Antisocial Personality Disorder

Antisocial personality disorder describes an ingrained pattern of behavior in which individuals consistently disregard and violate the rights of others around them.

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. The more egregious, harmful, or dangerous behavior patterns are referred to as sociopathic or psychopathic. There has been much debate as to the distinction between the two descriptions. Sociopathy is chiefly characterized as something severely wrong with one's conscience; psychopathy is characterized as a complete lack of conscience regarding others. Some professionals describe people with this constellation of symptoms as "stone cold" to the rights of others. Consequences of this disorder can include imprisonment, drug abuse, and alcoholism.

People with this illness may seem charming on the surface, but they are likely to be irritable and aggressive as well as irresponsible. They may have numerous somatic complaints and perhaps attempt suicide. Due to their manipulative tendencies, it is 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 but is given only if there is a history of some symptoms of conduct disorder before age 15. 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

According to the DSM-5, features of antisocial personality disorder include:

  • Violation of the physical or emotional rights of others
  • Lack of stability in job and home life
  • Irritability and aggression
  • Lack of remorse
  • Consistent irresponsibility
  • Recklessness, impulsivity
  • Deceitfulness
  • A childhood diagnosis (or symptoms consistent with) conduct disorder

Antisocial personality is confirmed by a psychological evaluation. Other disorders should be ruled out first, as this is a serious diagnosis.

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

Causes

While the exact causes of the disorder are unknown, both environmental and genetic factors have been implicated. Genetic factors are suspected since the incidence of antisocial behavior is higher in people with a biological parent who displays antisocial characteristics. Environmental factors may also play a role, however, as a person whose role model had antisocial tendencies is more likely to develop them.

About 3 percent of men and about 1 percent of women have antisocial personality disorder.

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. 

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

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.

Last reviewed 02/26/2019