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Antisocial Personality Disorder

Reviewed by Psychology Today Staff

Antisocial personality disorder (ASPD) describes an ingrained pattern of behavior in which individuals consistently disregard and violate the rights of others around them. Individuals with antisocial personality disorder may behave violently, recklessly, or impulsively, often with little regard for the wants and needs of others.

The disorder is best understood within the context of the broader category of personality disorders. A personality disorder is an enduring pattern of personal experience and behavior that deviates noticeably from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to personal distress or impairment.

The symptoms of antisocial personality disorder can vary in severity, and consequences can include imprisonment, drug abuse, and alcoholism. The more egregious, harmful, or dangerous behavior patterns are often colloquially referred to as “sociopathic” or “psychopathic.” Although neither sociopathy nor psychopathy are official diagnostic terms in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and neither maps perfectly onto the symptoms of antisocial personality disorder as outlined in the DSM, the constructs are thought to be closely related.

People with antisocial personality disorder may seem charming on the surface, but they are likely to be irritable and aggressive as well as irresponsible. Due to their manipulative tendencies, it may be difficult to tell whether they are lying or telling the truth.

The diagnosis of antisocial personality disorder is not given to individuals under the age of 18. However, ASPD symptoms will first appear in childhood or adolescence and may garner a diagnosis of conduct disorder during that time. Antisocial personality disorder is much more common in males than in females. The highest prevalence of antisocial personality disorder is found among males who abuse alcohol or drugs or who are in prisons or other forensic settings

Symptoms

Antisocial personality is confirmed by a psychological evaluation. Other disorders should be ruled out first. According to the DSM-5, features of antisocial personality disorder may include:

  • Failure to conform to basic social norms, often in ways that violate the law
  • Repeated violation of the physical or emotional rights of others
  • Lack of stability in job and home life; may go through long periods of unemployment, for example, even in localities or situations where jobs are readily available
  • Irritability and aggression; may get into frequent fights
  • Lack of remorse after harming someone or their property
  • Consistent irresponsibility
  • Recklessness, impulsivity
  • Deceitfulness
  • A childhood diagnosis (or symptoms consistent with) conduct disorder should generally be present before the age of 15 years

More generally, people with antisocial personality disorder may seem to lack empathy for the people around them, behave in arrogant or cocky ways, or have an excessively cynical view of the world. In some cases, they can appear charming on first meeting, though their charm is often glib and superficial. Their apparent confidence and charisma may lead to numerous sexual relationships, yet many of these relationships are likely to be short-term, often due to callous or duplicitous behavior toward their partners. As parents, individuals with antisocial personality disorder may be neglectful or even abusive.

Alcohol and drug abuse are common among people with antisocial personality disorder and can exacerbate symptoms of the disorder. When substance abuse and antisocial personality disorder coexist, treatment is more complicated for both.

How is antisocial personality disorder diagnosed?

Diagnosing antisocial personality disorder is typically done via an in-depth psychological evaluation that assesses personal and medical history, patterns of behavior and cognition, and relationships with others. Because people with ASPD may be unwilling to admit that their behavior or thought processes are problematic, a clinician may also interview family members or close others to assess the impact and scope of the person’s antisocial behaviors. 

Can other conditions mimic the symptoms of antisocial personality disorder?

ASPD is a disorder for which a careful diagnosis is especially important, as it may share some symptoms with several other personality disorders and psychiatric conditions. Individuals with narcissistic personality disorder or substance use disorder, for example, may break the law or otherwise behave in deceitful, manipulative, or aggressive ways; individuals with schizophrenia or bipolar disorder may also engage in violent or aggressive behavior, especially during a period of mania or a psychotic episode. Thus, such conditions should be ruled out before a diagnosis of ASPD is given.

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Causes

While the exact causes of antisocial personality disorder are not fully understood, a mix of environmental and genetic factors has been strongly implicated. Genetic factors are suspected since the incidence of antisocial behavior is higher in people with a biological parent or another immediate family member who displays antisocial characteristics. Environmental factors may also play a role, particularly childhood abuse or neglect; evidence suggests that someone who is treated violently or raised by someone who displayed other antisocial tendencies is more likely to develop them as well.

Why is antisocial personality disorder more common in men?

The exact reason for ASPD’s gender disparity is not fully understood, but may be due to a combination of genetic and cultural factors. Some experts hypothesize that gender differences in psychopathy, a related construct, may stem in part from diagnostic criteria that are biased toward male behavior. Psychopathic men, for instance, are more likely to behave violently, while women may be more likely to behave in less outwardly aggressive (yet still antisocial) ways, potentially making them better able to avoid detection. Whether the same is true for antisocial personality disorder is not clear, though some evidence suggests that males with ASPD are more likely to behave violently than females.

Which factors increase the risk of antisocial personality disorder?

Experiencing trauma, neglect, or abuse early in life appears to significantly increase someone’s likelihood of developing antisocial personality disorder, especially among those who are already genetically vulnerable. Growing up with parents who abused drugs or alcohol, or abusing drugs or alcohol oneself, may also increase risk. Being male further increases the likelihood that someone will be diagnosed with ASPD.

 

Treatment

Antisocial personality disorder is one of the most difficult personality disorders to treat. Individuals rarely seek treatment on their own and may initiate therapy only when mandated to do so by a court. When they do enter therapy, they may be unengaged or even actively hostile toward the therapist. Yet some therapies, sometimes combined with psychiatric treatment, have shown promise in certain cases.

There is no clearly indicated treatment for antisocial personality disorder, though CBT is sometimes used. Recently, the antipsychotic medication clozapine has shown promising results in improving symptoms among men with antisocial personality disorder.

Can therapy help treat antisocial personality disorder?

Therapy can be effective in some cases of antisocial personality disorder but not all; it tends to be less effective as the disorder increases in severity. In cases where it is used, it may be based on CBT or other talk therapy modalities that target behaviors and problematic thought patterns, or that aim to help the individual with ASPD better understand how their actions affect others. Therapy may also incorporate elements of anger management, substance abuse treatment, or other relevant approaches according to the individual’s specific symptoms and comorbid conditions.

Which medications may be used to treat antisocial personality disorder?

Several medications have been used to treat ASPD; they tend to be most effective at curbing aggression or erratic moods, rather than changing the underlying motivations that drive behavior. Antidepressants, antipsychotics, and mood stabilizers such as lithium may be prescribed to treat antisocial personality disorder; individuals who are in prison or receiving court-mandated treatment may be required to take medication (and/or undergo therapy) per the instructions of a judge.

References
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition
National Institutes of Health, National Library of Medicine, MedlinePlus, 2006. Antisocial Personality Disorder. www.nlm.nih.gov/medlineplus/ency/article/000921.htm
Stout, M. (2006). The sociopath next door: The ruthless versus the rest of us. Harmony Books.
Westermeyer, J. and Thuras, P. (2005). Association of antisocial personality disorder and substance disorder morbidity in a clinical sample. American Journal of Drug and Alcohol Abuse.  
Brown, D., Larkin, F., Sengupta, S., Romero-Ureclay, J. L., Ross, C. C., Gupta, N., ... & Das, M. (2014). Clozapine: an effective treatment for seriously violent and psychopathic men with antisocial personality disorder in a U.K. high-security hospital. CNS spectrums, 19(05), 391–402.
Abdalla-Filho, E., & Völlm, B. (2020). Does every psychopath have an antisocial personality disorder?. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999)42(3), 241–242. https://doi.org/10.1590/1516-4446-2019-0762
Alegria, A. A., Blanco, C., Petry, N. M., Skodol, A. E., Liu, S. M., Grant, B., & Hasin, D. (2013). Sex differences in antisocial personality disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions. Personality disorders4(3), 214–222. https://doi.org/10.1037/a0031681
Last updated: 11/04/2021