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Antisocial Personality Disorder (ASPD)


Mark Zimmerman

, MD, Rhode Island Hospital

Reviewed/Revised Sep 2023

Antisocial personality disorder is characterized by a pervasive pattern of disregard for consequences and for the rights of others. Diagnosis is by clinical criteria. Treatment may include cognitive-behavioral therapy, antipsychotic medications, and antidepressants.

People with antisocial personality disorder commit unlawful, deceitful, exploitative, reckless acts for personal profit or pleasure and without remorse; they may do the following:

  • Justify or rationalize their behavior (eg, thinking losers deserve to lose, looking out for number one)

  • Blame the victim for being foolish or helpless

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

Comorbidities are common. Most patients also have a substance use disorder Substance Use Disorders Substance use disorders involve a pathologic pattern of behaviors in which patients continue to use a substance despite experiencing significant problems related to its use. Diagnosis of substance... read more (and about half of those with a substance use disorder meet criteria for antisocial personality disorder) (3 General references Antisocial personality disorder is characterized by a pervasive pattern of disregard for consequences and for the rights of others. Diagnosis is by clinical criteria. Treatment may include cognitive-behavioral... read more ). Patients with antisocial personality disorder often also have an impulse control disorder Overview of Learning Disorders Learning disorders are conditions that cause a discrepancy between potential and actual levels of academic performance as predicted by the person’s intellectual abilities. Learning disorders... read more , mood disorders Overview of Mood Disorders Mood disorders are emotional disturbances consisting of prolonged periods of excessive sadness, excessive elevated mood, or both. Mood disorders can occur in adults, adolescents, or children... read more , anxiety disorders Overview of Anxiety Disorders Anxiety disorders are characterized by persistent and excessive fear and anxiety and the dysfunctional behavioral changes a patient may use to mitigate these feelings. Anxiety disorders are... read more , gambling disorder, attention-deficit/hyperactivity disorder Attention-Deficit/Hyperactivity Disorder (ADD, ADHD) Attention-deficit/hyperactivity disorder (ADHD) is a syndrome of inattention, hyperactivity, and impulsivity. The 3 types of ADHD are predominantly inattentive, predominantly hyperactive/impulsive... read more , or borderline personality disorder Borderline Personality Disorder (BPD) Borderline personality disorder is characterized by a pervasive pattern of instability and hypersensitivity in interpersonal relationships, instability in self-image, extreme mood fluctuations... read more .

General references

  • 1. Lenzenweger MF, Lane MC, Loranger AW, et al: DSM-IV personality disorders in the National Comorbidity Survey Replication. Biol Psychiatry 62(6):553-564, 2007. doi: 10.1016/j.biopsych.2006.09.019

  • 2. Trull TJ, Jahng S, Rachel L Tomko, et al: Revised NESARC personality disorder diagnoses: Gender, prevalence, and comorbidity with substance dependence disorders. J Pers Disord 24(4):412-426, 2010. doi: 10.1521/pedi.2010.24.4.412

  • 3. Regier DA, Farmer ME, Rae DS, et al: Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 264(19):2511-2518, 1990. PMID: 2232018.

  • 4. d'Huart D, Seker S, Burgin D, et al: The stability of personality disorders and personality disorder criteria: A systematic review and meta-analysis. Clin Psychol Rev 102:102284, 2023. doi: 10.1016/j.cpr.2023.102284

Etiology of Antisocial Personality Disorder

Both genetic and environmental factors (eg, abuse during childhood Overview of Child Maltreatment Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (eg, clergy, coach, teacher) that results... read more Overview of Child Maltreatment ) contribute to the development of antisocial personality disorder. A possible mechanism is impulsive rather than planned aggression, related to abnormal serotonin transporter functioning. Disregard for the pain of others during early childhood has been linked to antisocial behavior during late adolescence.

Antisocial personality disorder is more common among 1st-degree relatives of patients with the disorder than among the general population (1 Etiology references Antisocial personality disorder is characterized by a pervasive pattern of disregard for consequences and for the rights of others. Diagnosis is by clinical criteria. Treatment may include cognitive-behavioral... read more ). Risk of developing this disorder is increased in both adopted and biologic children of parents with the disorder.

Etiology references

  • 1. Polderman TJC, Benyamin B, de Leeuw CA, et al: Meta-analysis of the heritability of human traits based on fifty years of twin studies. Nat Genet 47(7):702-709, 2015. doi: 10.1038/ng.3285

  • 2. Storebø OJ, Simonsen EJ: The association between ADHD and antisocial personality disorder (ASPD): A review. Atten Disord: 20(10):815-24, 2016. doi: 10.1177/1087054713512150

  • 3. Reti IM, Samuels JF, Eaton WW, et al: Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection. Acta Psychiatr Scand 106(2):126-133, 2002. doi: 10.1034/j.1600-0447.2002.02305.x

Symptoms and Signs of Antisocial Personality Disorder

Patients 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 (eg, money, power, sex). They may use an alias.

These patients are impulsive; they do not plan ahead or consider the consequences for or the safety of self or others. As a result, they may suddenly change jobs, homes, or relationships. They may speed and drive while intoxicated, sometimes leading to crashes. They may consume excessive amounts of alcohol or take illicit drugs.

Patients with antisocial personality disorder are socially and financially irresponsible. They may change jobs with no plan for getting another. They may not seek employment when opportunities are available. They may not pay their bills, default on loans, or not pay child support.

These patients are often easily provoked and physically aggressive; they may start fights or abuse their spouse or partner. In sexual relationships, they may be irresponsible and exploit their partner and be unable to remain monogamous.

Remorse for actions is lacking. Patients with antisocial personality disorder may rationalize their actions by blaming those they hurt (eg, they deserved it) or the way life is (eg, unfair). They are determined not to be pushed around and to do what they think is best for themselves at any cost.

These patients lack empathy for others and may be contemptuous of or indifferent to the feelings, rights, and suffering of others.

Patients with antisocial personality disorder may be very opinionated, self-assured, or arrogant. They may be charming, voluble, and verbally facile in their efforts to get what they want.

Diagnosis of Antisocial Personality Disorder

  • Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision, (DSM-5-TR) criteria

  • A persistent disregard for the rights of others

This disregard is shown by the presence of 3 of the following:

  • Disregarding the law, indicated by repeatedly committing acts that are grounds for arrest

  • Being deceitful, indicated by lying repeatedly, using aliases, or conning others for personal gain or pleasure

  • Acting impulsively or not planning ahead

  • Being easily provoked or aggressive, indicated by constantly getting into physical fights or assaulting others

  • Recklessly disregarding their safety or the safety of others

  • Consistently acting irresponsibly, indicated by quitting a job with no plans for another one or not paying bills

  • Not feeling remorse, indicated by indifference to or rationalization of hurting or mistreating others

Also, patients must have evidence that a conduct disorder has been present before age 15 years. Antisocial personality disorder is diagnosed only in people 18 years.

Differential diagnosis

Antisocial personality disorder should be distinguished from the following:

Diagnosis reference

  • 1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). Washington, DC, American Psychiatric Association, 2022, pp 748-752.

Treatment of Antisocial Personality Disorder

  • Contingency management

  • Medications in selected cases

Treatment reference

Drugs Mentioned In This Article

Drug Name Select Trade
Eskalith, Eskalith CR, Lithobid
NOTE: This is the Professional Version. CONSUMERS: View Consumer Version
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