Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Antisocial Personality Disorder


Related Terms

  • Amoral Personality Disorder
  • Dyssocial Personality Disorder
  • Psychopathic Personality Disorder
  • Psychopathy
  • Sociopathic Personality Disorder
  • Sociopathy

Differential Diagnosis

  • Alcohol/substance abuse
  • Bipolar disorder
  • Organic brain syndromes
  • Other personality disorders
  • Schizophrenia

Specialists

  • Clinical Psychologist
  • Psychiatrist

Comorbid Conditions

  • Alcohol or substance abuse disorders
  • Anxiety disorders
  • Depressive disorders
  • Impulse control disorders (e.g., pathological gambling, kleptomania, pyromania, trichotillomania)

Factors Influencing Duration

Factors influencing outcome include substance abuse and its associated complications, reluctance to undergo treatment, the individual's support system, and his or her financial and legal status. The normal course of the disorder is to diminish with age.

Medical Codes

ICD-9-CM:
301.7 - Antisocial Personality Disorder, Amoral Personality, Asocial Personality, Dyssocial Personality

Overview

Antisocial personality disorder is characterized by a pervasive pattern of disregard for and violation of the rights of others. This pattern of behavior tends to be inflexible, maladaptive, and persistent, beginning in childhood or early adolescence and continuing into adulthood. Key features include ambition, persistence, goal-directed behavior, apparent need to control the environment, and unwillingness to trust the abilities of others. The antisocial personality performs antisocial or criminal acts, but the condition is not synonymous with criminality. As there is an inability or unwillingness to conform to social standards, it is also termed the dyssocial personality disorder.

As seen through the eyes of others, behavior appears as a spectrum from fearless in milder forms, to reckless in the more severe forms of the disorder. Individuals with the disorder tend to be impulsive, forceful, aggressive, irresponsible, and seldom inhibited by danger or fear of punishment. Risk-taking behavior often provides them with a feeling of exhilaration. Individuals tend to have an inherent lack of consideration for the rights of others. In more severe cases, there is irresponsible disregard for the rights and welfare of self and others. Antisocial personalities often show little remorse in using others to achieve their own desired goals. These individuals have difficulty developing and maintaining close interpersonal relationships, a characteristic that may stem from their fear that others will harm them in some way. They may also be argumentative, abusive, cruel, belligerent, or vindictive.

Individuals with antisocial personality disorder may repeatedly lie, manipulate others for personal power or gain, exhibit irresponsible sexual, parenting or work behaviors, default on debts, and fail to make amends for their behavior. They may blame their victims for being foolish, helpless, or deserving of mistreatment using rationalizations such as "losers deserve to lose," or "he had it coming anyway." These individuals usually display an inflated and arrogant self-appraisal, lack of empathy, and may display a superficial charm. They lack empathy for others and see others as a means of personal gratification with little regard for the feelings or rights of those who they may violate.

Incidence and Prevalence: In two large-scale US surveys, the Epidemiologic Catchment Area (ECA) study and the National Comorbidity Survey (NCS), the prevalence of antisocial personality disorder was 2.4% and 3.5%, respectively. In the National Comorbidity Survey, 5.8% of men and 1.2% of women met criteria for antisocial personality disorder. Prevalence in the prison population may be as high as 75%.

Source: Medical Disability Advisor



Causation and Known Risk Factors

Onset is before the age of 15 with a higher prevalence in lower socioeconomic classes in urban areas. It is five times more common among first-degree relatives of males with the disorder than among controls. Recent research suggests the existence of biological markers related to abnormalities in the hypothalamic-pituitary-thyroid axis in antisocial personalities that show criminal recidivism.

Source: Medical Disability Advisor



Diagnosis

History: A diagnosis of antisocial personality disorder is based on criteria listed in the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision). The individual must be at least 18 with a history of some symptoms of conduct disorder prior to age 15. Because deceit and manipulation are features of this disorder, it is helpful to obtain and integrate information from both the individual and corroborating sources such as family, school, and community contacts, if possible. Specific behaviors characteristic of conduct disorder are aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules. If there is no history of conduct disorder, then the individual may be assessed for another mental disorder.

A diagnosis of antisocial personality disorder can be made if three or more of the following criteria are met: failure to conform to social norms of lawful behavior by repeatedly performing acts that could lead to arrest; repeated lying, use of aliases, or conning others for personal profit or pleasure; impulsivity or failure to plan ahead; irritability and aggressiveness with repeated physical fights or assaults; reckless disregard for the safety of self or others; repeated failure to sustain consistent work behavior or honor financial obligations; and lack of remorse for behavior. The diagnosis cannot be made if the behavior occurs exclusively during the course of a schizophrenic or manic episode.

Physical exam: The exam is not helpful in diagnosing this disorder.

Tests: An electroencephalogram (EEG) and a thorough neurological exam should be performed. Individuals with this disorder may show abnormal EEG results and neurological signs suggestive of minimal brain damage in childhood. Functional MRI's (FMRI) are showing initial promise in identifying the neurobiological substrate of the disorder.

Psychological testing such as the Minnesota Multiphasic Personality Inventory - 2 (MMPI-2) can be helpful in diagnosing Personality Disorders. The Structured Clinical Interview for Axis II Disorders (SCID-II) is sometimes used for differential diagnosis (First).

Source: Medical Disability Advisor



Treatment

Both group and individual psychotherapy may be utilized for the treatment of antisocial personality disorder. However, outpatient treatment is especially difficult and unlikely to provide long-lasting benefit. Treatment in a residential therapeutic setting or community is usually more effective. Manipulation and undesirable behavior are better controlled and incentive to change increases. Self-help groups have also been used as well as family education and counseling. Dialectical behavioral therapy is a relatively new psychotherapeutic approach that has shown promise in treating borderline personality disorder and may have application in treating antisocial personality disorder.

Medications do not cure the disorder, but may be used to control the underlying symptoms of anxiety, depression, and physical violence. As there is a high incidence of substance abuse in this disorder, caution must be used in selecting and prescribing psychiatric medications. Some individuals with antisocial personality disorder may also have attention-deficit/hyperactivity disorder (ADHD) and may require a central nervous system stimulant to control the associated symptoms.

When hospitalization is required, the most effective treatment is best carried out in a specialized unit. Inability to trust, fantasize, feel or learn should be specifically addressed. Firm limits are needed in addition to defining acceptable alternatives for deviant behaviors.

Source: Medical Disability Advisor



Prognosis

Antisocial personality disorder frequently begins in late adolescence and usually follows a life-long course. Some studies report a decrease in symptoms, especially criminal behavior, by the fourth decade of life. Underlying symptoms of anxiety and depression frequently improve with medications.

Source: Medical Disability Advisor



Complications

Real or perceived control by authority figures or institutions may lead to resistance and aggressive behavior. Alcohol or other substance abuse is commonly associated with this disorder and can produce significant complications. Violent deaths such as suicide, accidents, and homicides are more likely in individuals with antisocial personality disorder than in the general population. Depression may complicate this disorder especially once therapy begins. Illegal activities may lead to arrest, incarceration, or other legal ramifications. Irresponsibility and disregard for the welfare and rights of others often lead to problems at the workplace and in personal relationships.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work accommodations may include providing written job instructions; clear communications, expectations, and boundaries; providing conflict-resolution mechanisms; providing guidelines for feedback on problem areas; and proactive management of problem areas.

The disrespect that this individual likely holds for authority figures and disregard for others' rights can create problems in management positions. The propensity for illegal acts prevents job duties requiring financial dealings or security.

Generally an employer is under no legal obligation to accommodate individuals who demonstrate antisocial behaviors in a work setting. The prognosis for change in an individual who may not recognize a problem is poor.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • Does individual fit criteria for antisocial personality disorder?
  • Was the diagnosis confirmed?
  • Was formal psychological testing performed?

Regarding treatment:

  • Although psychotherapy is usually the treatment of choice for antisocial personality disorder, are medications being used to help stabilize mood swings or treat specific coexisting psychiatric disorders?
  • If treatment difficulties are present, are they related to the health professional's misunderstanding of antisocial personality disorder?
  • Because individual shows a lack of remorse, is he or she assumed not to have any "real" feelings?
  • Has individual been able to establish an effective trust-relationship with therapist? If not, what can be done to foster this connection?
  • Is therapy following the approach that staying on "safe ground" is not likely to be as effective as discovering and labeling appropriate emotional states?
  • Is individual learning to face up to the consequences of his or her behavior?
  • Since the therapist should avoid using negative motivation, what does individual see as his or her motive for seeking therapy?
  • Is individual involved in a group therapy situation devoted exclusively to antisocial personality disorder? Is it proving to be beneficial or counterproductive to therapy goals?
  • Are individual and family involved in family therapy? Is family participating in family therapy even if individual refuses to go?

Regarding prognosis:

  • Does individual continue with behavior that may be a threat to self or others?
  • Would individual benefit from extended treatment?
  • Would a change in therapy or therapist be more beneficial?

Source: Medical Disability Advisor



References

Cited

First, Michael B., Lorna Smith Benjamin, and Janet B. William. Structured Clinical Interview for DSM-IV AXIS II Personality Disorders (SCID-II). 1st ed. 1 vols. Washington, DC: American Psychiatric Association, 1997.

Frances, Allen, ed. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). 4th ed. Washington, DC: American Psychiatric Association, 2000.

Frances, Allen, Harold Alan Pincus, and Michael B. First, eds. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). 4th ed. Washington, DC: American Psychiatric Association, 1994.

Source: Medical Disability Advisor






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