper treatment, individuals suffering with ASPD could lead a life that brings about harm to themselves or others. This can be detrimental to their families and careers. ASPD victims suffer from lack of interpersonal skills (e.g., lack of remorse, lack of empathy, lack of emotional-processing skills).[107][108] As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide.[109][110] They also see higher rates of committed crime, reaching peaks in their late teens and often committing higher-severity crimes in their younger ages of diagnoses.[105] Comorbidity of other mental illnesses such as Depression or substance use disorder is prevalent among ASPD victims. People with ASPD are also more likely to commit homicides and other crimes.[105] Those who are imprisoned longer often see higher rates of improvement with symptoms of ASPD than others who have been imprisoned for a shorter amount of time.[105]

According to one study, aggressive tendencies show in about 72% of all male patients diagnosed with ASPD. About 29% of the men studied with ASPD also showed a prevalence of pre-meditated aggression.[111] Based on the evidence in the study, the researchers concluded that aggression in patients with ASPD is mostly impulsive, though there are some long-term evidences of pre-meditated aggressions.[111] It often occurs that those with higher psychopathic traits will exhibit the pre-meditated aggressions to those around them.[111] Over the course of a patient's life with ASPD, he or she can exhibit this aggressive behavior and harm those close to him or her.

Additionally, many people (especially adults) who have been diagnosed with ASPD become burdens to their close relatives, peers, and caretakers. Harvard Medical School recommends that time and resources be spent treating victims who have been affected by someone with ASPD, because the patient with ASPD may not respond to the administered therapies.[106] In fact, a patient with ASPD may only accept treatment when ordered by a court, which will make their course of treatment difficult and severe. Because of the challenges in treatment, the patient's family and close friends must take an active role in decisions about therapies that are offered to the patient. Ultimately, there must be a group effort to aid the long-term effects of the disorder.[112]

Epidemiology[edit]

As seen in two North American studies and two European studies, ASPD is more commonly seen in men than in women, with men three to five times more likely to be diagnosed with ASPD than women.[113][105] The prevalence of ASPD is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. It has been found that the prevalence of ASPD among prisoners is just under 50%.[113] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) use treatment programs than in the general population, suggesting a link between ASPD and AOD use and dependence.[113][109] As part of the Epidemiological Catchment Area (ECA) study, men with ASPD were found to be three to five times more likely to excessively use alcohol and illicit substances than those men without ASPD. While ASPD occurs more often in men than women, there was found to be increased severity of this substance use in women with ASPD. In a study conducted with both men and women with ASPD, women were more likely to misuse substances compared to their male counterparts.[114][115]

Individuals with ASPD are at an elevated risk for suicide.[110] Some studies suggest this increase in suicidality is in part due to the association between suicide and symptoms or trends within ASPD, such as criminality and substance use.[116] Offspring of ASPD victims are also at risk.[117] Some research suggests that negative or traumatic experiences in childhood, perhaps as a result of the choices a parent with ASPD might make, can be a predictor of delinquency later on in the child's life.[104] Additionally, with variability between situations, children of a parent with ASPD may suffer consequences of delinquency if they're raised in an environment in which crime and violence is common.[103] Suicide is a leading cause of death among youth who display antisocial behavior, especially when mixed with delinquency. Incarceration, which could come as a consequence of actions from a victim of ASPD, is a predictor for suicide ideation in youth.[117][118]

History[edit]

The first version of the DSM in 1952 listed sociopathic personality disturbance. This category was for individuals who were considered "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals".[119][verification needed] There were four subtypes, referred to as "reactions": antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.[120]

The DSM-II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize.[121] The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM-II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.[122]

The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up".[123] However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.[124]

The DSM-IV maintained the trend for behavioral antisocial symptoms while noting "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorderThe Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".[81]

See also[edit]

References[edit]

  1. ^ "Antisocial Personality Disorder"National Library of Medicine. Retrieved 16 May 2018.
  2. Jump up to:a b c d American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 661ISBN 978-0890425558
  3. Jump up to:a b "Antisocial personality disorder"nhs.uk. 12 February 2021. Retrieved 12 September 2021.
  4. Jump up to:a b c d e f g h i Mayo Clinic Staff (2 April 2016). "Overview- Antisocial personality disorder"Mayo Clinic. Retrieved 12 April 2016.
  5. Jump up to:a b c d e f Berger FK (29 July 2016). "Antisocial personality disorder: MedlinePlus Medical Encyclopedia"MedlinePlus. Retrieved 1 November 2016.
  6. Jump up to:a b Black, Donald W (July 2015). "The Natural History of Antisocial Personality Disorder"Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie60 (7): 309–314. ISSN 0706-7437PMC 4500180PMID 26175389.
  7. ^ "Personality Disorders: Facts And Statistics"Vertava Health. Retrieved 12 September 2021.
  8. ^ Black, Donald (May 2010). "Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of life" (PDF)Annals of Clinical Psychiatry22 (2): 113–120.
  9. ^ Weiner IB, Freedheim DK (2003). Handbook of Psychology. John Wiley and Sons. p. 88.
  10. ^ Farrington DPCoid J (2004). Early Prevention of Adult Antisocial Behavior. Cambridge, England: Cambridge University Press. p. 82. ISBN 978-0-521-65194-3. Retrieved 12 January 2008.
  11. Jump up to:a b c d Patrick CJ (2005). Handbook of PsychopathyGuilford PressISBN 9781606238042.
  12. Jump up to:a b c d e Hare RD (1 February 1996). "Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion"Psychiatric Times. New York City: UBM plc13 (2). Retrieved 19 May 2017.
  13. Jump up to:a b c d Hare RD, Hart SD, Harpur TJ (August 1991). "Psychopathy and the DSM-IV criteria for antisocial personality disorder" (PDF)Journal of Abnormal Psychology100 (3): 391–8. doi:10.1037/0021-843x.100.3.391PMID 1918618. Archived from the original (PDF) on 26 September 2007. Retrieved 19 May 2017.
  14. Jump up to:a b Semple D, Smyth R, Burns J, Darjee R, McIntosh A (2005). The Oxford Handbook of Psychiatry. Oxford, England: Oxford University Press. pp. 448–449. ISBN 978-0-19-852783-1.
  15. Jump up to:a b c d e Skeem JL, Polaschek DL, Patrick CJ, Lilienfeld SO (December 2011). "Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy"Psychological Science in the Public Interest12 (3): 95–162. doi:10.1177/1529100611426706PMID 26167886S2CID 8521465.
  16. Jump up to:a b c d "Antisocial Personality Disorder"Psychology Today. New York City: Sussex Publishers. Retrieved 18 February 2018.
  17. Jump up to:a b c "Antisocial personality disorder"NHS. Retrieved 11 May 2016.
  18. Jump up to:a b c "Antisocial personality disorder: prevention and management"NICE. March 2013. Retrieved 11 May 2016.
  19. ^ "Differences Between a Psychopath vs Sociopath"World of Psychology. 12 February 2015. Retrieved 18 February 2018.
  20. ^ McCallum D (2001). Personality and dangerousness : genealogies of antisocial personality disorder. Cambridge, England: Cambridge University PressISBN 978-0521008754OCLC 52493285.
  21. ^ Diagnostic and Statistical Manual of Mental Disorders(4th ed.). Washington, DC: American Psychiatric Association. 2000.
  22. ^ Zoccolillo M, Pickles A, Quinton D, Rutter M (November 1992). "The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder". Psychological MedicineCambridge University Press22 (4): 971–86. doi:10.1017/s003329170003854xPMID 1488492.
  23. Jump up to:a b Kupfer D, Regier D, eds. (2013). Diagnostic and Statistical Manual of Mental Disorders (5 ed.). Washington, DC: American Psychiatric AssociationISBN 978-0890425558.
  24. ^ Hinshaw SP, Lee SS (2003). "Conduct and Oppositional Defiant Disorders" (PDF). In Mash EJ, Barkely RA (eds.). Child Psychopathology (2 ed.). New York City: Guilford Press. pp. 144–198. ISBN 978-1-57230-609-7.
  25. ^ Lynskey MT, Fergusson DM (June 1995). "Childhood conduct problems, attention deficit behaviors, and adolescent alcohol, tobacco, and illicit drug use". Journal of Abnormal Child PsychologySpringer Science+Business Media23 (3): 281–302. doi:10.1007/bf01447558PMID 7642838S2CID 40789985.
  26. ^ Loeber R, Keenan K, Lahey BB, Green SM, Thomas C (August 1993). "Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder". Journal of Abnormal Child Psychology21 (4): 377–410. doi:10.1007/bf01261600PMID 8408986S2CID 43444052.
  27. ^ Moffitt TE (October 1993). "Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy". Psychological Review100 (4): 674–701. doi:10.1037/0033-295x.100.4.674PMID 8255953.
  28. ^ Moffitt TE, Caspi A (June 2001). "Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females". Development and Psychopathology13 (2): 355–75. doi:10.1017/s0954579401002097PMID 11393651S2CID 29182035.
  29. ^ Baumgärtner G, Soyka M (November 2013). Translated by Welsh S. "[DSM-5--what has changed in therapy for and research on substance-related and addictive disorders?]"(PDF)Fortschritte der Neurologie-Psychiatrie81 (11): 648–54. doi:10.1159/000356537PMID 24194058. Retrieved 20 May2017.
  30. ^ Internet Mental Health – antisocial personality disorderArchived 4 June 2013 at the Wayback Machine. Mentalhealth.com. Retrieved on 7 December 2011.
  31. ^ Oscar-Berman M, Valmas MM, Sawyer KS, Kirkley SM, Gansler DA, Merritt D, Couture A (April 2009). "Frontal brain dysfunction in alcoholism with and without antisocial personality disorder"Neuropsychiatric Disease and Treatment5: 309–26. doi:10.2147/NDT.S4882PMC 2699656PMID 19557141.
  32. ^ Helle AC, Watts AL, Trull TJ, Sher KJ (2019). "Alcohol Use Disorder and Antisocial and Borderline Personality Disorders"Alcohol Research: Current Reviews40 (1): 1. doi:10.35946/arcr.v40.1.05PMC 6927749PMID 31886107.
  33. ^ Gerstley LJ, Alterman AI, McLellan AT, Woody GE (February 1990). "Antisocial personality disorder in patients with substance abuse disorders: a problematic diagnosis?". The American Journal of Psychiatry147 (2): 173–8. doi:10.1176/ajp.147.2.173PMID 2405719.
  34. Jump up to:a b "Antisocial Personality Disorder | MentalHealth.gov"mentalhealth.gov. Retrieved 18 February 2018.
  35. ^ Baker LA, Bezdjian S, Raine A (1 January 2006). "Behavioral Genetics: The Science of Antisocial Behavior"Law and Contemporary Problems69 (1–2): 7–46. PMC 2174903PMID 18176636.
  36. ^ Guo G, Ou XM, Roettger M, Shih JC (May 2008). "The VNTR 2 repeat in MAOA and delinquent behavior in adolescence and young adulthood: associations and MAOA promoter activity"European Journal of Human Genetics16 (5): 626–34. doi:10.1038/sj.ejhg.5201999PMC 2922855PMID 18212819.
  37. ^ Guo G, Roettger M, Shih JC (August 2008). "The integration of genetic propensities into social-control models of delinquency and violence among male youths" (PDF)American Sociological Review73 (4): 543–568. doi:10.1177/000312240807300402S2CID 30271933. Archived from the original (PDF) on 3 March 2016. Retrieved 20 November 2016. "Archived copy" (PDF). Archived from the original on 2 December 2008. Retrieved 16 February 2009.
  38. ^ Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW, et al. (August 2002). "Role of genotype in the cycle of violence in maltreated children". Science297 (5582): 851–4. Bibcode:2002Sci...297..851Cdoi:10.1126/science.1072290PMID 12161658S2CID 7882492Lay summary – eurekalert.org (1 August 2002).
  39. ^ Frazzetto G, Di Lorenzo G, Carola V, Proietti L, Sokolowska E, Siracusano A, et al. (May 2007). "Early trauma and increased risk for physical aggression during adulthood: the moderating role of MAOA genotype"PLOS ONE2 (5): e486. Bibcode:2007PLoSO...2..486Fdoi:10.1371/journal.pone.0000486PMC 1872046PMID 17534436.
  40. ^ Ficks CA, Waldman ID (September 2014). "Candidate genes for aggression and antisocial behavior: a meta-analysis of association studies of the 5HTTLPR and MAOA-uVNTR". Behavior Genetics44 (5): 427–44. doi:10.1007/s10519-014-9661-yPMID 24902785S2CID 11599122.
  41. ^ Aluja A, Garcia LF, Blanch A, De Lorenzo D, Fibla J (July 2009). "Impulsive-disinhibited personality and serotonin transporter gene polymorphisms: association study in an inmate's sample". Journal of Psychiatric Research43 (10): 906–14. doi:10.1016/j.jpsychires.2008.11.008PMID 19121834.
  42. ^ Glenn AL (January 2011). "The other allele: exploring the long allele of the serotonin transporter gene as a potential risk factor for psychopathy: a review of the parallels in findings"Neuroscience and Biobehavioral Reviews35 (3): 612–20. doi:10.1016/j.neubiorev.2010.07.005PMC 3006062PMID 20674598.
  43. ^ Yildirim BO, Derksen JJ (August 2013). "Systematic review, structural analysis, and new theoretical perspectives on the role of serotonin and associated genes in the etiology of psychopathy and sociopathy"Neuroscience and Biobehavioral Reviews37 (7): 1254–96. doi:10.1016/j.neubiorev.2013.04.009PMID 23644029S2CID 19350747.
  44. ^ Rautiainen MR, Paunio T, Repo-Tiihonen E, Virkkunen M, Ollila HM, Sulkava S, et al. (September 2016). "Genome-wide association study of antisocial personality disorder"Translational Psychiatry6 (9): e883. doi:10.1038/tp.2016.155PMC 5048197PMID 27598967.
  45. Jump up to:a b c d Black D. "What Causes Antisocial Personality Disorder?"Psych Central. Retrieved 1 November 2011.
  46. ^ Archer J (February 1991). "The influence of testosterone on human aggression"British Journal of Psychology. 82 ( Pt 1) (1): 1–28. doi:10.1111/j.2044-8295.1991.tb02379.xPMID 2029601.
  47. ^ Aromäki A, Lindman R, Erikson C (12 February 1999). "Testosterone, aggressiveness, and antisocial personality. Hormone Sensitivity and Bone Mineral Metabolism". Aggressive Behavior25 (2). doi:10.1002/(SICI)1098-2337(1999)25:2<113::AID-AB4>3.0.CO;2-4.
  48. ^ Mehta PH, Josephs RA (November 2010). "Testosterone and cortisol jointly regulate dominance: evidence for a dual-hormone hypothesis"Hormones and Behavior58 (5): 898–906. doi:10.1016/j.yhbeh.2010.08.020PMID 20816841S2CID 16459329.
  49. ^ Moore TM, Scarpa A, Raine A (2002). "A meta-analysis of serotonin metabolite 5-HIAA and antisocial behavior". Aggressive Behavior28 (4): 299–316. doi:10.1002/ab.90027.
  50. ^ Olivier B (December 2004). "Serotonin and aggression". Annals of the New York Academy of Sciences. 3–4. 1036 (3): 382–92. doi:10.1300/J076v21n03_03PMID 15817750.
  51. ^ American Psychiatric Association (2000). "Diagnostic criteria for 301.7 Antisocial Personality Disorder"BehaveNet. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Retrieved 8 July 2013.
  52. ^ Huizinga D, Haberstick BC, Smolen A, Menard S, Young SE, Corley RP, et al. (October 2006). "Childhood maltreatment, subsequent antisocial behavior, and the role of monoamine oxidase A genotype". Biological Psychiatry60 (7): 677–83. doi:10.1016/j.biopsych.2005.12.022PMID 17008143S2CID 12744470.
  53. ^ Séguin JR (June 2004). "Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account"Brain and Cognition55 (1): 185–97. doi:10.1016/S0278-2626(03)00273-2PMC 3283581PMID 15134852.
  54. ^ Aoki Y, Inokuchi R, Nakao T, Yamasue H (August 2014). "Neural bases of antisocial behavior: a voxel-based meta-analysis"Social Cognitive and Affective Neuroscience9 (8): 1223–31. doi:10.1093/scan/nst104PMC 4127028PMID 23926170.
  55. Jump up to:a b Sánchez de Ribera O, Kavish N, Katz IM, Boutwell BB (1 September 2019). "Untangling Intelligence, Psychopathy, Antisocial Personality Disorder, and Conduct Problems: A Meta–Analytic Review"European Journal of Personality33 (5): 529–564. doi:10.1002/per.2207S2CID 202253144.
  56. ^ Stevens MC, Kaplan RF, Hesselbrock VM (March 2003). "Executive–cognitive functioning in the development of antisocial personality disorder"Addictive Behaviors28 (2): 285–300. doi:10.1016/S0306-4603(01)00232-5PMID 12573679.
  57. ^ Unsworth N, Miller JD, Lakey CE, Young DL, Meeks JT, Campbell WK, Goodie AS (2009). "Exploring the relations among executive functions, fluid intelligence, and personality"Journal of Individual Differences30 (4): 194–200. doi:10.1027/1614-0001.30.4.194.
  58. ^ Loney BR, Frick PJ, Ellis M, McCoy MG (September 1998). "Intelligence, Callous-Unemotional Traits, and Antisocial Behavior"Journal of Psychopathology and Behavioral Assessment20 (1): 231–247. doi:10.1023/A:1023015318156S2CID 146174376.
  59. ^ Yang Y, Raine A (November 2009). "Prefrontal structural and functional brain imaging findings in antisocial, violent, and psychopathic individuals: a meta-analysis"Psychiatry Research174 (2): 81–8. doi:10.1016/j.pscychresns.2009.03.012PMC 2784035PMID 19833485.
  60. Jump up to:a b Glenn AL, Johnson AK, Raine A (December 2013). "Antisocial personality disorder: a current review"Current Psychiatry Reports15 (12): 427. doi:10.1007/s11920-013-0427-7PMID 24249521S2CID 10578128.
  61. ^ Galarza M, Merlo AB, Ingratta A, Albanese EF, Albanese AM (2004). "Cavum septum pellucidum and its increased prevalence in schizophrenia: a neuroembryological classification". The Journal of Neuropsychiatry and Clinical Neurosciences16 (1): 41–6. doi:10.1176/appi.neuropsych.16.1.41PMID 14990758.
  62. ^ May FS, Chen QC, Gilbertson MW, Shenton ME, Pitman RK (March 2004). "Cavum septum pellucidum in monozygotic twins discordant for combat exposure: relationship to posttraumatic stress disorder"Biological Psychiatry55 (6): 656–8. doi:10.1016/j.biopsych.2003.09.018PMC 2794416PMID 15013837.
  63. Jump up to:a b Raine A, Lee L, Yang Y, Colletti P (September 2010). "Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy"The British Journal of Psychiatry197 (3): 186–92. doi:10.1192/bjp.bp.110.078485PMC 2930915PMID 20807962.
  64. ^ Perry B, Szalavitz M (2017) [2006]. The Boy Who Was Raised as a Dog. New York: Basic Books. p. 123. ISBN 978-0-465-09445-5.
  65. ^ Lock MP (November 2008). "Treatment of antisocial personality disorder"The British Journal of Psychiatry193(5): 426, author reply 426. doi:10.1192/bjp.193.5.426PMID 18978330.
  66. Jump up to:a b c Stout M (2006). The sociopath next door: the ruthless versus the rest of us (1st ed.). New York: Broadway Books. ISBN 978-0-7679-1582-3.
  67. ^ Sutker PB, Allain AN (2002). "Antisocial Personality Disorder". In Sutker PB, Adams HE (eds.). Comprehensive Handbook of Psychopathology (3rd ed.). Boston, MA: Springer. pp. 445–490. doi:10.1007/0-306-47377-1_16ISBN 978-0-306-46490-4.
  68. ^ Berne E (1976). A Layman's Guide to Psychiatry and Psychoanalysis (first ed.). New York, NY: Grove. pp. 241–2. ISBN 978-0-394-17833-2.
  69. ^ McCallum D (2001). Personality and Dangerousness: Genealogies of Antisocial Personality Disorder. New York: Cambridge Univ. Press. p. 7. ISBN 978-0-521-00875-4.
  70. ^ Archer R, Wheeler E (2006). Forensic Uses of Clinical Assessment Instruments. Routledge. pp. 247–250.
  71. Jump up to:a b "Dissocial personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10)". Archived from the original on 11 September 2013. Retrieved 8 April 2020.
  72. Jump up to:a b c WHO (2010)ICD-10: Clinical descriptions and diagnostic guidelines: Disorders of adult personality and behavior
  73. ^ "F60.2 Dissocial personality disorder". World Health Organization. Retrieved 12 January 2008.
  74. ^ Blair RJ (January 2003). "Neurobiological basis of psychopathy"The British Journal of Psychiatry182: 5–7. doi:10.1192/bjp.182.1.5PMID 12509310.
  75. ^ Merriam-Webster Dictionary. "Definition of psychopathy". Retrieved 15 May 2013.
  76. Jump up to:a b Encyclopedia of Mental Disorders. "Hare Psychopathy Checklist". Retrieved 15 May 2013.
  77. ^ Hare RD (2003). Manual for the Revised Psychopathy Checklist (2nd ed.). Toronto, ON, Canada: Multi-Health Systems.
  78. ^ DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders (Fourth ed.). United States: American Psychiatric Association Press Inc. 2000. ISBN 978-0-89042-025-6.
  79. ^ "International Statistical Classification of Diseases and Related Health Problems" (10th ed.). World Health Organization. 2016.
  80. ^ Horley J (2014). "The emergence and development of psychopathy". History of the Human Sciences27 (5): 91–110. doi:10.1177/0952695114541864S2CID 145719285.
  81. Jump up to:a b Nussbaum A (2013). The Pocket Guide to the DSM-5 Diagnostic Exam. Arlington: American Psychiatric AssociationISBN 978-1-58562-466-9. Retrieved 5 January 2014.
  82. ^ Millon T (2000). Personality Disorders in Modern Life(Second ed.). Hoboken, New Jersey: John Wiley & Sons, Inc. pp. 158–161. ISBN 978-0-471-23734-1.
  83. ^ Millon, Theodore – Personality Subtypes. Millon.net. Retrieved on 7 December 2011. Archived 1 March 2018 at the Wayback Machine
  84. Jump up to:a b c d Gabbard GO, Gunderson JG (2000). Psychotherapy for Personality DisordersThe Journal of Psychotherapy Practice and Research9 (First ed.). American Psychiatric Publishing. pp. 1–6. ISBN 978-0-88048-273-8PMC 3330582PMID 10608903.
  85. ^ Stone MH (1993). Abnormalities of Personality. Within and Beyond the Realm of Treatment. Norton. ISBN 978-0-393-70127-2.
  86. Jump up to:a b Nolen-Hoeksema S (2 December 2013). Abnormal psychology (Sixth ed.). New York, NY. ISBN 9780078035388OCLC 855264280.
  87. ^ Meloy JR, Yakeley AJ (2011). Antisocial personality disorder.
  88. ^ Oldham JM, Skodol AE, Bender DS (2005). The American Psychiatric Publishing Textbook of Personality Disorders. American Psychiatric Publishing. ISBN 978-1-58562-159-0.
  89. ^ Salekin RT (February 2002). "Psychopathy and therapeutic pessimism. Clinical lore or clinical reality?". Clinical Psychology Review22 (1): 79–112. doi:10.1016/S0272-7358(01)00083-6PMID 11793579.
  90. ^ McRae L (February 2013). "Rehabilitating antisocial personalities: treatment through self-governance strategies"The Journal of Forensic Psychiatry & Psychology24 (1): 48–70. doi:10.1080/14789949.2012.752517PMC 3756620PMID 24009471.
  91. ^ Derefinko KJ, Widiger TA (2008). Antisocial Personality DisorderThe Medical Basis of Psychiatry. pp. 213–226. doi:10.1007/978-1-59745-252-6_13ISBN 978-1-58829-917-8.
  92. ^ "Treatment – Mayo Clinic"Mayo Clinic. Retrieved 13 June2017.
  93. ^ Bernstein DP, Arntz A, Vos Md (2007). "Schema Focused Therapy in Forensic Settings: Theoretical Model and Recommendations for Best Clinical Practice" (PDF)International Journal of Forensic Mental Health6 (2): 169–183. doi:10.1080/14999013.2007.10471261S2CID 145389897. Archived from the original (PDF) on 26 July 2011.
  94. ^ Gatzke LM, Raine A (February 2000). "Treatment and prevention implications of antisocial personality disorder". Current Psychiatry Reports2 (1): 51–5. doi:10.1007/s11920-000-0042-2PMID 11122932S2CID 33844568.
  95. ^ Darke S, Finlay-Jones R, Kaye S, Blatt T (September 1996). "Anti-social personality disorder and response to methadone maintenance treatment". Drug and Alcohol Review15 (3): 271–6. doi:10.1080/09595239600186011PMID 16203382.
  96. ^ Alterman AI, Rutherford MJ, Cacciola JS, McKay JR, Boardman CR (February 1998). "Prediction of 7 months methadone maintenance treatment response by four measures of antisociality". Drug and Alcohol Dependence49 (3): 217–23. doi:10.1016/S0376-8716(98)00015-5PMID 9571386.
  97. ^ Beck AT, Freeman A, Davis DD (2007). Cognitive Therapy of Personality Disorders (Second ed.). New York: Guilford Press. ISBN 978-1-59385-476-8.
  98. ^ Mayo Clinic staff (12 April 2013). "Antisocial personality disorder: Treatments and drugs"Mayo Clinic. Mayo Foundation for Medical Education and Research. Retrieved 17 December 2013.
  99. ^ Khalifa NR, Gibbon S, Völlm BA, Cheung NH, McCarthy L (September 2020). "Pharmacological interventions for antisocial personality disorder"The Cochrane Database of Systematic Reviews9: CD007667. doi:10.1002/14651858.CD007667.pub3PMC 8094881PMID 32880105.
  100. ^ Bucholz KK, Frey RJ, Edens EL (2009). "Antisocial Personality Disorder". In Korsmeyer P, Kranzler HR (eds.). Encyclopedia of Drugs, Alcohol & Addictive Behavior1 (3rd ed.). Detroit, MI: Macmillan Reference USA. pp. 181–183.
  101. ^ Hatchett G (1 January 2015). "Treatment Guidelines for Clients with Antisocial Personality Disorder"Journal of Mental Health Counseling37 (1): 15–27. doi:10.17744/mehc.37.1.52g325w385556315ISSN 1040-2861.
  102. ^ Simonoff E, Elander J, Holmshaw J, Pickles A, Murray R, Rutter M (February 2004). "Predictors of antisocial personality. Continuities from childhood to adult life"The British Journal of Psychiatry: The Journal of Mental Science184: 118–27. doi:10.1192/bjp.184.2.118PMID 14754823.
  103. Jump up to:a b Azeredo A, Moreira D, Figueiredo P, Barbosa F (December 2019). "Delinquent Behavior: Systematic Review of Genetic and Environmental Risk Factors". Clinical Child and Family Psychology Review22 (4): 502–526. doi:10.1007/s10567-019-00298-wPMID 31367800.
  104. Jump up to:a b Baglivio MT, Wolff KT, Piquero AR, Epps N (May 2015). "The relationship between adverse childhood experiences (ACE) and juvenile offending trajectories in a juvenile offender sample". Journal of Criminal Justice43 (3): 229–41. doi:10.1016/j.jcrimjus.2015.04.012.
  105. Jump up to:a b c d e f g h Fisher KA, Hany M (23 November 2019). "Antisocial Personality Disorder"StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing.
  106. Jump up to:a b c d "Antisocial Personality Disorder"Harvard Health Publishing. 13 March 2019. Retrieved 13 December 2020.
  107. ^ Mann FD, Briley DA, Tucker-Drob EM, Harden KP (November 2015). "A behavioral genetic analysis of callous-unemotional traits and Big Five personality in adolescence"Journal of Abnormal Psychology124 (4): 982–993. doi:10.1037/abn0000099PMC 5225906PMID 26595476.
  108. ^ Habel U, Kühn E, Salloum JB, Devos H, Schneider F (September 2002). "Emotional processing in psychopathic personality". Aggressive Behavior28 (5): 394–400. doi:10.1002/ab.80015.
  109. Jump up to:a b Mueser KT, Crocker AG, Frisman LB, Drake RE, Covell NH, Essock SM (October 2006). "Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders"Schizophrenia Bulletin32 (4): 626–36. doi:10.1093/schbul/sbj068PMC 2632266PMID 16574783.
  110. Jump up to:a b Krasnova A, Eaton WW, Samuels JF (May 2019). "Antisocial personality and risks of cause-specific mortality: results from the Epidemiologic Catchment Area study with 27 years of follow-up". Social Psychiatry and Psychiatric Epidemiology54 (5): 617–625. doi:10.1007/s00127-018-1628-5PMID 30506390S2CID 54221869.
  111. Jump up to:a b c Azevedo J, Vieira-Coelho M, Castelo-Branco M, Coelho R, Figueiredo-Braga M (March 2020). "Impulsive and premeditated aggression in male offenders with antisocial personality disorder"PLOS ONE15 (3): e0229876. Bibcode:2020PLoSO..1529876Adoi:10.1371/journal.pone.0229876PMC 7059920PMID 32142531.
  112. ^ "Antisocial personality disorder"nhs.uk. 21 March 2018. Retrieved 13 December 2020.
  113. Jump up to:a b c National Collaborating Centre for Mental Health (UK). (2010). Antisocial Personality Disorder: Treatment, Management and Prevention. Leicester (UK): British Psychological Society. PMID 21834198.
  114. ^ Robins LN, Tipp J, Przybeck T (1991). "Antisocial personality". In Robins LN, Regier DA (eds.). Psychiatric Disorders in America. New York: Free Press. pp. 258–290.
  115. ^ Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF (June 2005). "Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions". The Journal of Clinical Psychiatry66 (6): 677–85. doi:10.4088/jcp.v66n0602PMID 15960559.
  116. ^ Verona E, Patrick CJ, Joiner TE (August 2001). "Psychopathy, antisocial personality, and suicide risk". Journal of Abnormal Psychology110 (3): 462–70. doi:10.1037//0021-843x.110.3.462PMID 11502089.
  117. Jump up to:a b Mok PL, Pedersen CB, Springate D, Astrup A, Kapur N, Antonsen S, Mors O, Webb RT (October 2016). "Parental Psychiatric Disease and Risks of Attempted Suicide and Violent Criminal Offending in Offspring: A Population-Based Cohort Study"JAMA Psychiatry73 (10): 1015–1022. doi:10.1001/jamapsychiatry.2016.1728PMC 5079483PMID 27580483.
  118. ^ Abram KM, Choe JY, Washburn JJ, Teplin LA, King DC, Dulcan MK (March 2008). "Suicidal ideation and behaviors among youths in juvenile detention"Journal of the American Academy of Child and Adolescent Psychiatry47 (3): 291–300. doi:10.1097/CHI.0b013e318160b3cePMC 2945393PMID 18216737.
  119. ^ Diagnostic and Statistical Manual: Mental Disorders. American Psychiatric Association (APA). 1952. p. 38. ISBN 978-0890420171.
  120. ^ Forrest G (1994). Chemical dependency and antisocial personality disorder : psychotherapy and assessment strategies. New York: Haworth Press. ISBN 978-1560243083OCLC 25246264.
  121. ^ Diagnostic and Statistical Manual of Mental Disorders (DSM-II) (PDF). Washington, D. C.: American Psychiatric Association. 1968. p. 43. Archived from the original (PDF) on 1 November 2014.
  122. ^ International Handbook on Psychopathic Disorders and the Law, Volume 1, Alan Felthous, Henning Sass, 15 April 2008, e.g. Pgs 24 – 26
  123. ^ Kendler KS, Muñoz RA, Murphy G (February 2010). "The development of the Feighner criteria: a historical perspective". The American Journal of Psychiatry167 (2): 134–42. doi:10.1176/appi.ajp.2009.09081155PMID 20008944.
  124. ^ The DSM-IV Personality Disorders W. John Livesley, Guilford Press, 1995, Page 135

Further reading[edit]

  • Millon T, Davis RD (1998). "Ten Subtypes of Psychopathy". In Millon T (ed.). Psychopathy: Antisocial, Criminal and Violent Behavior. New York, NY: Guilford Press. ISBN 978-1-57230-344-7.
  • Hofer, Paul. "The Role of Manipulation in the Antisocial Personality", International Journal of Offender Therapy and Comparative Criminology, Vol. 33 No 2, 91–101 (1989)

External links[edit]

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Bullying is the use of force, coercion, hurtful teasing or threat, to abuse, aggressively dominate or intimidate. The behavior is often repeated and habitual. One essential prerequisite is the perception (by the bully or by others) of an imbalance of physical or social power. This imbalance distinguishes bullying from conflict.[1][2] Bullying is a subcategory of aggressive behavior characterized by hostile intent, imbalance of power and repetition over a period of time.[3] Bullying is the activity of repeated, aggressive behavior intended to hurt another individual, physically, mentally or emotionally. Bullying can be done individually or by a group, called mobbing,[4] in which the bully may have one or more followers who are willing to assist the primary bully or who reinforce the bully by providing positive feedback such as laughing.[5] Bullying in school and the workplace is also referred to as "peer abuse".[6] Robert W. Fuller has analyzed bullying in the context of rankism.[7] The Swedish-Norwegian researcher Dan Olweus says bullying occurs when a person is "exposed, repeatedly and over time, to negative actions on the part of one or more other persons",[8] and that negative actions occur "when a person intentionally inflicts injury or discomfort upon another person, through physical contact, through words or in other ways".[8] Individual bullying is usually characterized by a person behaving in a certain way to gain power over another person.[9] A bullying culture can develop in any context in which humans interact with each other. This may include school, family, the workplace,[10] the home, and neighborhoods. The main platform for bullying in contemporary culture is on social media websites.[11] In a 2012 study of male adolescent American football players, "the strongest predictor [of bullying] was the perception of whether the most influential male in a player's life would approve of the bullying behavior."[12] A study by The Lancet Child & Adolescent Health in 2019 showed a relationship between social media use by girls and an increase in their exposure to bullying.[13] Bullying may be defined in many different ways. In the United Kingdom, there is no legal definition of bullying,[14] while some states in the United States have laws against it.[15] Bullying is divided into four basic types of abuse – psychological (sometimes called emotional or relational), verbal, physical, and cyber.[16] Behaviors used to assert such domination may include physical assault or coercion, verbal harassment, or threat, and such acts may be directed repeatedly toward particular targets. Rationalizations of such behavior sometimes include differences of social class, race, religion, gender, sexual orientation, appearance, behavior, body language, personality, reputation, lineage, strength, size, or ability.[17][18][19] Etymology The word "bully" was first used in the 1530s meaning "sweetheart", applied to either sex, from the Dutch: boel, "lover, brother", probably diminutive of Middle High German: buole, "brother", of uncertain origin (compare with the German buhle "lover"). The meaning deteriorated through the 17th century through "fine fellow", "blusterer", to "harasser of the weak". This may have been as a connecting sense between "lover" and "ruffian" as in "protector of a prostitute", which was one sense of "bully" (though not specifically attested until 1706). The verb "to bully" is first attested in 1710.[20] In the past, in American culture, the term has been used differently, as an exclamation/exhortation, in particular famously associated with Theodore Roosevelt[21] and continuing to the present in the bully pulpit, Roosevelt's coining and also as faint/deprecating praise ("bully for him"). Types Bullying has been classified by the body of literature into different types. These can be in the form of nonverbal, verbal, or physical behavior. Another classification is based on perpetrators or the participants involved, so that the types include individual and collective bullying. Other interpretation also cite emotional and relational bullying in addition to physical harm inflicted towards another person or even property.[22] There is also the case of the more recent phenomenon called cyberbullying. Physical, verbal, and relational bullying are most prevalent in primary school and could also begin much earlier while continuing into later stages in individuals lives. Individual Individual bullying tactics are perpetrated by a single person against a victim or victims.[23] Individual bullying can be classified into four types outlined below:[24] Physical Physical bullying is any bullying that hurts someone's body or damages their possessions. Stealing, shoving, hitting, fighting, and intentionally destroying someone's property are types of physical bullying. Physical bullying is rarely the first form of bullying that a victim will experience. Often bullying will begin in a different form and later progress to physical violence. In physical bullying the main weapon the bully uses is his/her body, or some part thereof; or an object as a weapon when attacking his/her victim. Sometimes groups of young adults will target and alienate a peer because of some adolescent prejudice. This can quickly lead to a situation where they are being taunted, tortured, and "beaten up" by their classmates. Physical bullying will often escalate over time, and can lead to a detrimental or fatal ending, and therefore many try to stop it quickly to prevent any further escalation.[25] Verbal Verbal bullying is one of the most common types of bullying. This is any bullying that is conducted by speaking, other use of the voice, or some form of body language and does not involve any physical contact. Bullying usually begins at this stage and includes any of the following: Derogatory name-calling and nicknaming Spreading rumors or lying about someone Threatening someone Yelling at or talking to someone in a rude or unkind tone of voice, especially without justifiable cause Mocking someone's voice or style of speaking Laughing at someone Use of body language (i.e., the middle finger) to torture someone Making insults or otherwise making fun of someone In verbal bullying, the main weapon the bully uses is voice. In many cases, verbal bullying is common in both genders, but girls are more likely to perform it. Girls, in general, are more subtle with insults than boys. Girls use verbal bullying, as well as social exclusion techniques, to dominate and control other individuals and show their superiority and power, often to try to impress someone they idolize. Many boys are subtle enough to use verbal techniques for domination when they want to avoid the trouble that can come with physically bullying someone else.[26] Relational Relational bullying (sometimes referred to as social aggression) is the type of bullying that uses relationships to hurt others.[27] The term also denotes any bullying that is done with the intent to hurt somebody's reputation or social standing which can also link in with the techniques included in physical and verbal bullying. Relational bullying is a form of bullying common among youth, but particularly upon girls. Social exclusion (slighting or making someone feel "left out") is one of the most common types of relational bullying. Relational bullying can be used as a tool by bullies to both improve their social standing and control others. Unlike physical bullying which is obvious, relational bullying is not overt and can continue for a long time without being noticed.[28] Cyber Cyberbullying is the use of technology to harass, threaten, embarrass, or target another person. When an adult is involved, it may meet the definition of cyber-harassment or cyberstalking, a crime that can have legal consequences and involve jail time.[29] This includes bullying by use of email, instant messaging, social media websites (such as Facebook), text messages, and cell phones. It is stated that Cyberbullying is more common in secondary school than in primary school.[24] Collective Collective bullying tactics are employed by more than one individual against a victim or victims. Collective bullying is known as mobbing, and can include any of the individual types of bullying. Trolling behavior on social media, although generally assumed to be individual in nature by the casual reader, is sometime organized efforts by sponsored astroturfers. Mobbing Main article: Mobbing Mobbing refers to the bullying of an individual by a group, in any context, such as a family, peer group, school, workplace, neighborhood, community, or online. When it occurs as emotional abuse in the workplace, such as "ganging up" by co-workers, subordinates or superiors, to force someone out of the workplace through rumor, innuendo, intimidation, humiliation, discrediting, and isolation, it is also referred to as malicious, nonsexual, nonracial/racial, general harassment.[30] Characteristics Bullies and accomplices Studies have shown that envy and resentment may be motives for bullying.[31] Research on the self-esteem of bullies has produced equivocal results.[32][33] While some bullies are arrogant and narcissistic,[34] they can also use bullying as a tool to conceal shame or anxiety or to boost self-esteem: by demeaning others, the abuser feels empowered.[35] Bullies may bully out of jealousy or because they themselves are bullied.[36] Psychologist Roy Baumeister asserts that people who are prone to abusive behavior tend to have inflated but fragile egos. Because they think too highly of themselves, they are frequently offended by the criticisms and lack of deference of other people, and react to this disrespect with violence and insults.[37][full citation needed] Researchers have identified other risk factors such as depression[38] and personality disorders,[39] as well as quickness to anger and use of force, addiction to aggressive behaviors, mistaking others' actions as hostile, concern with preserving self-image, and engaging in obsessive or rigid actions.[40] A combination of these factors may also be causes of this behavior.[41] In one study of youth, a combination of antisocial traits and depression was found to be the best predictor of youth violence, whereas video game violence and television violence exposure were not predictive of these behaviors.[42] Bullying may also result from a genetic predisposition or a brain abnormality in the bully.[43] While parents can help a toddler develop emotional regulation and control to restrict aggressive behavior, some children fail to develop these skills due to insecure attachment with their families, ineffective discipline, and environmental factors such as a stressful home life and hostile siblings.[24] Moreover, according to some researchers, bullies may be inclined toward negativity and perform poorly academically. Dr. Cook says, "A typical bully has trouble resolving problems with others and also has trouble academically. He or she usually has negative attitudes and beliefs about others, feels negatively toward himself/herself, comes from a family environment characterized by conflict and poor parenting, perceives school as negative and is negatively influenced by peers."[44] Contrarily, some researchers have suggested that some bullies are psychologically strongest and have high social standing among their peers, while their targets are emotionally distressed and socially marginalized.[45] Peer groups often promote the bully's actions, and members of these peer groups also engage in behaviors, such as mocking, excluding, punching, and insulting one another as a source of entertainment.[24] Other researchers also argued that a minority of the bullies, those who are not in-turn bullied, enjoy going to school, and are least likely to take days off sick.[46] Research indicates that adults who bully have authoritarian personalities, combined with a strong need to control or dominate.[47] It has also been suggested that a prejudicial view of subordinates can be a particularly strong risk factor.[48] In a recent study, bullies showed lower school performance-related self-esteem than non-involved students. They also showed higher social self-esteem than victims of traditional bullying.[49] Brain studies have shown that the section of the brain associated with reward becomes active when bullies are shown a video of someone inflicting pain on another.[50] Bystanders Often, bullying takes place in the presence of a large group of relatively uninvolved bystanders. In many cases, it is the bully's ability to create the illusion they have the support of the majority present that instills the fear of "speaking out" in protestation of the bullying activities being observed by the group. Unless the "bully mentality" is effectively challenged in any given group in its early stages, it often becomes an accepted, or supported, norm within the group.[51][52] Unless action is taken, a "culture of bullying" is often perpetuated within a group for months, years, or longer.[53] Bystanders who have been able to establish their own "friendship group" or "support group" have been found to be far more likely to opt to speak out against bullying behavior than those who have not.[54][55] In addition to communication of clear expectations that bystanders should intervene and increasing individual self-efficacy, there is growing research to suggest interventions should build on the foundation that bullying is morally wrong.[56] Among adults, being a bystander to workplace bullying was linked to depression.[57] Victims Dr. Cook says, "A typical victim is likely to be aggressive, lack social skills, think negative thoughts, experience difficulties in solving social problems, come from a negative family, school and community environments and be noticeably rejected and isolated by peers."[44] Victims often have characteristics such as being physically and mentally weak, as well as being easily distraught emotionally. They may also have physical characteristics that make them easier targets for bullies such as being overweight or having some type of physical deformity. Boys are more likely to be victims of physical bullying while girls are more likely to be bullied indirectly.[58] Low levels of self-esteem has been identified as a frequent antecedent of bullying victimization. Victims of traditional bullying tend to have lower global, social, body-related, and emotional self-esteem compared to uninvolved students.[49][59][60][61][62] Victims of cyberbullying, on the other hand, may not have lower self-esteem scores than uninvolved students but might have higher body-related self-esteem than both victims of traditional bullying and bullies.[49] It has also been shown that victims are more likely to employ self-defeating or self-deprecating humor intended to entertain others at the expense of themselves and their own feelings.[63] The results of a meta-analysis conducted by Cook and published by the American Psychological Association in 2010 concluded the main risk factors for children and adolescents being bullied, and also for becoming bullies, are the lack of social problem-solving skills.[44] Children who are bullied often show physical or emotional signs, such as: being afraid to attend school, complaining of headaches or a loss of appetite, a lack of interest in school activities, spending time with friends or family, reluctance to go out in public for fear they may encounter their bullies in public places other than school, and having an overall sense of sadness. Effects Unbalanced scales.svg This section may lend undue weight to certain ideas, incidents, or controversies. Please help to create a more balanced presentation. Discuss and resolve this issue before removing this message. (May 2014) Mona O'Moore of the Anti-Bullying Centre at Trinity College in Dublin, has written, "There is a growing body of research which indicates that individuals, whether child or adult, who are persistently subjected to abusive behavior are at risk of stress related illness which can sometimes lead to suicide"[64] Those who have been the targets of bullying can develop long-term emotional and behavioral problems. Bullying can cause loneliness, depression, anxiety, lead to low self-esteem and increased susceptibility to illness.[65] Bullying has also been shown to cause maladjustment in young children, and targets of bullying who were also bullies themselves exhibit even greater social difficulties.[49][66] A mental health report also found that bullying was linked to eating disorders, anxiety, body dysmorphia and other negative psychological effects.[67] Both victims and perpetrators have been shown to exhibit higher levels of loneliness.[49] Suicide Main articles: Bullying and suicide and List of suicides that have been attributed to bullying Even though there is evidence that bullying increases the risk of suicide, bullying alone does not cause suicide. Depression is one of the main reasons why kids who are bullied die by suicide.[68] It is estimated that between 15 and 25 children die by suicide every year in the UK alone because they are being bullied.[69] Certain groups seem to incur a higher risk for suicide, such as Native Americans, Alaskan Natives, Asian Americans, and LGBT people. When someone feels unsupported by family or friends, it can make the situation much worse for the victim.[70] In a self-report study completed in New York by 9th through 12th graders, victims of bullying reported more depressive symptoms and psychological distress than those who did not experience bullying.[71] All types of involvement in bullying among both boys and girls is associated with depression even a couple years later.[72] Another study that followed up with Finnish teens two years after the initial survey showed that depression and suicidal ideation is higher with teens who are bullied than those who did not report experiencing bullying.[72] A Dutch longitudinal study on elementary students reported that boys who are bully-victims, who play both roles of a victim and a bully, were more likely to experience depression or serious suicidal ideation than the other roles, victims or bullies only, while girls who have any involvement in bullying have a higher level of risk for depression.[73] In a study of high school students completed in Boston, students who self reported being victims of bullying were more likely to consider suicide when compared to youth who did not report being bullied.[74] The same study also showed a higher risk of suicidal consideration in youth who report being a perpetrator, victim, or victim-perpetrator. Victims and victim-bullies are associated with a higher risk of suicide attempts. The place where youth live also appears to differentiate their bullying experiences such that those living in more urban areas who reported both being bullied and bullying others appear to show higher risk of suicidal ideation and suicide attempts.[74] A national survey given to American 6th through 10th grade students found that cyberbullying victims experience a higher level of depression than victims experiencing other forms of bullying. This can be related to the anonymity behind social media.[75] If a teen is being bullied and is displaying symptoms of depression it should be questioned and interventions should be implemented.[72] The Danish study showed that kids who are bullied talked to their parents and teachers about it and some reported a decrease in bullying or a stop in the bullying after a teacher or parent intervened. The study emphasizes the importance of implementing program-collaborations in schools to have programs and anti-bullying interventions in place to prevent and properly intervene when it occurs.[73] The study also shows the importance of having parents and teachers talk to the bullies about their bullying behavior in order to provide the necessary support for those experiencing bullying.[73] While some people find it very easy to ignore a bully, others may find it very difficult and reach a breaking point. There have been cases of apparent bullying suicides that have been reported closely by the media. These include the deaths of Ryan Halligan, Phoebe Prince, Dawn-Marie Wesley, Nicola Ann Raphael, Megan Meier, Audrie Pott, Tyler Clementi, Jamey Rodemeyer, Kenneth Weishuhn, Jadin Bell, Kelly Yeomans, Rehtaeh Parsons, Amanda Todd, Brodie Panlock,[76] Jessica Haffer,[77] Hamed Nastoh,[78] Sladjana Vidovic,[79] April Himes,[80] Cherice Moralez[81] and Rebecca Ann Sedwick.[82] According to the suicide awareness voices for education, suicide is one of the leading causes of death for youth from 15 to 24 years old. Over 16 percent of students seriously consider suicide, 13 percent create a plan, and 8 percent have made a serious attempt.[83] Strength and wisdom Some have argued that bullying can teach life lessons and instill strength. Helene Guldberg, a child development academic, sparked controversy when she argued that being a target of bullying can teach a child "how to manage disputes and boost their ability to interact with others", and that teachers should not intervene but leave children to respond to the bullying themselves.[84] Others, however, have pointed out that this is only true for normal peer conflicts but not for bullying cases.[85] The teaching of anti-bullying coping skills to children, carers and teachers has been found to be an effective long-term means of reducing bullying incidence rates and a valuable skill-set for individuals.[86] Testosterone production Statistically controlling for age and pubertal status, results indicated that on average verbally bullied girls produced less testosterone, and verbally bullied boys produced more testosterone than their nonbullied counterparts.[87] Dark triad Main article: Dark triad Research on the dark triad (narcissism, Machiavellianism, and psychopathy) indicate a correlation with bullying as part of evidence of the aversive nature of those traits.[88] Projection Main article: Psychological projection A bully may project his/her own feelings of vulnerability onto the target(s) of the bullying activity. Despite the fact that a bully's typically denigrating activities are aimed at the bully's targets, the true source of such negativity is ultimately almost always found in the bully's own sense of personal insecurity and/or vulnerability.[89] Such aggressive projections of displaced negative emotions can occur anywhere from the micro-level of interpersonal relationships, all the way up through to the macro-level of international politics, or even international armed conflict.[90] Emotional intelligence Main article: Bullying and emotional intelligence Bullying is abusive social interaction between peers which can include aggression, harassment, and violence. Bullying is typically repetitive and enacted by those who are in a position of power over the victim. A growing body of research illustrates a significant relationship between bullying and emotional intelligence (EI). Mayer et al., (2008) defines the dimensions of overall EI as "accurately perceiving emotion, using emotions to facilitate thought, understanding emotion, and managing emotion".[91] The concept combines emotional and intellectual processes.[92] Lower emotional intelligence appears to be related to involvement in bullying, as the bully and/or the victim of bullying. EI seems to play an important role in both bullying behavior and victimization in bullying; given that EI is illustrated to be malleable, EI education could greatly improve bullying prevention and intervention initiatives.[93] Context Internet Main article: Cyberbullying Cyberbullying is any bullying done through the use of technology. This form of bullying can easily go undetected because of lack of authoritative (including parental) supervision.[94] Because bullies can pose as someone else, it is the most anonymous form of bullying.[95] Cyberbullying includes abuse using email, instant messaging, text messaging, websites, and social networking sites.[96] Particular watchdog organizations have been designed to contain the spread of cyberbullying.[97] Disability Main article: Disability bullying Disabled people are disproportionately affected by bullying and abuse, and such activity has been cited as a hate crime.[98] The bullying is not limited to those who are visibly disabled, such as wheelchair users or physically deformed such as those with a cleft lip, but also those with developmental disabilities such as autism[99][100] and developmental coordination disorder.[101][102] There is an additional problem that those with learning disabilities are often not as able to explain things to other people, so are more likely to be disbelieved or ignored if they do complain.[citation needed] Homosexuality Main article: Gay bashing Gay bullying and gay bashing designate direct or indirect verbal or physical actions by a person or group against someone who is gay or lesbian, or perceived to be so due to rumors or because they are considered to fit gay stereotypes. Gay and lesbian youth are more likely than straight youth to report bullying, as well as be bullied.[103][104] Law Main article: Legal abuse Legal bullying is the bringing of a vexatious legal action to control and punish a person. Legal bullying can often take the form of frivolous, repetitive, or burdensome lawsuits brought to intimidate the defendant into submitting to the litigant's request, not because of the legal merit of the litigant's position, but principally due to the defendant's inability to maintain the legal battle. This can also take the form of Strategic Lawsuit Against Public Participation (SLAPP). It was partially concern about the potential for this kind of abuse that helped to fuel the protests against SOPA and PIPA in the United States in 2011 and 2012.[citation needed] Military Main articles: Bullying in the military and Dedovshchina In 2000, the UK Ministry of Defence (MOD) defined bullying as "the use of physical strength or the abuse of authority to intimidate or victimize others, or to give unlawful punishments".[105] Some argue that this behaviour should be allowed, due to ways in which "soldiering" is different from other occupations. Soldiers expected to risk their lives should, according to them, develop strength of body and spirit to accept bullying.[106] Parenting See also: Child abuse, Narcissistic parent, and Parental narcissistic abuse Parents who may displace their anger, insecurity, or a persistent need to dominate and control upon their children in excessive ways have been proven to increase the likelihood that their own children will in turn become overly aggressive or controlling towards their peers.[107] The American Psychological Association advises on its website that parents who may suspect their own children may be engaging in bullying activities among their peers should carefully consider the examples which they themselves may be setting for their own children regarding how they typically interact with their own peers, colleagues, and children.[108] Prison Main article: Prisoner abuse The prison environment is known for bullying. An additional complication is the staff and their relationships with the inmates. Thus, the following possible bullying scenarios are possible: Inmate bullies inmate (echoing school bullying) Staff bullies inmate Staff bullies staff (a manifestation of workplace bullying) Inmate bullies staff School Main article: School bullying A Centers for Disease Control and Prevention graphic presenting school anti-bullying guidelines. It is important to distinguish school bullying that per definition has the goal of harming the victim from normal peer conflict that is an inherent part of everyday school life and often promotes social development.[109] Unlike normal conflict, bullying is a systematic and repeated abuse committed intentionally by another student who has more power (physical, social, or otherwise). Bullying can occur in nearly any part in or around the school building, although it may occur more frequently during physical education classes and activities such as recess. Bullying also takes place in school hallways, bathrooms, on school buses and while waiting for buses, and in classes that require group work and/or after school activities. Bullying in school sometimes consists of a group of students taking advantage of or isolating one student in particular and gaining the loyalty of bystanders who want to avoid becoming the next target. In the 2011 documentary Bully, we see first hand the torture that kids go through both in school and while on the school bus. As the movie follows around a few kids we see how bullying affects them both at school as well as in their homes. While bullying has no age limit, these bullies may taunt and tease their target before finally physically bullying them. Bystanders typically choose to either participate or watch, sometimes out of fear of becoming the next target. Teachers play an important role in bullying prevention and intervention because they are the adults who spend most of their time with the students.[110][111] Bullying can, however, also be perpetrated by teachers and the school system itself; there is an inherent power differential in the system that can easily predispose to subtle or covert abuse (relational aggression or passive aggression), humiliation, or exclusion—even while maintaining overt commitments to anti-bullying policies.[112][113][114] In 2016, in Canada, a North American legal precedent was set by a mother and her son, after the son was bullied in his public school. The mother and son won a court case against the Ottawa-Carleton District School Board, making this the first case in North America where a school board has been found negligent in a bullying case for failing to meet the standard of care (the "duty of care" that the school board owes to its students). Thus, it sets a precedent of a school board being found liable in negligence for harm caused to a child, because they failed to protect a child from the bullying actions of other students. There has been only one other similar bullying case and it was won in Australia in 2013 (Oyston v. St. Patricks College, 2013).[115] Heterosexuality Main article: Sexual bullying See also: Slut-shaming Sexual bullying is "any bullying behaviour, whether physical or non-physical, that is based on a person's sexuality or gender. It is when sexuality or gender is used as a weapon by boys or girls towards other boys or girls – although it is more commonly directed at girls. It can be carried out to a person's face, behind their back or through the use of technology."[116] Transsexuality Main article: Trans bashing Trans bashing is the act of victimizing a person physically, sexually, or verbally because they are transgender or transsexual.[117] Unlike gay bashing, it is committed because of the target's actual or perceived gender identity, not sexual orientation. Work Main article: Workplace bullying Workplace bullying occurs when an employee experiences a persistent pattern of mistreatment from others in the workplace that causes harm.[118] Workplace bullying can include such tactics as verbal, nonverbal, psychological, physical abuse and humiliation. This type of workplace aggression is particularly difficult because, unlike the typical forms of school bullying, workplace bullies often operate within the established rules and policies of their organization and their society. Bullying in the workplace is in the majority of cases reported as having been perpetrated by someone in authority over the target. Bullies can also be peers, and occasionally can be subordinates.[119] The first known documented use of "workplace bullying" is in 1992 in a book by Andrea Adams called Bullying at Work: How to Confront and Overcome It.[120][121] Research has also investigated the impact of the larger organizational context on bullying as well as the group-level processes that impact on the incidence, and maintenance of bullying behavior.[122] Bullying can be covert or overt. It may be missed by superiors or known by many throughout the organization. Negative effects are not limited to the targeted individuals, and may lead to a decline in employee morale and a change in organizational culture.[10] A Cochrane Collaboration systematic review has found very low quality evidence to suggest that organizational and individual interventions may prevent bullying behaviors in the workplace.[123] Academia Main article: Bullying in academia Bullying in academia is workplace bullying of scholars and staff in academia, especially places of higher education such as colleges and universities. It is believed to be common, although has not received as much attention from researchers as bullying in some other contexts.[124] Blue-collar jobs Bullying has been identified as prominent in blue-collar jobs, including on oil rigs and in mechanic shops and machine shops. It is thought that intimidation and fear of retribution cause decreased incident reports. In industry sectors dominated by males, typically of little education, where disclosure of incidents are seen as effeminate, reporting in the socioeconomic and cultural milieu of such industries would likely lead to a vicious circle. This is often used in combination with manipulation and coercion of facts to gain favour among higher-ranking administrators.[125] Information technology Main article: Bullying in information technology A culture of bullying is common in information technology (IT), leading to high sickness rates, low morale, poor productivity, and high staff-turnover.[126] Deadline-driven project work and stressed-out managers take their toll on IT workers.[127] Courts Main article: Bullying in the legal profession Bullying in the legal profession is believed to be more common than in some other professions. It is believed that its adversarial, hierarchical tradition contributes towards this.[128] Women, trainees and solicitors who have been qualified for five years or less are more affected, as are ethnic minority lawyers and lesbian, gay and bisexual lawyers.[129] Medicine Main articles: Bullying in medicine and Bullying in nursing Bullying in the medical profession is common, particularly of student or trainee doctors and of nurses. It is thought that this is at least in part an outcome of conservative traditional hierarchical structures and teaching methods in the medical profession, which may result in a bullying cycle. Even though The American Nurses Association believes that all nursing personnel have the right to work in safe, non-abusive environments, bullying has been identified as being particularly prevalent in the nursing profession although the reasons are not clear. It is thought that relational aggression (psychological aspects of bullying such as gossiping and intimidation) are relevant. Relational aggression has been studied among girls but not so much among adult women.[127][130] Teaching Main article: Bullying in teaching School teachers are commonly the subject of bullying but they are also sometimes the originators of bullying within a school environment. Machines Children have been observed bullying anthropomorphic robots designed to assist the elderly. Their attacks start with blocking the robots' paths of movement and then escalate to verbal abuse, hitting and destroying the object. Seventy-five percent of the kids interviewed perceived the robot as "human-like" yet decided to abuse it anyway, while 35% of the kids who beat up the robot did so "for enjoyment".[131] Prevention Bullying prevention is the collective effort to prevent, reduce and stop bullying.[132] Many campaigns and events are designated to bullying prevention throughout the world. Bullying prevention campaigns and events include Anti-Bullying Day, Anti-Bullying Week, International Day of Pink, International STAND UP to Bullying Day and National Bullying Prevention Month. Anti-bullying laws in the U.S. have also been enacted in 23 of its 50 states, making bullying in schools illegal.[133] Responses Bullying is typically ongoing and not isolated behaviour. Common responses are to try to ignore it, to confront the bullies, or to turn to an authority figure. Ignoring it often does nothing to stop the bullying continuing, and it can become worse over time.[134] It can be important to address bullying behaviour early on, as it can be easier to control the earlier it is detected.[135] Bystanders play an important role in responding to bullying, as doing nothing can encourage it to continue, while small steps that oppose the behaviour can reduce it.[136] Authority figures can play an important role, such as parents or teachers in child or adolescent situations, or supervisors, human-resources staff or parent-bodies in workplace and volunteer settings. In the school context, teachers who set clear boundaries, communicate seriously that bullying behavior is unacceptable and will not be tolerated, and involve school administrators have been shown to reduce bullying.[137] Discussing bullying and its consequences with the whole class is also an important intervention that not only reduces bullying, but also encourages other students to step in and stop bullying even before it reaches its full form.[138] In general, authority figures can be influential in recognising and stopping bullying behaviour, and creating an environment that does not encourage or promote bullying.[139][140] In many situations, authority figures are untrained and unqualified, do not know how to respond, and can make the situation worse.[141] In some cases the authority figures even support the people doing the bullying, facilitating it continuing and increasing the isolation and marginalising of the target.[142] Some of the most effective ways to respond are to recognise that harmful behaviour is taking place, and to create an environment where it will not continue.[143] See also Abuse Abusive power and control Bashing (pejorative) Brodie's Law (act) Bully (2011 film) Bullying and suicide Bullying of students in higher education Discrimination Harassment Hate crime Hazing Mobbing Passive-aggressive behavior Psychological trauma Relational aggression Scapegoating Social dominance orientation Social exclusion Social media and suicide Social rejection Social undermining Taunting Teasing The Bully: A Discussion and Activity Story (book) Victimisation Workplace bullying References

Bullying is the use of force, coercion, hurtful teasing or threat, to abuse, aggressively dominate or intimidate. The behavior is often repeated and habitual. One essential prerequisite is the perception (by the bully or by others) of an imbalance of physical or social power. This imbalance distinguishes bullying from conflict.[1][2] Bullying is a subcategory of aggressive behavior characterized by hostile intent, imbalance of power and repetition over a period of time.[3] Bullying is the activity of repeated, aggressive behavior intended to hurt another individual, physically, mentally or emotionally. Bullying can be done individually or by a group, called mobbing,[4] in which the bully may have one or more followers who are willing to assist the primary bully or who reinforce the bully by providing positive feedback such as laughing.[5] Bullying in school and the workplace is also referred to as "peer abuse".[6] Robert W. Fuller has analyzed bullying in the context of rankism.[7] The Swedish-Norwegian researcher Dan Olweus says bullying occurs when a person is "exposed, repeatedly and over time, to negative actions on the part of one or more other persons",[8] and that negative actions occur "when a person intentionally inflicts injury or discomfort upon another person, through physical contact, through words or in other ways".[8] Individual bullying is usually characterized by a person behaving in a certain way to gain power over another person.[9] A bullying culture can develop in any context in which humans interact with each other. This may include school, family, the workplace,[10] the home, and neighborhoods. The main platform for bullying in contemporary culture is on social media websites.[11] In a 2012 study of male adolescent American football players, "the strongest predictor [of bullying] was the perception of whether the most influential male in a player's life would approve of the bullying behavior."[12] A study by The Lancet Child & Adolescent Health in 2019 showed a relationship between social media use by girls and an increase in their exposure to bullying.[13] Bullying may be defined in many different ways. In the United Kingdom, there is no legal definition of bullying,[14] while some states in the United States have laws against it.[15] Bullying is divided into four basic types of abuse – psychological (sometimes called emotional or relational), verbal, physical, and cyber.[16] Behaviors used to assert such domination may include physical assault or coercion, verbal harassment, or threat, and such acts may be directed repeatedly toward particular targets. Rationalizations of such behavior sometimes include differences of social class, race, religion, gender, sexual orientation, appearance, behavior, body language, personality, reputation, lineage, strength, size, or ability.[17][18][19] Etymology The word "bully" was first used in the 1530s meaning "sweetheart", applied to either sex, from the Dutch: boel, "lover, brother", probably diminutive of Middle High German: buole, "brother", of uncertain origin (compare with the German buhle "lover"). The meaning deteriorated through the 17th century through "fine fellow", "blusterer", to "harasser of the weak". This may have been as a connecting sense between "lover" and "ruffian" as in "protector of a prostitute", which was one sense of "bully" (though not specifically attested until 1706). The verb "to bully" is first attested in 1710.[20] In the past, in American culture, the term has been used differently, as an exclamation/exhortation, in particular famously associated with Theodore Roosevelt[21] and continuing to the present in the bully pulpit, Roosevelt's coining and also as faint/deprecating praise ("bully for him"). Types Bullying has been classified by the body of literature into different types. These can be in the form of nonverbal, verbal, or physical behavior. Another classification is based on perpetrators or the participants involved, so that the types include individual and collective bullying. Other interpretation also cite emotional and relational bullying in addition to physical harm inflicted towards another person or even property.[22] There is also the case of the more recent phenomenon called cyberbullying. Physical, verbal, and relational bullying are most prevalent in primary school and could also begin much earlier while continuing into later stages in individuals lives. Individual Individual bullying tactics are perpetrated by a single person against a victim or victims.[23] Individual bullying can be classified into four types outlined below:[24] Physical Physical bullying is any bullying that hurts someone's body or damages their possessions. Stealing, shoving, hitting, fighting, and intentionally destroying someone's property are types of physical bullying. Physical bullying is rarely the first form of bullying that a victim will experience. Often bullying will begin in a different form and later progress to physical violence. In physical bullying the main weapon the bully uses is his/her body, or some part thereof; or an object as a weapon when attacking his/her victim. Sometimes groups of young adults will target and alienate a peer because of some adolescent prejudice. This can quickly lead to a situation where they are being taunted, tortured, and "beaten up" by their classmates. Physical bullying will often escalate over time, and can lead to a detrimental or fatal ending, and therefore many try to stop it quickly to prevent any further escalation.[25] Verbal Verbal bullying is one of the most common types of bullying. This is any bullying that is conducted by speaking, other use of the voice, or some form of body language and does not involve any physical contact. Bullying usually begins at this stage and includes any of the following: Derogatory name-calling and nicknaming Spreading rumors or lying about someone Threatening someone Yelling at or talking to someone in a rude or unkind tone of voice, especially without justifiable cause Mocking someone's voice or style of speaking Laughing at someone Use of body language (i.e., the middle finger) to torture someone Making insults or otherwise making fun of someone In verbal bullying, the main weapon the bully uses is voice. In many cases, verbal bullying is common in both genders, but girls are more likely to perform it. Girls, in general, are more subtle with insults than boys. Girls use verbal bullying, as well as social exclusion techniques, to dominate and control other individuals and show their superiority and power, often to try to impress someone they idolize. Many boys are subtle enough to use verbal techniques for domination when they want to avoid the trouble that can come with physically bullying someone else.[26] Relational Relational bullying (sometimes referred to as social aggression) is the type of bullying that uses relationships to hurt others.[27] The term also denotes any bullying that is done with the intent to hurt somebody's reputation or social standing which can also link in with the techniques included in physical and verbal bullying. Relational bullying is a form of bullying common among youth, but particularly upon girls. Social exclusion (slighting or making someone feel "left out") is one of the most common types of relational bullying. Relational bullying can be used as a tool by bullies to both improve their social standing and control others. Unlike physical bullying which is obvious, relational bullying is not overt and can continue for a long time without being noticed.[28] Cyber Cyberbullying is the use of technology to harass, threaten, embarrass, or target another person. When an adult is involved, it may meet the definition of cyber-harassment or cyberstalking, a crime that can have legal consequences and involve jail time.[29] This includes bullying by use of email, instant messaging, social media websites (such as Facebook), text messages, and cell phones. It is stated that Cyberbullying is more common in secondary school than in primary school.[24] Collective Collective bullying tactics are employed by more than one individual against a victim or victims. Collective bullying is known as mobbing, and can include any of the individual types of bullying. Trolling behavior on social media, although generally assumed to be individual in nature by the casual reader, is sometime organized efforts by sponsored astroturfers. Mobbing Main article: Mobbing Mobbing refers to the bullying of an individual by a group, in any context, such as a family, peer group, school, workplace, neighborhood, community, or online. When it occurs as emotional abuse in the workplace, such as "ganging up" by co-workers, subordinates or superiors, to force someone out of the workplace through rumor, innuendo, intimidation, humiliation, discrediting, and isolation, it is also referred to as malicious, nonsexual, nonracial/racial, general harassment.[30] Characteristics Bullies and accomplices Studies have shown that envy and resentment may be motives for bullying.[31] Research on the self-esteem of bullies has produced equivocal results.[32][33] While some bullies are arrogant and narcissistic,[34] they can also use bullying as a tool to conceal shame or anxiety or to boost self-esteem: by demeaning others, the abuser feels empowered.[35] Bullies may bully out of jealousy or because they themselves are bullied.[36] Psychologist Roy Baumeister asserts that people who are prone to abusive behavior tend to have inflated but fragile egos. Because they think too highly of themselves, they are frequently offended by the criticisms and lack of deference of other people, and react to this disrespect with violence and insults.[37][full citation needed] Researchers have identified other risk factors such as depression[38] and personality disorders,[39] as well as quickness to anger and use of force, addiction to aggressive behaviors, mistaking others' actions as hostile, concern with preserving self-image, and engaging in obsessive or rigid actions.[40] A combination of these factors may also be causes of this behavior.[41] In one study of youth, a combination of antisocial traits and depression was found to be the best predictor of youth violence, whereas video game violence and television violence exposure were not predictive of these behaviors.[42] Bullying may also result from a genetic predisposition or a brain abnormality in the bully.[43] While parents can help a toddler develop emotional regulation and control to restrict aggressive behavior, some children fail to develop these skills due to insecure attachment with their families, ineffective discipline, and environmental factors such as a stressful home life and hostile siblings.[24] Moreover, according to some researchers, bullies may be inclined toward negativity and perform poorly academically. Dr. Cook says, "A typical bully has trouble resolving problems with others and also has trouble academically. He or she usually has negative attitudes and beliefs about others, feels negatively toward himself/herself, comes from a family environment characterized by conflict and poor parenting, perceives school as negative and is negatively influenced by peers."[44] Contrarily, some researchers have suggested that some bullies are psychologically strongest and have high social standing among their peers, while their targets are emotionally distressed and socially marginalized.[45] Peer groups often promote the bully's actions, and members of these peer groups also engage in behaviors, such as mocking, excluding, punching, and insulting one another as a source of entertainment.[24] Other researchers also argued that a minority of the bullies, those who are not in-turn bullied, enjoy going to school, and are least likely to take days off sick.[46] Research indicates that adults who bully have authoritarian personalities, combined with a strong need to control or dominate.[47] It has also been suggested that a prejudicial view of subordinates can be a particularly strong risk factor.[48] In a recent study, bullies showed lower school performance-related self-esteem than non-involved students. They also showed higher social self-esteem than victims of traditional bullying.[49] Brain studies have shown that the section of the brain associated with reward becomes active when bullies are shown a video of someone inflicting pain on another.[50] Bystanders Often, bullying takes place in the presence of a large group of relatively uninvolved bystanders. In many cases, it is the bully's ability to create the illusion they have the support of the majority present that instills the fear of "speaking out" in protestation of the bullying activities being observed by the group. Unless the "bully mentality" is effectively challenged in any given group in its early stages, it often becomes an accepted, or supported, norm within the group.[51][52] Unless action is taken, a "culture of bullying" is often perpetuated within a group for months, years, or longer.[53] Bystanders who have been able to establish their own "friendship group" or "support group" have been found to be far more likely to opt to speak out against bullying behavior than those who have not.[54][55] In addition to communication of clear expectations that bystanders should intervene and increasing individual self-efficacy, there is growing research to suggest interventions should build on the foundation that bullying is morally wrong.[56] Among adults, being a bystander to workplace bullying was linked to depression.[57] Victims Dr. Cook says, "A typical victim is likely to be aggressive, lack social skills, think negative thoughts, experience difficulties in solving social problems, come from a negative family, school and community environments and be noticeably rejected and isolated by peers."[44] Victims often have characteristics such as being physically and mentally weak, as well as being easily distraught emotionally. They may also have physical characteristics that make them easier targets for bullies such as being overweight or having some type of physical deformity. Boys are more likely to be victims of physical bullying while girls are more likely to be bullied indirectly.[58] Low levels of self-esteem has been identified as a frequent antecedent of bullying victimization. Victims of traditional bullying tend to have lower global, social, body-related, and emotional self-esteem compared to uninvolved students.[49][59][60][61][62] Victims of cyberbullying, on the other hand, may not have lower self-esteem scores than uninvolved students but might have higher body-related self-esteem than both victims of traditional bullying and bullies.[49] It has also been shown that victims are more likely to employ self-defeating or self-deprecating humor intended to entertain others at the expense of themselves and their own feelings.[63] The results of a meta-analysis conducted by Cook and published by the American Psychological Association in 2010 concluded the main risk factors for children and adolescents being bullied, and also for becoming bullies, are the lack of social problem-solving skills.[44] Children who are bullied often show physical or emotional signs, such as: being afraid to attend school, complaining of headaches or a loss of appetite, a lack of interest in school activities, spending time with friends or family, reluctance to go out in public for fear they may encounter their bullies in public places other than school, and having an overall sense of sadness. Effects Unbalanced scales.svg This section may lend undue weight to certain ideas, incidents, or controversies. Please help to create a more balanced presentation. Discuss and resolve this issue before removing this message. (May 2014) Mona O'Moore of the Anti-Bullying Centre at Trinity College in Dublin, has written, "There is a growing body of research which indicates that individuals, whether child or adult, who are persistently subjected to abusive behavior are at risk of stress related illness which can sometimes lead to suicide"[64] Those who have been the targets of bullying can develop long-term emotional and behavioral problems. Bullying can cause loneliness, depression, anxiety, lead to low self-esteem and increased susceptibility to illness.[65] Bullying has also been shown to cause maladjustment in young children, and targets of bullying who were also bullies themselves exhibit even greater social difficulties.[49][66] A mental health report also found that bullying was linked to eating disorders, anxiety, body dysmorphia and other negative psychological effects.[67] Both victims and perpetrators have been shown to exhibit higher levels of loneliness.[49] Suicide Main articles: Bullying and suicide and List of suicides that have been attributed to bullying Even though there is evidence that bullying increases the risk of suicide, bullying alone does not cause suicide. Depression is one of the main reasons why kids who are bullied die by suicide.[68] It is estimated that between 15 and 25 children die by suicide every year in the UK alone because they are being bullied.[69] Certain groups seem to incur a higher risk for suicide, such as Native Americans, Alaskan Natives, Asian Americans, and LGBT people. When someone feels unsupported by family or friends, it can make the situation much worse for the victim.[70] In a self-report study completed in New York by 9th through 12th graders, victims of bullying reported more depressive symptoms and psychological distress than those who did not experience bullying.[71] All types of involvement in bullying among both boys and girls is associated with depression even a couple years later.[72] Another study that followed up with Finnish teens two years after the initial survey showed that depression and suicidal ideation is higher with teens who are bullied than those who did not report experiencing bullying.[72] A Dutch longitudinal study on elementary students reported that boys who are bully-victims, who play both roles of a victim and a bully, were more likely to experience depression or serious suicidal ideation than the other roles, victims or bullies only, while girls who have any involvement in bullying have a higher level of risk for depression.[73] In a study of high school students completed in Boston, students who self reported being victims of bullying were more likely to consider suicide when compared to youth who did not report being bullied.[74] The same study also showed a higher risk of suicidal consideration in youth who report being a perpetrator, victim, or victim-perpetrator. Victims and victim-bullies are associated with a higher risk of suicide attempts. The place where youth live also appears to differentiate their bullying experiences such that those living in more urban areas who reported both being bullied and bullying others appear to show higher risk of suicidal ideation and suicide attempts.[74] A national survey given to American 6th through 10th grade students found that cyberbullying victims experience a higher level of depression than victims experiencing other forms of bullying. This can be related to the anonymity behind social media.[75] If a teen is being bullied and is displaying symptoms of depression it should be questioned and interventions should be implemented.[72] The Danish study showed that kids who are bullied talked to their parents and teachers about it and some reported a decrease in bullying or a stop in the bullying after a teacher or parent intervened. The study emphasizes the importance of implementing program-collaborations in schools to have programs and anti-bullying interventions in place to prevent and properly intervene when it occurs.[73] The study also shows the importance of having parents and teachers talk to the bullies about their bullying behavior in order to provide the necessary support for those experiencing bullying.[73] While some people find it very easy to ignore a bully, others may find it very difficult and reach a breaking point. There have been cases of apparent bullying suicides that have been reported closely by the media. These include the deaths of Ryan Halligan, Phoebe Prince, Dawn-Marie Wesley, Nicola Ann Raphael, Megan Meier, Audrie Pott, Tyler Clementi, Jamey Rodemeyer, Kenneth Weishuhn, Jadin Bell, Kelly Yeomans, Rehtaeh Parsons, Amanda Todd, Brodie Panlock,[76] Jessica Haffer,[77] Hamed Nastoh,[78] Sladjana Vidovic,[79] April Himes,[80] Cherice Moralez[81] and Rebecca Ann Sedwick.[82] According to the suicide awareness voices for education, suicide is one of the leading causes of death for youth from 15 to 24 years old. Over 16 percent of students seriously consider suicide, 13 percent create a plan, and 8 percent have made a serious attempt.[83] Strength and wisdom Some have argued that bullying can teach life lessons and instill strength. Helene Guldberg, a child development academic, sparked controversy when she argued that being a target of bullying can teach a child "how to manage disputes and boost their ability to interact with others", and that teachers should not intervene but leave children to respond to the bullying themselves.[84] Others, however, have pointed out that this is only true for normal peer conflicts but not for bullying cases.[85] The teaching of anti-bullying coping skills to children, carers and teachers has been found to be an effective long-term means of reducing bullying incidence rates and a valuable skill-set for individuals.[86] Testosterone production Statistically controlling for age and pubertal status, results indicated that on average verbally bullied girls produced less testosterone, and verbally bullied boys produced more testosterone than their nonbullied counterparts.[87] Dark triad Main article: Dark triad Research on the dark triad (narcissism, Machiavellianism, and psychopathy) indicate a correlation with bullying as part of evidence of the aversive nature of those traits.[88] Projection Main article: Psychological projection A bully may project his/her own feelings of vulnerability onto the target(s) of the bullying activity. Despite the fact that a bully's typically denigrating activities are aimed at the bully's targets, the true source of such negativity is ultimately almost always found in the bully's own sense of personal insecurity and/or vulnerability.[89] Such aggressive projections of displaced negative emotions can occur anywhere from the micro-level of interpersonal relationships, all the way up through to the macro-level of international politics, or even international armed conflict.[90] Emotional intelligence Main article: Bullying and emotional intelligence Bullying is abusive social interaction between peers which can include aggression, harassment, and violence. Bullying is typically repetitive and enacted by those who are in a position of power over the victim. A growing body of research illustrates a significant relationship between bullying and emotional intelligence (EI). Mayer et al., (2008) defines the dimensions of overall EI as "accurately perceiving emotion, using emotions to facilitate thought, understanding emotion, and managing emotion".[91] The concept combines emotional and intellectual processes.[92] Lower emotional intelligence appears to be related to involvement in bullying, as the bully and/or the victim of bullying. EI seems to play an important role in both bullying behavior and victimization in bullying; given that EI is illustrated to be malleable, EI education could greatly improve bullying prevention and intervention initiatives.[93] Context Internet Main article: Cyberbullying Cyberbullying is any bullying done through the use of technology. This form of bullying can easily go undetected because of lack of authoritative (including parental) supervision.[94] Because bullies can pose as someone else, it is the most anonymous form of bullying.[95] Cyberbullying includes abuse using email, instant messaging, text messaging, websites, and social networking sites.[96] Particular watchdog organizations have been designed to contain the spread of cyberbullying.[97] Disability Main article: Disability bullying Disabled people are disproportionately affected by bullying and abuse, and such activity has been cited as a hate crime.[98] The bullying is not limited to those who are visibly disabled, such as wheelchair users or physically deformed such as those with a cleft lip, but also those with developmental disabilities such as autism[99][100] and developmental coordination disorder.[101][102] There is an additional problem that those with learning disabilities are often not as able to explain things to other people, so are more likely to be disbelieved or ignored if they do complain.[citation needed] Homosexuality Main article: Gay bashing Gay bullying and gay bashing designate direct or indirect verbal or physical actions by a person or group against someone who is gay or lesbian, or perceived to be so due to rumors or because they are considered to fit gay stereotypes. Gay and lesbian youth are more likely than straight youth to report bullying, as well as be bullied.[103][104] Law Main article: Legal abuse Legal bullying is the bringing of a vexatious legal action to control and punish a person. Legal bullying can often take the form of frivolous, repetitive, or burdensome lawsuits brought to intimidate the defendant into submitting to the litigant's request, not because of the legal merit of the litigant's position, but principally due to the defendant's inability to maintain the legal battle. This can also take the form of Strategic Lawsuit Against Public Participation (SLAPP). It was partially concern about the potential for this kind of abuse that helped to fuel the protests against SOPA and PIPA in the United States in 2011 and 2012.[citation needed] Military Main articles: Bullying in the military and Dedovshchina In 2000, the UK Ministry of Defence (MOD) defined bullying as "the use of physical strength or the abuse of authority to intimidate or victimize others, or to give unlawful punishments".[105] Some argue that this behaviour should be allowed, due to ways in which "soldiering" is different from other occupations. Soldiers expected to risk their lives should, according to them, develop strength of body and spirit to accept bullying.[106] Parenting See also: Child abuse, Narcissistic parent, and Parental narcissistic abuse Parents who may displace their anger, insecurity, or a persistent need to dominate and control upon their children in excessive ways have been proven to increase the likelihood that their own children will in turn become overly aggressive or controlling towards their peers.[107] The American Psychological Association advises on its website that parents who may suspect their own children may be engaging in bullying activities among their peers should carefully consider the examples which they themselves may be setting for their own children regarding how they typically interact with their own peers, colleagues, and children.[108] Prison Main article: Prisoner abuse The prison environment is known for bullying. An additional complication is the staff and their relationships with the inmates. Thus, the following possible bullying scenarios are possible: Inmate bullies inmate (echoing school bullying) Staff bullies inmate Staff bullies staff (a manifestation of workplace bullying) Inmate bullies staff School Main article: School bullying A Centers for Disease Control and Prevention graphic presenting school anti-bullying guidelines. It is important to distinguish school bullying that per definition has the goal of harming the victim from normal peer conflict that is an inherent part of everyday school life and often promotes social development.[109] Unlike normal conflict, bullying is a systematic and repeated abuse committed intentionally by another student who has more power (physical, social, or otherwise). Bullying can occur in nearly any part in or around the school building, although it may occur more frequently during physical education classes and activities such as recess. Bullying also takes place in school hallways, bathrooms, on school buses and while waiting for buses, and in classes that require group work and/or after school activities. Bullying in school sometimes consists of a group of students taking advantage of or isolating one student in particular and gaining the loyalty of bystanders who want to avoid becoming the next target. In the 2011 documentary Bully, we see first hand the torture that kids go through both in school and while on the school bus. As the movie follows around a few kids we see how bullying affects them both at school as well as in their homes. While bullying has no age limit, these bullies may taunt and tease their target before finally physically bullying them. Bystanders typically choose to either participate or watch, sometimes out of fear of becoming the next target. Teachers play an important role in bullying prevention and intervention because they are the adults who spend most of their time with the students.[110][111] Bullying can, however, also be perpetrated by teachers and the school system itself; there is an inherent power differential in the system that can easily predispose to subtle or covert abuse (relational aggression or passive aggression), humiliation, or exclusion—even while maintaining overt commitments to anti-bullying policies.[112][113][114] In 2016, in Canada, a North American legal precedent was set by a mother and her son, after the son was bullied in his public school. The mother and son won a court case against the Ottawa-Carleton District School Board, making this the first case in North America where a school board has been found negligent in a bullying case for failing to meet the standard of care (the "duty of care" that the school board owes to its students). Thus, it sets a precedent of a school board being found liable in negligence for harm caused to a child, because they failed to protect a child from the bullying actions of other students. There has been only one other similar bullying case and it was won in Australia in 2013 (Oyston v. St. Patricks College, 2013).[115] Heterosexuality Main article: Sexual bullying See also: Slut-shaming Sexual bullying is "any bullying behaviour, whether physical or non-physical, that is based on a person's sexuality or gender. It is when sexuality or gender is used as a weapon by boys or girls towards other boys or girls – although it is more commonly directed at girls. It can be carried out to a person's face, behind their back or through the use of technology."[116] Transsexuality Main article: Trans bashing Trans bashing is the act of victimizing a person physically, sexually, or verbally because they are transgender or transsexual.[117] Unlike gay bashing, it is committed because of the target's actual or perceived gender identity, not sexual orientation. Work Main article: Workplace bullying Workplace bullying occurs when an employee experiences a persistent pattern of mistreatment from others in the workplace that causes harm.[118] Workplace bullying can include such tactics as verbal, nonverbal, psychological, physical abuse and humiliation. This type of workplace aggression is particularly difficult because, unlike the typical forms of school bullying, workplace bullies often operate within the established rules and policies of their organization and their society. Bullying in the workplace is in the majority of cases reported as having been perpetrated by someone in authority over the target. Bullies can also be peers, and occasionally can be subordinates.[119] The first known documented use of "workplace bullying" is in 1992 in a book by Andrea Adams called Bullying at Work: How to Confront and Overcome It.[120][121] Research has also investigated the impact of the larger organizational context on bullying as well as the group-level processes that impact on the incidence, and maintenance of bullying behavior.[122] Bullying can be covert or overt. It may be missed by superiors or known by many throughout the organization. Negative effects are not limited to the targeted individuals, and may lead to a decline in employee morale and a change in organizational culture.[10] A Cochrane Collaboration systematic review has found very low quality evidence to suggest that organizational and individual interventions may prevent bullying behaviors in the workplace.[123] Academia Main article: Bullying in academia Bullying in academia is workplace bullying of scholars and staff in academia, especially places of higher education such as colleges and universities. It is believed to be common, although has not received as much attention from researchers as bullying in some other contexts.[124] Blue-collar jobs Bullying has been identified as prominent in blue-collar jobs, including on oil rigs and in mechanic shops and machine shops. It is thought that intimidation and fear of retribution cause decreased incident reports. In industry sectors dominated by males, typically of little education, where disclosure of incidents are seen as effeminate, reporting in the socioeconomic and cultural milieu of such industries would likely lead to a vicious circle. This is often used in combination with manipulation and coercion of facts to gain favour among higher-ranking administrators.[125] Information technology Main article: Bullying in information technology A culture of bullying is common in information technology (IT), leading to high sickness rates, low morale, poor productivity, and high staff-turnover.[126] Deadline-driven project work and stressed-out managers take their toll on IT workers.[127] Courts Main article: Bullying in the legal profession Bullying in the legal profession is believed to be more common than in some other professions. It is believed that its adversarial, hierarchical tradition contributes towards this.[128] Women, trainees and solicitors who have been qualified for five years or less are more affected, as are ethnic minority lawyers and lesbian, gay and bisexual lawyers.[129] Medicine Main articles: Bullying in medicine and Bullying in nursing Bullying in the medical profession is common, particularly of student or trainee doctors and of nurses. It is thought that this is at least in part an outcome of conservative traditional hierarchical structures and teaching methods in the medical profession, which may result in a bullying cycle. Even though The American Nurses Association believes that all nursing personnel have the right to work in safe, non-abusive environments, bullying has been identified as being particularly prevalent in the nursing profession although the reasons are not clear. It is thought that relational aggression (psychological aspects of bullying such as gossiping and intimidation) are relevant. Relational aggression has been studied among girls but not so much among adult women.[127][130] Teaching Main article: Bullying in teaching School teachers are commonly the subject of bullying but they are also sometimes the originators of bullying within a school environment. Machines Children have been observed bullying anthropomorphic robots designed to assist the elderly. Their attacks start with blocking the robots' paths of movement and then escalate to verbal abuse, hitting and destroying the object. Seventy-five percent of the kids interviewed perceived the robot as "human-like" yet decided to abuse it anyway, while 35% of the kids who beat up the robot did so "for enjoyment".[131] Prevention Bullying prevention is the collective effort to prevent, reduce and stop bullying.[132] Many campaigns and events are designated to bullying prevention throughout the world. Bullying prevention campaigns and events include Anti-Bullying Day, Anti-Bullying Week, International Day of Pink, International STAND UP to Bullying Day and National Bullying Prevention Month. Anti-bullying laws in the U.S. have also been enacted in 23 of its 50 states, making bullying in schools illegal.[133] Responses Bullying is typically ongoing and not isolated behaviour. Common responses are to try to ignore it, to confront the bullies, or to turn to an authority figure. Ignoring it often does nothing to stop the bullying continuing, and it can become worse over time.[134] It can be important to address bullying behaviour early on, as it can be easier to control the earlier it is detected.[135] Bystanders play an important role in responding to bullying, as doing nothing can encourage it to continue, while small steps that oppose the behaviour can reduce it.[136] Authority figures can play an important role, such as parents or teachers in child or adolescent situations, or supervisors, human-resources staff or parent-bodies in workplace and volunteer settings. In the school context, teachers who set clear boundaries, communicate seriously that bullying behavior is unacceptable and will not be tolerated, and involve school administrators have been shown to reduce bullying.[137] Discussing bullying and its consequences with the whole class is also an important intervention that not only reduces bullying, but also encourages other students to step in and stop bullying even before it reaches its full form.[138] In general, authority figures can be influential in recognising and stopping bullying behaviour, and creating an environment that does not encourage or promote bullying.[139][140] In many situations, authority figures are untrained and unqualified, do not know how to respond, and can make the situation worse.[141] In some cases the authority figures even support the people doing the bullying, facilitating it continuing and increasing the isolation and marginalising of the target.[142] Some of the most effective ways to respond are to recognise that harmful behaviour is taking place, and to create an environment where it will not continue.[143] See also Abuse Abusive power and control Bashing (pejorative) Brodie's Law (act) Bully (2011 film) Bullying and suicide Bullying of students in higher education Discrimination Harassment Hate crime Hazing Mobbing Passive-aggressive behavior Psychological trauma Relational aggression Scapegoating Social dominance orientation Social exclusion Social media and suicide Social rejection Social undermining Taunting Teasing The Bully: A Discussion and Activity Story (book) Victimisation Workplace bullying References