Donald Black: Well you know, I always have to look it up, because even though I'm an expert in this area, I can never remember exactly how things are worded; and I'll tell you, because I have it right here next to me. Basically, "A pervasive pattern of disregard for and violation of the rights of others, occurring since age fifteen years." And the person has to have three of seven different behaviors. That's how a lot of our diagnoses work: there's a whole list of symptoms, and then we require for diagnosis "x" that the person have a certain number of the criteria. I'm not going to read them all, but just for example:
1. Failure to conform to social norms with respect to lawful behaviors. In other words, criminality.
2. Deceitfulness. In other words, repeated lying.
3. Impulsivity, or failure to plan ahead. So, acting without thinking.
4. Irritability and aggressiveness as indicated by repeated physical fights or assaults.
5. Reckless disregard for the safety of others.
And several others.
And the person has to be at least 18 years old, and there's evidence of a conduct disorder before age 15. So as I was saying, these people have an early onset with misbehavior of their conduct prior to age 15. I've certainly talked to mothers of anti-social men, who say, "Even by age two (2) my child was misbehaving." And you think, what would that be at age two? How would a 2 year old misbehave? But these mothers say, "You know, there was something different about that kid." And certainly when they're a little older and capable of lying, they're doing that, or getting into fights with their friends, or something of this nature.
So you get the idea that this is, as I said, "Recurrent misbehavior over time." I've also used the phrase "Recurrent serial misbehavior." Because if you watch these people, if you follow them around, for example let's say if you had a mini-cam watching them, most of the time their behavior is just fine -- probably no different from yours or mine. But on a regular basis they're going to be getting into trouble with someone, being irresponsible, committing a crime, lying about that crime, or something else. So there's this misbehavior over time.
Rob Kall: OK. Now, you've mentioned that this is a Men's disease. That it's like 8-1 men to women?
Donald Black: It depends on the study. but that's a figure that I use. Interestingly, I did a study of anti-social personalty disorder in a local prison. I'm a consultant for the correctional system here in Iowa, and I found that the prevalence, that is the percent of men and women having this condition, was about equal. So in certain populations it may be about equal; in the general population, it's really a man's disorder.
This was interesting, because I said that in the first edition when it came out in 1999; and I had letters, and later, emails, from people who essentially said I was sexist, and I need to talk about the female anti-social. So I made certain in the 2nd edition to talk about the female sociopath (or anti-social), and to point out that they are there -- there are fewer of them, and we don't know exactly why. It could be genetic, it could be partly cultural, it could be partly definitional, we don't really know. But there are women anti-socials out there, and I discuss some of the differences that they have with male anti-socials, and I mention a few popular cases in the news.
Rob Kall: OK. What about related diagnoses? I noted that in your book you mention that a lot of women who might not be diagnosed as anti-social might be diagnosed as "borderline."
Donald Black: Yes.
Rob Kall: You also mentioned in your book that there is a lot of co-morbidity for anti-social personalities with depression and alcoholism.
Donald Black: Yeah, that's true.