Antisocial Personality Disorder

Antisocial Personality Disorder

Antisocial Personality Disorder

Antisocial personality disorder (ASPD), also referred to as sociopathy or psychopathy, is a personality disorder characterized by pervasive and persistent disregard for morality, social and cultural norms, and the violation of the human rights and feelings of others. Criminal activity and abuse is common.

People with ASPD are unlikely to seek help because they don’t believe they need it.

Prevalence

1% to 4% of the population has ASPD. The male to female ratio is 3:1.

  • 3% to 30% of mental health outpatients have ASPD.
  • About 65% of incarcerated women and 80% of incarcerated men have ASPD.
  • 27% to 60% of alcoholics and drug addicts have ASPD, depending on how many substances they are addicted to.
  • A high number of CEOs of large companies have some ASPD symptoms.

Prevention

The earlier signs of ASPD are noticed —preferably before the teen years — the sooner psychotherapy can begin to address thought patterns, behavior, response to conflict, and problem-solving skills.

Symptoms of Antisocial Personality Disorder:

People with ASPD:

  • Are often impulsive and reckless and frequently fail to consider the consequences of their actions or to consider the safety of others
  • Typically have no remorse or regret in taking advantage of and exploiting other people (often in harmful and cruel ways) for their own gain, satisfaction, and/or pleasure
  • May use manipulation, lying, deceit, intimidation, abuse, and violence to achieve their goals
  • Believe they are superior and are very verbal with their opinions
  • Can be arrogant, callous, and hostile; get very irritated and agitated; have explosive tempers; and have no respect or empathy whatsoever toward their victims

Causes of Antisocial Personality Disorder:

The exact cause of ASPD is unknown; however, genetic history and environmental factors like poverty and family-modeled behaviors have been implicated.

The risks predisposing one to developing ASPD include:


  • Existing child conduct disorder – 25 to 40% will go on to have APSD.
  • Family history of ASPD, mood disorders, or personality disorders
  • A lower production of monoamine oxidase A (MAO-A) and serotonin, and a higher production of testosterone than is normal, making antisocial behavior and aggression more likely
  • Childhood abuse, trauma, head trauma, or neglect
  • Family violence, abuse, substance abuse, lack of affection, and dysfunction
  • Negative peer values and social values

Diagnosing Antisocial Personality Disorder:

Diagnosis is dependent on the individual’s account of symptoms and the accounts of family and friends — because the individual alone is likely to downplay or ignore many of the symptoms.

For a diagnosis of ASPD to be made, a doctor will examine the medical history and do a physical evaluation (to rule out any other conditions). He/she might also give the person a self-assessment questionnaire to examine thoughts, feelings, and behavioral choices.

A diagnosis will be made based on the following criteria:

  • At least 18 years of age
  • A history of conduct disorder before the age of 15
  • Disregard for, and violation of the rights of, others since the age 15, as indicated by one of the seven sub-features:

    1. Failure to abide by laws and norms by engaging in behaviors which result in, or would warrant, criminal arrest
    2. Lying, deception, and manipulation for profit or self-amusement
    3. Impulsivity
    4. Irritability and aggression – frequently assaulting others
    5. A complete lack of consideration for the safety of self and others
    6. A consistent pattern of irresponsibility
    7. Lack of remorse for actions

Women are often misdiagnosed with borderline personality disorder rather than ASPD.

ASPD often coexists with other mood and personality disorders and substance abuse.

Antisocial Personality Disorder complications:

Not all people with ASPD will share the same behaviors, but they can experience one or more of the following complications from having the disorder;

  • Unstable daily life/work – Irresponsibility is a core characteristic of ASPD and, consequently, people with this condition are often unable to maintain stable employment as well as to fulfil their familial, social, and financial duties. Many end up homeless and living in poverty.
  • Dysfunctional relationships – While people with ASPD generally don’t have any problems in establishing relationships — due, in part, to their superficial yet seductive charm and wit — they may have difficulties in sustaining and maintaining them because of weak emotional bonds and attachments as well as their own selfishness, greed, and self-absorbed tendencies. Spousal and child abuse is common.
  • Other mental health disorders – such as a mood disorder
  • Incarceration, often frequent – People with ASPD are obstinate, rebellious, unruly, and defiant. They often flout rules, regulations, and laws, and they can have frequent and extensive involvement with the criminal justice system from an early age. At least 50% of people in prison populations in the UK have a diagnosis of ASPD. Theft, violence, and destruction of property are common, as are gang-related activities.
  • Early death – can compromise their own safety and that of others, which can result in serious harm or fatality, either deliberately or through misadventure.
  • Substance and alcohol abuse – ASPD often coexists with addiction problems such as alcohol and opioid dependence syndromes, and sometimes the person uses multiple drugs regularly such as heroin and cocaine.
  • Suicide – an increased risk of suicidal behavior.
  • Homicide – an increased risk of committing homicide/murder.

There is no “one size fits all” for those with ASPD. Some will be more protective of their reputation and avoid being caught while others will be more reckless. Some will be more responsible and settle into some semblance of following a structured life while others will drift through life. Some will appear to be plain evil while others will adapt but be angry about it.

Treatment of Antisocial Personality Disorder:

ASPD is thought to be one of the toughest personality disorders to treat, but some do improve if they are fully invested in the process, they accept the diagnosis, and symptoms are milder to begin with. People with this condition in the criminal justice system usually receive treatment as part of their imprisonment and rehabilitation.

Psychotherapy, also known as talk therapy, is found to be helpful for people with ASPD. Therapy may include:

  • Behavioral talk therapy – examines triggers of mood swings and behavior and discusses alternative, healthier ways to respond to them. Looks at thinking patterns for truth and ways to respond differently to them.
  • Anger and violence management – teaches relational skills, conflict resolution skills, stress management, and emotional-processing skills.
  • Cognitive therapy –Rational and objective discussion and an examination of all the chosen behaviours can help retrain the brain to think about long-term consequences before decisions are made. The effectiveness of this therapy is limited.

Medication

There are no medications specifically approved by the Food and Drug Administration to treat ASPD, but treatment for substance abuse and depression, aggression, mood swings, or anxiety can help with the overall treatment plan.

Even if there was a medication that reduced the severity of symptoms, it is unlikely someone with ASPD would take it as prescribed; and due to the likelihood of drug abuse, any meds are prescribed with caution.

Coping with Antisocial Personality Disorder:

Studies have shown ASPD symptoms sometimes decline with age, but other than that, living with someone with ASPD can be very difficult.


  • Individual therapy and family therapy – can be very helpful in learning how to set boundaries, communicate clearly, avoid co-dependency and enablement, and utilize self-protective measures.
  • Community support – Ask for a referral to a family support group in your area.
  • Self-care – can help one feel less restricted and more independent. Exercise, healthy eating habits, and time with friends and family provide a much-needed mental break and more energy.
 

Symptoms of Antisocial Personality Disorder:

People with ASPD:

  • Are often impulsive and reckless and frequently fail to consider the consequences of their actions or to consider the safety of others
  • Typically have no remorse or regret in taking advantage of and exploiting other people (often in harmful and cruel ways) for their own gain, satisfaction, and/or pleasure
  • May use manipulation, lying, deceit, intimidation, abuse, and violence to achieve their goals
  • Believe they are superior and are very verbal with their opinions
  • Can be arrogant, callous, and hostile; get very irritated and agitated; have explosive tempers; and have no respect or empathy whatsoever toward their victims
 

Causes of Antisocial Personality Disorder:

The exact cause of ASPD is unknown; however, genetic history and environmental factors like poverty and family-modeled behaviors have been implicated.

The risks predisposing one to developing ASPD include:


  • Existing child conduct disorder – 25 to 40% will go on to have APSD.
  • Family history of ASPD, mood disorders, or personality disorders
  • A lower production of monoamine oxidase A (MAO-A) and serotonin, and a higher production of testosterone than is normal, making antisocial behavior and aggression more likely
  • Childhood abuse, trauma, head trauma, or neglect
  • Family violence, abuse, substance abuse, lack of affection, and dysfunction
  • Negative peer values and social values
 

Diagnosing Antisocial Personality Disorder:

Diagnosis is dependent on the individual’s account of symptoms and the accounts of family and friends — because the individual alone is likely to downplay or ignore many of the symptoms.

For a diagnosis of ASPD to be made, a doctor will examine the medical history and do a physical evaluation (to rule out any other conditions). He/she might also give the person a self-assessment questionnaire to examine thoughts, feelings, and behavioral choices.

A diagnosis will be made based on the following criteria:

  • At least 18 years of age
  • A history of conduct disorder before the age of 15
  • Disregard for, and violation of the rights of, others since the age 15, as indicated by one of the seven sub-features:

    1. Failure to abide by laws and norms by engaging in behaviors which result in, or would warrant, criminal arrest
    2. Lying, deception, and manipulation for profit or self-amusement
    3. Impulsivity
    4. Irritability and aggression – frequently assaulting others
    5. A complete lack of consideration for the safety of self and others
    6. A consistent pattern of irresponsibility
    7. Lack of remorse for actions

Women are often misdiagnosed with borderline personality disorder rather than ASPD.

ASPD often coexists with other mood and personality disorders and substance abuse.

 

Antisocial Personality Disorder complications:

Not all people with ASPD will share the same behaviors, but they can experience one or more of the following complications from having the disorder;

  • Unstable daily life/work – Irresponsibility is a core characteristic of ASPD and, consequently, people with this condition are often unable to maintain stable employment as well as to fulfil their familial, social, and financial duties. Many end up homeless and living in poverty.
  • Dysfunctional relationships – While people with ASPD generally don’t have any problems in establishing relationships — due, in part, to their superficial yet seductive charm and wit — they may have difficulties in sustaining and maintaining them because of weak emotional bonds and attachments as well as their own selfishness, greed, and self-absorbed tendencies. Spousal and child abuse is common.
  • Other mental health disorders – such as a mood disorder
  • Incarceration, often frequent – People with ASPD are obstinate, rebellious, unruly, and defiant. They often flout rules, regulations, and laws, and they can have frequent and extensive involvement with the criminal justice system from an early age. At least 50% of people in prison populations in the UK have a diagnosis of ASPD. Theft, violence, and destruction of property are common, as are gang-related activities.
  • Early death – can compromise their own safety and that of others, which can result in serious harm or fatality, either deliberately or through misadventure.
  • Substance and alcohol abuse – ASPD often coexists with addiction problems such as alcohol and opioid dependence syndromes, and sometimes the person uses multiple drugs regularly such as heroin and cocaine.
  • Suicide – an increased risk of suicidal behavior.
  • Homicide – an increased risk of committing homicide/murder.

There is no “one size fits all” for those with ASPD. Some will be more protective of their reputation and avoid being caught while others will be more reckless. Some will be more responsible and settle into some semblance of following a structured life while others will drift through life. Some will appear to be plain evil while others will adapt but be angry about it.

 

Treatment of Antisocial Personality Disorder:

ASPD is thought to be one of the toughest personality disorders to treat, but some do improve if they are fully invested in the process, they accept the diagnosis, and symptoms are milder to begin with. People with this condition in the criminal justice system usually receive treatment as part of their imprisonment and rehabilitation.

Psychotherapy, also known as talk therapy, is found to be helpful for people with ASPD. Therapy may include:

  • Behavioral talk therapy – examines triggers of mood swings and behavior and discusses alternative, healthier ways to respond to them. Looks at thinking patterns for truth and ways to respond differently to them.
  • Anger and violence management – teaches relational skills, conflict resolution skills, stress management, and emotional-processing skills.
  • Cognitive therapy –Rational and objective discussion and an examination of all the chosen behaviours can help retrain the brain to think about long-term consequences before decisions are made. The effectiveness of this therapy is limited.

Medication

There are no medications specifically approved by the Food and Drug Administration to treat ASPD, but treatment for substance abuse and depression, aggression, mood swings, or anxiety can help with the overall treatment plan.

Even if there was a medication that reduced the severity of symptoms, it is unlikely someone with ASPD would take it as prescribed; and due to the likelihood of drug abuse, any meds are prescribed with caution.

 

Coping with Antisocial Personality Disorder:

Studies have shown ASPD symptoms sometimes decline with age, but other than that, living with someone with ASPD can be very difficult.


  • Individual therapy and family therapy – can be very helpful in learning how to set boundaries, communicate clearly, avoid co-dependency and enablement, and utilize self-protective measures.
  • Community support – Ask for a referral to a family support group in your area.
  • Self-care – can help one feel less restricted and more independent. Exercise, healthy eating habits, and time with friends and family provide a much-needed mental break and more energy.
Sources MAYO CLINIC – Symptoms and Causes | MEDLINE – Antisocial Personality Disorder | NHS – Antisocial Personality Disorder | NICE – Antisocial personality disorder: prevention and management | DSM-5 – Antisocial Prevalance | PSYCHOLOGY TODAY – Antisocial Personality Disorder Symptoms, Causes and Treatment | LUMEN LEARNING – Antisocial Personality Disorder | ALLENPRESS – Antisocial Personality DisorderTreatment Guidelines | PSYCHIATRIC DISORDERS – Antisocial Personality Disorder: I Don’t Care | Zoccolillo M, Pickles A, Quinton D, Rutter M (November 1992). “The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder”. Psychological Medicine. Cambridge, England: Cambridge University Press. 22 (4): 971–86. | National Collaborating Centre for Mental Health (UK). Antisocial Personality Disorder: Treatment, Management and Prevention. Leicester (UK): British Psychological Society; 2010. (NICE Clinical Guidelines, No. 77.) 2, ANTISOCIAL PERSONALITY DISORDER. | Korten, David (2001), When Corporations Rule the World (Berret-Kohler Publications)