Sometimes referred to as 'sociopaths', people with antisocial personality disorder (ASPD) have little regard for others and serve their own self-interests above all else. This disorder can be harmful to the sufferer and others in equal measure and is difficult to treat as people with ASPD rarely believe they have a problem.
- People with ASPD repeatedly antagonize, manipulate and exploit others for their own gain. They have no sense of right and wrong and show no guilt or contrition for the way their actions impact others.
- An individual must be 18 years of age to be diagnosed with ASPD. There must also be evidence of Conduct Disorder (CD) onset before the age of 15.
- People with ASPD are sometimes referred to as sociopaths. ASPD is a medical diagnosis, whereas sociopath is a word commonly used to describe someone with antisocial tendencies.
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What is an antisocial personality disorder?
Antisocial personality disorder (ASPD) is a mental disorder involving inconsiderate, reckless, and often harmful behavior. While it shares similarities with borderline personality disorder and narcissistic personality disorder; ASPD is unique in the lack of conscience sufferers display even when confronted with their actions.
People with ASPD repeatedly antagonize, manipulate and exploit others for their own gain. They have no sense of right and wrong and show no guilt or contrition for the way their actions impact others.
How is an antisocial personality disorder diagnosed?
For diagnosis of ASPD, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) requires a person to show at least three of the following symptoms:
- Disregard for Norms- Repeated violation of laws, leading to arrest
- Deceitfulness – Pattern of lying and fraudulent behavior to achieve their own ends.
- Callousness – Lack of regard for the lives of others and lack of guilt for how their reckless actions affect others. Potentially aggressive or sadistic.
- Hostility – Pattern of excessive anger or irritability. Regularly involved in fights or assaults
- Irresponsibility – Pattern of ignoring financial, work, or social obligations. Failure to deliver on promises and agreements.
- Impulsivity – Acting on the spur of the moment without regard for how their actions might impact the future.
- Risk Taking – Pattern of engaging in unnecessary, dangerous activities without thought of how they could harm themselves or others. A lack of concern for their own limitations and vulnerability.
An individual must be 18 years of age to be diagnosed with ASPD. There must also be evidence of Conduct Disorder (CD) onset before the age of 15.[1]
Additionally, any antisocial behavior must be adjudged to not be the result of another condition, such as schizophrenia, before a diagnosis of ASPD can be substantiated.
Is having ASPD the same as being a sociopath?
People with ASPD are sometimes referred to as sociopaths. ASPD is a medical diagnosis, whereas sociopath is a word commonly used to describe someone with antisocial tendencies.
Is having ASPD the same as being a psychopath?
It is a common misapprehension that ASPD and psychopathy are synonymous. Whilst psychopaths display antisocial traits, such as juvenile criminal behavior and childhood behavioral issues, it is a separate condition from ASPD. Research shows that one-third of people with ASPD meet the criteria for psychopathy.[2]
Warning signs of ASPD
Central tenets of ASPD include a pervasive lack of empathy, a callous indifference to people’s suffering, an inability to differentiate between right and wrong, and a desire to exploit others for their own gain. These can manifest in the following early warning signs:
- A difficulty sustaining long-term relationships.
- Animal cruelty
- Lack of remorse
- Violent behavior
- Frequent criminal behavior
- Alcohol or substance abuse
- Arson
- Bullying others in school
- Stealing
- Lying incessantly for personal gain
- Aggressive behavior toward peers
- Lack of regard for authority in school
- Chronic truancy
Causes of ASPD
The cause of ASPD is unknown. Both genetic factors and environmental factors may influence the development of ASPD.
Genetic factors
There is a pattern of hereditary inheritance of ASPD; genetic factors account for roughly 50% of the cause of ASPD.[3] However, no sole genetic factor is thought to be responsible for ASPD.
Environmental factors
Whilst genetic factors significantly impact the development of ASPD, environmental factors also play an important role. These include prenatal, post-natal, familial, and peer-related factors.[8]
Maternal smoking, substance use, alcohol use, stress, or anxiety can increase the likelihood a child develops conduct issues as they grow older.[8]
Research shows that ASPD is prevalent in people whose families were impoverished and neglectful during their childhood. The trauma experienced by children due to parental conflicts and other forms of maltreatment is strongly linked to the development of conduct issues associated with ASPD.[8]
Studies show that people who have both a genetic predisposition to ASPD and a harmful home environment are more likely to be diagnosed with ASPD than others with just one or the other.[7]
How common is ASPD?
Men are three to five times more likely to be diagnosed with ASPD than females and it is estimated that around 3% of men and 1% of women in the general population have ASPD.[4]
Is ASPD dangerous?
There are numerous complications associated with living with ASPD, many of which prove dangerous to both the sufferer and others.
ASPD often occurs alongside other conditions. Evidence shows that individuals with ASPD are four times more likely to experience a mood disorder, 13 times more likely to have a substance use disorder, and nine times more likely to attempt suicide.[5]
People with ASPD are at greater risk of incarceration due to their hostile, deceitful behavior and lack of regard for other people's wellbeing.[4] Hospitalization is not encouraged, as not only is this unbeneficial to treating the condition, people with ASPD can unsettle patients seeking therapeutic relief for other ailments.[4] Studies show that 40-70% of prison populations are diagnosed with ASPD compared with 1-3% of the general population.[3]
People with ASPD are more prone to contracting STDs and viral diseases associated with high-risk behavior, e.g., Hepatitis C and HIV.[4] ASPD also increases the likelihood of coronary heart disease, liver disease, gastrointestinal disease, and arthritis.[5]
Additionally, the death rate due to accidents, homicides, and suicides is higher among people with ASPD.[4] If you or anyone you know has exhibited suicidal behavior or actions, it is recommended to call one of the following hotlines:
- The Crisis Text Line Text HOME to 741741
- The National Suicide Lifeline: 988
- The National Suicide Prevention Lifeline for people who are deaf or hard of hearing: For TTY users, dial 711 then 988.
If you are a caregiver of someone with ASPD, ensure you have a support network in place in case you feel your safety is compromised. This can be a physician, a mental health professional, or a trusted family member. You will not be able to change their behavior but you can do your best to keep yourself protected.
Is ASPD treatable?
ASPD is a challenging condition to manage and treat. This is, in part, due to people with ASPD rarely showing the inclination to pursue treatment of their own volition.
Research indicates that initiating treatment in children diagnosed with conduct disorder s the most efficient and cost-effective way of treating ASPD.[4]
Pharmacological treatment
No pharmacological treatment has proved successful in wholly remedying APSD, but medications can help treat some of the symptoms that accompany it.[4] For example, antipsychotics such as risperidone can be used to treat the aggression that is characteristic of APSD.[4] Other medications that may be prescribed include antidepressants, mood stabilizers, and beta blockers.
Consult a medical professional before embarking on any course of pharmacological treatment.
Psychotherapy
Cognitive behavioral therapy (CBT) is the frontline therapeutic treatment for ASPD, with goal-orientated procedures used to remedy negative behaviors.[6] Patients are encouraged to question the rationality of their violent or negative thought processes, and eventually, replace them with healthier ones.
Other forms of psychotherapy, including schema-based therapy, group, and family therapy have shown promise in the treatment of ASPD.
