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This is a wonderful question and one that I myself have been pondering and battling as I went through medical school and ultimately graduated through this past year. It’s very insightful of you to ask, because perhaps you are looking to go into medical school yourself or are wondering what sorts of things people actually learn in school.There are actually a huge set of skills that they don’t teach you in medical school, but the main ones that I will cover are ones that I feel my particular institution fell short on (and a few of my friends who were at various other institutions as well have agreed). **Please note that I write this as a United States Allopathic Medical School Graduate so results and opinions may differ depending on where you are from**Business/money skillsThis fits under the same category that someone else has actually mentioned in their post which is “Management and Entrepreneurship.” Most of medical school time is spent memorizing anatomy, biological cycles within the body, medications, physical examination skills and pathological diseases. None of the curriculum required by the Liaison Committee on Medical Education (LCME) which is the accrediting medical school body has a financial planning requirement. They have requirements for schools to offer financial aid and financial counseling (which tends to be in the form of an office much like undergraduates have), but no actual requirements to teach individuals how to run a business, the basics of money, the basics of running a hospital or clinic, etc. Reality is that sometimes someone with a Bachelor’s in Business which takes 3–4 years is leagues ahead of a Doctor of Medicine who has been in school for at least 8 years when it comes to financial mastery.This is an even more important skill to learn especially when you take in the fact that the AVERAGE medical school debt is around $166,000. On top of the fact that the average resident salary is $52,000 (please keep in mind this is PRE-TAX) with a 5%-7% accruing debt interest, it’s all the more important to teach future docs how to handle money. This fact has become prominent enough to even have stories in everyday news ($1 million mistake: Becoming a doctor)Teaching skillsAgain I will refer to the LCME curriculum standards which anyone can see here: http://lcme.org/wp-content/uploads/filebase/standards/2017-18_Functions-and-Structure_2016-03-24.docx (which is the most up to date as far as I understand). Currently the curricular content section under “Standard 7” states the following categories:Biomedical, Behavioral, Social SciencesOrgan Systems/Life Cycle/Primary Care/Prevention/Wellness/Symptoms/Signs/ Differential Diagnosis, Treatment Planning, Impact of Behavioral and Social FactorsScientific Method/Clinical/Translational ResearchCritical Judgment/Problem-Solving SkillsSocietal ProblemsCultural Competence and Health Care DisparitiesMedical EthicsCommunication SkillsInterprofessional Collaborative SkillsAs you can see it is not a requirement to teach medical students how to teach, about adult or child learning theory, or even about how to learn as an individual. Why might this be important you ask? Well as a physician no matter what you do YOU WILL TEACH. As a resident (the first level of being a doctor a.k.a a doctor in training) you WILL be teaching medical students and patients. As an attending (when you are a fully fledged physician practicing on your own) you WILL once again be most likely teaching medical students, residents, and of course patients. Teaching is such an invaluable skill that as one of the most academic fields out there I find it amazing that we choose to ignore educating such a valuable skill. Some institutions are trying to implement programs, for example the school I came from had a medical education track which I was a part of, but again this is not required so not every doctor knows how to do this.Research SkillsSo listed above you see “Scientific Method/Clinical/Translational Research.” The way my school implemented it was to give a few lectures on the subject (by a few I really mean a few, as in maybe 1–3 a year perhaps like 8–10 over the course of 4 years and this is with us being constantly in class for the first 2 years getting lectures at least 5 days a week from 7am-5pm). These lectures entailed how to critically read a research article, learning how to cite sources and find good articles, and learn how to understand basic statistics. Unfortunately as many Ph.D’s, Masters Degree holders, and many avid researchers know there is so much more to actually be able to do research. How does one go ahead and get a grant? What forms do you need and how do you get IRB approval? How does one start a lab and get funding? What does a career in research look like and how does it even start?My school was particularly good in that if you were interested enough you could work real hard and find a good mentor in research and join a track program called the “Research Track” that had additional lectures and resources, but again this was not a requirement so not every doctor learns these skills. We would also have some required “research” projects, but to be honest it was not regulated in a way that Master’s/Ph.D Thesis’ would be nor would you get any assigned mentors (unless you were perhaps in the track program) so guidance was all up to how aggressively you sought it out. This means that some lackluster “research” projects were approved and not everyone actually learns how good solid research is conducted. Myself included.Technology/Innovation SkillsMy background was in Biomedical Engineering before I went to medical school. Upon going there, I practically lost it all. I found that quite a few of my classmates didn’t even know how to operate computers beyond the basic everyday usage, to the point that every time there was an I.T. issue (such as the projector shutting down) I was called to the front of the class to help fix the issue. Why would doctors need to know anything about technology? Well in an industry where our medical technology continues to grow at such a rapid pace, it would be good for doctors to at least understand how an x-ray, CT scanner, MRI, and Ultrasound machine worked. The surgical tools used in everyday surgeries have gotten so advanced now that we can perform operations that use to take patients weeks to heal now to operations with such small incisions that they heal within a few days. Isn’t that AMAZING?! The thing is we need more doctors who can understand the technology and continue working with engineers to keep innovating! I personally did research with Biomedical Engineers and Doctors during my time in medical school and the #1 frustration I kept hearing from both sides was “Ugh the Engineers don’t understand what us doctors need” and “Ugh the Doctors are so demanding, don’t understand anything about how technology is now.” Hence an interesting gap was born in my eyes.Interestingly enough Texas A&M University has plans to create such a program in creating “Physician Engineers”. If you are interested check it out here: Texas A&M planning to create medical school for physician engineers at Houston Methodist HospitalHealth PolicyMy school was located smack dab in the heart of Washington D.C. the nations capital. Health policy is currently an optional track program where students can actually go to Capitol Hill and get very very involved if they want to. This was an amazing opportunity offered. But again I stress this is OPTIONAL. This freaks me out because a lot of people graduating from medical school don’t know anything about how health policy works, how it is lobbied, and how to make change. This explains why there aren’t that many doctors on Capitol Hill.The scarier thing for me is that to this day…I DON’T COMPLETELY UNDERSTAND HOW HEALTH INSURANCE WORKS. And I ran the student run clinic at my institution. We often deferred to the social workers or the business department of the hospital. We are never taught how expensive different medications are, how patients get billed, how we can lower costs for patients in general. Heck we don’t even know the different policies, restrictions, and costs it takes to run a clinic or hospital. Again. This is optional. Shocking because I always shuddered at this question I would often get asked from patients “Do you take my health insurance? If not where can I go or what can I do? Because I really need help now.”How to find a job if one decides to do anything other than directly become a practicing physicianTo give everyone some statistics (and these numbers come from the National Residency Match Program a.k.a NRMP themselves and you can see them here: Press Release: Results of 2016 NRMP Main Residency Match Largest on Record as Match Continues to Grow). Over the last four years there has been a 10.6% increase in the number of U.S. Allopathic Medical Students graduating. Hitting an all time high of 18,668! Such a wonderful accomplishment that we should be proud of! Especially with the incoming doctor shortage that the American Association of Medical Colleges (AAMC) has done studies on in 2016 estimating a shortage of 61,700-94,700 physicians by 2025. (If you are interested look here: GME Funding and Physician Workforce). Now here is the other issue. We are opening more medical schools, but the RESIDENCY (doctors in training) positions are not growing as quickly. Take a look at this image:This is published data from the latest match which you can look at here if you are interested: http://www.nrmp.org/wp-content/uploads/2016/04/Main-Match-Results-and-Data-2016.pdfNotice how the two lines aren’t getting closer together? Well the purple line is the number of doctors in training positions available. The green line is the number of people who graduated with M.D.s whether from this country or not applying for those spots. So we keep making more schools and having more potential applicants, but we aren’t increasing the number of spots available for training which is a required part of training doctors. I think we can all see the problem here. Still not convinced? Take a look at this graph:Registered Applicants up 1,036. Active applicants (those who got interviews and went to interview then selected a list of places they wanted to go to) up 571. Program positions? Up 538. Notice it’s smaller than those first two numbers. Active Seniors 18,187 up from last year. Matched Seniors 17,057 up from last year. % Positions filled by Seniors 61.2% DOWN from last year. Also take notice that the number of active seniors went up 162, but the number of matched seniors went up 125. That’s 37 seniors lacking in matching. Critics will say that there are numerous factors for this, and I whole-heartedly agree, but where the heck are these seniors going? In addition isn’t it worrisome that there are 1,130 UNMATCHED seniors??? This is only U.S. graduates, not even including those from Doctors of Osteopathic Medical Schools, U.S. citizens trying to come home from Carribbean Schools, and International Medical Graduates. For which the numbers are far worse and can hover down to 40–50%.Now what are these seniors suppose to do in the mean time or if they want to do something related to medicine but not be a clinical physician? Unfortunately having an M.D. degree doesn’t qualify you for a wide range of jobs that something like an M.B.A might qualify you for. At least not that I am aware of (I would love for someone with insight to comment on this), but from personal experience myself it is hard to figure out what jobs I can get with an M.D. degree solely because my education has only trained me to be a doctor. There is so much talent wasted, and there is so much about the healthcare field that needs to be fixed that I am shocked there isn’t more education and resources to get these graduates to other jobs/opportunities that can help the healthcare field in general. I am saying this after I spoke to 12 different physicians AND after going to my career center at my institution who could not advise me on what I could do with just an M.D. degree other than go to residency. Scary and disheartening if I do say so myself.7. How to stay physically healthy and have good mental hygieneIn medical school you are constantly under a stressful environment. This is something that no one ever seems to talk about. There was a survey based study done by Goebert et al. which showed that of more than 2,000 medical students and residents surveyed who responded (with an 89% response rate) 12% had probably MAJOR depression and 9.2% had probably mild/moderate depression. (study here: Depressive symptoms in medical students and residents: a multischool study.) Now this study isn’t perfect, and there are numerous flaws with a survey based design such as response bias, but the fact that 21.2% of medical students and residents had potential DEPRESSION with some having suicidal ideation should worry all of us. Having an incidence of disease of 5% makes the entire medical community react, why not 21.2%? The one phrase that medical schools LOVE saying is “Welcome. You will now be learning as if you are drinking from a fire hose.” I personally hate that phrase and think there is something fundamentally wrong with how you are teaching when that is how you start off your educational journey.It is estimated that about 300–400 physicians die annually from suicide. That is an average that means that about one doctor will die A DAY from a preventable cause. Which personally scares me. Especially since we are always talking about the “Physician Shortage.” The new CDC report notes that: “In 1999, the age-adjusted rate of suicide was 10.5 per 100,000 of the population. In 2014, it was 13.0, representing an overall rise of 24% The rate increased by 1% per year from 1999-2006, and then doubled to 2% after that” That means that each year there are 41,457 suicides in the United States alone (I used the current 2014 population data of the US having 318.9 million people). Mental health is extremely important. Poor mental hygiene costs lives. To put this into perspective a little bit Ebola in 2014 costed 4,033 deaths according to the CDC. That means more than 10 times the number of people are killing themselves each year. (And please note, I am not claiming that suicide is any more or less devastating than Ebola, lives lost are all equally saddening to me). (Here are links for these topics: Medical student suicide: It's impact is devastating. This case proves it., petition: Stop the suicide epidemic in medical schools and residency programs!). Physician Burn-out is very real, and something that many people are trying to work on.8. The actual entire process of what is expected to happen into medical school and residency and beyondThis to me is the funniest thing that ends up happening in medical school which is something that I have heard from numerous sources. Many just had to sort of figure out how medical school plays out as they went along. When we all enter medical school many of us didn’t know that there was a licensing examination that was broken up into 3 parts that is needed before we are allowed to practice (Step 1, Step 2, Step 3). And for those that did, they weren’t sure of when those tests would be taken, unless they were fortunate enough to have someone in the family who had been through the process before. In addition, many of us are not informed that you need to know what kind of doctor you want to be by the end of 3rd year because you have to know before you apply for residency since it is a large headache to switch from one specialty to another and it can even be nearly impossible to (for example if you wanted to switch from a primary care practice of family medicine to Orthopedic surgery or Ophthalmology). Most of us learn of these things either from the school or through word of mouth as we are going along. Mainly because we are so overwhelmed with trying to learn the medical knowledge, trying to plot your career path for the rest of our lives is something most of us aren’t even thinking about…but we should be because well…it’s the career path for the REST OF OUR LIVES. Note this may sound grossly exaggerated, but ask any doctor how hard it is to switch from one specialty field to another in the case interest changes, and you will be surprised at how hard it truly is. I have met very motivated physicians who really wanted to switch and basically had to start back at square one as a resident physician and work their way back up, that is if they get into any of the already limited residency positions.These are a few of the personal things that I have observed are missing. Again this is MY personal experience with MY institution, I can’t say that this is how it feels everywhere, but I have spoken to numerous friends at at least 10 different institutions who agree that they felt the same way as well. This includes individuals who decided to leave medical school altogether because of some of these issues.Phew, now this was an extremely extremely long post. I hope that it was at least somewhat helpful, thank you for reading all the way through. If I came off as just a complainer, I apologize because that is not what I wanted to do at all. These are observations that I have made as someone who is extremely passionate about education with an extensive background in it. I am personally trying to find a job in medical education as well currently so that I hope to be able to make some changes to the field. If anyone has any comments or questions please don’t hesitate to ask! I love to answer :)Thanks again for reading and have a great one! It would mean so much to me if you could up-vote this post and share it as well if you find it helpful because I really want to shed more light on the path to becoming a doctor and the medical system in general. It is such an important topic for even those who don’t want to be doctors to understand since we all eventually get involved in the medical system one way or another.Thank you so much once again.

Antisocial Personality DisorderFisher KA, Hany M.Continuing Education ActivityThis activity reviews the evaluation and treatment of antisocial personality disorder (ASPD). ASPD is a deeply ingrained and dysfunctional thought process that focuses on social exploitive, delinquent, and criminal behavior most commonly known due to the affected individual's lack of remorse for these behaviors. ASPD falls into 1 of 4 cluster-B personality disorders within the DSM V, which also includes narcissistic, borderline, and histrionic personality disorders. This activity reviews the role of the an interprofessional team in evaluating, treating, and improving the care for patients with this condition.Objectives:Identify the psychopathology of antisocial personality disorderSummarize the diagnostic criteria of Antisocial personality disorder.Outline the treatment and management options available for Antisocial personality disorder.Summarize interprofessional team strategies for improving care coordination and communication to advance the treatment of antisocial personality disorder and improve outcomes.Earn continuing education credits (CME/CE) on this topic.IntroductionAntisocial personality disorder (ASPD) is a deeply ingrained and rigid dysfunctional thought process that focuses on social irresponsibility with exploitive, delinquent, and criminal behavior with no remorse. Disregard for and the violation of others' rights are common manifestations of this personality disorder, which displays symptoms that include failure to conform to the law, inability to sustain consistent employment, deception, manipulation for personal gain, and incapacity to form stable relationships.[1]The Diagnostic and Statistical Manual of Mental Disorders (DSM 5) classifies all ten personality disorders into three clusters (A, B, and C). Antisocial personality disorder falls into 1 of 4 cluster-B disorders, which also includes borderline, narcissistic, and histrionic. All of these disorders characteristically present with dramatic, emotional, and unpredictable interactions with others.[2] Antisocial personality disorder is the only personality disorder that is not diagnosable in childhood. Before the age of 18, the patient must have been previously diagnosed with conduct disorder (CD) by the age of 15 years old to justify diagnostic criteria for ASPD.[1]Many researchers and clinicians argue this diagnosis, with concerns of significant overlap with other disorders, including psychopathy. However, others counter that psychopathy is simply a subtype of antisocial personality disorder, with a more severe presentation. Recent literature states that although a heterogeneous construct that can subdivide into multiple subtypes that share many similarities and are often comorbid but not synonymous, individuals with ASPD must be characterized biologically and cognitively to ensure more accurate categorization and appropriate treatment.[3]EtiologyAlthough the precise etiology is unknown, both genetic and environmental factors have been found to play a role in the development of ASPD. Various studies in the past have shown differing estimations of heritability, ranging from 38% to 69%. Environmental factors that correlate to the development of antisocial personality disorder include adverse childhood experiences (both physical and sexual abuse, as well as neglect) along with childhood psychopathology (CD and ADHD).[4]Other studies stress the importance of both shared and non-shared environmental factors, including both family dynamics and peer relations on the development of ASPD. Research has focused on establishing the exact gene contributing to ASPD, and much evidence is pointing toward the 2p12 region of chromosome 2 and variation within AVPR1A. Interactions of specific genes with the environment have been an area of study as well, with evidence of variation in the oxytocin receptor gene (OXTR) contributing to the broad ranges of behavior elicited in antisocial personality disorder due to its effect on the influence of deviant peer affiliation.[5]EpidemiologyThe estimated lifetime prevalence of ASPD amongst the general population falls within 1 to 4%.[6][7] Due to the predicting factor of the initial diagnosis of conduct disorder before the age of 15, this assumption can be quite broad as CD does not always get adequately evaluated.[8] Gender distribution tends to be skewed towards males, with 3 to 5 times more likelihood of being diagnosed with ASPD than females, with 6% men and 2% women within the general population.[9] Substance abuse has been found to show a significant correlation to the diagnosis of antisocial personality disorder,[10] while education and intelligence displays a negative correlation,[9][11] with a higher prevalence of ASPD amongst those with lower IQs and reading levels.[12] Research has shown reductions in the prevalence rate with increasing age in criminal populations,[13] as well as epidemiological samples.[9] Changes in personality traits with age and increased mortality with the behavior of antisocial personality disorder have been hypothesized to justify this age-dependent alteration.[14]History and PhysicalBefore performing a comprehensive psychiatric assessment of the patient, a careful history and physical examination is necessary. "The DSM-5 diagnostic criteria for Antisocial Personality DisorderA pervasive pattern of disregard for and violation of the rights of others, since age 15 years, as indicated by three (or more) of the following:Failure to conform to social norms concerning lawful behaviors, such as performing acts that are grounds for arrest.Deceitfulness, repeated lying, use of aliases, or conning others for pleasure or personal profit.Impulsivity or failure to plan.Irritability and aggressiveness, often with physical fights or assaults.Reckless disregard for the safety of self or others.Consistent irresponsibility, failure to sustain consistent work behavior, or honor monetary obligations.Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.The individual is at least age 18 years.Evidence of conduct disorder typically with onset before age 15 years.The occurrence of antisocial behavior is not exclusively during schizophrenia or bipolar disorder."EvaluationNo current diagnostic modalities, such as tests including serology, are currently accepted standards in diagnosing antisocial personality disorder. However, genetic testing and neuroimaging have been used to evaluate potential causes and patterns, respectively, with ASPD (see Etiology section above). Patients with antisocial personality disorder are at a higher risk of contracting certain viral infections and sexually transmitted diseases associated with high-risk behavior, including hepatitis C and human immunodeficiency virus, as well as increased mortality rates due to accidents, traumatic injuries, suicides, and homicides.[15][16][17]Treatment / ManagementAlthough there has been a multitude of interventions tested in the past, an appropriate algorithm fails to exist today. Literature suggests early treatment intervention with conduct disorder in children as the least costly and most effective with treating ASPD.[18] However, researchers have employed certain psychopharmacology and psychotherapy throughout literature, but due to the severity of potential harms in adulthood, intricate consideration are necessary when delineating a treatment course.[19]Most of the needs of antisocial personality disorder are addressable in the outpatient setting. Hospitalization is not cost-effective as it provides little to no benefit to those with ASPD, and it is very costly. Also, the presence of those with ASPD in a psychiatric hospital disrupts the environment, thus affecting the treatment of other patients in need of therapeutic care. Hospitalization is reserved for treating co-occurring conditions or possible complications, such as substance intoxication/withdrawal or recent suicidal behavior.Insufficient evidence exists to support any psychological intervention in adults with ASPD.[20] No pharmacological intervention has been shown to treat ASPD, but medications are highly recommended to treat co-occurring conditions. Aggressive behavior is treatable with second-generation antipsychotics as first-line therapy, including risperidone (2 to 4mg/day), quetiapine (100 to 300mg/day). Second and third-line therapies for aggression include selective serotonin reuptake inhibitors (SSRI), sertraline (100 to 200mg/day) or fluoxetine (20mg/day), and mood stabilizers; lithium and carbamazepine (dosed at recommended levels for bipolar disorder), respectively. Anticonvulsants, such as oxcarbazepine and carbamazepine, can be used to aid with impulsivity. Bupropion and atomoxetine are often used to treat associated ADHD due to their non-addictive nature.Differential DiagnosisNarcissistic personality disorder (cluster B personality disorder with overlap; exploitive and uncompassionate, but not aggressive or deceitful)Borderline personality disorder (cluster B personality disorder with overlap; manipulative, but for reassurance and nurture)Substance use disorder (Impulsivity and irresponsibility due to substance influence must be ruled out before diagnosing ASPD. ASPD can be diagnosed if substance use is co-occurring)PrognosisOf those children with conduct disorder, 25% of girls and 40% of boys will meet the diagnostic criteria for antisocial personality disorder. Boys exhibit symptoms earlier than girls, who often only elicit these symptoms in puberty. Children who do not develop conduct disorder and progress to the age of 15 without antisocial behaviors will not develop ASPD. Childhood conduct disorder is a reliable prognosticator of adulthood ASPD.[1] The small percentage of adults with antisocial personality disorder who never met the criteria or never received an assessment for conduct disorder, tend to have milder symptoms.[21]Antisocial personality disorder, although a chronic condition with a lifelong presentation, has had moderations shown with advancing ages, with the mean remitted age of 35 years old. Those with less baseline symptomatology showed better-remitted rates. Studies in the past revealed remission rates of 12 to 27% and 27 to 31% rates of improvement, but not remitted. Crime rates and severity reflect this relation as well, with peak crime statistics in late teens and higher severity of crimes at younger ages. Those with later presentations of antisocial behavior showed less severe behavioral problems. Those who were either never imprisoned or imprisoned for longer periods displayed greater remission rates than those imprisoned for shorter periods. This finding indicated that short-term incarceration could be somewhat preventive for future antisocial behavior.[1]ComplicationsMany individuals diagnosed with antisocial personality disorder remain a burden to their families, coworkers, and closely associated peers, such as neighbors, despite becoming less troublesome with age. Mental health comorbidities and associated addictive disorders, as well as higher mortality rates due to suicides and homicides, only add to this burden. Most of those who improve with age remain unable to re-claim their lost prospects, including education, domestication, and employment. Those patients who did show remission were more likely to have spousal or family ties, with better social support.[1]Deterrence and Patient EducationAntisocial personality disorder is one of the best-documented disorders in all of literature pertaining to psychiatry, including etiology, epidemiology, pathophysiology, neuroanatomy, heritability, and interventional treatment. However, an established treatment algorithm and specialized psychopharmacology currently fail to exist.Better preventative measures are necessary as many of those with ASPD may only have an evaluation upon incarceration after inflicting harm. One is not apt to seek help for ASPD symptomatology. Many only seek assistance for co-occurring mental disorders or only present for court-mandated assessments.Even with the remission rates in advanced ages, antisocial personality disorder causes much turmoil to the patient and the patient’s surrounding community. The lives of those with ASPD remain negatively impacted even after remission.Enhancing Healthcare Team OutcomesThe diagnosis, categorization, and management of ASPD is quite complex and multifaceted, often only presenting after harm has already taken place. Management of the disorder is best with an interprofessional team dedicated to the treatment of mental health disorders. People with antisocial personality disorder are at risk of incarceration due to the violent and deceitful nature of the behaviors elicited in ASPD. Hospitalization provides no benefit to a patient with ASPD and can actually create a disruptive hospital environment to others who truly need hospitalization for therapeutic purposes. The majority of these individuals are noncompliant with therapy and often fail to show up at clinics. Thus, management can be difficult.The physician overseeing the case almost inevitably needs to be a psychological specialist; they can work collaboratively with the patient's family physician, but the complexity of this diagnosis requires specist-level care. Nursing staff should also have specialized psychological training, so they have received adequate training on ways to approach and cope with these individuals, as well as to be able to recognize therapeutically significant signs and behaviors that need to be brought to the treating physician's attention. They can also assess patient compliance as well as give their impressions of treatment effectiveness. A pharmacist should also provide consultation on the medications used, verifying dosing and checking carefully for drug interactions, and reporting to the nurse or physician if there are any concerns. Only with a collaborative interprofessional team approach patients with antisocial personality disorder receive optimal care leading to better outcomes. [Level 5]Continuing Education / Review QuestionsAccess free multiple choice questions on this topic.Earn continuing education credits (CME/CE) on this topic.Comment on this article.References1.Black DW. The Natural History of Antisocial Personality Disorder. Can J Psychiatry. 2015 Jul;60(7):309-14. [PMC free article] [PubMed]2.Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013 Jun;12(2):92-8. [PMC free article] [PubMed]3.Brazil IA, van Dongen JDM, Maes JHR, Mars RB, Baskin-Sommers AR. Classification and treatment of antisocial individuals: From behavior to biocognition. Neurosci Biobehav Rev. 2018 Aug;91:259-277. [PubMed]4.DeLisi M, Drury AJ, Elbert MJ. The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Compr Psychiatry. 2019 Jul;92:1-6. [PubMed]5.Fragkaki I, Cima M, Verhagen M, Maciejewski DF, Boks MP, van Lier PAC, Koot HM, Branje SJT, Meeus WHJ. Oxytocin Receptor Gene (OXTR) and Deviant Peer Affiliation: A Gene-Environment Interaction in Adolescent Antisocial Behavior. J Youth Adolesc. 2019 Jan;48(1):86-101. [PubMed]6.Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007 Sep 15;62(6):553-64. [PMC free article] [PubMed]7.Trull TJ, Jahng S, Tomko RL, Wood PK, Sher KJ. Revised NESARC personality disorder diagnoses: gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord. 2010 Aug;24(4):412-26. [PMC free article] [PubMed]8.Werner KB, Few LR, Bucholz KK. Epidemiology, Comorbidity, and Behavioral Genetics of Antisocial Personality Disorder and Psychopathy. Psychiatr Ann. 2015 Apr;45(4):195-199. [PMC free article] [PubMed]9.Compton WM, Conway KP, Stinson FS, Colliver JD, Grant BF. 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. J Clin Psychiatry. 2005 Jun;66(6):677-85. [PubMed]10.Moran P. The epidemiology of antisocial personality disorder. Soc Psychiatry Psychiatr Epidemiol. 1999 May;34(5):231-42. [PubMed]11.Neumann CS, Hare RD. Psychopathic traits in a large community sample: links to violence, alcohol use, and intelligence. J Consult Clin Psychol. 2008 Oct;76(5):893-9. [PubMed]12.Simonoff E, Elander J, Holmshaw J, Pickles A, Murray R, Rutter M. Predictors of antisocial personality. Continuities from childhood to adult life. Br J Psychiatry. 2004 Feb;184:118-27. [PubMed]13.Harpur TJ, Hare RD. Assessment of psychopathy as a function of age. J Abnorm Psychol. 1994 Nov;103(4):604-9. [PubMed]14.Vachon DD, Lynam DR, Widiger TA, Miller JD, McCrae RR, Costa PT. Basic traits predict the prevalence of personality disorder across the life span: the example of psychopathy. Psychol Sci. 2013 May;24(5):698-705. [PubMed]15.Black DW, Gunter T, Loveless P, Allen J, Sieleni B. Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of life. Ann Clin Psychiatry. 2010 May;22(2):113-20. [PubMed]16.Falcus C, Johnson D. The Violent Accounts of Men Diagnosed With Comorbid Antisocial and Borderline Personality Disorders. Int J Offender Ther Comp Criminol. 2018 Jul;62(9):2817-2830. [PubMed]17.Instanes JT, Haavik J, Halmøy A. Personality Traits and Comorbidity in Adults With ADHD. J Atten Disord. 2016 Oct;20(10):845-54. [PubMed]18.Frick PJ. Early Identification and Treatment of Antisocial Behavior. Pediatr Clin North Am. 2016 Oct;63(5):861-71. [PubMed]19.Repo-Tiihonen E, Hallikainen T. [Antisocial personality disorder]. Duodecim. 2016;132(2):130-6. [PubMed]20.Gibbon S, Duggan C, Stoffers J, Huband N, Völlm BA, Ferriter M, Lieb K. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev. 2010 Jun 16;(6):CD007668. [PMC free article] [PubMed]21.Goldstein RB, Dawson DA, Saha TD, Ruan WJ, Compton WM, Grant BF. Antisocial behavioral syndromes and DSM-IV alcohol use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Alcohol Clin Exp Res. 2007 May;31(5):814-28. [PubMed]Publication DetailsAuthor InformationAuthorsKristy A. Fisher1; Manassa Hany2.Affiliations1 Aventura Medical Center2 Icahn School of Medicine at Mount SinaiPublication HistoryLast Update: December 8, 2020.CopyrightCopyright © 2021, StatPearls Publishing LLC.This book is distributed under the terms of the Creative Commons Attribution 4.0 International License (Creative Commons - Attribution 4.0 International - CC BY 4.0), which permits use, duplication, adaptation, distribution, and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, a link is provided to the Creative Commons license, and any changes made are indicated.PublisherStatPearls Publishing, Treasure Island (FL)NLM CitationFisher KA, Hany M. Antisocial Personality Disorder. [Updated 2020 Dec 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-.