A 30 year old man who recently got out of jail for the fourth time sees you for mandatory follow-up. He has been in trouble with the law since his late teenage years. But when you look farther back, he's had problems since age 10 with fights with peers, conflicts with authority figures, stealing, vandalism, fire setting, and running away from home. He's never been able to hold a consistent job. His social support is poor; he has been divorced, and his ex-wife says he never showed any empathy. He doesn't have any strong interpersonal relationships. He is estranged from his family for stealing and lying. When you talk to him, he doesn't show any remorse for his past transgressions.
He has past diagnoses of substance misuse, major depressive disorder, and attention deficit hyperactivity disorder. He continues to smoke, drink, and use marijuana, but has avoided other drugs.
Challenge: What personality disorder do you recognize here?
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The Difficult Patient
Antisocial personality disorder is characterized by a pattern of socially irresponsible, exploitative, and guiltless behavior beginning in childhood or early adolescence. Behaviors show disregard for and violation of the rights of others.
Source: UpToDate.
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