document_title: Naruto: Shippuden (season 15)

question_text: what episode does naruto use nine tails chakra

text: Naruto: Shippuden (season 15)

text: Episode listing[edit]

text:
No.
Title
Original air date

321
"Reinforcements Arrive"
"Zōen tōchaku" (増援到着)
July 18, 2013

As the White Zetsu Army clones continue to wreak havoc on all the battlefields, the Allied Shinobi Forces struggle to find a way to cope with the situation until Naruto arrives. Elsewhere, the Feudal Lord Protection Squad continue their battle with Black Zetsu. Eventually Naruto's shadow clones arrive on all the battlefields, and the Alliance slowly retakes the upper-hand on the battlefield. As reports come into HQ of Naruto's part in turning the tides of the war back in their favor, Tsunade smugly gestures to A who solemnly dismisses her. The Sensor Division is asked to check on Madara's status and Ao reveals that he had started to move with a team of reincarnated jinchūriki. Meanwhile where the remainder of the Fourth Division is located, Kabuto puts his trump card into play as he uses Mū to summon the coffin holding it. After Mū dodges the coffin being blown off, with a sensor amongst the Alliance alerting them to a new enemy, Ōnoki recognizes the figure to be Madara Uchiha himself. Believing their enemy to have finally entered the fray, Gaara's revelation that Madara is a reanimated ninja causes confusion as Temari reveals the masked man who called himself Madara is seen elsewhere with a personal army of reanimated Jinchuriki.

322
"Madara Uchiha"
"Uchiha Madara" (うちはマダラ)
July 25, 2013

Though believing he was resurrected, Madara learns he was brought back with the Reanimation jutsu instead as Kabuto takes control over Mū's body and explains to the Uchiha that he has been made stronger than during his prime. With that, learning of the changes that occurred after his death, Madara pushes forward and takes down a large portion of the Fourth Division with his Susanoo. However, when Gaara, Onoki and Naruto attempt to take him down, Madara reveals himself to have the Rinnegan as it confirmed Kabuto's hypothesis that Madara actually died sometime after the events that created the Valley of the End. Madara then wipes a fraction of the Fourth Division with his Shattered Heaven attack despite Onoki stopping one of the two summoned meteorites, attempting to summon the Nine-Tails before learning that the tailed beast is sealed within Naruto. Madara then proceeds to reveal that he possesses Hashirama's cells by using the First Hokage's Secret Wood Style Jutsu: Deep Forest Emergence, leaving Naruto and the other surviving shinobi of the Fourth Division in shock.

323
"The Five Kage Assemble"
"Gokage Shūketsu...!!" (五影集結...!!)
August 1, 2013

As Onoki and the remaining Fourth Division members tackle both Madara and Mū, Tsunade and A make preparations of heading to Madara's location in a very risky gambit with Mabui's Heavenly Transfer Jutsu, which would likely kill them as it is meant for transporting objects. However, Tsunade decides to take the gamble using her Reverse Seal: Release. Shikaku telepathically communicates to Genma to have him, Raidō and Iwashi to perform the Flying Raijin Justu to transport Mei to Madara's location as well after Black Zetsu is kept at bay by Naruto long enough for Chojuro to defeat the inhuman being. When the other Kage arrive at the battlefield, Tsunade heals Gaara and Onoki while A and Mei engage Madara as Dodai and the Hokage Guard Platoon chase after the Kabuto-controlled Mū. Once healed, the two saving A and Mei from their enemy's Yasaka Magatama, Gaara holds Madara at bay while Onoki joins the Kage under the cover of Mei's Hiding in Mist Jutsu to use a jutsu that effects A's weight so he can knock Mū and Madara a distance away. Though Naruto wants to help, Tsunade tells the boy that they will deal with Madara while he goes after the "other Madara". As the clone disperses, the Kage leave him one word: "win".

324
"The Unbreakable Mask and the Shattered Bubble"
"Warenai Kamen — Wareta Shabondama" (割れない仮面・割れたシャボン玉)
August 8, 2013

As a Naruto clone disappears, the real Naruto comes face to face with the masked man and attempts to headbutt the mask. As the masked man readies his reincarnated Jinchuriki, Naruto recognises one of the jutsu. In a fantasy world, Naruto meets with a reincarnated Utakata, who reveals what became of him after he left Tsuchigumo village. After the conversation, the reanimated Jinchūriki use various jutsus to attack Naruto and Killer Bee. When Naruto mentions the real Madara, telling the youth to call him "Madara" or Tobi if he likes, the masked man proclaims that his identity is pointless and that all he cares for the completion of the Eye of the Moon Plan. Tobi explains the world is worthless and that both Naruto and Bee should understand the misery it holds better than anyone else. However, Naruto admits his life with a Tailed Beast inside him isn't that bad while calling Tobi a liar and vowing to unmask him. However, as each of the reanimated Jinchuriki grows a tail, Tobi declares he will capture Naruto and Bee to fulfill his plan.

325
"Jinchūriki vs. Jinchūriki!!"
"Jinchūriki VS Jinchūriki!!" (人柱力VS人柱力!!)
August 15, 2013

After he and Naruto learn that the captive Tailed Beasts have been resealed into their Jinchuriki, Killer Bee makes the first move by attacking Fu but he and Naruto learn the reanimated Jinchuriki are able to use the coordination of the Rinnegan's Six Paths of Pain in conjunction with the Sharingan's increased reaction time. As Naruto attempts to destroy the Chakra receivers, Bee transforms into Gyuki to level the forest while knocking down the other Jinchuriki. However, the reanimated Jinchuriki strike back with Han transforming into the Five-Tails while the others attack Naruto. Though Tobi attempts to use Kamui on Naruto to increase the odds in his favor, his plot is foiled by Kakashi and Guy arriving in the nick of time. Though Tobi tells them that they still have no chance against his eyes and Tailed Beasts, Kakashi states his Sharingan while Guy adds his notability as Konoha's Sublime Green Beast of Prey.

326
"Four Tails, the King of Sage Monkeys"
"Yonbi — Sen'en no Ō" (四尾・仙猿の王)
August 22, 2013

After killing White Zetsu using his Eternal Mangekyo Sharingan's Susano'o, Sasuke sets off to destroy Konoha. Back at the battlefield, as Kakashi and Guy learn that Tobi is using a large amount of chakra to assert full control over the Tailed Beasts, they hear the voice of the Five Tails as Tobi subjugates the creature. Voicing his disdain for humans' treatment of them, the Nine Tails recaps his own subjugation under Madara and then by the Uzumaki Clan from Hashirama's wife Mito to Naruto's mother Kushina. After being swallowed by Roshi after he fully transformed into the Four Tails, Naruto meets the Tailed Beast himself, who insists that he be called by his actual name: Son Goku. After brief discussion about the humans' treatment of the Tailed Beasts, upon which Naruto learned the Nine-Tailed Fox's true name is Kurama, Son sees Naruto to be an exception. Wanting to know if Naruto's desire to aid him and the other Tailed Beasts would not waver, Son asks the youth to free him from his chains.

327
"Nine Tails"
"Kyūbi" (九尾)
August 29, 2013

Before revealing the method by which to stop him, Son verbally states his distrust of Naruto especially after Jinchuriki have mistreated him in the past. As the Nine Tailed Fox listens to their dialogue, he relates to Son's distrust after he himself was simply used and sealed by many ninja in the past. Losing himself into thought, the Nine-Tails recalls how he sought to weaken Minato's Eight-Trigram seal and hence free himself by influencing Naruto with his own chakra on many occasions. Eventually after experiencing many trials and battles, Naruto frees himself from his own hatred with Killer Bee's help and successfully takes control of the Nine-Tails' chakra, leaving the latter to ponder just what type of person Naruto actually is.

328
"Kurama"
"Kurama" (九喇嘛)
August 29, 2013

With the battle receding at their end, Sakura and Shizune depart to assist Naruto and Bee. Elsewhere, realizing that Naruto is inside the Four-Tails, Tobi tries absorbing them both, although Naruto exits the Four-Tails' body by having him regurgitate due to his Multi-Shadow Clone Technique. Inside his subconscious, Son reveals to Naruto that the chakra rod is stuck at the base of his neck while in Tailed-Beast form and Naruto locates and starts pulling it out, with resistance from Tobi. Silently observing all that transpires, Kurama recalls Naruto's past achievements by his willingness to never give up and accepts that if Naruto truly wishes to help the Tailed-Beasts from the bottom of his heart, then as he always has, his actions would speak far louder than his words. Finally, Naruto uses a clone in Sage Mode he left inside the Four-Tails' body to find the exact spot the rod is located in relation to its position outside and uses Frog Strike to successfully push the rod out of the Four-Tails.

329
"Two-Man Team"
"Tsū Man Seru" (ツーマンセル)
September 5, 2013

Though he succeeds in freeing Son Goku from Tobi's control, receiving a gift from the Four Tails for his compassion, Naruto is upset upon learning the Tailed Beast is still bound to the Gedo Statue. Once Son is sealed back into the Gedo Statue, Tobi has all the other Jinchūriki fully transform into their Tailed Beasts for an all out attack. Silently proud of Naruto's victory of winning Son over, Kurama offers to lend the youth more power. Though annoyed of being thanked for helping Naruto during his encounter with Madara, Kurama suggests melding their chakra together. Declaring Kurama as a friend as he removes the seal, causing their chakra to meld, Naruto assumes a stronger version of his Nine Tails Chakra Mode. In his new Tailed Beast Mode, saving Kakashi and Guy, Naruto uses his remaining time in the form to battle the five Tailed Beasts while his clone locates their chakra receivers. The five Tailed Beasts make a collaborative Tailed Beast Ball, which Naruto matches with one of his own, sending the attacks into the sky. He sends clones through Kurama's chakra arms to remove the chakra receivers. Upon touching them, Naruto finds himself in a mental plane, along with Kurama, the other Jinchuriki and their Tailed Beasts. After the Jinchuriki and the Tailed Beasts give Naruto their names, they reveal the relationship between Roshi and Son to the youth. Watching his fellow Tailed Beasts each gift Naruto with a bit of their chakra like Son had, Kurama recalls their last moments with the Sage of the Six Paths at the time of their creation long ago. As Naruto removes the chakra receivers, Kurama is assured by the others' agreement with him that Naruto is the one the Sage foretold to show them the way. Forced to seal the Tailed Beasts back into the Gedo Statue, Tobi tells a reverted Naruto that his victory changes nothing despite the youth insisting that it has after learning a lot of difficult names.

330
"The Promise of Victory"
"Shōri e no Yogen" (勝利への予言)
September 12, 2013

Tobi is confused by Naruto's claim of learning difficult names, which Naruto teases him for. Guy and Kakashi discuss now Naruto's progress is making them feel old, though not that old. Tobi begins to sweat, but believes it to be the rain that's starting to fall. Tobi gets a strange feeling from Naruto, and concludes that the war will make everything irrelevant. At the Allied Shinobi's HQ, Naruto's use of Kurama's chakra was felt, though they also feel something else. Ao relays to events to Shikaku, who wants to use it to raise the army's morale all at once, despite the strain it would cause to communications by Inoichi. Naruto's friends all rush towards his direction, intent on supporting him. Elsewhere, Sasuke also walks towards the battlefield as a thunderstorm begins.

331
"Eyes That See in the Dark"
"Yami o Miru Me" (闇を見る眼)
September 19, 2013

Having escaped from the Mountains' Graveyard, Sasuke wanders through a small town to discover that it is deserted, leading him to be confused. Meanwhile in the Hidden Leaf, Konohamaru and his team-mates patrol through the village in order to watch out for the enemy when they heard an angry voice of a prisoner from the Leaf's Intelligence Division. It is revealed to be Karin, who is feigning her mental instability to lessen the guards' attention and begins to plot her escape. At the same time, Jūgo and Suigetsu continue their search for Sasuke, arriving at one of Orochimaru's hideouts. The two walk in as Jūgo asks Suigetsu of his intention of joining Team Taka while suddenly Jūgo goes on a rampage and attacks Suigetsu. Suigetsu simply reforms and drowns Jūgo in order to subdue him. After this, he discovers a secret room revealed by Jūgo's rampage and finds a scroll containing important information. Sasuke is confronted by a group of White Zetsu Army clones. He actives his Susano'o and incinerates them. With the clones defeated, he interrogates one of them with a Sharingan genjutsu, through which the clone reveals information about the war. Elsewhere, Itachi is on the move.

332
"A Will of Stone"
"Ishi no Ishi" (石の意志)
September 26, 2013

The intense battle between Madara and the five Kage continues as Ōnoki attacks Madara with a gigantic rock golem. However, Madara counters with his Wood Style: Deep Forest Bloom, shattering the golem into pieces. Tsunade remembers the jutsu being her grandfather's and as the jutsu released its pollen, she instructs the Kage not to inhale. Gaara suspends the Kage and Ōnoki levitates A. Kabuto muses on how people thought no other shinobi is as powerful as Hashirama Senju, just like how people consider the powers of the Sage of the Six Paths a myth. Elsewhere, the Hokage Guard Platoon along with Dodai and Sagan continue to pursue Mū. While the Kage are distracted, Madara unleashes his Susanoo, causing them to fall through the trees. Madara proceeds to set the forest ablaze and not long after, the five Kage became unconscious. Ōnoki, continuously losing his consciousness, remembers of his talk with the First Tsuchikage about the strong will of the Iwa shinobi. Refusing to give up, Ōnoki destroys the forest created by Madara with his Particle Style and as a result, the Kage regained their consciousness. As Madara's body is reforming from Ōnoki's attack, to the Kage's horror, the face formed from the DNA of Hashirama appeared on Madara's chest. Meanwhile, Itachi continues his search for Kabuto, as Sasuke detects the latter. Sasuke follows him but his brother refused to talk to him. With no choice, Sasuke attempts to catch Itachi with his Susanoo, only for Itachi to counter with his own. The two begin to have a conversation. Meanwhile at the battlefield, Madara decides to take out Tsunade first after realising she was a Senju and also deemed her a weak woman, pathetic compared to the likes of her grandfather. Tsunade stated that she inherited something more than power from her grandfather the Will of Fire, something that Madara should not take so lightly.

333
"The Risks of the Reanimation Jutsu"
"Edo Tensei no Risuku" (穢土転生のリスク)
October 3, 2013

Madara questioned Tsunade if the Will of Fire is enough to take him down. Tsunade states the three rules of a medical-nin as she releases her seal. She then reveals a fourth rule — that only a medical-nin who has mastered the One Hundred Healings Jutsu are allowed to break the three rules. The other Kage are stunned to hear this while Madara remains unimpressed with Tsunade's abilities. He activates his Susanoo ribcage as Tsunade attacked him, slightly cracking the Susanoo. Madara tries immolating Tsunade but is stopped by Mei, who also attacks. A and Onoki deals a heavy blow on Madara while Tsunade lands a kick on the latter. Madara commented on Tsunade's abilities. Madara noted that all that remains of Hashirama is his cells inside of him and all that's left of Izuna was his eyes that belong to him now. He further stated that the only thing that could be passed on is hatred. Meanwhile, at the other battlefield, Chōza reveals to Dan that Madara Uchiha has been reanimated and that the five Kage are dealing with him. Dan was shocked to learn that Tsunade was now the Hokage. Dan expressed concern that they should instead, find the caster of the technique, noting that Hashirama is the only shinobi capable of defeating Madara. At the same time, Tsunade landed a devastating attack on Madara as his body begins to reform. Gaara attempted to bind and seal him although it was revealed to be a clone. Though the real Madara stabs Tsunade with his Susanoo Sword from below, he finds that Tsunade is able to heal without hand seals. Onoki attacks Madara with Particle Style but, Madara absorbs it through the Preta Path. Tsunade questions Madara's confidence, stating that the Kage forced him to use a wood clone. Madara admits five on one is a good match-up, thus creating twenty five wood cloones, with five each to battle each of the Kage. Meanwhile in the forest, after evading Sasuke with his crows, Itachi finds Kabuto. However, Sasuke managed to follow his brother while he mistook Kabuto for Orochimaru. Kabuto attempted to manipulate Sasuke, only for him to note that he is his enemy. Sasuke attempts to kill Kabuto but is stopped by Itachi who noted that they need to not kill him in order to stop the technique. As Sasuke agrees to cooperate but for Itachi to answer his questions later, the two Uchiha brothers and Kabuto prepared themselves for a dynamic battle that is to come.

334
"Sibling Tag Team"
"Kyōdai Taggu!!" (兄弟, 共闘!!)
October 10, 2013

Kabuto blocks his vision with his hood as a means of evading the Uchiha's visual genjutsu, then starts the fight by unleashing multiple snakes at the two brothers. Both Itachi and Sasuke evade the snakes, then used their Susano'os to grab hold of them. As the fight continues, Kabuto tells Sasuke that he is underestimating him before reveals that he possesses similar variations of some of the abilities of Taka: Suigetsu's flesh-liquid transformations, Karin's accelerated healing abilities, and Jugo's ability to utilize nature energy. Kabuto then reveals Jugo's lineage and how Orochimaru developed the Cursed Marks when his study on Jugo's DNA led him to the legendary Ryūchi Cave where the White Snake Sage lives. Though Orochimaru could not use Sage Jutsu as his host bodies couldn't tolerate nature energy, Kabuto semi-mastered it as he unveils his Sage Mode, as to fully be able to master sage mode means not taking on the appearance of the animal you learned it from. Sasuke says that his new form is nothing different from Orochimaru, but Kabuto explains that he exceeded his former master and considers himself as a snake transformed into a dragon. Kabuto proceeds to overwhelm the Uchiha before Itachi manages to counter at the last moment. Asking Sasuke if he remembered the plan they used while on a mission hunting a wild boar, Itachi uses his brother's aid to manage to cuts off one of Kabuto's horns. Meanwhile, battling twenty five wood clones, the Five Kage find themselves at a greater disadvantage when Madara has his clones conjure Susano'os of their own.

335
"To Each Their Own Leaf"
"Tagai no Konoha" (互いの木ノ葉)
October 24, 2013

Kabuto is amused at the fact that Sasuke is now getting along well with his late brother, despite his intent to kill him in the past. Attempting to manipulate him over to his side by saying both their goals are to destroy the Hidden Leaf, Sasuke remains unconvinced as the young man denied his and Kabuto's goals are mutual. Recalling his life as a spy working for Konoha, Kabuto notes that he and Itachi are the same — both worked for the village and yet received dishonour in return. Itachi, however, declares that he is still Konoha's Itachi Uchiha, regardless of its dark side and inconsistencies. Casting the conversation aside, Itachi tells Sasuke about a technique that decides destiny — Izanami, which he will use to stop Kabuto and the Reanimation jutsu. Wasting no time, Kabuto attacks the brothers once more with his Sage Art: Inorganic Reincarnation, causing the cave formations to attack them. Kabuto attempts to rewrite Itachi's mind with the talisman but is thwarted by Sasuke. Kabuto begins to boast about his current abilities and that he is closer than anyone in the world to the Sage of the Six Paths. Criticising the Uchiha name in the process, he was stopped by Sasuke before he could say anything more as Itachi noted Kabuto reminded him of his old self. Kabuto recalls his childhood as an orphan, being raised by Nonō in the Leaf Orphanage, while stating that from the very beginning, he was not aware of his identity and had nothing for life.

336
"Kabuto Yakushi"
"Yakushi Kabuto" (薬師カブト)
October 31, 2013

Kabuto remembers when he first met Orochimaru when he and the rest of the Leaf Orphanage aided several wounded Hidden Leaf Ninja, the Sannin member seeing potential in the child despite not interested in becoming a ninja. But that night, when Nonō is blackmailed by Danzo into an intelligence gathering mission in the Hidden Stone Village, Kabuto also ends up in Root's services as he spend much of his childhood infiltrating the villages of the Five Great Shinobi Nations. It was only while on a mission in the Stone Village to take out an enemy, Kabuto is attacked by who he quickly learned to be Nonō when he gravely wounded her. Attempting to heal her, Kabuto is shocked that she did not recognize him as he is forced to run away. Pondering this, Kabuto is once again approached by Orochimaru who bring him to his secret laboratory where he reveals that Root orchestrated Kabuto and Nonō to kill each other to silence them. Though he admits that he was supposed to kill any survivor, reminding the child of his lack of individuality due to Root, Orochimaru instead offers Kabuto a position as his right hand with the promise of true identity of his very own. Years later, after Orochimaru's later defeat by Sasuke, Kabuto injected himself with his former mentor's blood to achieve his quest to find his "true self".

337
"The Izanami Activated"
"Hatsudō: Izanami" (発動・イザナミ)
November 7, 2013

Casting aside Itachi's lectures to him, Kabuto reveals he assimilated more than just Orochimaru's DNA as he creates a construct of Sakon from the base of his navel snake through which he can use the signature attacks of the Sound Five. Although easily countering Kabuto's attacks at first, Itachi and Sasuke find themselves trapped in Tayuya's genjutsu so he can finish them off with an white snake Orochimaru construct. However, though a combined effort, Sasuke and Itachi escape the genjutsu and fend the snake off by casting genjutsu on each other. Kabuto, however, appears from the mouth of the snake with a surprise attack and bisects Itachi, tearfully stating his superiority before attempting to regain control over the reanimated ninja. As his body reforms, Itachi called out to Sasuke as he threw his sword at Kabuto, only for the snake sage to block and then counter. Kabuto then attacks Itachi with the sword and claimed that his genjutsu cannot affect him. But upon realizing a sense of déjá vu in the brothers' attack pattern, having claimed to be immune to such a trick, Kabuto learns that he is trapped with his mind via the endless loop of the Uchiha Clan's genjutsu Izanami.

338
"Izanagi and Izanami"
"Izanagi to Izanami" (イザナギとイザナミ)
November 14, 2013

With Izanami activated, and Kabuto trapped within its infinite loop, Sasuke uses this time to question his brother about the technique. Itachi tells Sasuke about the history behind Izanami's creation as well as the Uchiha clan's use of the technique. Itachi ultimately reveals to Sasuke that Izanami was created with the sole purpose of stopping the users of the technique's counterpart: Izanagi so that they would accept their fate — which is also the way to escape the infinite loop. Angered by the fact that Itachi would cast a technique that has an escape route, Sasuke questions his motives to which Itachi says that he wished to give Kabuto an opportunity to accept his fate. Sasuke, however, claims that Itachi is perfect and rather different from Kabuto but the elder Uchiha refuses this claim. Elsewhere, somewhere in a forest seemingly some distance away, a grown-up Urushi tells his comrade that he hoped by the time he gets home, Kabuto will be there. Back at the cave, Itachi prepares to put an end to the Reanimation jutsu.

339
"I Will Love You Always"
"Omae o Zutto Aishiteiru" (お前をずっと愛している)
November 21, 2013

Back at the front lines, the five Kage struggle to hold their own against Madara's Susanoo-clad wood clones. However, Ōnoki rallies them to fight, noting that they need to fulfil a task at which they cannot fail. Madara realises that Ōnoki is the problem and that he must break his will. With that, the Kage go on the offensive against Madara's clones once more. However, the situation soon takes a turn for the worse as Madara in turn responds with his full power by activating his final Susanoo and proceeds to use its sword to attack them. Elsewhere at the cave, Itachi commands Kabuto to put an end to the Reanimation Jutsu. Sasuke resolves that he will destroy the village that made his brother suffer for so long and bids farewell to Itachi forever. As lights begin to descend on the battlefield and the reincarnated shinobi begin to fade into pillars of light, Itachi approaches Sasuke and uses his Sharingan to show Sasuke everything about the Uchiha clan massacre. With the truth revealed to Sasuke at last, Itachi then imparts his final words to his brother, stating that no matter what happens and regardless of what he does from here on out, he will love him always.

340
"Reanimation Jutsu: Release!"
"Edo Tensei: Kai" (穢土転生・解)
November 28, 2013

Watching Itachi's soul depart back into the afterlife, Sasuke becomes conflicted with his resolve before being found by Suigetsu and Jugo. Elsewhere, across the battlefield, the various ninja that Kabuto reanimated are descending back into the afterlife. The other Kage mystified by the turn of events while Onoki notes whoever is responsible is a true hero among ninja. Using his Ghost Transformation jutsu to take control of his then-ascending soul, Dan reaches Tsunade's location. Speaking to Tsunade within her subconscious, Dan gives her the remainder of his chakra before fading away to restore her Reserve Seal. As Tsunade comes to, she and the other Kage find Madara still among the living as he reveals that he rescinded the summoning contract while advising the Kage to tell the caster not to use a forbidden jutsu so carelessly. Elsewhere, seeing the reanimated Jinchurikis' departure as a sign of Itachi's success, Naruto provokes Tobi as the masked man decides to move on with his plan by bringing forth the Benihisago and Sealing Urn.

341
"Orochimaru's Return"
"Fukkatsu!! Orochimaru" (復活!! 大蛇丸)
December 5, 2013

Suigetsu proceeds to show Sasuke the scroll that he found at Orochimaru's hideout earlier. After examining its contents, Sasuke's next motive is to meet with Orochimaru and explained to a confused Suigetsu that he is not one to die so easily as he has Jugo's assistance in reviving Orochimaru via the Curse Unsealing ability. Expressing shock that Sasuke would be the one to resurrect him, stating his intent to still take his body if he was in better condition, Orochimaru asserts that he shows no interest in the war. But when Sasuke then shows Orochimaru the scroll he was given earlier and states he wants to get answers from those who know everything, Orochimaru siphons back his stolen chakra from the immobilized Kabuto while agreeing to guide his former apprentice to the answers he seeks. Elsewhere, Naruto and the others watch on as Tobi moves forward with the revival of the Ten-Tails by revealing its actual body: The Gedo Statue. With Kakashi wondering why Tobi would bluff as the Eight and Nine-Tails' chakra are still intact, Gyūki notes that Tobi may have got his chakra from the clone he created to cover Killer Bee's escape from Taka. Kurama also adds that his chakra is present in the treasured tools, which contain the sealed Gold and Silver Brothers, that the Gedo Statue swallowed earlier. Though the allied ninja all agree that its resurrection must be stopped, Tobi declares that even if an incompletely revived Ten Tails would still ensure the achievement of the Infinite Tsukuyomi. As the group rally to fight, Naruto enters his Nine-Tails Chakra Mode and proceeds to attack the statue.

342
"The Secret of the Transportation Technique"
"Jikūkan Ninjutsu no Himitsu" (時空間忍術の秘密)
December 12, 2013

Bent on stopping Naruto and his allies from interfering with the Gedo Statue as it begins to regenerate back into the Ten-Tails, Tobi engages Naruto and Guy while latter is able to create an opening for the youth to land a blow. As Tobi is distracted, Kakashi attempts to use Kamui on the Gedo Statue before it was suddenly nullified to his confusion. By then, Naruto fails to land his attack as Tobi separates him from the others to get the upper hand. Rushing to Naruto's aid, Kakashi launches his lightning-imbued kunai at Tobi before forced to warp the kunai away when the villain changes its trajectory towards Naruto. However, Tobi finds a slight fissure appearing on his mask that the others notice as he erects a barrier around the Gedo Statue to hinder Gyūki. Analyzing the masked man's abilities, Kakashi asks the group to aid him in testing his theory to confirm that Tobi has been using one technique the entire time in this fight: the exact same Kamui as himself. When asked where he got his Sharingan from, Tobi upsets Kakashi by claiming to obtained it while from battle at the Kannabi Bridge. As Tobi states there is no more hope for the world, Naruto rejects his views and Kurama — who briefly takes over his Jinchuriki's body — declares that Minato sealed him within Naruto to give the youth the power to take him down. With that as he gives the youth back his body, the Nine-Tails tells Naruto to charge Tobi head on.

343
"Who Are You?"
"Temē wa Dare da!!" (てめーは誰だ!!)
December 19, 2013

Naruto enters Tailed Beast Mode and attacks Tobi, causing both Kakashi and Guy to look on, stunned but Tobi later emerges from the blast, unharmed. Meanwhile, a hesitant Kakashi is in disbelief of the masked man's identity but Guy snaps him out of it. As the battle rages on, Kakashi is finally motivated to fight and prepares to join the fray. Tobi unleashes a shower of gigantic chakra receivers, paralyzing B and Gyūki. Naruto creates a shadow clone and it charges forward with Rasengan while the original prepares a Tailed Beast Ball with B and Gyūki acting as a shield. As Naruto launches his technique, Tobi simply phases through and with that, fully enters the other dimension. There, he witnesses the clone earlier and realizes that Kakashi did not just teleport the Rasengan but the clone itself. With little time to react, Tobi curses Kakashi before he is hit by Naruto's Rasengan; his mask shattered into pieces. Watching on, Kakashi and Guy are shocked to see that the masked man is their former comrade, Obito Uchiha, who as a child had dreams of becoming the Hokage but who would never beat Kakashi or Guy. During his time at the Academy, Obito was later placed into a team consisting of himself, Kakashi and a young girl named Rin Nohara with the team being led by Naruto's father, Minato Namikaze. Obito had romantic feelings for Rin who actually loved Kakashi which in turn fueled Obito's desire to defeat Kakashi. However, Obito was left badly injured following a mission in which a boulder crushed the right side of his body. Believing himself to be on the verge of death, Obito gave Kakashi the Sharingan from Obito's own left eye which served as a replacement for Kakashi's left eye which had been left permanently scarred and damaged during a fight against a lone rogue ninja. When more ninja assaulted the cave, Kakashi and Rin were able to escape with Obito being engulfed by the landslide. In the present, rendered speechless, Kakashi is shocked that Obito survived. Naruto questions who the individual is, to which Guy responds that he is their former comrade who was supposedly killed in action during the previous war. In response to Kakashi's question, Obito explains that the reason why he hadn't revealed himself up until this point was because he let Rin die. Naruto motivates a devastated Kakashi as Obito's plan to conquer the world needs to be stopped. Obito attacks the group with his Fire Style: Bomb Blast Dance but Naruto intercepts with Kurama's tails. Just then, Madara appears alongside Obito, much to the others' surprise.

344
"Obito and Madara"
"Obito to Madara" (オビトとマダラ)
January 9, 2014

When Obito is joined by Madara, Naruto and allies shocked to see the legendary ninja who they assumed to still be battling the five Kage. This leads Naruto to immediately question Madara of their condition. Madara nonchalantly reveals that he dispatched them. From there, ignoring Naruto and expressing disappointment towards Obito for deviating from their plan, Madara learns that his intended resurrection through the Samsara of Life was ruined by Nagato using it on the Hidden Leaf ninja. Upon learning of Nagato was nothing more but a sacrificial pawn, Naruto attacks Madara with a Super Mini-Tailed Beast Ball which the Uchiha dispatches as he moves to capture the jinchuriki while Obito deals with Kakashi and Guy. When Kakashi used this opportunity to question his old friend about what had happened to him, Obito gets a flashback of being heavily bandaged and stitched together by an elderly figure he learns to be Madara who explains of his physical condition after saving him. As Madara tells the younger Uchiha of his goals to unify the world, an uninterested Obito attempts to escape, eager to meet his team-mates once again.

345
"I'm in Hell"
"Ore wa Jigoku ni Iru" (オレは地獄に居る)
January 16, 2014

Obito is tended to by two Zetsu clones, who help in his rehabilitation, while also telling him about Madara's goal and annoying Obito with potty humor. Obito recovers and gets used to his new artificial body parts, undergoing possible months of training to get used to them. One day, Zetsu arrives with news of Obito's team-mates being in danger, surrounded by Mist ninjas. When Obito fails to break through the rock blocking the exist, Tobi Zetsu offers himself as an armour for Obito. Obito draws power from the Gedo Statue to break the rock. Madara tells Obito he will properly thank him in the future, and that Obito will come back to him. On his way to the battle site, Obito has a vision of Rin through his empty eye-socket but ignores it. He arrives just in time to realize that Kakashi has run his Chidori through Rin's chest although Rin manages to say Kakashi's name before hitting the ground, dead. As Kakashi studies Rin's body, both he and Obito unknowingly awaken both their Mangekyō Sharingan. Kakashi passes out from exhaustion while Obito, enraged and grief-stricken over witnessing Rin's death proceeds to massacre the Mist ninjas while managing to avoid their attacks. Obito first kills some ninja before slaughtering the rest using Wood Style: Cutting Sprigs. Having slaughtered the Mist ninja force, standing in a pool of blood and watching Rin's dead body, Obito concludes he is in hell as he mourns the death of the girl he loved.

346
"World of Dreams"
"Yume no Sekai" (夢の世界)
January 23, 2014

Still in disbelief over what has happened, Obito walks over towards Rin's body, having slaughtered the Hidden Mist ninja while ignoring the unconscious Kakashi. Obito then cradles Rin's body in his arms and remembers Madara and White Zetsu's words while vowing to change the world into one where she and the Ten-Tails. After teaching Obito the means to summon the Gedo Statue along with imparting all his skill and knowledge, Madara uses a Yin-Yang Style ability on White Zetsu to infuse the clone with his will, completing Zetsu with the birth of Black Zetsu. After disconnecting himself from the Gedo Statue, Madara dies telling Obito that he will be Madara until the day he is to be resurrected by the one he transplanted his eyes into: Nagato. Soon after, now going by the name Madara Uchiha with Zetsu accompanying him, Obito arrives to the Hidden Rain Village where he meets Nagato and his friends. Though Obito tempts Nagato with his knowledge and offer to aid him in achieving peace, Yahiko gets his friend and Konan away. Despite being warned by Yahiko to stay away, Obito tells Nagato that he would reappear at the same time and place everyday until he accepts the truth of words. Soon after saving orphans and gaining new member of their growing group, Yahiko decides to name their group the Akatsuki.

347
"Creeping Shadow"
"Shinobiyoru Kage" (忍び寄る影)
January 23, 2014

Being informed by Kakashi that the orphans he trained are now attempting to bring about change in the Hidden Rain Village through dialogue, Jiraiya expresses his satisfaction with his students' progress. At the Hidden Rain Village, Kyūsuke brings letters of requests for the Akatsuki's aid to Yahiko, who intends to surpass Hanzo one day. Having learned of the Akatsuki's existence from one of his men, Hanzo expresses his approval for an organisation that shares his ideals. Meanwhile, Yahiko, Konan and Nagato head to a small village that was earlier attacked and meet a group of people who want to attack the Hidden Stone Village. Though the Akatsuki insists solving the issue through peace talks, it ended with the three leading members being attacked by Hidden Stone ninja with an enraged Nagato unconsciously summoning the Gedo Statue in response to seeing Yahiko and Konan injured. Luckily, the two manage to stop Nagato in time and leave with Danzo and his ANBU finding the corpses of the Hidden Stone ninja. As Yahiko and his friends depart with the remainder of their group following, Danzo proceeds to disguise some of the Hidden Stone ninja as Hidden Rain ninja to convince Hanzo that the Akatsuki are a threat to his authority.

348
"The New Akatsuki"
"Shinsei: Akatsuki" (新生・“暁”)
January 30, 2014

Yahiko and Nagato attend a meeting with the Rain's leader, Hanzō. Other members of Akatsuki discover that Leaf's ANBU shinobi are also meeting with Hanzō, and suspect a possible betrayal. They attempt to catch up with Yahiko and Nagato, only to die at the hands of Zetsu and Obito who wanted Nagato to witness tragic reality just like Obito had when he'd witnessed Rin die at Kakashi's hand. Leaf's Root Division and their leader Danzō are revealed to have plotted with Hanzō to end the Akatsuki's rebellion, capturing Konan and giving Nagato an ultimatum: kill Yahiko or they will kill Konan. Choosing for him, Yahiko runs himself into Nagato's kunai, killing himself, leaving Nagato and Konan devastated. Enraged, Nagato uses his Rinnegan to slaughter the Leaf and Rain shinobi by summoning the Gedo Statue, although Hanzō manages to escape. After this turn of events, Nagato finally turns to Obito, who witnessed the entire meeting. The final scene shows Nagato looking at Yahiko, whose body is now the Deva Path of his Six Paths of Pain, and saying that Yahiko will always be the true leader of the Akatsuki.

text: Home releases[edit]

text: Japanese[edit]

text:
Volume
Date
Discs
Episodes
Reference

1
March 4, 2014
1
321–324
[4]

2
April 2, 2014
1
325–328
[4]

3
May 7, 2014
1
329–332
[4]

4
July 2, 2014
1
333–336
[4]

5
July 2, 2014
1
337–340
[4]

6
August 6, 2014
1
341–344
[4]

7
September 3, 2014
1
345–348
[4]

text: English[edit]

text:
Viz Media (North America, Region 1)

Box set
Date
Discs
Episodes
Reference

25
January 26, 2016
2
310–322
[5]

26
April 5, 2016
2
323–335
[6]

27
July 5, 2016
2
336–348
[7]

text:
Madman Entertainment (United Kingdom, Region 2)

Volume
Date
Discs
Episodes
Reference

25
August 15, 2016
2
310–322
[8]

26
October 17, 2016
2
323–335
[9]

27
February 6, 2017
2
336–348
[10]

text:
Madman Entertainment (Australia/New Zealand, Region 4)

Collection
Date
Discs
Episodes
Reference

25
April 6, 2016
2
310–322
[11]

26
September 7, 2016
2
323–335
[12]

27
October 5, 2016
2
336–348
[13]


document_title: Kuhn

question_text: where does the last name kuhn come from

question_tokens: where does the last name kuhn come from

root

text: Kuhn

text: Kuhn is a surname of German origin, derived from the Old German name Conrad.[1] It may refer to the following individuals:

tag: p

text:
Abraham Kuhn (1838–1900), Alsatian otolaryngologist
Adam Kuhn, the naturalist and physicist
Alvin Boyd Kuhn (1880–1963), American scholar of mythology and linguistics
Bob Kuhn, a former mayor of Glendora, California
Bradley M. Kuhn (born 1973), American free software activist
Bowie Kuhn (1926–2007), American Major League Baseball commissioner
Franz Kuhn (1884–1961), German lawyer and translator of Chinese novels
Franz Felix Adalbert Kuhn (1812–1881), German philologist and folklorist
Frédéric Kuhn (born 1968), French hammer thrower
Friedrich Adalbert Maximilian Kuhn (1842–1894), German botanist
Fritz Kuhn (born 1955), German Green Party politician
Fritz Julius Kuhn (1896–1951), leader of the German American Bund
Harold W. Kuhn (1925–2014), American mathematician, John von Neumann Theory Prize winner, developer of Kuhn poker
Heino Kuhn (born 1984), South African cricketer
Johannes von Kuhn (1806–1887), German Catholic theologian
Joseph Kuhn-Régnier (1873–1940), French illustrator
John Kuhn (born 1982), American football player
Judy Kuhn (born 1958), American singer and actress, Tony Award winner
Köbi Kuhn (born 1943), head coach of the Switzerland national football team
Maggie Kuhn (1905–1995), American activist, founder of the Gray Panthers
Markus Kuhn (American football) (born 1986), German-born NFL player
Markus Kuhn (computer scientist) (born 1971), German computer scientist
Oliver Kuhn (1898–1968), "Doc Kuhn", American football, baseball and basketball player
Oskar Kuhn (1908–1990), German paleontologist
Paul Kuhn
Peter Kuhn (1955–2009), American race car driver
Richard Kuhn (1900–1967), Austrian biochemist, winner of the 1938 Nobel Prize in Chemistry
Rick Kuhn (born 1955), Marxist economist and lecturer at the Australian National University
Robert Lawrence Kuhn (born 1944), American author, investment banker, China specialist and PBS TV documentary host
Robert "Bob" Frederick Kuhn (1920–2007), American illustrator and sculptor
Robert Verrill Kuhn, (known as Bob Keane, 1922–2009) American clarinetist, producer and label owner
Simone Kuhn (born 1980), Swiss beach volleyball player
Steve Kuhn (born 1938), American jazz pianist
Thomas Samuel Kuhn (1922–1996), American philosopher and historian of science, author of The Structure of Scientific Revolutions
Walt Kuhn (1877–1949), American painter

tag: ul

text: Kihn (variant)[2]

text:
Hans Alfred Kihn, German playwright
Greg Kihn, American musician and novelist
Martin Kihn, American writer and digital marketer
W. Langdon Kihn (1898–1957), American painter and illustrator


document_title: Antisocial personality disorder

question_text: when was antisocial personality disorder added to the dsm

text: Antisocial personality disorder

text: Signs and symptoms[edit]

text: Antisocial personality disorder is defined by a pervasive and persistent disregard for morals, social norms, and the rights and feelings of others.[3] Individuals with this personality disorder will typically have no compunction in exploiting others in harmful ways for their own gain or pleasure and frequently manipulate and deceive other people, achieving this through wit and a facade of superficial charm or through intimidation and violence.[11] They may display arrogance, think lowly and negatively of others, and lack remorse for their harmful actions and have a callous attitude to those they have harmed.[3][4] Irresponsibility is a core characteristic of this disorder: they can have significant difficulties in maintaining stable employment as well as fulfilling their social and financial obligations, and people with this disorder often lead exploitative, unlawful, or parasitic lifestyles.[3][4][12][13]

text: Those with antisocial personality disorder are often impulsive and reckless, failing to consider or disregarding the consequences of their actions. They may repeatedly disregard and jeopardize their own safety and the safety of others and place themselves and others in danger.[3][4][14] They are often aggressive and hostile and display a disregulated temper and can lash out violently with provocation or frustration.[3][13] Individuals are prone to substance abuse and addiction, and the abuse of various psychoactive substances is common in this population. These behaviors lead such individuals into frequent conflict with the law, and many people with ASPD have extensive histories of antisocial behavior and criminal infractions stemming back before adulthood.[3][4][12][13]

text: Serious problems with interpersonal relationships are often seen in those with the disorder. Attachments and emotional bonds are weak, and interpersonal relationships often revolve around the manipulation, exploitation, and abuse of others.[3] While they generally have no problems in establishing relationships, they may have difficulties in sustaining and maintaining them.[12] Relationships with family members and relatives are often strained due to their behavior and the frequent problems that these individuals may get into.

text: Conduct disorder[edit]

text: While antisocial personality disorder is a mental disorder diagnosed in adulthood, it has its precedent in childhood.[15] The DSM-5's criteria for ASPD require that the individual have conduct problems evident by the age of 15.[11] Persistent antisocial behavior as well as a lack of regard for others in childhood and adolescence is known as conduct disorder and is the precursor of ASPD.[16] About 25-40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.[17]

text: Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD and is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated. Children with the disorder often display impulsive and aggressive behavior, may be callous and deceitful, and may repeatedly engage in petty crime such as stealing or vandalism or get into fights with other children and adults.[18] This behavior is typically persistent and may be difficult to deter with threat or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population, and children with the disorder may also engage in substance abuse."[19][20] CD is differentiated from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, and property, though many children diagnosed with ODD are subsequently rediagnosed with CD.[21]

text: Two developmental courses for CD have been identified based on the age at which the symptoms become present. The first is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10 years. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of aggression and violence.[22] The second is known as the "adolescent-onset type" and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood.[23] In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood onset subtype, especially if callous and unemotional traits are present, tends to have a worse treatment outcome.[24]

text: Causes and pathophysiology[edit]

text: Personality disorders are seen to be caused by a combination and interaction of genetic and environmental influences.[25] Genetically, it is the intrinsic temperamental tendencies as determined by their genetically influenced physiology, and environmentally, it is the social and cultural experiences of a person in childhood and adolescence encompassing their family dynamics, peer influences, and social values.[3] People with an antisocial or alcoholic parent are considered to be at higher risk. Fire-setting and cruelty to animals during childhood are as well linked to the development of antisocial personality. The condition is more common in males than in females, and among people who are in prison.[25][11]

text: Genetic[edit]

text: Research into genetic associations in antisocial personality disorder is suggestive that ASPD has some or even a strong genetic basis. Prevalence of ASPD is higher in people related to someone afflicted by the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behavior and conduct disorder.[26]

text: In the specific genes that may be involved, one gene that has seen particular interest in its correlation with antisocial behavior is the gene that encodes for Monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norephinephrine. Various studies examining the gene's relationship to behavior have suggested that variants of the gene that results in less MAO-A being produced, such as the 2R and 3R alleles of the promoter region, have associations with aggressive behavior in men.[27][28] The association is also influenced by negative experience in early life, with children possessing a low-activity variant (MAOA-L) who experience such maltreatment being more likely to develop antisocial behavior than those with the high-activity variants (MAOA-H).[29][30] Even when environmental interactions (e.g. emotional abuse) are controlled for, a small association between MAOA-L and aggressive and antisocial behavior remains.[31]

text: The gene that encodes for the serotonin transporter (SCL6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behavior and personality traits. Genetic associations studies have suggested that the short "S" allele is associated with impulsive antisocial behavior and ASPD in the inmate population.[32] However, research into psychopathy find that the long "L" allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e.g. lack of empathy, fearlessness) and interpersonal (e.g. grandiosity, manipulativeness) personality disturbances.[33] This is suggestive of two different forms, one associated more with impulsive behavior and emotional dysregulation, and the other with predatory aggression and affective disturbance, of the disorder.[34]

text: Various other gene candidates for ASPD have been identified by a genome-wide association study published in 2016. Several of these gene candidates are shared with attention-deficit hyperactivity disorder, with which ASPD is comorbid.[35]

text: Physiological[edit]

text: Hormones and neurotransmitters[edit]

text:
Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development.[36]
Aggressiveness and impulsivity are among the possible symptoms of ASPD. Testosterone is a hormone that plays an important role in aggressiveness in the brain.[37] For instance, criminals who have committed violent crimes tend to have higher levels of testosterone than the average person.[37] The effect of testosterone is counteracted by cortisol which facilitates the cognitive control of impulsive tendencies.[37]

text: One of the neurotransmitters that have been discussed in individuals with ASPD is serotonin, also known as 5HT.[36] A meta-analysis of 20 studies found significantly lower 5-HIAA levels (indicating lower serotonin levels), especially in those who are younger than 30 years of age.[38]

text: While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5HT metabolism, but may be the most essential psychopathological aspect linked with such dysfunction.[39] Correspondingly, the DSM classifies "impulsivity or failure to plan ahead" and "irritability and aggressiveness" as two of seven sub-criteria in category A of the diagnostic criteria of ASPD.[40][11]

text: Some studies have found a relationship between monoamine oxidase A and antisocial behavior, including conduct disorder and symptoms of adult ASPD, in maltreated children.[41]

text: Neurological[edit]

text: Antisocial behavior may be related to head trauma.[42]  Antisocial behavior is associated with decreased grey matter in the right lentiform nucleus, left insula, and frontopolar cortex.  Increased volumes have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post central cortex.[43]

text: People that exhibit antisocial behavior demonstrate decreased activity in the prefrontal cortex.  The association is more apparent in functional neuroimaging as opposed to structural neuroimaging.[44]  The prefrontal cortex is involved in many executive functions, including behavior inhibitions, planning ahead, determining consequences of action, and differentiating between right and wrong.

text: Cavum septi pellucidi (CSP) is a marker for limbic neural maldevelopment, and its presence has been loosely associated with certain mental disorders, such as schizophrenia and post-traumatic stress disorder.[45][46][47] One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.[47]

text: Environmental[edit]

text: Family environment[edit]

text: Some studies suggest that the social and home environment has contributed to the development of antisocial behavior.[36] The parents of these children have been shown to display antisocial behavior, which could be adopted by their children.[36]

text: Cultural influences[edit]

text: The socio-cultural perspective of clinical psychology views disorders as influenced by cultural aspects; since cultural norms differ significantly, mental disorders such as ASPD are viewed differently.[48] Robert D. Hare has suggested that the rise in ASPD that has been reported in the United States may be linked to changes in cultural mores, the latter serving to validate the behavioral tendencies of many individuals with ASPD.[49]:136 While the rise reported may be in part merely a byproduct of the widening use (and abuse) of diagnostic techniques,[50] given Eric Berne's division between individuals with active and latent ASPD – the latter keeping themselves in check by attachment to an external source of control like the law, traditional standards, or religion[51] – it has been plausibly suggested that the erosion of collective standards may indeed serve to release the individual with latent ASPD from their previously prosocial behavior.[49]:136–7

text: There is also a continuous debate as to the extent to which the legal system should be involved in the identification and admittance of patients with preliminary symptoms of ASPD.[52]

text: Diagnosis[edit]

text: DSM IV-TR[edit]

text: The APA's Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR) defines antisocial personality disorder as:[40]

text:
failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest;
deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure;
impulsivity or failure to plan ahead;
irritability and aggressiveness, as indicated by repeated physical fights or assaults;
reckless disregard for safety of self or others;
consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations;
lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

tag: ol

text:
The essential features of a personality disorder are impairments in personality (self and interpersonal) functioning and the presence of
pathological personality traits. To diagnose antisocial personality disorder, the following criteria must be met:[53]

text: A. Significant impairments in personality functioning manifest by:

text: AND

text: B. Pathological personality traits in the following domains:

text: C. The impairments in personality functioning and the individual's personality trait expression are relatively stable across time and consistent across situations.

text: D. The impairments in personality functioning and the individual's personality trait expression are not better understood as normative for the individual's developmental stage or sociocultural environment.

text: E. The impairments in personality functioning and the individual's personality trait expression are not solely due to the direct physiological effects of a substance (e.g., a drug of abuse, medication) or a general medical condition (e.g., severe head trauma).

text: F. The individual is at least age 18 years.

text: Antisocial personality disorder falls under the dramatic/erratic cluster of personality disorders, "Cluster B."

text: The WHO's International Statistical Classification of Diseases and Related Health Problems, tenth edition (ICD-10), has a diagnosis called dissocial personality disorder (F60.2):[54][55]

text:
Callous unconcern for the feelings of others;
Gross and persistent attitude of irresponsibility and disregard for social norms, rules, and obligations;
Incapacity to maintain enduring relationships, though having no difficulty in establishing them;
Very low tolerance to frustration and a low threshold for discharge of aggression, including violence;
Incapacity to experience guilt or to profit from experience, particularly punishment;
Marked readiness to blame others or to offer plausible rationalizations for the behavior that has brought the person into conflict with society.

text: The ICD states that this diagnosis includes "amoral, antisocial, asocial, psychopathic, and sociopathic personality". Although the disorder is not synonymous with conduct disorder, presence of conduct disorder during childhood or adolescence may further support the diagnosis of dissocial personality disorder. There may also be persistent irritability as an associated feature.[55][56]

text: It is a requirement of the ICD-10 that a diagnosis of any specific personality disorder also satisfies a set of general personality disorder criteria.[55]

text: Psychopathy[edit]

text: Psychopathy is commonly defined as a personality disorder characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls.[10][57][58][59] Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL-R).[60] "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy.[10][54][59][61][62]

text: American psychiatrist Hervey Cleckley's work[63] on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy.[6][10] However, critics argue ASPD is not synonymous with psychopathy as the diagnostic criteria are not the same, since criteria relating to personality traits are emphasized relatively less in the former. These differences exist in part because it was believed such traits were difficult to measure reliably and it was "easier to agree on the behaviors that typify a disorder than on the reasons why they occur".[6][7][8][9][10]

text: Although the diagnosis of ASPD covers two to three times as many prisoners than the diagnosis of psychopathy, Robert Hare believes the PCL-R is better able to predict future criminality, violence, and recidivism than a diagnosis of ASPD.[6][7] He suggests there are differences between PCL-R-diagnosed psychopaths and non-psychopaths on "processing and use of linguistic and emotional information", while such differences are potentially smaller between those diagnosed with ASPD and without.[7][8] Additionally, Hare argued confusion regarding how to diagnose ASPD, confusion regarding the difference between ASPD and psychopathy, as well as the differing future prognoses regarding recidivism and treatability, may have serious consequences in settings such as court cases where psychopathy is often seen as aggravating the crime.[7][8]

text: Nonetheless, psychopathy has been proposed as a specifier under an alternative model for ASPD. In the DSM-5, under "Alternative DSM-5 Model for Personality Disorders", ASPD with psychopathic features is described as characterized by "a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviors (e.g., fraudulence)." Low levels of withdrawal and high levels of attention-seeking combined with low anxiety are associated with "social potency" and "stress immunity" in psychopathy.[18]:765 Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components.[64]

text: Other[edit]

text: Theodore Millon suggested 5 subtypes of ASPD.[65][66] However, these constructs are not recognized in the DSM and ICD.

text: This article uses citations that link to broken or outdated sources. Please improve the article or discuss this issue on the talk page. Help on using footnotes is available. (May 2016) (Learn how and when to remove this template message)

tag: table

text:
Subtype

Features

Nomadic antisocial (including schizoid and avoidant features)

Drifters; roamers, vagrants; adventurer, itinerant vagabonds, tramps, wanderers; they typically adapt easily in difficult situations, shrewd and impulsive. Mood centers in doom and invincibility.

Malevolent antisocial (including sadistic and paranoid features)

Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals, including serial killers Ted Bundy, Harvey Glatman, and mass murderer  Anders Behring Breivik fit these criteria.

Covetous antisocial (including negativistic features)

Rapacious, begrudging, discontentedly yearning; an angle was seen as assertively hostile as to dominate; was envious, seek more profit, and avariciously greedy; pleasures more in taking than in having.

Risk-taking antisocial (including histrionic features)

Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures.

Reputation-defending antisocial (including narcissistic features)

Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights.

text:
Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk-taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means
special ... Taxonomies may be put forward at levels that are more coarse or more fine-grained."[49]:223

text: Comorbidity[edit]

text: ASPD commonly coexists with the following conditions:[67]

text:
Anxiety disorders
Depressive disorder
Impulse control disorders
Substance-related disorders
Somatization disorder
Attention deficit hyperactivity disorder
Bipolar Disorder
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
Sadistic personality disorder

text: When combined with alcoholism, people may show frontal function deficits on neuropsychological tests greater than those associated with each condition.[68]

text: The rates of antisocial personality disorder tends to be around  40-50% in male alcohol and opiate addicts.[69]

text: Treatment[edit]

text: ASPD is considered to be among the most difficult personality disorders to treat.[70][71][verification needed] Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community.[72] Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.[70] They may only simulate remorse rather than truly commit to change: they can be seductively charming and dishonest, and may manipulate staff and fellow patients during treatment.[73][verification needed] Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.[74]

text:
Most treatment done is for those in the criminal justice system are given the treatment regimes as part of their imprisonment.[75] Those with ASPD may stay in treatment only as required by an external source, such as parole conditions.[verification needed] Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended.[70] There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.[76]
Psychotherapy also known as talk therapy is found to help treat patients with ASPD.[77]Schema therapy is also being investigated as a treatment for ASPD.[78] A review by Charles M. Borduin features the strong influence of Multisystemic therapy (MST) that could potentially improve this imperative issue. However, this treatment requires complete cooperation and participation of all family members.[79] Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance abuse,[80] although others have reported contradictory findings.[81]

text: Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative, and abusive behaviors.[70] Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of even this form of therapy.[82]

text: The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD.[83] A 2010 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which 8 studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD.[84] Nonetheless psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.[83]

text: Prognosis[edit]

text: According to Professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience, "childhood hyperactivity and conduct disorder showed equally strong prediction of antisocial personality disorder (ASPD) and criminality in early and mid-adult life. Lower IQ and reading problems were most prominent in their relationships with childhood and adolescent antisocial behaviour."[85]

text: Epidemiology[edit]

text: ASPD is seen in 3% to 30% of psychiatric outpatients.[67] The prevalence of the disorder is even higher in selected populations, like prisons, where there is a preponderance of violent offenders.[86] A 2002 literature review of studies on mental disorders in prisoners stated that 47% of male prisoners and 21% of female prisoners had ASPD.[87] Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) abuse treatment programs than in the general population,[86] suggesting a link between ASPD and AOD abuse and dependence.[88]

text: History[edit]

text: The first version of the DSM in 1952 listed sociopathic personality disturbance. Individuals to be placed in this category were said to be "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals".[verification needed] There were four subtypes, referred to as "reactions"; antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.[89]

text: The DSM-II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize.[90] The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM-II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers. (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.[91]

text: The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up".[92] However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the  Feighner criteria who had been using them as part of diagnostic interviews.[93]

text: The DSM-IV maintained the trend for behavioral antisocial symptoms while noting "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".[64]