Antisocial personality disorder is characterized by a long-standing pattern
of a disregard for other people’s rights, often crossing the line and violating
those rights. It usually begins in childhood or as a teen and continues into
their adult lives.
Antisocial personality disorder is often referred to as psychopathy or
sociopathy in popular culture. However, neither psychopathy nor sociopathy are
recognized professional labels used for diagnosis.
Individuals with Antisocial Personality Disorder frequently lack empathy and
tend to be callous, cynical, and contemptuous of the feelings, rights, and
sufferings of others. They may have an inflated and arrogant self-appraisal
(e.g., feel that ordinary work is beneath them or lack a realistic concern
about their current problems or their future) and may be excessively
opinionated, self-assured, or cocky. They may display a glib, superficial charm
and can be quite voluble and verbally facile (e.g., using technical terms or jargon
that might impress someone who is unfamiliar with the topic).
Lack of empathy, inflated self-appraisal, and superficial charm are features
that have been commonly included in traditional conceptions of psychopathy and
may be particularly distinguishing of Antisocial Personality Disorder in prison
or forensic settings where criminal, delinquent, or aggressive acts are likely
to be nonspecific. These individuals may also be irresponsible and exploitative
in their sexual relationships.
A personality disorder is an enduring pattern of inner experience and
behavior that deviates from the norm of the individual’s culture. The pattern
is seen in two or more of the following areas: cognition; affect; interpersonal
functioning; or impulse control. The enduring pattern is inflexible and
pervasive across a broad range of personal and social situations. It typically
leads to significant distress or impairment in social, work or other areas of
functioning. The pattern is stable and of long duration, and its onset can be
traced back to early adulthood or adolescence.
Symptoms of Antisocial Personality Disorder
Antisocial personality disorder is diagnosed when a person’s pattern of
antisocial behavior has occurred since age 15 (although only adults 18 years or
older can be diagnosed with this disorder) and consists of the majority of
- Failure to conform to social norms
with respect to lawful behaviors as indicated by repeatedly performing
acts that are grounds for arrest
- Deceitfulness, as
indicated by repeated lying, use of aliases, or conning others for
personal profit or pleasure
- Impulsivity or failure to
- Irritability and aggressiveness,
as indicated by repeated physical fights or assaults
- Reckless disregard for
safety of self or others
- Consistent irresponsibility,
as indicated by repeated failure to sustain consistent work behavior or
honor financial obligations
- Lack of remorse, as
indicated by being indifferent to or rationalizing having hurt,
mistreated, or stolen from another
There should also be evidence of Conduct Disorder in the individual as a
child, whether or not it was ever formally diagnosed by a professional.
Because personality disorders describe long-standing and enduring patterns
of behavior, they are most often diagnosed in adulthood. It is uncommon for
them to be diagnosed in childhood or adolescence, because a child or teen is
under constant development, personality changes and maturation. According to
the DSM-5, antisocial personality disorder cannot be diagnosed in people younger
than 18 years old.
Antisocial personality disorder is 70 percent more prevalent in males than
females. The 12-month prevalence rate of this disorder is between 0.2 and 3.3
Like most personality disorders, antisocial personality disorder typically
will decrease in intensity with age, with many people experiencing few of the
most extreme symptoms by the time they are in the 40s or 50s.
How is Antisocial Personality Disorder
Personality disorders such as antisocial personality disorder are typically
diagnosed by a trained mental health professional, such as a psychologist or
psychiatrist. Family physicians and general practitioners are generally not
trained or well-equipped to make this type of psychological diagnosis. So while
you can initially consult a family physician about this problem, they should
refer you to a mental health professional for diagnosis and treatment. There
are no laboratory, blood or genetic tests that are used to diagnose antisocial
Many people with antisocial personality disorder don’t seek out treatment.
People with personality disorders, in general, do not often seek out treatment
until the disorder starts to significantly interfere or otherwise impact a
person’s life. This most often happens when a person’s coping resources are
stretched too thin to deal with stress or other life events.
A diagnosis for antisocial personality disorder is made by a mental health
professional comparing your symptoms and life history with those listed here. They
will make a determination whether your symptoms meet the criteria necessary for
a personality disorder diagnosis.
Causes of Antisocial Personality Disorder
Researchers today don’t know what causes antisocial personality disorder.
There are many theories, however, about the possible causes of antisocial
personality disorder. Most professionals subscribe to a biopsychosocial model
of causation — that is, the causes of are likely due to biological and genetic
factors, social factors (such as how a person interacts in their early
development with their family and friends and other children), and
psychological factors (the individual’s personality and temperament, shaped by
their environment and learned coping skills to deal with stress). This suggests
that no single factor is responsible — rather, it is the complex and likely
intertwined nature of all three factors that are important. If a person has
this personality disorder, research suggests that there is a slightly increased
risk for this disorder to be “passed down” to their children.
Treatment of Antisocial Personality Disorder
As with most personality disorders, individuals with this disorder rarely
seek treatment on their own, without being mandated to therapy by a court or
significant other. Court referrals for assessment and treatment for this
disorder are likely the most common referral source. A careful and thorough
assessment will ensure that the person that the person has antisocial
personality disorder. This can often be confused with simple criminal activity
(all criminals do not have this disorder), adult antisocial behavior, and other
activities which do not justify the personality disorder diagnosis. As with a
thorough assessment of any suspected personality disorder, formal psychological
testing should be considered invaluable.
Because many people who suffer from this disorder will be mandated to
therapy, sometimes in a forensic or jail setting, motivation on the patient's
part may be difficult to find. In a confined setting, it may be nearly
impossible and therapy should then focus on alternative life issues, such as
goals for when they are released from custody, improvement in social or family
relationships, learning new coping skills, etc. In an outpatient setting, the
focus of therapy can also be on these types of issues, but a part of the
therapy should be devoted to discussing the antisocial behavior and feelings
(or lack thereof). Common in the population who suffer from antisocial
personality disorder is the lack of connections between feelings and behaviors.
Helping the client draw those lines between the two may be beneficial.
Threats are never an appropriate motivating factor in any sort of treatment,
and least of all with this disorder. If the only way to motivate the patient is
to threaten to report their noncompliance with therapy to the courts or warden,
it is highly unlikely the clinician will make any type of gains within therapy
anyway. It is appropriate, however, to try and help the individual with this
disorder find good reasons that they may want to work on this problem further.
For instance, ensuring that they not come into contact with the court system
again, be incarcerated, have to submit themselves to additional psychological
Effective psychotherapy treatment for this disorder is limited. It is
likely, though, that intensive, psychoanalytic approaches are inappropriate for
this population. Approaches the reinforce appropriate behaviors and attempting
to make connections between the person's actions and their feelings may be more
beneficial. Emotions are usually a key aspect of treatment of this disorder.
Patients often have had little or no significant emotionally-rewarding
relationships in their lives. The therapeutic relationship, therefore, can be
one of the first ones. This can be very scary for the client, initially, and it
may become intolerable. A close therapeutic relationship can only occur when a
good and solid rapport has been established with the client and he or she can
trust the therapist implicitly.
Trust brings up the issue of confidentiality, since often the patient with
antisocial personality disorder is mandated to therapy. This means that the
clinician may have to occasionally report on the patient's progress in therapy.
While this can usually be done in a very general way which reveals no
significant details of the content of therapy, it is still an important issue
for the client. He or she may be suspicious and distrustful of the clinician at
first, since it will be unclear as to who has the highest priority -- the
patient or the court. This fear can only be alleviated with an honest
disclosure as to what the therapist will reveal to the courts, and with time,
as the client learns that what he says in the therapy session does not become
common knowledge. The limitations of therapy should be discussed with the
patient up-front, in a clear and matter-of-fact manner, so there are no
The content of therapy should focus on the patient's emotions (or lack
thereof). As the individual learns to experience various emotional states, one
of the first may be depression. The client will likely be unfamiliar with the
feelings associated with depression, and so it is beneficial for the clinician
to be supportive and empathetic to the individual during this time. Reinforcing
any emotions, outside of anger or frustration, is usually beneficial.
Experiencing intense affect is usually a sign of progress in therapy. Staying
on "safe issues," and discussing more real-life concerns, while one
way of treating this disorder, is not likely to be as effective in long term
behavioral change as an approach emphasizing the discovery and labeling of
appropriate emotional states.
People who have antisocial personality disorder often experience
difficulties with authority figures. The therapist should usually take a
neutral stance in this matter, since it is a firmly held belief by the client.
The clinician should avoid arguments and taking sides on authority issues and
those who hold authority over the client. Their moral and ethical makeup may
leave a lot to be desired as well. While this may be an appropriate topic for
discussion in therapy, it will also likely be one of little progress. Usually
one of the more effective ways for a person with this disorder to learn to
change their ineffective behaviors is to have to face up to the consequences of
their behavior. This sometimes means dealing with courts and jails, but it can
also eventually be a motivating factor in the client's treatment.
Other modalities of psychotherapy, such as group and family therapy, can be
helpful. Often people with this disorder find themselves in a group setting,
because they aren't given any treatment choices. This is usually not conducive
to their treatment, since in most groups, the individual can remain
emotionally-closed and has little reason to share with others. It also doesn't
help that these groups are often made up of people suffering from a wide range
of mental disorders. Groups which are devoted exclusively to this disorder,
though rare, are the best choice. In such a group, the patient is given a
greater reason to contribute and share with others. Care must be utilized by
group leaders to ensure the group doesn't become a "How-to" course in
criminal behavior. Family therapy can be helpful to increase education and
understanding among family members. Families often misunderstand and are confused
about the cause of the antisocial behaviors and the idea that it is a mental
disorder. Phillip W. Long, M.D. adds, "This confusion, guilt, the
temptation to make restitution for the patient's criminal acts, and the
frustrations of working with someone who is seen to be quite ill but who will
not be treated should all be discussed openly with family members."
While there are many theories, as with all personality disorders, research
has found little significant causative factors.
Rarely is inpatient care appropriate or necessary for this personality
disorder. Like most personality disorders, most people will go through their
lives with little realization of the difficulty they have. In this case,
though, the person is more likely to be seen as a criminal and have a history
of difficulties with the law. Loss of freedom may be more of a motivating
factor than in other personality disorders, so some specialized treatment
facilities have started to treat people with this disorder.
One such program we've read about is the Patuxent Institute, located in
Jessup, Maryland in the U.S. This hospital utilizes a strict behavioral
approach of placing patients on a token economy based upon their treatment
progress. This is a relatively new and radical approach to this sort of
disorder and little research has been conducted to confirm its long-term
As with any treatment, the focus on feelings and connecting antisocial
behavior to appropriate feeling states is appropriate. Since inpatient programs
tend to be more intensive and expensive, they are rarely sought out by the
patient themselves. Community followup and support, either by the hospital or
professionals, or with the use of self-help support groups, is imperative to
maintaining treatment gains.
Medications should only be utilized to treat clear, acute and serious Axis I
concurrent diagnoses. No research has suggested that any medication is
effective in the treatment of this disorder.
Self-help methods for the treatment of this disorder are often overlooked by
the medical profession because very few professionals are involved in them.
Groups can be especially helpful for people with this disorder, if they are
tailored specifically for antisocial personality disorder. Individuals with
this disorder typically feel more at ease in discussing their feelings and
behaviors in front of their peers in this type of supportive modality. Leaders
of such self-help support groups, though, must be wary of individuals who come
to group just to brag about their exploits and who may seek to use the group
inappropriately. Usually a group can be very helpful and beneficial to most
people with this disorder, once they overcome their initial fears and
hesitation to join such a group. Many support groups exist within communities
throughout the world which are devoted to helping individuals with this
disorder share their commons experiences and feelings.