Antisocial personality disorder is a mental health condition that is characterized by a pervasive pattern of disregard for consequences and for the rights of others.
People with antisocial personality disorder behave in any way they want to without considering the consequences for themselves or others and without feeling any remorse or guilt.
Doctors diagnose antisocial personality disorder based on symptoms, including disregard for consequences and for the rights of others and use of deceit and/or manipulation to get what they want.
Antisocial personality disorder is difficult to treat, but psychotherapy in which people are rewarded for positive behavioral change, and in some cases, certain medications may help lessen aggression and impulsive behavior.
Personality disorders are mental health conditions that involve long-lasting, pervasive patterns of thinking, perceiving, reacting, and relating that cause the person significant distress and/or impair the person's ability to function.
People with antisocial personality disorder may commit unlawful, deceitful, exploitative, and reckless acts for personal profit or pleasure and without remorse. They may
Justify or rationalize their behavior (for example, they may think that "losers deserved to lose")
Blame the victim for being foolish or helpless
Be indifferent to the exploitative and harmful effects of their actions on others
Callously disregard the rights and feelings of others and the law
Estimates of how common antisocial personality disorder is vary between 2 to 6% of people in the United States and the United Kingdom. It is 3 times more common among men than women. The disorder is less common in older age groups, suggesting that people can learn over time to change their behavior.
Other disorders are also often present. These disorders include
An impulse-control disorder
Causes of Antisocial Personality Disorder
Genes and environmental factors (such as adversity during childhood) contribute to the development of antisocial personality disorder.
Antisocial personality disorder is more common among first-degree relatives (parents, siblings, and children) of people with the disorder than among the general population. Risk of developing this disorder is increased in both adopted and biologic children of parents with the disorder.
If children develop conduct disorder and attention-deficit/hyperactivity disorder before they are 10 years old, they are more likely to develop antisocial personality disorder as adults. Conduct disorder involves a repetitive pattern of behavior that violates the basic rights of others and/or age-appropriate societal norms. Conduct disorder may be more likely to develop into antisocial personality disorder when parents abuse or neglect the child or are inconsistent in discipline or in parenting style (for example, switching from being warm and supportive to being cold and critical).
Disregard for the pain of others during early childhood has been linked to antisocial behavior during late adolescence.
Symptoms of Antisocial Personality Disorder
Disregard for others
People 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—whether it be money, power, sex, or personal gratification. They may use an alias to accomplish their goals.
People with this disorder do not often feel remorse or guilt for what they have done. They may rationalize their actions by blaming those they hurt (for example, by thinking they deserved it) or the way life is (for example, by thinking that it is unfair). They are determined not to be pushed around and to do what they think is best for themselves at any cost; this attitude may stem from pervasive mistrust of others.
People with antisocial personality disorder lack empathy for others and may be contemptuous of or indifferent to the feelings, rights, and suffering of others.
Impulsive behavior (impulsivity)
People with antisocial personality disorder are generally impulsive. They have difficulty planning ahead and considering the consequences for themselves or others. As a result, they may do the following:
Suddenly change homes, or relationships, or jobs (with no plan for getting another)
Drive too fast and/or drive while intoxicated, sometimes leading to motor vehicle accidents
Consume excessive amounts of alcohol or take illicit drugs
Commit criminal acts
People with antisocial personality disorder are often easily provoked and physically aggressive because they have problems controlling their impulses and do not appreciate the effect of their actions on others.
They have a shorter life expectancy than the general population.
Irresponsibility
People with antisocial personality disorder are often socially and financially irresponsible. As a result, they may do the following:
Not seek employment when opportunities are available
Not pay their bills or default on loans
Not pay child support
Other symptoms
These people may be very opinionated, self-assured, or arrogant. They may be charming, persuasive, and convincing in their efforts to get what they want.
Diagnosis of Antisocial Personality Disorder
A doctor's evaluation, based on standard psychiatric diagnostic criteria
Doctors usually diagnose personality disorders based on criteria in the Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR), the standard reference for psychiatric diagnosis from the American Psychiatric Association.
For doctors to diagnose antisocial personality disorder, people must persistently disregard the rights of others, as shown by at least 3 of the following:
They disregard the law, shown by repeatedly committing acts that are grounds for arrest.
They are deceitful, shown by lying repeatedly, using aliases, or conning others for personal gain or pleasure.
They act impulsively and do not plan ahead.
They are easily provoked or aggressive, shown by constantly getting into physical fights or assaulting others.
They recklessly disregard their safety and/or the safety of others.
They consistently act irresponsibly, shown by quitting a job with no plans for another one or not paying bills.
They do not feel remorse, shown by indifference to or rationalization of hurting or mistreating others.
Antisocial personality disorder is diagnosed only in people aged 18 years or older.
Treatment of Antisocial Personality Disorder
Contingency management
Medications in some cases
Antisocial personality disorder is very difficult to treat. There is no evidence that any particular treatment results in long-term improvement. Thus, doctors focus on some more immediate goal, such as avoiding harm to others and illegal behaviors. However, identifying and treating children with conduct disorder as early as possible may help lessen the social problems caused by antisocial personality disorder.
Contingency management is a type of behavioral therapy in which the person is rewarded for positive behavioral changes.
If aggression and impulsiveness are problems, people may benefit from medications used to stabilize mood (such as and antiseizure medications) or certain antidepressants called selective serotonin reuptake inhibitors (SSRIs).
Some types of psychotherapy should not be used for people with antisocial personality disorder. For example, cognitive-behavioral therapy (a type of therapy that focuses on identifying and changing the destructive thought patterns that influence behavior and emotion) should be avoided because it is likely to be ineffective, and in some cases, may be harmful.
