Antisocial Personality Disorder

What Is Antisocial Personality Disorder?

Antisocial personality disorder (ASPD), also called sociopathy, is a mental illness characterized by a consistent disregard for right and wrong.

Contrary to the common belief that “antisocial” means “not social,” the term refers to how a person’s behavior goes against social norms. Individuals with this personality disorder may ignore the rights and emotions of others and tend to provoke or manipulate people to get what they want.

The American Psychiatric Association (APA) groups ASPD under Cluster B personality disorders, characterized by “overly emotional, dramatic, and unpredictable thought patterns and behavior.”

People with antisocial personality disorder are known to violate the law, behave violently or impulsively, and have problems with substance abuse. They may also have issues with deceitfulness, such as lying or sneaking.

About Personality Disorders

Personality disorders are characterized by unhealthy, abnormal patterns of thinking and behaving that cause significant issues or limitations in all facets of life. These characteristics make it difficult for people with a personality disorder to understand or relate to their peers or particular situations.

Most individuals with personality disorders are unaware of their symptoms because their thinking seems natural. It’s common for family or friends to be the ones who ultimately point out their disordered behavior.

Healthcare professionals categorize personality disorders into three different clusters based on their characteristics. These three clusters include:

• Cluster A (odd, eccentric)
  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
• Cluster B (dramatic or unpredictable)
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Narcissistic Personality Disorder
• Cluster C (anxious, fearful)
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder

Symptoms of Antisocial Personality Disorder

ASPD often stands out from other personality disorders due to its list of unpredictable and sometimes violent symptoms. At its core, antisocial personality disorder causes the individual to feel little or no remorse for hurting others or breaking laws.

It’s important to remember that while some people receive their diagnosis due to criminal behavior, others may never turn to violence or crime. This list of symptoms includes general symptoms but is not an exhaustive list or mandatory criteria to have this disorder.

Symptoms of antisocial personality disorder may include:

• Disregard for right and wrong
• Impulsiveness or failure to plan ahead
• Acting cold, cynical, and disrespectful to others
• Consistent irresponsibility and impairments in fulfilling work or financial obligations
• Failure to consider the negative consequences of behavior or learn from them
• Lying to exploit or con others
• Using charm or wit to manipulate others for personal gain or personal pleasure
• Arrogance or a sense of superiority
• Recurring delinquency, including criminal behavior
• Repeatedly violating the rights of others through intimidation or violence
• Hostility, significant irritability, agitation, aggression, or violence
• Lack of empathy or remorse about harming others
• Unnecessary risk-taking or dangerous behavior regardless of safety for self or others
• Poor or abusive relationships

Antisocial Personality Disorder VS Psychopathy

People sometimes confuse ASPD and sociopathy because they seem similar in certain ways. Both personality disorders have a poor sense of right and wrong and tend to engage in risky, violent, or criminal behavior. But despite being used interchangeably, sociopathy and psychopathy are different from each other.

An antisocial personality disorder is an official diagnosis found in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), but sociopathy and psychopathy have different diagnostic criteria. Instead, they fall under the ASPD diagnosis umbrella and can be used to describe whether or not the person has a conscience.

Sociopaths have a weak sense of conscience and can form some close attachments, while psychopaths have no conscience and pretend to have close attachments. Sociopaths tend to be more rage-prone and erratic, likely developing due to childhood trauma.

Psychopaths, on the other hand, are known for their cold, calculating behavior, plus their ability to act normally. Still, they are more likely the result of brain differences due to genetics. Research shows psychopaths have underdeveloped brain components commonly responsible for emotion regulation and impulse control.

Causes of Antisocial Personality Disorder

It’s believed that genetic and environmental factors contribute to the development of antisocial personality disorder. An individual develops their personality traits mainly during childhood. Significant events or trauma can trigger the progression of ASPD early on, especially if someone is genetically predisposed to personality disorders.

Risk Factors of Antisocial Personality Disorder

Because genetics and upbringing can put someone at risk of developing ASPD, it’s essential to be aware of any history of personality disorders in the family and/or prior trauma.

Research shows that certain factors can lead to an increased risk of developing ASPD, including:

• Diagnosis of Conduct Disorder (CD) in childhood due to aggressive behavior and rule-breaking
• Family history of personality disorders or mental health disorders
• A traumatic childhood experience, like abuse or neglect
• Unstable, violent, or chaotic family life during childhood

How Common is Antisocial Personality Disorder?

An estimated 10% of adults in the United States have a personality disorder, the most common of which are obsessive-compulsive personality disorder, narcissistic personality disorder, and borderline personality disorder.

According to research from the World Health Organization’s World Mental Health (WMH) Survey Initiative, the estimated lifetime prevalence of ASPD among the general population is between 1% and 4%.

Men are 3 to 5 times more likely to be diagnosed with antisocial personality disorder than women.

Common Comorbidities and Related Conditions

It’s not uncommon for an individual to have symptoms of more than one personality disorder, especially within the same cluster.

Regarding ASPD and comorbidities, research indicates a strong correlation between drug or alcohol use disorders and the diagnosis of antisocial personality disorder.

Studies from the Journal of Substance Abuse Treatment show that about 40% to 50% of individuals with a substance use disorder meet the criteria for ASPD.

In addition, approximately 90% of individuals diagnosed with ASPD also have a co‐occurring substance use disorder.

Antisocial Personality Disorder and Addiction

There’s strong evidence that addiction and ASPD commonly occur together. Because ASPD often includes risky behavior and a disregard for personal safety and the safety of others, many individuals with ASPD will also engage in substance abuse and alcohol use.

Research indicates symptoms from Cluster B personality disorders (i.e., antisocial, narcissistic, histrionic, and borderline personality disorders) were significantly related to drug and alcohol abuse and dependence.

The highest rates of past-year alcohol dependence were found in those with Cluster B disorders—with antisocial symptoms being significantly related to substance use diagnoses.

How is Antisocial Personality Disorder Diagnosed?

Each personality disorder has specific diagnostic criteria. Patients will need to be evaluated by a psychiatrist or similar mental health professional to make an accurate diagnosis and suggest a treatment plan.

To be diagnosed with ASPD, an individual must have shown symptoms of conduct disorder before age 15.

Most adults with ASPD will have shown signs of behavioral problems during childhood or early adolescence. However, a formal diagnosis won’t occur until age 18.

Symptoms are usually at their worst during the late teenage years and 20s, sometimes improving as a person ages. Unfortunately, treating ASPD can be complicated, as patients typically don’t think there’s anything wrong, making them less likely to seek diagnosis on their own.

Antisocial Personality Disorder Treatment

Treatment for ASPD usually includes a combination of behavioral therapy or psychotherapy in individual or group settings and psychotropic medications.

Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT) are the most common types of psychotherapy used in treating personality disorders. They can help identify problematic or illegal behavior to avoid in the future.

The FDA has not approved any medications specifically for antisocial personality disorder.

However, healthcare providers sometimes prescribe medications to treat symptoms like impulsive aggression and mood swings, including mood stabilizers, antidepressants, or antipsychotics.

Seeking Treatment For Antisocial Personality Disorder

Addressing antisocial personality disorder can be incredibly difficult, especially for friends and family members affected by its most harmful symptoms. Despite ASPD’s reputation, individuals with this condition still deserve a happy, fulfilling future. People with ASPD can flourish and live productive lives with the right therapy methods, medications, and support.