Did you know that astronauts in space have a hard time communicating without words because

their weightless bodily fluids make their faces all puffy and hard to read? Have you heard that Botox
can actually improve your mood, and not by smoothing your wrinkles, but actually by easing
depression? Or that this "come here" gesture is common in the US, but is considered so rude in the
Philippines that it could actually get you arrested? Yeah. All true.

Emotions and the ways we express them are strange and powerful things. And emotions aren't just
a psychological phenomena, they affect our bodies and our health. Because so many emotions
have a certain contagious quality, our feelings and the behaviors they drive also affect the minds,
and bodies, and health of those around us. This is true whether your emotions at the moment are of
the feel-good variety, or not. The powers of both positivity and negativity are stronger than you may
know. Lots of studies have shown that people with a positive outlook on life tend to live longer,
more fulfilling lives than their mean and grumpy neighbors.

Fear, anger, and other more difficult emotions and how we handle them are pretty closely related to
this thing called stress. And stress is so powerful that it can straight up kill you in any number of
ways, given the right opportunity. For better or worse, we spend a lot of our lives swirling around
like leaves on the winds of competing emotions. Before we can hope to harness these feelings, we
first have to understand them.

(Intro)

What do you think this person is feeling? How about him? And her? What about this one? It's not
really hard to tell, is it? Most of us are better than we think at reading non-verbal cues and subtle
expressions. The understanding among some, but not all psychologists, like emotion expert Paul
Ekman, is that facial expressions are culturally universal. So, a Greek, Britain, American, Samoan, or
Nigerian would all be able to discern the same basic emotions - happiness, sadness, disgust,
anger, fear, and surprise, just by looking at your face.

And our expressions don't just communicate emotions, according to the facial feedback
hypothesis, they can help regulate our emotions, too. The act of smiling broadly, even if you aren't
happy, can actually lift your mood just as scowling can lower it. This is how, bizarrely enough, a
recent randomized controlled clinical trial suggested that a little Botox injection in the forehead
might actually lessen depression. 'Cause apparently it's hard to feel down if your frowning muscles
are frozen. Of course, whether your face is paralyzed or not, some people are better at reading your
emotions than others. For example, introverts are usually better at interpreting people's feelings,
while extroverts are often better at expressing them.
And you've probably heard embarrassing stories, or even experienced first-hand how different
cultures express emotions through particular gestures that are far from universal.
For example, in the United States, this is a peace sign, but you don't wanna flip it around in the UK,
and the iconic thumbs up gesture means "good job" in many cultures, but if you toss that thumb
around in Greece, let's just say you won't make any new friends.

But of course, emotions involve a lot more than making faces and hand gestures - they're also
about our conscious experience of what we're feeling. So, how do we actually feel all these feels,
and how many different emotions are there? Back in the 1970s, American psychologist Carroll Izard
identified ten distinct basic human emotions, present from infancy on. They are: joy, surprise,
sadness, anger, disgust, contempt, shame, fear, guilt, and interest or excitement. Others have since
suggested that pride should be added to that list, and still others believe that love should be
classified as a basic emotion as well, but Izard has argued that these and other emotions are just
familiar combinations of the classic ten.

Today, some psychologists describe our emotional experiences using a two-dimensional model.
The idea there is that any of the emotions you might feel while, like, reading Harry Potter or
something, are expressed on a spectrum, and as a combination of valence - roughly speaking,
good or bad - and arousal - excited or not excited, basically. So if you're feeling both really excited
and super positive when Harry final bested Voldemort, you could say you were "elated". On the
other hand, if you're at that part in Deathly Hallows when Harry, Ron, and Hermione are just sorta
wandering around on the land in a heavy mood, maybe your emotions fell more on the opposite
side of the spectrum - in this instance, feeling depressed might be a combination of negative
emotion and lack of excitement.

Eventually, every emotion can fall in degrees on this two-dimensional scale - like being terrified
means you're more frightened than if you're just scared - just as being enraged is a more extreme
version of anger than simply being mad. These polarities, positive versus negative, high arousal
versus low arousal, affect our psychological states, and therefore, our bodies, as well, because
you'll remember that what is psychological is ultimately biological. And when it comes to the
physical effects of our emotions, it pretty much goes the way you might expect: happiness is
healthful while chronic anger or depression makes us vulnerable to all kinds of problems with health
and well-being.

The good news is that if we're angry or sad, we often overestimate the duration of our bad moods
and underestimate our capacity to adapt and bounce back from traumas, even if things feel
hopeless, depressing or stressful in the thick of it. And we've all experienced stress before -
sometimes on a daily, or even hourly basis. Much like anger or joy, stress can slowly build and
simmer, or it can strike suddenly and with great intensity. And yeah, stress, certainly the chronic or
extreme type, can be bad for your health, but defining stress is trickier than you might think.
Psychologists would define stress as the process by which we perceive and respond to certain
events, or stressors, that we view as challenging or threatening. In other words, stress isn't
technically an emotion, it's more of a reaction to a disturbing or disruptive stimulus.

And our reactions stem in part from our appraisal of that stimulus. A person can either roll with or
get worked up about a missed flight, an increased work load, or a strange thump in the house.
These external stressors typically fall into three main categories: catastrophes, or unpredictable
large-scale events like war, natural disasters, or terrorist attacks, significant life changes, things like
moving, having a child, losing or getting a new job, or the death of a loved one, and then just
everyday inconveniences, like getting caught in traffic or running late or feuding with your
roommates.

Any of these stressful events, big or small, even the good things, can fire up your sympathetic
nervous system and trigger that old "fight or flight" response. In this way, it's important to
understand that stress is ultimately natural. You experience it for a reason, and a bit of short-lived
stress can actually be a good thing. It can make you active and alert when you need to be, like an
upcoming chemistry test might be stressing you out, but that might help you find focus so you can
dominate that thing. And in your body moderate stress can kick the immune system into action to
do things like heal wounds and fight infections. It does this by triggering the release of stress
hormones like adrenaline and cortisol. These chemical messengers are what get your organ
systems to respond the way you need them to when you're getting charged by a bear, or focusing
really hard on the gas law for your chemistry test.

But they're also why chronic stress can really wreck a body and mind. Research has shown that
abused children have a high risk of chronic disease, and people suffering from post-traumatic
stress disorder, PTSD, which we'll talk about in an upcoming episode, experience higher rates of
digestive, respiratory, circulatory, and infectious diseases.

A lot of these negative connections between your body's systems have to do with the fact that
many of its most basic functions, like blood pressure, breathing, body temperature, digestion, and
heartbeat, are in part regulated by the autonomic nervous system. We've talked before about how
the sympathetic side of that system cranks you up and the parasympathetic arm calms you down,
but both of those systems also interact with the so-called "brain in the gut", the enteric nervous
system, which helps regulate gastrointestinal functioning.

And it's this brain-gut connection that explains how stress causes digestive problems. Because
when that werewolf pops out of the bushes and a wave of cortisol washes through you, your body
wants to focus its energy on sending blood to your muscles so that you can react quickly. Which is
good, right? But it may do that partly by shutting down digestion or decreasing the amount of
digestive secretions and making your colon spasm. An anxious mind can lead to an anxious gut.
Stress is an even bigger risk factor in North America's leading cause of death, heart disease,
because it contributes to increased blood pressure, heart rate, and cholesterol levels in a number of
different ways. Essentially, when your stressed-out nervous system is redirecting all of its energy
sources to your muscles and brain, it pulls flow away from your other organs. And one of those
organs is the liver, whose job includes removing the fat and cholesterol from your blood. So
basically, when a stressed liver can't filter properly, that extra fat and cholesterol ends up circulating
in your blood, which can settle around the heart.

Don't believe me? One study monitored the blood cholesterol and clotting speed of forty male tax
accountants throughout the year, and it found that their cholesterol and clotting rates, and thus risk
of heart attacks, increased dramatically during the weeks before tax day, as they stressed out about
finishing their work.

And physiologically speaking, it's worth pointing out that some close relatives to stress, when it
comes to their effects on the body, are pessimism and depression, which also has been linked to
stress and heart disease. Many types of studies have found that people characterized by their
optimism, happiness, love, and positive feelings often live significantly longer than their grumpy,
dour counterparts. Researchers don't quite know exactly how chronic negative emotional states
influence health, but it may be some combination of lifestyle or behavioral factors, like neglecting
your health or not taking your heart meds when you're feeling blue, or social factors, like the way
that depression can be isolating and thus prevent others from helping you out, or biological factors,
like increases in certain kinds of inflammatory proteins released by the immune system in response
to stress and sadness.

So in the end, while stress may not directly cause disease, you could say that the two walk hand in
hand. In that way, it isn't a stretch to say that chronic stress can kill, so go ahead, take a deep
breath, feel your emotions, appreciate them, don't let them run your life.

Today, we talked more about how our emotions work and how we use facial expressions to help us
communicate. We also looked at the two-dimensional model of emotional experience and how
anger, happiness, and depression can affect our health. We also discussed what stress does to
your nervous system and how chronic stress can damage the functioning of your biological
systems.

Thanks for watching, especially to our Subbable subscribers who make Crash Course possible. To
find out how you can become a supporter just go to [Link]. This episode was written by
Kathleen Yale, edited by Blake de Pastino, and our consultant is Dr. Ranjit Bhagwat. Our director
and editor is Nicholas Jenkins, the script supervisor is Michael Aranda, who is also our sound
designer, and the graphics team is Thought Café.
When Lauren was fifteen years old, her family moved across the country and she started going to a
new school. Already shy, Lauren suffered from low self-confidence and had a hard time
transitioning; nothing felt right and soon her changing body became a source of insecurity.

Eventually, she began thinking that maybe if she lost weight and focused on fitness, she'd make
more friends and feel better about herself and life would get better. Soon she became obsessed
with dieting and it quickly spiraled into her subsisting only on rice cakes and apples and candy corn
and celery.

She like this new feeling of control every time she stood on the scale and saw a lower number. She
was achieving something, and that made her feel good. Soon, she thought of nothing else.

But what Lauren couldn't see was that she was no longer healthy. Even when her hair started falling
out and her skin grew dry and cracked, and when she could never get warm.

When she looked in the mirror, she still saw a chubby girl.

Her family, though, did notice, and yet, at a visit to the doctor, she was just told to eat more.

She didn't.

One day while jogging, she had a heart attack and collapsed. As a teenager, she was 5 feet 7
inches and weighed eighty-two pounds. Lauren was finally admitted to a psychiatric hospital where
she was treated for anorexia nervosa. She was put on bed rest, saw a therapist twice a week,
joined a support group and slowly began eating small amounts of food again.
Her recovery was slow but, with the support of her family and doctors, she was released eight
months later. Though Lauren suffered a few relapses over the years, she is now healthy.

Ultimately, she was lucky. Anorexia, bulimia, and other eating and body dysmorphic disorders can
kill.

Eating disorders are among the deadliest psychological disorders, with some of the highest rates of
death directly attributable to the illness. They slowly ruin the body, but, in order for these conditions
to be recognized and treated successfully, they have to be understood as disorders of the mind.

(Intro)

Anorexia, Bulimia, Binge-Eating Disorder

Here's some scary figures: According to the National Eating Disorder Association, forty-two percent
of first to third grade girls want to be thinner; eighty-one percent of ten year olds are afraid of being
fat; over half of teenage girls and nearly a third of teenage boys have used troubling weight control
methods like fasting, skipping meals, smoking, vomiting, or taking laxatives.

The rate of new cases of eating disorders in Western culture has been increasing since the 1950s,
and today in the US, an estimated twenty million women and ten million men have suffered from a
clinically significant eating disorder at some point in their lives.

But get this straight: we're not talking about fad diets or lifestyle choices spurred by vanity. Eating
disorders are psychological illnesses that often come with serious consequences.

These disorders tend to fall into three main categories: anorexia, bulimia, and binge eating
disorders.
Those suffering from anorexia nervosa, most often adolescent females, essentially maintain a
starving diet and, eventually, and abnormally low body weight. As in Lauren's case, anorexia can
begin as a diet that quickly spirals out of control as a person becomes obsessed with continued
weight loss, all while still feeling overweight.

Our old friend, the DSM V, actually delineates two sub types of the disorder. The first involves
restriction, which usually consists of an extremely low-calorie diet, excessive exercise, or purging,
like vomiting or the use of laxatives. The second type is the binge/purge sub type, which involves
episodes of binge eating combined with the restriction behavior.

As you can easily imagine, the physiological effects of this psychological condition can be
devastating. As the body is denied crucial nutrients, it slows down to conserve what little energy it
has, often resulting in abnormally slow heart rate, loss of bone density, fatigue, muscle weakness,
hair loss, severe dehydration, and an extremely low body mass index.

And it's that low body mass that's the defining characteristic of anorexia nervosa - a refusal to
maintain a weight at or above what would normally be considered minimally healthy.

If this condition persists, of course, it can be deadly, which is why anorexia has what's often
estimated to be the highest mortality rate of any psychiatric disorder.

That might surprise you, given the host of troubling disorders we've already covered here on Crash
Course Psychology, but mortality rates associated with, say, major depression or PTSD or
schizophrenia tend to be the result of secondary behavior, like suicide. But with anorexia, the
mortality rate is especially high because people can die as a direct result of extreme weight loss
and physiological damage.

Another common eating disorder is bulimia nervosa.

While anorexia is characterized primarily by the refusal to maintain a minimal body weight, bulimia is
not. People with bulimia tend to maintain an apparently normal, or at least minimally healthy, body
weight, but alternate between binge eating, followed by fasting or purging, often by vomiting or
using laxatives.

A bulimic body may not be as obviously underweight as an anorexic one, but that addictive cycle of
binging and purging can seriously damage the whole digestive system, leading to irregular
heartbeat, inflammation of the esophagus and mouth, tooth decay and staining, irregular bowel
movements, peptic ulcers, pancreatitis, and other organ damage.

Sometimes the two diagnoses can be difficult to discern, especially because someone may shift
back and forth between anorexic diagnostic features and bulimic diagnostic features.

The DSM V recently added a third category called binge-eating disorder, which is marked by
significant binge-eating, followed by emotional distress, feelings of lack of control, disgust, or guilt,
but without purging or fasting.

Although sometimes triggered by stress or a need for, or lack of, control, the presence of an eating
disorder is not a tell-tale sign of childhood sexual abuse, as was once commonly thought. Instead,
these disorders are often predictive indicators of a person's feelings of low self-worth, need to be
perfect, falling short of expectations, and concern with others perceptions.

Although the prevalence of bulimia and binge-eating is similar among ethnic groups in the United
States, anorexia is is much more common among white women, often of higher socioeconomic
status.

Types of Body Dysmorphic Disorders

But the prevalence of these disorders is rising in males, too. Today, between ten and twenty
percent of people diagnosed with eating disorders are men who feel the same pressure to attain
what they imagine is physical perfection, and that's worth noting.

These disorders have strong cultural and gender components; the so-called "ideal standard of
beauty" varies wildly among cultures and time, and thinness is far from a universal desire, especially
in countries where malnutrition and starvation are problems.

But in the Western world, and increasingly in other countries, thinness is a common pursuit. And
being bombarded with images of unrealistically slender models and jacked celebrities has
increased many people's dissatisfaction, or even shame and disgust, with their own bodies. These
are all attitudes that can contribute to eating disorders.

Some people have even had plastic surgery to look more like Beyonce, or J-Lo, or... Barbie.

When taken to extremes, this kind of behavior starts inching into the realm of body dysmorphic
disorder.

Body dysmorphic disorder is another psychological illness, one that centers on a person's
obsession with physical flaws - either minor or just imagined. Those suffering from this disorder
often obsess over their appearance, often staring into mirrors for hours, and feel distressed or
ashamed by what they see.

Although it's often lumped in with the eating disorders, our growing understanding of body
dysmorphia suggests that it actually shares some traits with obsessive-compulsive disorder,
particularly the obsession with some imagined bodily perfection and the compulsion to check
oneself over and over to discern perceived flaws.

Not surprisingly, BDD and OCD may share some similar neurophysiological features, although
that's still being researched.
People suffering from BDD may exercise excessively, groom themselves excessively, or seek out
extreme cosmetic procedures, but, unless treated, they usually remain critical and unsatisfied with
their looks, to the point of fearing that they have a deformity.

People with BDD may suffer from anxiety and depression, start avoiding social situations, and stay
home for fear that others will notice and judge their appearance negatively.

Obviously, this causes a lot of emotional distress and dysfunction. Some bodybuilders suffer from a
particular type of BDD called muscle dysmorphia, sort of the opposite of anorexia, where they
become obsessed with the notion that they aren't muscular enough, even if they're ripping shirts
like the Hulk.

And again, this isn't mere vanity; people suffering from body dysmorphia disorder look in the mirror
and often see a distorted, even grotesque, image in their reflection.

Psychological And Environmental Roots

So, how do these disorders come about?

Well, to be honest, we still have a lot of dots to connect.

Neurologically, there are a few compelling clues. In the case of eating disorders, for example,
research has long suggested that neurotransmitters like serotonin and dopamine may play a role.
Dopamine is involved in regions of the brain connected to hunger and eating, like the hypothalamus
and nucleus accumbens, and some research has found that binge eating appears to alter the
regulation of dopamine production in a way that can reinforce further binging.

The result is a neurological pattern that can resemble drug addiction, although the addiction
comparison is still pretty controversial.

Genetics appear to play a role, too, as there seems to be increased risk among genetic relatives
with eating disorders as compared to controls.

But a lot of attention is also being paid to environmental and familial factors, particularly the
behavioral modeling and learning processes that shape how we think about ourselves and our
bodies. Specifically, children who grow up observing problematic or unhealthy eating behavior in
parents may be at higher risk for developing an eating disorder. And explicitly learning unreasonable
or unhealthy values about your weight or your shape from your family, and definitely from your
peers, can have a powerful effect.

Conclusion

Eating and body dysmorphic disorders are serious business, but they are treatable - and perhaps
even preventable.

If cultural learning contributes to how we eat and how we want to look, then maybe education can
help increase our acceptance of our own appearance, and be more accepting of others.
What You Learned

Today, you learned about the symptoms and sub types of anorexia, bulimia, and binge-eating
disorder, as well as various types of body dysmorphic disorder, and some of the physiological and
environmental roots of these conditions.

Credits

Thank you for watching, especially to all of our Subbable subscribers. This episode of Crash Course
Psychology was co-sponsored by Subbable subscriber Matthew Woolsey and by Rich Brown of
Beach Ready Auto Repair in Outer Banks, North Carolina.

To find out how you can become a co-sponsor for one of our videos, just go to
[Link]/crashcourse.

This episode was written by Kathleen Yale, edited by Blake de Pastino, and our consultant is Dr.
Ranjit Bhagwat. Our director and editor is Nicholas Jenkins, the script supervisor and sound
designer is Michael Aranda, and the graphics team is Thought Café.
I can be smooth and charming and slick. I can make a very confident impression and it is hard to
leave me at a loss for words.

Sometimes I find myself fantasizing about unlimited success and power, and beauty.

I have repeatedly used deceit to cheat, con, or defraud others for my personal gain. To be honest, I
don't have much concern for the feelings of other people, or their suffering.

Doesn't sound like the Hank you know, does it? These are all statements from the Self-Assessment
measure for Personality Disorders, that lets patients describe themselves, ranking each statement in
terms of how accurate they think it is.

To be honest, you can't rely too much on this kind of self-reporting to access what we are talking
about today because while some people who are over-confident or obsessed with power or
downright deceitful might tell you that they are, there is a certain subset that won't.

Many of the disorders that we have talked about so far are considered, "ego-distonic" meaning that
people who have them are aware that they have a problem and tend to be distressed by their
symptoms.

Like a person with Bipolar Disorder or OCD generally knows that they have a psychological
condition and they don't like what it does to them.

But some disorders are trickier then [Link] are "ego-syntonic", the person experiencing them
doesn't necessarily think that they have a problem and sometimes, they think the problem is with
everyone else.

Personality disorders fall into this category. These are psychological disorders marked by inflexible,
disruptive, and enduring behavior patterns that impair social and other functioning-whether the
sufferer recognizes that or not.

Unlike many other conditions that we've talked about, personality disorders are often considered to
be chronic and enduring syndromes that create noticeable problems in life.

And as you can tell from these self assessment statements, they can range from relatively harmless
displays of narcissism, to a true and troubling lack of empathy for other people.
Not only can personality disorders be difficult to diagnose and understand, they can also be
downright scary. Most of the extreme and severe disorders go by names that you probably
recognize: psychopathy and sociopathy. I'm talking, like, serial killers here, mob bosses, Vlad the
Impaler.

[Intro Music plays]

Cultures have been studying human personality characteristics for thousands of years, but the
concept of personality disorders is a much newer idea.

Much of our modern classifications of these disorders are based on the work of German
psychiatrist, Kurt Schneider, who was one of the earliest researchers into what was then known as
psychopathy and published a treaties on the study in 1923.

Today, the DSM 5 contains ten distinct personality disorder diagnoses, grouped into three clusters.
The first cluster, cluster A, includes what are often labeled simply as "odd" or "eccentric"
personality characteristics. For example, someone with paranoid personality disorder may feel a
pervasive distrust of others and be constantly guarded and suspicious while a person with a
schizoid personality disorder would seem overly aloof and indifferent, showing no interest in
relationships and few emotional responses.
Cluster B encompasses dramatic emotional or impulsive personality characteristics. For example, a
narcissistic personality can display a selfish grandiose sense of self-importance and entitlement.
Meanwhile, a histrionic personality might seem like they're acting a part to get attention, even
putting themselves at risk with dramatic, dangerous and even suicidal gestures and behaviors.
Cluster B can be truly self-destructive and frightening and these disorders are often associated with
frequent hospitalization.

Finally, Cluster C encompasses anxious, fearful, or avoidant personality traits. For example, those
with avoid and independent personality disorders often avoid meeting new people or taking risks
and show a lack of confidence, an excessive need to be taken care of and a tremendous fear of
being abandoned. Now, in the past, and, to a great extent, today, some of these categories have
been controversial. Many researchers argue that some of these conditions overlap with each other
so much that it can be impossible to keep them apart. Narcissistic personality disorder, for
example, has many traits that resemble histrionic personality disorder. And because of this gray
area, the most commonly diagnosed personality disorder is actually personality disorder not other
wise specified or PDNOS. The prevalence of this diagnosis suggests that while clinicians can
identify a personality disorder in a patient, figuring out the details of the condition can be messy
and difficult.

One proposed alternative for diagnosing these disorders is the Dimensional Model, which, in
essence, gets rid of discrete disorders and replaces them with a range of personality traits or
symptoms, rating each person on each dimension. So the Dimensional Model would assess a
patient not with the aim of diagnosing one disorder or another, but instead, simply finding out that
they rank high on say, narcissism and avoidance. It's a work in progress, so with another
generation, the clinical definition of 'personality disorder' may evolve pretty radically.

One of the best-studied personality disorders right now is Borderline Personality Disorder, or BPD.
Borderline makes it sounds like patients are like, pretty close to being healthy, but not quite, but
that is not at all the case. BPD sufferers have often learned to use dysfunctional, unhealthy ways to
get their basic psychological needs met, like love and validation, by using things like outbursts of
rage, or on the other end of the spectrum, self-injury behaviors like cutting or worse. People with
BPD were once commonly maligned by clinicians as 'difficult' or 'attention-seeking', but we now
understand BPD as a complicated set of learned behaviors and emotional responses to traumatic
or neglectful environments, particularly in childhood. In a sense, people with this disorder learn that
rage or self-harm help them cope with traumatic situations, but as a result, they also end up using
them in non-traumatic situations. Although challenging for patients and clinicians alike, the good
news is that some psychotherapies have helped even the most severely suffering, repeatedly
hospitalized BPD patients.

But probably the most famous well-established, and frankly, troubling personality disorder is
Antisocial Personality Disorder. Now, you've heard of this before, but maybe by one of its now
somewhat out of vogue synonyms, 'psychopathy' or 'sociopathy'. People with Antisocial
Personality Disorder, usually men, exhibit a lack of conscience for wrongdoing, even towards
friends and family members. Their destructive behavior surfaces in childhood or adolescence,
beginning with excessive lying, fighting, stealing, violence, or manipulation. As adults, people with
this disorder are thought to generally end up in one of two situations: either they are unable to keep
a job and engage in violent criminal or similarly dysfunctional behavior, or they become clever,
charming con-artists, or ruthless executives who make their way to positions of power. Tony
Soprano would have qualified for the diagnosis, even if he wasn't nearly as bad as, say, serial killer
Ted Bundy or Vlad the Impaler, the infamous 15th century Romanian prince who personally
watched about 100,000 people get impaled or have the skin of their feet licked off by goats. Yeah.
That happened. Despite this classic remorselessness, lack of empathy, and sometimes criminal
behavior, criminality is not always a component of antisocial behavior. Certainly many people with
criminal records don't fit that psychopathic profile. Most show remorse, love, and concern for
friends and family, but still, although anti-social personalities make up just about 1% of the general
population, they were estimated in one study to constitute about 16% of the incarcerated
population. So, how might someone end up with such a disturbing disorder? Well, as you might
expect, the causes are probably a tangled combination of biological and psychological threads,
both genetic and environmental. Although no one has found a single genetic predictor of Antisocial
Personality Disorder, twin and adoption studies do show that relatives of those with psychopathic
features do have a higher likelihood of engaging in psychopathic behavior themselves. And early
signs are sometimes detected as young as age three or four, often as an impairment in fear
conditioning, in other words, lower than normal response to things that typically startle or frighten
children like loud and unpleasant noises. Most kids only need to get burned by a hot dish to know
to stay away, but kids who end up displaying Antisocial Personalities as adults don't necessarily
connect or care about the learned consequences when they're little. From there, like we've seen in
other disorders, genetic and biological influences can intersect with an abusive or neglectful
environment to help wire the personality in a peculiar and damaged way. While the vast majority of
traumatized people don't grow up to be killers or con-artists, genes do seem to predispose some
people to be more sensitive to abuse or trauma.

Meanwhile, studies exploring the neural basis of Antisocial Disorder have revealed that when shown
evocative photographs, like a child being hit or a woman with a knife at her throat, those with
psychopathic personality features showed little change in heart rate and perspiration, as compared
to control groups. The classic antisocial lack of impulse control and other symptoms have also
been linked to deficits in certain brain structures. One study compared PET scans from 41 people
convicted of murder to those of non-criminals and found that the convicted killers had greatly
reduced activity in the frontal lobe, an area associated with impulse control and keeping aggressive
behavior in check. In fact, violent repeat offenders had as much as 11% less frontal lobe tissue
than the average brain. Their brains also responded less to facial displays of stress or anguish,
something that's also observed in childhood, so it's possible that some antisocial personalities lack
empathy because they simply don't or can't register others feelings. Research has also suggested
an overly reactive dopamine reward system, suggesting that the drive to act on an impulse to gain
stimulation or short-term rewards regardless of the consequences may be more intense than the
average person's.

As we mentioned before, because personality disorders are pretty much egosyntonic by definition,
people don't often acknowledge that they have a problem or the need for treatment, and in the
case of Antisocial Personality Disorder, even if they did, there aren't many specific treatments
available, at least not for adults. But there are some promising interventions for kids and
adolescents whose minds and brains are more plastic and adaptable. In this way, the best way to
treat Antisocial Personality Disorder may be in trying to prevent it. According to American
psychiatrist Donald W. Black, among others, many kids diagnosed with Conduct Disorder, the
diagnostic precursor to Antisocial Disorder, are at high-risk for developing Antisocial Personalities
as adults. But by identifying warning signs early on and by working with these kids and families to
correct their behavior and remove negative influences, some of that impulse fearlessness could be
channeled into healthier directions, like to reward promoting athleticism, or a spirit of adventure.
It's important to remember that Antisocial Personality Disorder is only one type of personality
disorder. This is a diverse family of psychological conditions determined by many different factors
and we're still in the early stages of diagnosing and understanding the mechanisms behind them.

Today, you learned about personality disorders and the difference between ego-dystonic and
ego-syntonic disorders. We looked at the three clusters of personality disorder, according to the
DSM V, and how personality disorder symptoms often overlap. We also took a look at Borderline
and Antisocial Personality Disorders, including their potential biopsychosocial roots. Thank you for
watching, especially to all of our Subbable subscribers, without whom we could not make
CrashCourse. To find out how you can become a supporter, just go to
[Link]/CrashCourse. This episode was written by Kathleen Yale, edited by Blake de
Pastino, and our consultant is Dr. Ranjit Bhagwat. Our director and editor is Nicholas Jenkins, the
script supervisor and sound designer is Michael Aranda, and the graphics team is Thought Cafe.