Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is a mental health condition that affects how a person thinks, behaves, perceives things, and relates with others. The condition causes prolonged patterns of exploitation, manipulation, insensitivity, and violation of other people’s rights. Similar to other personality disorders, ASPD is pervasive. However, the severity of symptoms can range from mild lack of consideration for others to committing serious crimes.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) groups personality disorders into four categories: cluster A, cluster B, cluster C, and other personality disorders. ASPD belongs to cluster B personality disorders, which are characterized by constantly changing dramatic and emotional behaviors or thoughts.

An estimated 0.6% to 3.6% of adults live with ASPD, and it appears to be more common in people assigned male at birth than those assigned female at birth. While this condition can be challenging, the right support and treatment can help manage symptoms over time.

Antisocial Personality Disorder Symptoms

Antisocial personality disorder causes several pervasive symptoms that can start in childhood or early adolescence and last throughout life. The most common symptoms include:

• Inability to show care or concern when others are in distress
• Lack of remorse or regret for one’s actions
• Repeated breaking of the law
• Irresponsible and reckless behaviors that conflict with social norms
• Disregard for the safety of oneself or others
• Substance use
• Ability to act witty and charming but still exploit others
• Constantly engaging in fighting, lying, and stealing behaviors
• Tendency to flatter others and manipulate their emotions

These behaviors affect various spheres of life, often causing profound impairments in a person’s interpersonal relationships, career, daily functioning, and overall quality of life. 

Causes

The exact reason why some people develop antisocial personality disorder is not yet known. However, researchers and health experts do know that a combination of the following risk factors may play a role:

• Genetics: Some research estimates that 20% of people with ASPD have an immediate relative who also lives with the condition.
• Upbringing: Having a history of trauma, abuse, neglect, and poor parenting can increase the risk of ASPD.
• Medical conditions: Traumatic brain injuries, endocrine disorders, and brain tumors are all associated with a higher risk of this personality disorder.
  
• History of mental health conditions: Conduct disorder (a condition that causes aggressive and antisocial behaviors) occurs in children and teenagers, which can sometimes develop into ASPD as a person gets older.

Diagnosis

If you or a loved one are experiencing symptoms or traits of antisocial personality disorder, getting a diagnosis can help manage symptoms and improve quality of life. That said, many people with personality disorders don't opt to receive medical or psychiatric care for their condition—so it's normal to see some hesitancy to visit a provider if your loved one may have a personality disorder.

However, if your loved one (or you yourself) are willing to seek care, meeting with a primary care provider or mental health specialist is a good start. It's worth noting that providers only diagnose antisocial personality disorder in adulthood (people who are 18 years old or older). However, many people exhibit some of the signs earlier in life and may have been diagnosed with conduct disorder in their adolescence or childhood. 

During the diagnostic process, your provider will perform a psychological evaluation to learn more about your symptoms, traits, moods, and behaviors. In some cases, your provider may also interview your loved ones to inquire about your personality. Your provider can only give you a diagnosis if you are 18 years old (or older) and show three or more of the following symptoms:

1. Deceitfulness, such as lying and tricking others
2. Repeatedly breaking the law
3. Impulsivity or failure to make plans
4. Aggression and irritability
5. Constant irresponsible actions
6. Reckless regard for personal and others' safety
7. Indifference and lack of remorse

Antisocial Personality Disorder Treatment

Receiving a diagnosis for a personality disorder can feel overwhelming—and it's fine to feel however you feel. ASPD can sometimes be challenging to treat. That's because the condition often co-occurs with (or, happens at the same time as) other mental health conditions like anxiety or bipolar disorder. Some people with the condition also believe that there is nothing wrong with them or their behaviors and tend not to seek medical treatment on their own.

However, treatment can help significantly reduce symptoms. Everyone's treatment plan looks slightly different, but your healthcare team will likely suggest therapy, medications, or a combination.

Psychotherapy

Also called talk therapy, psychotherapy involves various techniques that mental health providers use to restructure harmful thoughts, behaviors, and emotions. The most common therapy options for people with antisocial personality disorder are:

• Cognitive behavioral therapy (CBT): A form of psychotherapy (talk therapy) that focuses on identifying and shifting unhelpful thought patterns and behaviors
• Social skills training (SST): A form of behavioral therapy that focuses on improving social skills
• Mentalization-based therapy (MBT): A form of psychotherapy that focuses on the connections between your mental state and behaviors and the mental states of others

Sometimes, healthcare providers also recommend group therapy (doing therapy sessions with other people with ASPD) or family therapy (adding loved ones to your therapy sessions) to help people with ASPD feel more support during their treatment journey.

Medications

Currently, no medication has been approved for specifically treating personality disorders. However, some health experts may recommend medications that help offset specific symptoms of ASPD, such as irritability, anger, depression, and anxiety.

If your healthcare provider thinks that medication may be an appropriate option for you, you may receive one of the following medication options:

• Antipsychotic medications, such as Risperdal (risperidone)
• Mood stabilizers, such as Tegretol (carbamazepine)
• Antidepressants, such as Desyrel (tradozone)
  

Prevention

There is no way to prevent any personality disorder. However, researchers are actively studying whether prevention strategies exist to lower or eliminate the risk of developing a personality disorder.

One evidence-based study indicates that treatment or early intervention directed at children with antisocial behaviors and character traits may improve academic performance and prevent the development of antisocial personality in adolescence.

Another study suggests that treating impulsivity in early adolescence may help prevent the development of antisocial personality disorder later in life.

Complications

Antisocial personality disorder can be a difficult condition to live with and manage—especially because it raises the risk of other complications. If ASPD is left untreated, the condition can also increase the risk of:

• Substance use disorders
• Physical traumas or accidents due to reckless behaviors
• Sexually transmitted infections (STIs)
  
• Hepatitis C infection resulting from intravenous substance use
• Suicidal thoughts or attempts

Living with ASPD

Living with antisocial personality disorder can be incredibly challenging, both for the people diagnosed and their loved ones. However, evidence suggests that up to 31% of people with ASPD experience a significant improvement in symptoms with treatment. It may also be encouraging to know that ASPD generally improves as you get older.

If you have received a diagnosis of ASPD, your healthcare provider will work with you to give you the best treatment tailored to your specific needs. Additionally, they may also recommend some management strategies that can help you live with your condition in a more effective way. For example:

• Acknowledge that you need care and support
• Work with your healthcare team, family, and loved ones to improve your mental health
• Ensure that you follow your treatment plan as directed by your healthcare provider
• Practice self-care
• Limit alcohol and drug use
• Be patient with your treatment plan and not being too hard on yourself during your journey

Additionally, working with a healthcare provider you are comfortable with matters—and you deserve to receive treatment in a safe and supportive environment. That said, if you don't feel supported by your provider, it's absolutely OK to shop around for a provider that may benefit you and your overall needs.