Dilution – ASPD as a Disorder

I keep reading posts on social media where neurotypicals are trying to dismiss ASPD symptoms as unnecessary for someone to be antisocial.  “Before you stigmatize those with ASPD, remember that there are those out there that are behaving prosocially and are just trying to make it through each day,” is a common refrain.  This is misguided.  For one to have ASPD, there must be a level of disorder present.  Kicking a cat once is not grounds for the disorder.  Stealing or getting in a fight back in the day also does not merit a diagnosis of ASPD.  Simply put, the behaviors of the candidate must be so severe as to cause consistent and measurable distress for either the person with ASPD or those around her.  That is, the antisocial must be in distress (whether or not they consider it distress) marked by unstable interpersonal relationships, inconsistent employment, legal trouble, financial destitution, etc.  Or, those around the antisocial must have their quality of life diminished by the actions of the antisocial.  At the time of diagnosis, there is no such thing as an antisocial that is mostly prosocial as that would not be considered disordered.  Stop making the disorder out to be something that it is not.  Dilution solves nothing.

There is a reason that personality disorders are called disorders.  With the vast differences between any two personalities, we need to be able to identify traits that are not only abnormal but that are also damaging to the one affected as well as those around them.  The DSM is a good start.  While there are many criticisms – some valid, some not – of the DSM, in general it paints a picture in which disorders are not taken lightly and where it is much harder to qualify for a disorder than not.  ASPD in particular is marked by a (paraphrased) “pervasive and persistent disregard for the rights and health of others.”  This means that no one incident is grounds for a diagnosis of ASPD.  This also means that those with ASPD have engaged in antisocial behaviors on a persistent basis for a long time.  There simply cannot be one that is disordered if they have not been playing fast and loose with the rights of others for a long time.

This also means that many who believe themselves to have ASPD do not have the disorder.  A trained professional that can recognize the persistence and pervasiveness of antisocial behavior is needed to cement any assessment.  People can be jerks or assholes and not qualify for ASPD – in fact, most people with questionable behavior toward others would not be considered for the diagnosis.  Those that confuse tomfoolery for antisocial behavior are merely diluting the power of the actual disorder.  People with ASPD tend to be unpleasant and irredeemable.  Assholes that are not ASPD on the other hand are much more likely to have traits that are admirable.

The upshot of all of this is that we need to call a spade a spade and recognize that disordered behavior is measurable and extraordinary in magnitude.  Stop treating it as something that it is not.  Do not romanticize the condition with pictures of redeemable people that merely got off on the wrong foot.  Stop imagining people that merely silently suffer with ASPD.  None of this is sensible.  Lastly, recognize disorder for what it is.  A person can behave poorly and remain functional in person and with others.  Odds are, such a person is not disordered.  One does not get a diagnosis of ASPD without good reason and not everyone that is unpleasant would be eligible for a diagnosis.  By labeling things as disorder where they are not, or by white-knighting disorder that is present, the nature of disorder is diluted and becomes less understood.  Just stop.

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