June escapes the authorities when the spacecraft is attacked and continues to lie about her identity and show lack of empathy. After the attack, June, pretending to help, steals the coat of an injured man to gain access to his escape vehicle, leaving him to die. However, she allows two mechanics to share the escape vehicle with her, saving their lives. They crash on an uninhabited planet. At this point, she decides to keep the identity of the original escape vehicle and jacket owner, i.e., ‘Dr. Smith.’ June pretends to care about the deceased female mechanic, who did not make it through a rough landing, and offers to bury the body. The male mechanic does not see through this ruse and ‘Dr. Smith’ is able to hide evidence against herself in the grave. June and the male continue on together. Interestingly, June lies about having a brother to gain empathy and make a connection with the mechanic. She also lies about being a doctor and chooses to be a Psychologist. It is possible that June believes she can use her natural abilities to fake being a Psychologist. Obviously, June does not feel guilty and continues to be dishonest.
June continually endangers others; prioritizing her safety above the safety of her companions except on certain occasions. When the mechanic discovers an injured woman that possibly ejected from her escape vehicle, he feels guilty about leaving her without help. He decides to carry her. June realizes that helping the woman will slow them down. She steals the only flare during a storm, and tells the mechanic she will go for help. However, when she finds help after using the flare, she states that she is alone. The emotion of being thankful for being saved seems forced and awkward. At one point, June has the opportunity to escape, endangering the lives of the family that rescued her. The reason she decides not to escape is unclear. It is possible that her malice has limits or she saw another opportunity to benefit. The events that have occurred show a pattern of self-serving behavior that threatens the well-being of others.
June is a master at manipulation and does not have remorse for using others to her advantage. Those with Antisocial Personality Disorder frequently lack empathy and can display superficial charm (American Psychiatric Association, 2013). She repeatedly lies about her past and family to gain sympathy from those around her. With her sister, she purposefully appeared weak to get her guard down. It seems that she is aware that connections with individuals are essential. For example, to make a connection with the family that saved her June said that she specializes in Family Therapy. June also flatters the family and pretends to have an easygoing and understanding demeanor. Moreover, it is evident that she uses the family’s trust to achieve her own goals. June tried to gain control of the little boy’s robot for her safety and goal of reaching the colony. Without remorse, she violated the family’s privacy for her own gain. June constantly plays on the emotion of others for her benefit.
Based on the information presented, my provisional diagnosis is Antisocial Personality Disorder. According to the American Psychiatric Association (2013), those with Antisocial Personality Disorder continually disregard the rights of others. This disorder is often referred to as ‘sociopathy’ (APA, 2013). Deceit and manipulation are central to Antisocial Personality Disorder (APA, 2013). June meets the general criteria of APD.
More information needs to be gathered to confirm the diagnosis. Antisocial Personality Disorder must be present starting at 15 years of age (American Psychiatric Association, 2013). Conduct Disorder must also have been present before 15 years of age (APA, 2013). It is unknown when the pattern of antisocial behavior began for June. Her parents or sister may have this information. Differential diagnoses must also be ruled out, like schizophrenia and bipolar, to diagnose. APD cannot be diagnosed if it occurs during an episode of schizophrenia or bipolar (APA, 2013). It is essential to have accurate client history to diagnose APD.
June meets criteria A1 in the DSM-5. The American Psychiatric Association (2013) stated the first criteria for Antisocial Personality Disorder is an inability to conform to the laws of society. This unlawful behavior is repetitive (APA, 2013). June repeatedly breaks laws and has a lengthy criminal record for trespassing, identity theft, and more.
The second criterion for Antisocial Personality Disorder is also satisfied. The American Psychiatric Association (2013) explained criteria A2 as deceitfulness, consisting of lying, using aliases, and conning others. Those with APD use people for their benefit (APA, 2013). June lies about her identity, her past, and her intentions. June’s cons put others at risk to save herself. Her goal is to make it to the new colony, and she dupes others into helping her reach that goal. June, seemingly, lives an elaborate lie most of the time.
June is also impulsive and fails to plan, meeting DSM-5 criteria A3, even though she has a final goal. June takes advantage of moments when they appear. For example, she took advantage of her sister’s invitation to steal. June gained the upper hand during the attack to escape the authorities. She does not use an elaborate plan to get what she wants. Instead, she consistently acts impulsively in a self-serving manner. However, she does have goals, aspirations, and desires. It seems that June genuinely wants to survive and obtain a better life. From the information gathered, she does not plan to commit crimes. Usually, she is in a situation that facilitates crime, and she impulsively takes action regardless of the law.
Irritability is present in the client most of the time; however, aggressiveness is difficult to discern. June is easily annoyed when people ‘get in her way.’ The American Psychiatric Association (2013) described aggressiveness as a symptom of Antisocial Personality Disorder. Aggressiveness is indicated by physical fights (APA, 2013). However, self-defense or defending others is not evidence of this criterion (APA, 2013). June has hurt people and killed an individual. According to her statements, she was acting in self-defense. Nevertheless, she does not engage in aggressive behavior most of the time. The people close to her, that do not know her past, would not consider her aggressive (especially while June is impersonating Dr. Smith). Aggressiveness may present differently in females, and bias may cause females to be underdiagnosed (Crosby & Sprock, 2004). Men are more commonly diagnosed with Antisocial PD (APA, 2013). Thus, irritability is a is more apparent than aggression, complicating APD diagnosis in June’s case.
Clearly, June disregards the safety of others. There are only two instances out of many where June seemingly questions her actions and refrains from hurting others. The American Psychiatric Association (2013) described the disregard of safety in APD as reckless. June has pushed a button to flush a man out of an airlock, left people behind to save herself, and caused dangerous situations putting many lives at risk. For example, she lured a dangerous robot into the crash survivors camp for her benefit. June’s safety seems to be her only concern most of the time.
The client’s sister stated that June is irresponsible and has never been able to hold a job, indicating that criteria A6 for Antisocial Personality Disorder in the DSM-5 is fulfilled. In June’s case, it seems that her irritability, inability to plan, and impulsiveness hinder her capacity to be a productive member of society. June can be considered a ‘leech.’ Instead of contributing, she takes as much as she can. Since she was seemingly homeless for a time, it is evident that exploiting others has not always worked for her. June’s irresponsibility has put a strain on her wellbeing in the past.
The last criteria that June meets under A regards lack of remorse. This criteria, in my opinion, is highly useful for diagnosing Antisocial Personality Disorder. The DSM-5 does not require that a person exhibit this symptom, instead only requiring three out of seven for diagnosis under A; nevertheless, I feel it is a distinct quality. The American Psychiatric Association (2013) described individuals with APD as rationalizing their behavior with excuses, including a “help number one” view (p. 660). June justifies her actions by perceiving the world as a place where people must fend for themselves. She also blames others for her actions, ridding her of guilt. Not feeling remorse facilitates June’s criminal activities and further substantiates the diagnosis of Antisocial Personality Disorder.
There are other factors to consider in an Antisocial Personality Disorder diagnosis. Information from individuals the client has contact with is necessary, especially since the client is prone to lie and manipulate. Since conduct disorder before age 15 is essential, it would be useful to ask relatives and other past caregivers whether the client was aggressive towards animals, destroyed property, or stole before age 15. Considering these factors will enable an accurate diagnosis.
The client has a few risk and resilience factors that are worth contemplating. Both genetic and environmental factors increase the risk of Antisocial Personality Disorder developing (American Psychiatric Association, 2013). The American Psychiatric Association (2013) indicated that there is a risk of APD being passed to offspring. Jovev, McKenzie, Whittle, Allen, and Chanen (2013) stated: “neglect was associated with elevated symptoms of ASPD” (p. 221). The American Psychiatric Association (2013) alluded to a good (adoptive) family environment being a possible resilience factor. Therefore, genetics may cause a child to be prone to Conduct Disorder and then APD, but environmental factors may increase the risk of development or severity. In June’s case, she does not have a good relationship with her family; it is possible that there was neglect, although there is no actual indication of neglect. Analyzing risk and resilience helps create an better understanding of antisocial behavior.
Continued assessment of the client would be prudent. It is possible that antisocial behavior occurs due to circumstances and as a way to survive in high-stress situations (American Psychiatric Association, 2013). It’s important to note that not all criminals have Antisocial Personality Disorder and vice versa. The incidents reported about Jane all relate to survival situations; for example, the Earth’s pollution, alien attack, and crashing on an unknown planet. A continued assessment would differentiate between situational or pervasive disorder.
Four factors impede the accuracy of diagnosing Antisocial Personality Disorder, i.e., substance abuse, schizophrenia or bipolar, other personality disorder(s), and regular crime. If antisocial behavior is associated with substance use disorder in adulthood then it is not diagnosed (American Psychiatric Association, 2013). Substance use and APD can only be comorbid if they both originated in childhood (APA, 2013). Antisocial behavior can occur during episodes of schizophrenia and bipolar; a diagnosis of APD would not be made in these cases (APA, 2013). All the personality disorders share traits in common, and it can be difficult to distinguish one from the other (APA, 2013). Narcissistic personality disorder shares superficial charm and lack of empathy; however, it is not characteristically deceitful (APA, 2013). Histrionic PD shares impulsive and manipulative traits; although, Histrionic PD is well known for exaggerated emotions (APA, 2013). Borderline and Paranoid PD uses manipulation as well, the difference is that the manipulation is used to gain nurturance or revenge respectively (APA, 2013). Lastly, criminal behavior may not constitute for Antisocial PD if it is not part of a persistent personality trait that causes severe impairment (APA, 2013). June’s characteristics mainly lean towards Antisocial Personality Disorder. The symptoms that June has that are unlike other personality disorders include deceit, manipulation for power, exploitation, reasonable emotional distress, and conduct disorder. Regardless, a therapist must investigate all differential diagnoses to ensure accuracy.
The client presents with psychosocial and family issues. Individuals with APD pose a threat to their family (Reid & Gacono, 2000). This danger is apparent when June drugs her sister and steals her sister’s identity. June does not get along well with others after some time. First, she does not care for others or exhibit real compassion. She will, however, show factitious compassion when meeting other individuals. Some individuals, e.g., the mechanic, will not see through her forged facade. Others will immediately feel suspicious causing relationship strife. Those that know her well choose not to associate with her any longer. For example, her family will no longer offer assistance. June also scapegoats her family leading to feelings of resentment and anger. These psychosocial issues contribute to June’s impairment.
Another issue leading to increased impairment within society pertains to June’s inability to maintain a career. There is no indication that June has ever held a job for a lengthy period or learned a trade. This irresponsibility may be one of the reasons her parents did not give her college tuition or a position within the company they owned. Vocation issues affect one’s ability to be self-reliant. June is not able to take care of herself in a healthy way, which leads her to exploit others.
June has committed violent crimes; a diagnosis may affect how a judge adjudicates her. Antisocial Personality Disorder is commonly found in the prison system (APA, 2013). APD is used in the court systems, by the defense and prosecution, and research confirms that it does impact trial outcomes (Edens & Cox, 2012). This impact causes a legal and ethical dilemma for the psychologist. Most of the time APD is introduced by the prosecution to argue that an individual does pose a threat to society (Edens & Cox, 2012). Thus, psychologists must take precaution in diagnosing APD as it could put the individual’s or another’s life at risk.
The recommendations for follow-up include further assessment. Paris (2015) suggested the use of FFM to assess personality disorder. The FFM assessment consists of “(1) extraversion-introversion, (2) neuroticism, (3) openness to experience, (4) agreeableness, and (5) conscientiousness” (Paris, 2015, p. 184). This assessment will be useful in differentiating Antisocial Personality Disorder and situational crime or antisocial behavior.
The recommendation for treatment is Cognitive Behavioral Therapy. CBT is meant to alter the way individuals think, and therapist’s using this method have been successful in treating Antisocial Personality Disorder (Rodrigo, Rajapakse, & Jayananda, 2010). Rodrigo, Rajapakse, and Jayananda (2010) stated CBT had a better outcome than all other interventions (Rodrigo, Rajapakse, & Jayananda, 2010). However, CBT is very time consuming, requiring highly trained staff (Rodrigo, Rajapakse, & Jayananda, 2010). Another downfall of CBT is that it does not work on individuals with low intelligence (Rodrigo, Rajapakse, & Jayananda, 2010). Reid and Gacono (2000) warned that those with APD must have very rigid treatments, disallowing the client to manipulate or malinger. I feel that CBT would work for June since she has a desire to better herself, i.e., she wishes to be in a better place. Also, June is exceptionally intelligent, and this could enhance receptibility to CBT. The therapist should be aware of June’s patterns of lying to gain sympathy and then using that to her advantage; June may try to gain power and influence over the therapist. With that in mind, CBT is a plausible treatment method.
In conclusion, June’s provisional diagnosis is Antisocial Personality Disorder; however, she still needs further assessment. Prevalent complications when diagnosing APD are differentiating APD from circumstantial crime and other personality disorders. Information on when (i.e., what age) antisocial behavior began is essential to diagnose APD. June’s history shows a pattern of crime, deceit and exploitation of others. Her recent history is indicative of APD, for example, she has used aliases and false personas. June is especially manipulative. She lacks concern for others and consistently endangers those around her. June meets Criterion A1 through A7 in the DSM-5. Her inability to hold a job or interpersonal relationships are debilitating. It’s possible that childhood neglect put her at risk for developing APD. Continued assessment and then Cognitive Behavioral Therapy is recommended in this case. It is vital to remember, a diagnosis can impact the safety of others and the client. Care must be taken in diagnosing APD.