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Antisocial Personality Disorder (ASPD)

By Robert M. A. Hirschfeld, MD, DeWitt Wallace Senior Scholar and Professor, Department of Psychiatry, Weill Cornell Medical College

Antisocial personality disorder is characterized by a pervasive pattern of disregard for consequences and for the rights of others.

  • People with antisocial personality disorder go after what they want without considering the consequences for themselves or others and without feeling any remorse or guilt.

  • Doctors diagnose antisocial personality disorder based on symptoms, including disregard for consequences and for the rights of others and use of deceit and/or manipulation to get what they want.

  • Antisocial personality disorder is difficult to treat, but cognitive-behavioral therapy and certain drugs may help lessen aggression and impulsive behavior.

Personality disorders are long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.

People with antisocial personality disorder may commit unlawful, deceitful, exploitative, and reckless acts for personal profit or pleasure and without remorse. They may

  • Justify or rationalize their behavior (for example, they may think that "losers deserved to lose")

  • Blame the victim for being foolish or helpless

  • Be indifferent to the exploitative and harmful effects of their actions on others

  • Callously disregard the rights and feelings of others and the law

Antisocial personality disorder occurs in 1 to 3.6% of the general population. It is 6 times more common among men. The disorder is less common in older age groups, suggesting that people can learn over time to change their behavior.

Other disorders are also often present. These disorders include

Most people with antisocial personality disorder also have a substance use disorder, and about half of those with a substance use disorder have antisocial personality disorder.

Causes

Genes and environmental factors (such as adversity during childhood) contribute to the development of antisocial personality disorder.

Antisocial personality disorder is more common among first-degree relatives (parents, siblings, and children) of people with the disorder than among the general population. Risk of developing this disorder is increased in both adopted and biologic children of parents with the disorder.

If children develop conduct disorder and attention-deficit/hyperactivity disorder before they are 10 years old, they are more likely to develop antisocial personality disorder as adults. Conduct disorder may be more likely to develop into antisocial personality disorder when parents abuse or neglect the child or are inconsistent in discipline or in parenting style (for example, switching from being warm and supportive to being cold and critical).

Disregard for the pain of others during early childhood has been linked to antisocial behavior during late adolescence.

Symptoms

Disregard for others

People with antisocial personality disorder may express their disregard for others and for the law by destroying property, harassing others, or stealing. They may deceive, exploit, con, or manipulate people to get what they want—whether it be money, power, sex, or personal gratification. They may use an alias to accomplish their goals.

People with this disorder do not often feel remorse or guilt for what they have done. They may rationalize their actions by blaming those they hurt (for example, by thinking they deserved it) or the way life is (for example, by thinking that it is unfair). They are determined not to be pushed around and to do what they think is best for themselves at any cost; this may stem from pervasive mistrust of others.

People with antisocial personality disorder lack empathy for others and may be contemptuous of or indifferent to the feelings, rights, and suffering of others.

Impulsive behavior (impulsivity)

People with antisocial personality disorder are generally impulsive. They have difficulty planning ahead and considering the consequences for themselves or others. As a result, they may do the following:

  • Suddenly change homes, or relationships, or jobs (with no plan for getting another)

  • Speed when driving and drive while intoxicated, sometimes leading to accidents

  • Consume excessive amounts of alcohol or take illegal drugs that may have harmful effects

  • Commit criminal acts

People with antisocial personality disorder are often easily provoked and physically aggressive because they have problems controlling their impulses and do not appreciate the effect of their actions on others.

They have a shorter life expectancy than the general population.

Irresponsibility

People with antisocial personality disorder are often socially and financially irresponsible. As a result, they may do the following:

  • Not seek employment when opportunities are available

  • Not pay their bills or default on loans

  • Not pay child support

Other symptoms

These people tend to have a high opinion of themselves and may be very opinionated, self-assured, or arrogant. They may be charming, persuasive, and convincing in their efforts to get what they want.

Diagnosis

  • A doctor's evaluation, based on specific criteria

Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5—see Classification and Diagnosis of Mental Illness), published by the American Psychiatric Association.

For doctors to diagnose antisocial personality disorder, people must persistently disregard the rights of others, as shown by at least three of the following:

  • They disregard the law, shown by repeatedly committing acts that are grounds for arrest.

  • They are deceitful, shown by lying repeatedly, using aliases, or conning others for personal gain or pleasure.

  • They act impulsively and do not plan ahead.

  • They are easily provoked or aggressive, shown by constantly getting into physical fights or assaulting others.

  • They recklessly disregard their safety and/or the safety of others.

  • They consistently act irresponsibly, shown by quitting a job with no plans for another one or not paying bills.

  • They do not feel remorse, shown by indifference to or rationalization of hurting or mistreating others.

Antisocial personality disorder is diagnosed only in people aged 18 years or older.

Treatment

  • For some symptoms, cognitive-behavioral therapy and certain drugs

Antisocial personality disorder is very difficult to treat. There is no evidence that any particular treatment results in long-term improvement. Thus, doctors focus on some more immediate goal, such as avoiding legal consequences. However, identifying and treating children with conduct disorder as early as possible may help lessen the social problems caused by antisocial personality disorder.

If aggression and impulsiveness are problems, people may benefit from treatment with cognitive-behavioral therapy, drugs used to stabilize mood (such as lithium and the anticonvulsant valproate), or certain antidepressants called selective serotonin reuptake inhibitors (SSRIs).