Conduct Disorder, Anti-Social Personality Disorder, and Sociopathy

A glance through the files of a detention center will turn up the diagnosis of Conduct Disorder again and again. From Wikipedia:

Conduct disorder (CD) is a mental disorder diagnosed in childhood or adolescence that presents itself through a repetitive and persistent pattern of behavior that includes theft, lies, physical violence that may lead to destruction, and reckless breaking of rules,[1] in which the basic rights of others or major age-appropriate norms are violated. These behaviors are often referred to as "antisocial behaviors",[2] and is often seen as the precursor to antisocial personality disorder; however, the latter, by definition, cannot be diagnosed until the individual is 18 years old.

As noted, the Conduct Disorder diagnosis is extremely common in the files of juvenile offenders. It’s so common that, by itself, it reveals very little about the client sitting in front of you. The traits that characterize Conduct Disorder occur on a continuum of severity. At the moderate end, there are youths who will respond to counseling, respond to kindness, respect, and an effort to get to know them. At the more severe end there are individuals known as sociopaths.

This discussion will focus on the traits and characteristics of the youths at the more severe end. These are individuals who go through life with a profound disregard for the rights and feelings of others. They often lack an internal sense of right and wrong and may view the world thinking of others in purely transactional terms: What can this person offer me? What can I take from this person? The terms sociopath, psychopath, and anti-social individual are used interchangeably in common speech. I use the term sociopathic to describe a youth whose indifference to others stands out as his most dominant trait and the lens that most accurately explains his behavior.

So, who are these individuals and how do you know when your client is one of them? Experienced PO’s and counselors may identify these clients in the first meeting or two from their vibe. There is usually a disconnect, a sense that the client is either on a mission to convince you of something or get something from you, or a sense that he does not care about you or the session. He’s absent, indifferent in a way that creates discomfort and doesn’t feel normal.

Individuals incarcerated for crimes like shootings, armed robberies, assault with a weapon, or aggravated domestic violence deserve scrutiny. Particularly severe and remorseless abuses of power are a tell. A criminal history starting before age 10 is also noteworthy. I had a sex offending client who sexually abused a little girl for years starting when he was 10. He credibly threatened to stab her and her family members to keep her quiet. He eventually invited a peer to abuse her with him and this abuse lasted a while. In a therapeutic interview in treatment when he was 16, he became visibly enraged, sputtering and red in the face, because the girl told on him.

This was an actual but extreme case. If you work in this field, it’s important to understand there are people who seem born feeling entitled, devoid of compassion and a sense of morality. With clinical experience, this constellation of traits becomes recognizable.

So, if your client is sociopathic, what does that mean in practice? It means the typical, “How do you feel about that?“ approach in counseling is a waste of time. As a rule, the following may be useful things to do:

1. Identify clear, behavioral objectives for your client, i.e.: You will minimize write-ups in order to get released.

2. Engage on topics of specific interest to the client such as job training.

3. Offer suggestions of pro-social approaches for the client to use pursuing his goals, pointing out that selfishness and indifference don’t pay once they are seen by others.

4. Accept the client for who he is but earn the client’s respect and have clear and enforceable boundaries from the outset.

5. Sociopathic youths are good at assessing power. They’re beyond good at it. Know where your power lies and what you will do if control of the session is challenged.

6. Steps to ensure an appropriate balance of power will appear in a future blog.

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