5. Antisocial personality disorder

Cluster B comprises antisocial, borderline, histrionic, and narcissistic personality disorder. Until Schneider broadened the concept of personality disorder to include those who ‘suffer from their abnormality’, personality disorder was more or less synonymous with antisocial personality disorder. Antisocial personality disorder is far more common in men than in women, and is characterized by a callous unconcern for the feelings of others. The person disregards social rules and obligations, is irritable and aggressive, acts impulsively, lacks guilt, and fails to learn from experience. In many cases he has no difficulty finding relationships, and can even appear superficially charming (the so-called ‘charming psychopath’). However, his relationships are usually fiery, turbulent, and short-lived. People with antisocial personality disorder often have a criminal record or even a history of being in and out of prison.

Antisocial Personality Disorder Symptoms

Antisocial personality disorder is characterized by a long-standing pattern of a disregard for other people’s rights, often crossing the line and violating those rights. It usually begins in childhood or as a teen and continues into their adult lives.

Antisocial personality disorder is often referred to as psychopathy or sociopathy in popular culture. However, neither psychopathy nor sociopathy are recognized professional labels used for diagnosis.

Individuals with Antisocial Personality Disorder frequently lack empathy and tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. They may have an inflated and arrogant self-appraisal (e.g., feel that ordinary work is beneath them or lack a realistic concern about their current problems or their future) and may be excessively opinionated, self-assured, or cocky. They may display a glib, superficial charm and can be quite voluble and verbally facile (e.g., using technical terms or jargon that might impress someone who is unfamiliar with the topic).

Lack of empathy, inflated self-appraisal, and superficial charm are features that have been commonly included in traditional conceptions of psychopathy and may be particularly distinguishing of Antisocial Personality Disorder in prison or forensic settings where criminal, delinquent, or aggressive acts are likely to be nonspecific. These individuals may also be irresponsible and exploitative in their sexual relationships.

A personality disorder is an enduring pattern of inner experience and behavior that deviates from the norm of the individual’s culture. The pattern is seen in two or more of the following areas: cognition; affect; interpersonal functioning; or impulse control. The enduring pattern is inflexible and pervasive across a broad range of personal and social situations. It typically leads to significant distress or impairment in social, work or other areas of functioning. The pattern is stable and of long duration, and its onset can be traced back to early adulthood or adolescence.

Symptoms of Antisocial Personality Disorder

Antisocial personality disorder is diagnosed when a person’s pattern of antisocial behavior has occurred since age 15 (although only adults 18 years or older can be diagnosed with this disorder) and consists of the majority of these symptoms:

• Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
• Deceitfulness, as indicated by repeated 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

There should also be evidence of Conduct Disorder in the individual as a child, whether or not it was ever formally diagnosed by a professional.

Because personality disorders describe long-standing and enduring patterns of behavior, they are most often diagnosed in adulthood. It is uncommon for them to be diagnosed in childhood or adolescence, because a child or teen is under constant development, personality changes and maturation. According to the DSM-5, antisocial personality disorder cannot be diagnosed in people younger than 18 years old.

Antisocial personality disorder is 70 percent more prevalent in males than females. The 12-month prevalence rate of this disorder is between 0.2 and 3.3 percent.

Like most personality disorders, antisocial personality disorder typically will decrease in intensity with age, with many people experiencing few of the most extreme symptoms by the time they are in the 40s or 50s.

How is Antisocial Personality Disorder Diagnosed?

Personality disorders such as antisocial personality disorder are typically diagnosed by a trained mental health professional, such as a psychologist or psychiatrist. Family physicians and general practitioners are generally not trained or well-equipped to make this type of psychological diagnosis. So while you can initially consult a family physician about this problem, they should refer you to a mental health professional for diagnosis and treatment. There are no laboratory, blood or genetic tests that are used to diagnose antisocial personality disorder.

Many people with antisocial personality disorder don’t seek out treatment. People with personality disorders, in general, do not often seek out treatment until the disorder starts to significantly interfere or otherwise impact a person’s life. This most often happens when a person’s coping resources are stretched too thin to deal with stress or other life events.

A diagnosis for antisocial personality disorder is made by a mental health professional comparing your symptoms and life history with those listed here. They will make a determination whether your symptoms meet the criteria necessary for a personality disorder diagnosis.

Causes of Antisocial Personality Disorder

Researchers today don’t know what causes antisocial personality disorder. There are many theories, however, about the possible causes of antisocial personality disorder. Most professionals subscribe to a biopsychosocial model of causation — that is, the causes of are likely due to biological and genetic factors, social factors (such as how a person interacts in their early development with their family and friends and other children), and psychological factors (the individual’s personality and temperament, shaped by their environment and learned coping skills to deal with stress). This suggests that no single factor is responsible — rather, it is the complex and likely intertwined nature of all three factors that are important. If a person has this personality disorder, research suggests that there is a slightly increased risk for this disorder to be “passed down” to their children.

Treatment of Antisocial Personality Disorder

Treatment of antisocial personality disorder typically involves long-term psychotherapy with a therapist that has experience in treating this kind of personality disorder. Medications may also be prescribed to help with specific troubling and debilitating symptoms. For more information about treatment, please see antisocial personality disorder treatment.

Antisocial personality disorder (ASPD) facts

• A personality disorder (PD) is a persistent pattern of thoughts, feelings, and behaviors that is significantly different from what is considered normal within the person's own culture.
• Personality disorders are grouped into clusters A, B, and C based on the dominating symptoms.
• Antisocial personality disorder is specifically a pervasive pattern of disregarding and violating the rights of others and may include symptoms such as breaking laws, frequent lying, starting fights, lack of guilt and taking personal responsibility, and the presence of irritability and impulsivity.
• Psychopathy is considered to be a more severe form of antisocial personality disorder. Specifically, in order to be considered a psychopath, an individual must experience a lack of remorse or guilt about their actions in addition to demonstrating antisocial behaviors.
• Psychopaths tend to be highly suspicious or paranoid, even in comparison to individuals with antisocial personality disorder, which tends to lead the psychopathic person to interpret all aggressive behaviors toward them as being arbitrary and unfair.
• Antisocial personality disorder is likely the result of a combination of biologic/genetic and environmental factors.
• Some theories about the biological risk factors for antisocial personality disorder include dysfunction of certain genes, hormones, or parts of the brain.
• Diagnoses often associated with antisocial personality disorder includesubstance abuse, attention deficit hyperactivity disorder (ADHD), and reading disorders.
• Theories regarding the life experiences that put people at risk for antisocial personality disorder include a history of childhood physical,sexual, or emotional abuse; neglect, deprivation, or abandonment; associating with peers who engage in antisocial behavior; or having a parent who is either antisocial or alcoholic.
• Since there is no specific definitive test that can accurately assess the presence of antisocial personality disorder, health-care professionals conduct a mental-health interview that looks for the presence of antisocial symptoms. If the cultural context of the symptoms is not considered, antisocial personality disorder is often falsely diagnosed as being present.
• Research indicates ethnic minorities tend to be falsely diagnosed as having antisocial personality disorder, inappropriately resulting in less treatment and more punishment for those individuals.
• Although antisocial personality disorder can be quite resistant to treatment, the most effective interventions tend to be a combination of firm but fair programming that emphasizes teaching the antisocial personality disorder individuals skills that can be used to live independently and productively within the rules and limits of society.
• While medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions like depression, anxiety, and mood swings that co-occur with this condition.
• If untreated, people with antisocial personality disorder are at risk for developing or worsening a myriad of other mental disorders. Antisocial personality disorder individuals are also at risk for self-mutilation or dying from homicide or suicide.
• Many people with antisocial personality disorder experience a remission of symptoms by the time they reach 50 years of age.

Personality disorders are mental health conditions that affect how someone thinks, perceives, feels or relates to others.

Antisocial personality disorder is a particularly challenging type of personality disorder, characterised by impulsive, irresponsible and often criminal behaviour.

Someone with antisocial personality disorder will typically be manipulative, reckless and not care for other people's feelings.

However, like other personality disorders, the disorder is on a spectrum – so it can range in severity from occasional bad behaviour, to repeatedly breaking the law and committing serious crimes. Psychopaths are considered to have a severe form of antisocial personality disorder.

What are the signs of antisocial personality disorder?

Someone with antisocial personality disorder may:

• exploit, manipulate or violate the rights of others (they can be good at flattery and turn on the charm)
• lack concern, regret or remorse about other people's distress
• behave irresponsibly and show disregard for normal social behaviour
• have difficulty sustaining long-term relationships
• not be able to control their anger
• lack guilt, or not learn from their mistakes
• blame others for problems in their lives
• break the law repeatedly

As children they may have displayed ruthless and immoral behaviour, such as cruelty to animals and starting fires.

A diagnosis of antisocial personality disorder is made after a psychological assessment. It can only be made if the person is aged at least 18 and at least three of the following apply:

• repeatedly breaking the law
• repeatedly being deceitful
• being impulsive or incapable of planning ahead
• being irritable and aggressive
• having a reckless disregard for their safety or the safety of others
• being consistently irresponsible
• lack of remorse

These signs must not be part of a schizophrenic or manic episode – rather they are part of that person's everyday personality.

This behaviour becomes most extreme and challenging during the late teens and early 20s, and may improve by the time the person reaches their 40s.

Who is at risk?

Antisocial personality disorder affects far more men than women.

It's not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences (such as child abuse or neglect) are believed to play a role.

Someone with antisocial personality disorder will typically have an antisocial or alcoholic parent, and will have grown up with harsh, inconsistent parenting. 

What are the risks associated with the condition?

There's a high risk that someone with antisocial personality disorder will commit crimes and be imprisoned at some point in their life.

Men with antisocial personality disorder have been found to be three to five times more likely to abuse alcohol andmisuse drugs than those without the disorder, and are at high risk of accidentally injuring themselves or committing suicide.

Many will be unemployed and/or homeless.

How is antisocial personality disorder treated?

It used to be thought that antisocial personality disorder was a lifelong disorder, but that's not always true – it can be treated.

Evidence suggests that with therapy, behaviour can improve over time, even if core characteristics (such as lack of empathy) remain. 

However, antisocial personality disorder is one of the hardest personality disorders to treat. Also, it's rare that someone with antisocial personality disorder will seek treatment on their own – they may only start therapy when required to by a court.

The main treatment is psychotherapy, which involves talking to a trained therapist about feelings that the person has about themself and other people, particularly family and those close to them. Cognitive behavioural therapy is one of the most common types of psychotherapy used – the above link will take you to detailed information about this. 

Family and friends of the person may be involved in decisions about their treatment and care. Substance misuse services and social care may also need to be involved. 

Some antipsychotics and antidepressants may help people with antisocial disorder, although there's no strong evidence to support the use of medication in antisocial personality disorder. The antipsychotic drugs carbamazepine andlithium may help aggression and impulse control, and a class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may improve anger and personality disorder symptoms in general.