Antisocial Personality Disorder
Antisocial personality disorder, sometimes called sociopathy, is a mental health condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. People with antisocial personality disorder tend to purposely make others angry or upset and manipulate or treat others harshly or with cruel indifference. They lack remorse or do not regret their behavior.
People with antisocial personality disorder often violate the law, becoming criminals. They may lie, behave violently or impulsively, and have problems with drug and alcohol use. They have difficulty consistently meeting responsibilities related to family, work or school.
Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It’s the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood. It’s likely shaped by inherited genes as well as life situations and experiences.
The exact cause of antisocial personality disorder isn’t known, but:
- Genes may make you vulnerable to developing antisocial personality disorder — and life situations, especially neglect and abuse, may trigger its development.
- Changes in the way the brain functions may have resulted during brain development.
Symptoms of antisocial personality disorder include repeatedly:
- Ignoring right and wrong.
- Telling lies to take advantage of others.
- Not being sensitive to or respectful of others.
- Using charm or wit to manipulate others for personal gain or pleasure.
- Having a sense of superiority and being extremely opinionated.
- Having problems with the law, including criminal behavior.
- Being hostile, aggressive, violent or threatening to others.
- Feeling no guilt about harming others.
- Doing dangerous things with no regard for the safety of self or others.
- Being irresponsible and failing to fulfill work or financial responsibilities.
Adults with antisocial personality disorder usually show symptoms of conduct disorder before the age of 15. Symptoms of conduct disorder include serious, ongoing behavior problems, such as:
- Aggression toward people and animals.
- Destruction of property.
- Lying and dishonesty.
- Theft.
- Serious violation of rules.
Antisocial personality disorder is considered a lifelong condition. But in some people, certain symptoms ― particularly destructive and criminal behavior ― may decrease over time. It’s not clear whether this decrease is a result of the effect aging has on their mind and body, an increased awareness of the impact that antisocial behavior has had on their life, or other factors.
People with antisocial personality disorder are not likely to seek help on their own. If you suspect that a friend or family member may have the condition, you might gently suggest that the person seek help from a mental health provider and offer to help them find one.
Certain factors seem to increase the risk of developing antisocial personality disorder, such as:
- Diagnosis of childhood conduct disorder.
- Family history of antisocial personality disorder or other personality disorders or mental health conditions.
- Experiencing abuse or neglect during childhood.
- Unstable or violent family life during childhood.
Men are at greater risk of having antisocial personality disorder than women are.
Complications and problems resulting from antisocial personality disorder may include:
- Spouse abuse or child abuse or neglect.
- Problems with alcohol or drugs.
- Being in jail or prison.
- Attempting suicide or trying to kill someone else.
- Having other mental health conditions such as depression or anxiety.
- Financial, educational or social problems.
- Dying early, usually because of violence.
There’s no sure way to prevent antisocial personality disorder from developing in those at risk. Because antisocial behavior is thought to have its roots in childhood, parents, teachers and pediatricians may be able to see early warning signs. It may help to try to identify those most at risk, such as children who show signs of conduct disorder, and then offer early intervention.
People with antisocial personality disorder are not likely to believe they need help. But they may seek help from their primary health care provider because of other symptoms such as depression, anxiety or angry outbursts. Or they may seek treatment for problems with alcohol or drug use.
People with antisocial personality disorder may not give an accurate description of their symptoms. A key factor in diagnosis is how the person relates to others. With permission, family and friends may be able to give helpful information.
After a medical exam to help rule out other medical conditions, the health care provider may make a referral to a mental health provider with experience in diagnosing and treating antisocial personality disorder.
Diagnosis of antisocial personality disorder is usually based on:
- A mental health exam that includes talking about thoughts, feelings, relationships, behavior patterns and family history.
- Symptoms.
- Personal and medical history.
Antisocial personality disorder usually isn’t diagnosed before age 18. But some symptoms may occur in childhood or the early teen years.
Identifying antisocial personality disorder early may help improve long-term outcomes.
Antisocial personality disorder is challenging to treat, but for some people, treatment and close follow-up over the long term may help. Look for medical and mental health providers with experience in treating antisocial personality disorder.
Treatment depends on each person’s situation, their willingness to participate in treatment and the severity of their symptoms.
Talk therapy
Talk therapy, also called psychotherapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for problems with alcohol or drugs, and treatment for other mental health conditions.
But talk therapy is not always effective, especially if symptoms are severe and the person can’t admit that they contribute to serious problems.
Medications
There are no medicines specifically approved by the Food and Drug Administration (FDA) to treat antisocial personality disorder. Health care providers may prescribe medicines for conditions that sometimes occur along with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression.
References
- Antisocial personality disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5-TR. 5th ed. American Psychiatric Association; 2022. https://dsm.psychiatryonline.org. Accessed Jan. 4, 2023.
- Bateman AW. Mentalizing and group psychotherapy: A novel treatment for antisocial personality disorder. The American Journal of Psychotherapy. 2022; doi:10.1176/appi.psychotherapy.20210023.
- Defoe IN, et al. Cascades from early adolescent impulsivity to late adolescent antisocial personality disorder and alcohol use disorder. Journal of Adolescent Health. 2022; doi:10.1016/j.jadohealth.2022.06.007.
- Antisocial personality disorder (ASPD). Merck Manual Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/antisocial-personality-disorder-aspd. Accessed Jan. 5, 2023.
- DeLisi M, et al. The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology. Comprehensive Psychiatry. 2019; doi:10.1016/j.comppsychh.2019.04.001.
- Kliegman RM, et al., eds. Disruptive, impulse-control, and conduct disorders. In: Nelson Textbook of Pediatrics. 21st ed. Elsevier; 2020. https://www.clinicalkey.com. Accessed Jan. 5, 2023.
- Antisocial personality disorder. MentalHealth.gov. https://www.mentalhealth.gov/what-to-look-for/personality-disorders/antisocial-personality-disorder. Accessed Jan. 5, 2023.
- What are personality disorders? American Psychiatric Association. https://www.psychiatry.org/patients-families/personality-disorders/what-are-personality-disorders. Accessed Jan. 5, 2023.
- Junewicz A, et al. Preempting the development of antisocial behavior and psychopathic traits. Journal of the American Academy of Psychiatry and the Law. 2021; doi:10.29158/JAAPL.200060-20.
- Gibbon S, et al. Psychological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews. 2020; doi:10.1002/14651858.CD007668.pub3.
- Black DW. Treatment of antisocial personality disorder. https://www.uptodate.com/contents/search. Accessed Jan. 6, 2021.
- Medical review (expert opinion). Mayo Clinic. Jan. 12, 2023.
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