Aggression and Sexual Offense in Asperger's Syndrome
Kohn, Yoav, Fahum, Tarek, Ratzoni, Gidi, Apter, Alan, The Israel Journal of Psychiatry and Related Sciences
Abstract: Asperger's Syndrome is one of the diagnostic subcategories of pervasive developmental disorders. It is characterized by a defect in reciprocal social interaction, lack of empathy for others and poor non-verbal communication. Antisocial acts, including aggression and sexual offense, are not considered to be common in this disorder. We describe an adolescent with Asperger's Syndrome whose main problems are his violence and sexual offenses. We assume that these symptoms are secondary to his diagnosis of Asperger's as a manifestation of his difficulties with the "theory of mind" of others. This atypical case report is in contrast with the low prevalence of aggression and sexual offense in Asperger's, as reported in the literature. We discuss the reasons for this low prevalence. Our conclusions are based on one case history and a literature review. We call for further research in this field.
Asperger's Syndrome is a psychiatric disorder of early childhood. It is characterized by a lack of or deficiency in reciprocal social interaction, especially of non-verbal communication; normal development of spoken language; normal intelligence with stronger verbal than performance abilities; intense preoccupation with restricted and bizarre areas of interests; and insistence on sameness. First described by Asperger (1) as "autistic psychopathy," this syndrome was practically unknown in the English literature until Wing (2) described Asperger's work, while adding her own observations.
Much has been debated about the validity of Asperger's as a disorder distinct from "classical" infantile autism (2, 3, 4). The pendulum has swung from viewing them as two different syndromes to a concept of two points on one spectrum of disorders of impaired neuropsychological development of many capacities including social relatedness. The inclusion of Asperger's as a separate diagnosis in ICD-10 (5) and DSMIV (6) has not put an end to the argument.
The etiology of Asperger's is unknown. Asperger himself (1) noted an increased occurrence of the disorder in fathers of his patients. Perinatal brain damage has been reported to be common among these patients (2). It has been postulated that a cognitive deficit of "theory of mind" renders these individuals, as well as autistic patients, unable to impute mental state to others. Hence their difficulty with social situations can be understood (7, 8, 9). Though BaronCohen and his colleagues have found some evidence to support this hypothesis in autism, Bowler (10) found no differences in this area between Asperger's patients, chronic schizophrenics and normal controls. He reasoned that although Asperger's patients may have a theory of mind, they lack the ability to apply it in social interactions.
Aggression and sexual offense do not fall under the classical description of Asperger's syndrome, though Wing (2) notes that "a small minority have a history of rather bizarre antisocial acts, perhaps because of their lack of empathy. This was true of 4 of the present series, one of whom injured another boy in the course of his experiments on the properties of chemicals. A young man with Asperger's syndrome observes that most of his contemporaries have girlfriends and eventually marry and have children. He wishes to be normal in this respect, but has no idea of how to indicate his interest and attract a partner in a socially acceptable fashion. If he has a strong sex drive, he may approach and touch or kiss a stranger, or someone much older or younger than himself and as a consequence find himself in trouble with the police. "
Ghaziuddin et al. (11) reviewed the literature on violence and Asperger's and concluded that only a minority (2.27%) of those who suffer from the syndrome would commit an act violent enough to cause them serious trouble. In this review very strict criteria were used to define the studies selected in terms of the validity of the diagnosis and the act of violence described. …