Antisocial Personality Disorder
Antisocial personality disorder (ASPD) is marked by a lack of interest in or concern with the rights of others, or with societal standards in general. It leads to a wide variety of manipulative, self-interested, and antisocial behavior, causing conflicts in relationships and, quite often, a slew of legal problems. Personality disorders like ASDP are difficult to treat, but with diligent effort its worst tendencies can be managed and its most destructive effects neutralized.
What Is Antisocial Personality Disorder?
Men and women with antisocial personality disorder (ASPD) exhibit an alarming and pervasive indifference toward the rights, feelings, and concerns of other people. They prioritize their own interests and can be deceitful and manipulative in pursuit of their goals and ambitions. They are impulsive and careless and friends or family members are often the ones who pay the price for their reckless behavior.
Despite some overlap in symptoms and behavior, people with antisocial personality disorder are not automatically classified as sociopaths or psychopaths. They may be capable of showing compassion and empathy and do have a certain amount of emotional depth, which they can demonstrate under the right circumstances.
Nevertheless, antisocial personality disorder leads to chronic egocentric behavior. Those who have it are always inclined to put themselves first and will feel no shame or remorse about using others to get what they want. Their relationships tend to be fleeting and unfulfilling as a result of their self-centeredness and irresponsibility, and they often end up friendless and isolated.
Given the conflicts it creates with societal norms, it is not surprising that antisocial personality disorder is associated with high levels of criminal activity. Like other personality disorders it is difficult to treat, but people with ASPD are doomed to loneliness, disappointment, and failure if they don’t make the effort to change, since their behavior is ultimately self-defeating.
Facts and Statistics
In the comprehensive 2001-2002 National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), it was revealed that about 3.6 percent of adults in the United States meet the criteria for antisocial personality disorder. Based on current population estimates, this means that approximately nine million American adults have ASPD.
One of the defining characteristics in ASPD is gender discrepancy—about 75 percent of those who have the disorder are men. ASPD cannot be officially diagnosed until a person reaches the age of 18, but antisocial behavior in such individuals can be expected to occur in childhood and during adolescence.
There is a close association between criminal behavior and antisocial personality disorder. Studies of incarcerated people have pegged the rate of ASPD among prisoners at somewhere between 35 and 70 percent, and inmates who have antisocial personality disorder are far more likely to have been found guilty for crimes of violence.
Symptoms and Diagnosis of Antisocial Personality Disorder
Some of the more common antisocial personality disorder symptoms include:
- Manipulative behavior, the use of charm or flattery for personal gain
- Callousness or indifference toward the suffering of others
- Lack of interest in or understanding of right and wrong
- Constant cynicism about the motives of other people
- Frequent lying, motivated by self-interest
- Chronic irritability, impatience, or hostility
- Impulsiveness, recklessness that endangers themselves and other people
- Shallow and insincere expressions of emotion
- Irresponsibility in personal, financial, and work-related affairs
- Lack of remorse or guilt about the impact of their actions on others
- Being prone to violence, which can sometimes be extreme
- Frequent encounters with the police and the legal system
People with antisocial personality disorder are good at hiding their true motivations when they believe it is in their interest to do so. But over time, and with frequent exposures, eventually others will begin to catch on and come to see these individuals are untrustworthy and unreliable. This is why they are often estranged from their families and why most of their intimate relationships end badly.
Diagnosing Antisocial Personality Disorder
Under standards established in the latest edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), antisocial personality disorder can be diagnosed if the following criteria are matched:
- Significant impairments are experienced in personality functioning, involving:
- Impairments in self-functioning, marked by extreme egocentrism and/or the pursuit of self-gratification
- Impairments in interpersonal functioning, revealed by a persistent lack of empathy and/or an inability to form intimate, mutually satisfying relationships
- Pathological personality traits demonstrated in the domains of:
- Antagonism. Examples may include manipulativeness, deceitfulness, callousness, and/or chronic hostility
- Disinhibition. Examples may include irresponsibility and unnecessary risk-taking
To verify the diagnosis, these impairments and pathological personality traits must be:
- Stable over time and in a variety of situations
- Not traceable entirely to socio-cultural standards or developmental stages of life
- Not explainable as a side effect of drug or alcohol use, or of another medical condition
The person must be at least 18 years old to be diagnosed with antisocial personality disorder. If symptoms manifest at an earlier age, the child or adolescent could be diagnosed with conduct disorder, a related condition that covers persistent antisocial behavior in youth. Up to 40 percent of young people diagnosed with conduct disorder will later be diagnosed with ASDP, and mental health professionals expect those with ASPD to have demonstrated some of the disorder’s distinctive characteristics by the age of 15.
Antisocial Personality Disorder Causes and Risk Factors
The origin of antisocial personality can be traced to a combination of biological and environmental determinants.
The specific risk factors for ASPD include:
- Genetics. Multiple twin, family, and adoption studies have found a significant genetic component in the development of antisocial behavior and personality traits.
- Family history of personality disorders. Genetics are a factor here, but having parents or other caretakers with personality disorders helps create a home environment conducive to the onset of ASPD.
- Childhood exposure to physical, emotional, and sexual abuse, or severe neglect. The self-centered and egocentric attitudes and behaviors of those with ASPD may be a coping mechanism designed to protect the person from future abuse or mistreatment.
- Being diagnosed with conduct disorder as a youth. Conduct disorder is the childhood version of ASPD, although less than half of those with conduct disorder will develop antisocial personality disorder in adulthood.
- Unstable and inconsistent family dynamics during childhood. Those who experience family and home life as hazardous, unreliable, and stressful are prone to a wide range of mental health disorders, including those that distort personality.
- Neurological aberrations. A loss of volume in the frontal lobe, the part of the brain responsible for judgment, problem-solving, and emotional expression, has been observed in people diagnosed with ASPD.
More than 90 percent of people with antisocial personality disorder will have other comorbid mental or behavioral health conditions.
The mental disorders that frequently co-occur with ASPD include:
- Anxiety disorders. In one comprehensive survey, more than 50 percent of people diagnosed with ASPD had at least one co-occurring anxiety disorder at some point in their lifetimes.
- Major depression. Individuals who have co-occurring ASPD and anxiety disorders are much more likely than the general population to develop depression.
- Other personality disorders. People with antisocial personality disorders often show a significant symptomatic overlap with other cluster B personality disorders (borderline, histrionic, and narcissistic) and the association with ASPD and borderline personality disorder.
- Substance use disorders. People with antisocial personality disorder have higher rates of substance use disorders than the general population across all categories of alcohol or drug addiction.
Treatment and Prognosis for Antisocial Personality Disorder
Personality disorders manifest as relatively stable but aberrant pattern of thoughts, emotional reactions, and behaviors. As such, it can be difficult to convince the person who has one that there is a problem, since from their perspective everything they do seems rational and sensible.
Treatment for personality disorder can be complicated, since the motivation and ability to change must both be present—and neither is assured when someone has been diagnosed with antisocial personality disorder.
But where there is awareness there is hope. When a person with ASPD reaches the point where their stress and unhappiness over their life failures become overwhelming, they may be ready to face the truth and accept the assistance of trained mental health professionals at residential treatment centers, who understand the true nature of personality disorders.
Because personality disorders involve fixed patterns of thinking and feeling, therapy for people with any personality disorder, including ASPD, must be practical in its orientation. Cognitive behavioral therapy (CBT), for example, can be effective in showing people with antisocial personality disorder how to control their aggressive and impulsive behavior, and to become more conscious about how their actions affect others.
Individual therapy will form the core of an antisocial personality disorder rehab program, but group and family therapy may be offered as well, along with life skills classes and instruction in holistic healing practices such as yoga, meditation, Tai Chi, or arts and music therapy.
In most instances, people with ASPD who enter inpatient or outpatient rehabilitation programs at mental health treatment centers will do so in part to receive help for other conditions, including anxiety or mood disorders. They may also have a dual diagnosis for antisocial personality disorder and a substance use disorder. When other conditions are present, rehab services will address them simultaneously with the personality disorder, and if medications are prescribed they will be for these conditions only (medications are not prescribed specifically for personality disorders).
Regardless of the therapeutic approach or the nature of the personality disorder treatment plan they choose, people with ASPD can learn to be more reflective and less reactive, and this can help them build more sustainable relationships and find more success in their careers and in their lives in general.
The idea in treatment is to help people with ASPD find more effective ways to manage their thoughts and emotions, and to show them how to interact with others in ways that are mutually rewarding and beneficial. If they are diligent in their approach to recovery, men and women with antisocial personality disorder can overcome the most debilitating and self-destructive effects of their condition, and that can improve the quality of their lives immensely.