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Personality disorders are mental health conditions that affect how someone thinks, perceives, feels or relates to others. Antisocial personality disorder is a particularly challenging type of personality disorder characterised by impulsive, irresponsible and often criminal behaviour. Someone with antisocial personality disorder will typically be manipulative, deceitful and reckless, and will not care for other people's feelings. Like other types of personality disorder, antisocial personality disorder is on a spectrum, which means it can range in severity from occasional bad behaviour to repeatedly breaking the law and committing serious crimes. Psychopaths are considered to have a severe form of antisocial personality disorder. The Mind website has more information about signs of antisocial personality disorder Find out more about personality disorders A person with antisocial personality disorder may:
A person with antisocial personality disorder will have a history of conduct disorder during childhood, such as truancy (not going to school), delinquency (for example, committing crimes or substance misuse), and other disruptive and aggressive behaviours. Antisocial personality disorder affects more men than women. It's not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences, such as child abuse or neglect, are thought to play a role. A person with antisocial personality disorder will have often grown up in difficult family circumstances. One or both parents may misuse alcohol, and parental conflict and harsh, inconsistent parenting are common. As a result of these problems, social services may become involved with the child's care. These types of difficulties in childhood will often lead to behavioural problems during adolescence and adulthood. Criminal behaviour is a key feature of antisocial personality disorder, and there's a high risk that someone with the disorder will commit crimes and be imprisoned at some point in their life. Men with antisocial personality disorder have been found to be 3 to 5 times more likely than women to misuse alcohol and drugs than those without the disorder. They also have an increased risk of dying prematurely as a result of reckless behaviour or attempting suicide. People with antisocial personality disorder are also more likely to have relationship problems during adulthood and be unemployed and homeless. To be diagnosed with antisocial personality disorder, a person will usually have a history of conduct personality disorder before the age of 15. Antisocial personality disorder is diagnosed after rigorous detailed psychological assessment. A diagnosis can only be made if the person is aged 18 years or older and at least 3 of the following criteria behaviours apply:
These signs are not part of a schizophrenic or manic episode – they're part of a person's everyday personality and behaviour. This behaviour usually becomes most extreme and challenging during the late teens and early 20s. It may improve by the time the person reaches their 40s. In the past, antisocial personality disorder was thought to be a lifelong disorder, but that's not always the case and it can sometimes be managed and treated. Evidence suggests behaviour can improve over time with therapy, even if core characteristics such as lack of empathy remain. But antisocial personality disorder is one of the most difficult types of personality disorders to treat. A person with antisocial personality disorder may also be reluctant to seek treatment and may only start therapy when ordered to do so by a court. The recommended treatment for someone with antisocial personality disorder will depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug misuse. The person's family and friends will often play an active role in making decisions about their treatment and care. Sometimes, substance misuse services and social care may also need to be involved. National Institute for Health and Care Excellence (NICE): management and prevention of antisocial personality disorder Talking therapiesCognitive behavioural therapy (CBT) is sometimes used to treat antisocial personality disorder. It's a talking therapy that aims to help a person manage their problems by changing the way they think and behave. Mentalisation-based therapy (MBT) is another type of talking therapy that's becoming more popular in the treatment of antisocial personality disorder. The therapist will encourage the person to consider the way they think and how their mental state affects their behaviour. Democratic therapeutic communities (DTC)Evidence suggests community-based programmes can be an effective long-term treatment method for people with antisocial personality disorder, and is becoming increasingly popular in prisons. DTC is a type of social therapy that aims to address the person's risk of offending, as well as their emotional and psychological needs. It's based around large and small therapy groups and focuses on community issues, creating an environment where both staff and prisoners contribute to the decisions of the community. There may also be opportunities for educational and vocational work. The recommended length of treatment is 18 months, as there needs to be enough time for a person to make changes and put new skills into practice. Self-motivation is another important factor for acceptance on to this type of scheme. For example, the person must be willing to work as part of a community, participate in groups, and be subject to the democratic process. Read more about DTC and working with offenders with personality disorder on GOV.UK MedicineThere's little evidence to support the use of medicine for treating antisocial personality disorder, but certain antipsychotic and antidepressant medicines may be helpful in some instances. Carbamazepine and lithium may help control symptoms such as aggression and impulsive behaviour, and a class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may improve anger and general personality disorder symptoms. Further informationAntisocial personality disorder (ASPD) is a mental health condition. People with ASPD show a lack of respect toward others. They don’t follow socially accepted norms or rules. People with ASPD may break the law or cause physical or emotional harm to the people around them. They may disregard consequences or refuse to take responsibility for their actions. ASPD is one of many personality disorders. Personality disorders affect the way someone thinks or behaves. How common is antisocial personality disorder (ASPD)?Research suggests that ASPD affects about 1% to 4% of people in the U.S. Is having antisocial personality disorder (ASPD) the same as being a sociopath?Sometimes the terms “sociopath” or “sociopathy” get used to describe ASPD. Healthcare providers don’t use these terms as clinical diagnoses. But traits of ASPD and sociopathy overlap, including a general lack of conscience. There is no single cause of ASPD, but the following factors may increase a person’s risk of developing the disorder:
At what age does antisocial personality disorder (ASPD) develop?Traits of ASPD usually develop during late childhood or the early teen years. Before age 18, the condition gets diagnosed as conduct disorder. Children with conduct disorder may lie, steal, ignore rules or bully other children. Sometimes parents or healthcare providers miss the signs of conduct disorder. The signs may overlap with other conditions like attention-deficit/hyperactivity disorder (ADHD), depression or oppositional defiant disorder. When children get diagnosed and treated early, the condition may not continue into adulthood. If the behavior does continue, the diagnosis becomes antisocial personality disorder at age 18. What are the signs and symptoms of antisocial personality disorder (ASPD)?People with antisocial personality disorder may:
There is no blood test or imaging exam that can diagnose ASPD. A healthcare provider will consider your health history, perform a physical exam and assess your symptoms. You may see a healthcare provider who specializes in mental health disorders. A psychiatrist or psychologist evaluates your behavior. They look for patterns of:
What is a differential diagnosis?A differential diagnosis means distinguishing between several health conditions with similar symptoms. Certain disorders may mimic ASPD, so it’s important for your healthcare provider to make the right diagnosis. These disorders include: There is no set treatment for ASPD. Therapies such as medication or psychotherapy may help control specific behaviors, though. Studies suggest that symptoms of ASPD are worst around ages 24 to 44, then tend to improve after age 45. Are there medications for antisocial personality disorder (ASPD)?Medication generally only helps people with aggression, depression or erratic moods alongside ASPD. Your healthcare provider may recommend: How can psychotherapy help antisocial personality disorder (ASPD)?Cognitive behavioral therapy is a type of counseling that focuses on changing a person’s thinking and behavior. Therapy for ASPD may help people think about how their behavior affects others. Someone with ASPD may benefit from individual therapy, group therapy or family therapy. There isn’t a way to prevent ASPD. But if conduct disorder gets caught early in childhood, therapy may prevent the development of ASPD in adulthood. There is no cure for antisocial personality disorder. People generally manage the condition throughout their lives. But medication and therapy can help you cope with certain aspects of the disorder. The right treatment may help you adjust your behavior and reduce harm to those around you. Maintaining healthy relationships and a support system are key factors in managing ASPD long term. If you or someone you know has any of the following symptoms, seek medical attention right away:
You can call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a network of local crisis centers that provide free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. In an emergency, call 911. A note from Cleveland Clinic ASPD causes people to act without thinking how they're affecting others. Someone with ASPD may break rules or laws. They often show no remorse and take no responsibility. Psychotherapy and certain medications may help people with ASPD. With treatment, they may be able to control their thoughts and behavior. Healthcare providers, such as psychiatrists and psychologists, do thorough assessments to diagnose ASPD. They can recommend the right treatment plan. Last reviewed by a Cleveland Clinic medical professional on 05/12/2021. References
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