Sunday, December 16, 2012

Adam Lanza and Asperger's Disorder

Adam Lanza (Elite Daily)
I knew this would happen, that someone would slap Asperger's on Adam Lanza, a child so shy, so withdrawn, that he clung to the walls of the school. His mother took him out of school, home-schooled him.

She also told a babysitter, when he was a young teen, "Don't take your eyes off of him for a minute."

Mrs. Lanza kept a pristine, perfectly ordered home. People will say Adam was angry at her for that, or because he was enmeshed. At age twenty, two years after his last contact with his father Peter, he snapped, bought a gun, and became a mass murderer. Some will say it was about that. Others will say he was a bully, that he picked on people younger than himself. He attacked children.

And then there is always the sociopathic diagnosis, but Adam doesn't fit that as it appears in the DSM IV. He wasn't charming and he didn't con people.

We might have thought he had a severe version of Intermittent Explosive Disorder, except that these murders were premeditated, not a result of a simple tantrum.  It was a complicated tantrum.

Most people are saying that schools need better protection. I envision bullet-proof doors and intercoms. Even then, even after gaining admission to the building, visitors will first pass through a metal detector, with no one else in that lobby (this is my imagination on autopilot) and if they don't pass, won't be admitted through the second set of doors.

We can't afford to lose school guards, principals, psychologists to people who have lost all control, who are listening to voices in their heads that tell them, "Do it! Kill everyone!"

Life is precious. We are all in tears over this.

The Wall Street Journal posted excellent advice, what to tell your children, how to discuss these murders. They need to talk, and all week, this week, hopefully they will have that chance.

When the discussion comes to diagnosis, every child with Asperger's will be hiding under their desks!
It shouldn't be this way. It is not a violent disorder. Paranoid Schizophrenia-- that's a violent disorder, and Schizoid Personality Disorder, typified by aloofness characteristic of Adam Lanza, is sometimes premorbid to that.

The history we're hearing does not indicate any prior sociopathy. We're hearing he was shy, wore black.

I wrote about this when Cho Sueng Hu massacred 32 students at the Virginia Tech five years ago. Most professionals agreed that he suffered from Schizophrenia, Paranoid Type, and perhaps had Schizoid Personality Disorder, too.

For the record, since the DSM V (the American Psychiatric Association's diagnostic and statistical manual) isn't out yet, we're stuck with the DSM-IV. Here are the features of the disorders I think are relevant to Adam Lanza. Of course, I could be wrong. You be the judge.

Asperger's Disorder, 299.80

(I) Qualitative impairment in social interaction, as manifested by at least two of the following:
    (A) marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body posture, and gestures to regulate social interaction
    (B) failure to develop peer relationships appropriate to developmental level
    (C) a lack of spontaneous seeking to share enjoyment, interest or achievements with other people, (e.g.. by a lack of showing, bringing, or pointing out objects of interest to other people)
    (D) lack of social or emotional reciprocity
(II) Restricted repetitive & stereotyped patterns of behavior, interests and activities, as manifested by at least one of the following:
    (A) encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
    (B) apparently inflexible adherence to specific, nonfunctional routines or rituals
    (C) stereotyped and repetitive motor mannerisms (e.g. hand or finger flapping or twisting, or complex whole-body movements)
    (D) persistent preoccupation with parts of objects

(III) The disturbance causes clinically significant impairments in social, occupational, or other important areas of functioning.

(IV) There is no clinically significant general delay in language (E.G. single words used by age 2 years, communicative phrases used by age 3 years)

(V) There is no clinically significant delay in cognitive development or in the development of age-appropriate self help skills, adaptive behavior (other than in social interaction) and curiosity about the environment in childhood.

(VI) Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia.



Schizophrenia, Paranoid Type 295.30

The DSM IV-TR doesn't paginate, the following four all merge into one in the bible. Actual symptoms, that check list, won't help you at all.

The essential feature is the presence of prominent delusions or auditory hallucinations in the context of a relative preservation of cognitive functioning and affect. Symptoms characteristic of the Disorganized and Catatonic Types are not prominent. 

Delusions are typically persecutory or grandiose, or both, but delusions with other themes (e.g., jealousy, religiosity, or somatization) may also occur. The delusions may be multiple, but are usually orgnaized around a coherent theme. 

Hallucinations are also typically related to the content of the delusional theme.

Associated features include anxiety, anger, aloofness and argumentativeness.

The individual may have a superior and patronizing manner and either a stilted, formal quality or extreme intensity in interpersonal interactions.

The persecutory themes may predispose the individual to suicidal behavior, and the combination of persecutory and grandiose delusions with anger may predispose the individual to violence.

Schizoid Personality Disorder 301.20


A. A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four or more of the following:

(1) neither desires, nor enjoys close relationships, including family
(2) almost always chooses solitary activities
(3) has little, if any, interest in having sexual experiences with another person
(4) takes pleasure in few, if any, activities
(5) lacks close friends or confidants other than first-degree relatives
(6) appears indifferent to the praise or criticism of others.
(7) shows emotional coldness, detachment, or flattened affectivity

B. Does not occur exclusively during the course of Schizophrenia, a Mood Disorder With Psychotic Features, another Psychotic Disorder, or a Pervasive Developmental Disorder, or another medical condition.

Schizoid Personality Disorder is found premorbid to schizophrenia.


What did people say about him? Everyone has something to say. 

therapydoc

14 comments:

Mound Builder said...

I was hoping you might post something about this. Like you, like I imagine just about everyone, this massacre...words do fail. So sad. I feel so sad about the families of the little children who've been killed, their friends, the whole community. I feel so sad about the adults who tried to stop Adam Lanza from killing. Almost beyond comprehension.

I've read, repeatedly, that he had Asperger's and a personality disorder. I didn't think Asperger's led to this kind of violence and feel for anyone else who has that diagnosis. I hadn't thought of someone schizoid as doing such a thing, either, though, and it sounds like from what you say, that might be a precursor to being paranoid schizophrenic. I wonder if we'll ever know what led him to do such a thing.

great massage service said...
This comment has been removed by a blog administrator.
therapydoc said...

Probably what will hapoen is more $ for surveillance cameras. That wud be a start in many schools.

Anonymous said...

Try schizotypal PD, genius...

therapydoc said...

It crossed my mind, but since he lacked the odd features, fascinations with strange foods, beliefs, decided it didn't fit.

therapydoc said...

If he did, please share, anon.

Smitty said...

I am so tired of diagnosis. They oversimplify the person that needs, above all, CARE.

To say that someone paranoid is very likely to be violent? Another generalization, that adds to fear.

A paranoid person, in my humble experience, is simply one who has taken their OWN lack of self-trust and turned that on the world around them.

Smitty said...

Let's just say that at a basic, unexamined, level, I don't trust myself. Under the right conditions of unregulated emotion, which for me can include times I have very low blood sugar or lack of sleep, I might find myself paranoid

If I have insight I can get help. I can tell you from experience, that when this is caught in time, the symptoms go away.

The cause however, is there until I have the insight to deal with it.

I can, and have, learned to trust myself. I am grateful for good insurance coverage and for a network of friends and family who listen.

I am betting Adam Lanza and his mom had neither of these. At least no one who helped them to see how having guns in the house and training in how to use them, MIGHT just be part of a recipe for disaster.

Thanks for hearing me on this.

Smitty

therapydoc said...

Thank you Smitty.

Anonymous said...

In my opinion, I think that Adam Lanza may have repressed extreme rage due to early childhood experience/s that made him feel abandoned and unloved. Eventually, this rage erupted and caused the mayhem. More people than we would like to assume, carry within them this degree of rage. Testing patients over many years has been very revealing in regards to this problem.

Mound Builder said...

In the case of Adam Lanza, it might have been hard for people close to the family or within the community to have alerted anyone to a potential problem. It sounds like his mother helped support him in his isolation. But that had me thinking... what is it reasonable to do, if you truly think someone is a potential danger? If you're not immediate family, but you feel concerned, how should you approach the family? It was occurring to me that it might be hardest for family members to admit to others that their loved one is potentially violent. And it is also hard, I think, to get a person who is of legal age to get help, if you think they are a risk to others or even to themselves. What would you suggest, therapydoc, about how to approach this kind of situation where you can see that something is wrong, that someone may become violent, and that it appears, from the outside, that no one is doing anything about it?

Anonymous said...

You're exchanging one prejudice for another. People with schizophrenia, when treated, are no more likely to be violent than anyone else. Without treatment, they do have a slightly higher chance of violence but it's almost always spur of the moment and (in their minds) defensive. It's rarely an attack like this which requires forethought and planning.

And again, even untreated, the link between schizophrenia and violence is a small statistic compared to the increases in gun violence in countries with lax gun laws.

Rossa Forbes said...

Whoever you are, you claim "this blog is not to diagnose." You somehow feel it's okay to violate that statement in this post.

in the vanguard said...

NUTCASE SYNDROME - those who put faith in idiotic psychiatry