Diagnosing Antisocial Personality Disorder (ASPD)
When cruelty is the point: Sociopathy, psychopathy, and the criminal type.
Posted Nov 04, 2019
Antisocial Personality Disorder (ASPD) is not the best label for the long-standing pattern of behavior described by it. Antisocial does not mean shy, withdrawn, detached, loner, or quiet. The “social” in antisocial refers to social norms and rules. Individuals with ASPD have no regard for the rules, norms, and laws of society. It is widely known that prior to the DSM-III, the behaviors described by the label ASPD were described with the terms, “psychopath” or “sociopath.”
There are some conceptual problems with the construct of ASPD in connection to its label. Because the pattern of behavior described by it was long described under the label “psychopath,” some may equate the diagnosis with its most extreme instances (e.g. serial killers).
On the other hand, the label "sociopath" also permits a conceptualization of a longstanding pattern of behavior at the low end of the spectrum of psychopathology i.e., low-level sociopathy. Pop psychology books tempt putative buyers with the promise of revealing the key tricks to spotting or identifying psychopaths, suggesting they are all around us. This view risks classifying merely mean and selfish people as psychopaths or antisocial. A higher bar is warranted for the designation of a disorder.
Antisocial Personality Disorder (ASPD) in the Diagnostic and Statistical Manual for Mental Disorders (DSM-IV/5)
The DSM content definition of ASPD is a longstanding pattern of “a disregard for the rights of others” as manifested by three or more of the following: (a) chronic lying, (b) irresponsibility, (c) impulsivity, (d) cruelty without remorse, (e) breaking of laws, (f) reckless disregard for the safety of self or others and/or (f) physical fighting.
Clinical Considerations and Criticism
The psychiatric diagnostic evaluation of ASPD requires the interviewer to obtain information in connection to the frequency with which the interviewee engaged in behaviors that are a predicate for arrest, e.g., by asking “how many times have you laundered money in the past five years
(or between the age of 15 and age at the time of the evaluation)?" In addition, diagnosing ASPD also requires that the interviewer assess for a history of conduct disorder with an onset before 15 years of age by asking specific questions about the frequency of certain antisocial behaviors, e.g., “how many times did you skip school before the age of 15?”
The diagnosis of ASPD requires the clinician or researcher to probe and explore "yes" or "no" answers by encouraging specific examples and elaboration. Medical records and arrest records can be helpful in substantiating a history of recurrent unlawful behavior and childhood misconduct. A major criticism of ASPD is that because so many incarcerated people meet criteria for it, it is essentially a personality disorder that refers to criminality and pathologizes morality rather than being a longstanding pattern of behavior subsumed by the term “personality.”
Childhood Predictors of Antisocial Personality Disorder (ASPD)
One of the requirements for a diagnosis of ASPD in individuals over the age of 15 is that they have a history of what is labeled "conduct disorder" with an onset prior to 15. ASPD and conduct disorder are externalizing disorders—i.e., they involve outward displays of pathological behavior rather than internal mental suffering.
They can both be described as a disorder of conscientiousness—i.e., possessing low levels of this trait, one of five major factors that define personality. Accordingly, as a child, the individual with ASPD often has a history of staying out much later than allowed by their parents. As children, individuals with ASPD often have a history of skipping school or running away from home.
The adult with ASPD was often a child who threatened or picked on other kids and started physical fights. Furthermore, individuals with severe ASPD often have a history of hurting animals, forcing sex, damaging property, or starting fires. Other childhood predictors of ASPD include getting into trouble for lying, breaking promises, and threatening others to get what one wants, as well as breaking into someone else’s property, such as a car or a house.
Narrative Description of ASPD
Individuals with ASPD may have a history of moving from one place to another without knowing how long they are going to stay or where they are going next. Individuals with ASPD typically have a past in which they have walked off a job or quit without a specific plan. They are chronically irresponsible and often break their word.
They prefer high-risk recreational activities, like speeding in cars, and may have a reputation for being a daredevil. Additionally, Iidividuals with ASPD may face negative consequences for their risk-taking behavior in the workplace, such as being the target of disciplinary action.
Individuals with ASPD often have a history of theft, extortion, blackmail, embezzlement, running numbers, selling drugs, selling stolen property, money laundering, sex for money or other behaviors that could be grounds for arrest. Individuals with ASPD are known for not paying bills or meeting other financial obligations—e.g., not paying contractors who completed their job. People with ASPD typically have been in trouble for their chronic lateness or absence from school or work and are known for spending lots of money recklessly. The person with ASPD is chronically getting into trouble for failing to plan ahead.
A core feature of ASPD is the capacity to lie with ease when it serves one’s ends. People with ASPD commonly use false names or aliases and develop schemes to con people into giving them what they want (e.g., offering a fake diploma in exchange for money). Individuals with ASPD never feel sorry or guilty for violating the rights of others.
They express indifference at harming others, and they typically feel that their actions were justified by the situation. Furthermore, individuals with ASPD display impulsivity—risk-taking behavior that is putatively self-destructive. Individuals with ASPD may gamble more money than they can afford to lose. They may frequently have one-night stands involving unsafe sex.
Such people often abuse drugs and/or alcohol. Individuals with ASPD may also have a habit of going on eating binges to the point of feeling sick. Other risky, self-destructive ASPD behaviors include shoplifting, getting a DWI, or recurrently getting into physical fights or assaults.
Pfohl B, Blum N, Zimmerman M. Structured interview for DSM-IV personality (SIDP-IV). American Psychiatric Association; Washington (DC): 1997.