Antisocial personality disorder
What is it?
- Antisocial personality disorder is a type of chronic mental illness in which your ways of thinking, perceiving situations and relating to others are dysfunctional. When you have antisocial personality disorder, you typically have no regard for right and wrong. You may often violate the law and the rights of others, landing yourself in frequent trouble or conflict. You may lie, behave violently, and have drug and alcohol problems. And you may not be able to fulfill responsibilities to your family, work or school.
- Antisocial personality disorder is sometimes known as sociopathic personality disorder. It's also sometimes referred to as psychopathy. But some researchers believe that antisocial personality disorder and psychopathic personality are different conditions.
Signs and symptoms of antisocial personality disorder may include:
- Disregard for right and wrong
- Persistent lying or deceit
- Using charm or wit to manipulate others
- Recurring difficulties with the law
- Repeatedly violating the rights of others
- Child abuse or neglect
- Intimidation of others
- Aggressive or violent behavior
- Lack of remorse about harming others
- Impulsive behavior
- Poor or abusive relationships
- Irresponsible work behavior
The intensity of antisocial symptoms tends to peak during the 20's and then may decrease over time. It's not clear whether this is a result of aging or an increased awareness of the consequences of antisocial behavior. But while you might be less likely to commit crimes against others later in life, you may still have trouble functioning in relationships, work or school.
Personality is the combination of thoughts, emotions, and behaviors that makes you unique. It's the way you view, understand and relate to the outside world, as well as how you see yourself. Personality forms during childhood, shaped through an interaction of two factors:
- Inherited tendencies, or your genes. These are aspects of your personality passed on to you by your parents, such as shyness or having a happy outlook. This is sometimes called your temperament. It's the "nature" part of the nature vs. nurture debate.
- Environment, or your life situations. This is the surroundings you grew up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting you had, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate.
Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some research suggests that you may have a genetic vulnerability to developing antisocial personality disorder and that your life situation may trigger its actual development.
Although the precise cause of antisocial personality disorder isn't known, researchers have identified certain factors that seem to increase the risk of developing or triggering antisocial personality disorder, including:
- Being diagnosed with childhood conduct disorder
- A family history of antisocial personality disorder or other personality disorders or mental illness
- Being subjected to verbal, physical or sexual abuse during childhood
- Having an unstable or chaotic family life during childhood
- Loss of parents through death or divorce during childhood
Antisocial personality disorder is relatively uncommon. It affects about 3 to 5 percent of men and 1 percent of women.
Complications and problems that antisocial personality disorder may cause or be associated with include:
- Aggression or violence
- Suicidal behavior
- Reckless behavior
- Risky sexual behavior
- Child abuse
- Alcohol or substance abuse
- Gambling problems
- Relationship difficulties
- Social isolation
- School and work problems
- Strained relationships with health care providers
When doctors believe someone has antisocial personality disorder, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing your symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:
- Physical exam. This may include measuring height and weight, checking vital signs, such as heart rate, blood pressure and temperature, listening to your heart and lungs, and examining your abdomen.
- Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a check of your thyroid function.
- Psychological evaluation. A doctor or mental health provider talks to you about your thoughts, feelings, relationships and behavior patterns. He or she asks about your symptoms, including when they started, how severe they are, how they affect your daily life and whether you've had similar episodes in the past. You also discuss any thoughts you may have of suicide, self-injury or harming others.
Pinpointing which personality disorder you have
It sometimes can be difficult to determine if you have antisocial personality disorder or another personality disorder. For one thing, some personality disorders share similar symptoms. In addition, a diagnosis is often based largely on how you describe your symptoms and behavior, along with how your doctor interprets those symptoms and observes you behaving. Because of this, it can take some time and effort to get an accurate diagnosis. Be sure to stick with it, though, so that you can get appropriate treatment designed for your particular illness and situation, whether it's antisocial personality disorder or another condition.
To be diagnosed with antisocial personality disorder, you must meet the symptom criteria for that disorder listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.
Symptom criteria required for a diagnosis of antisocial personality disorder include:
- You are at least 18 years old.
- You had symptoms of conduct disorder before age 15, which may include such acts as stealing, vandalism, violence, cruelty to animals and bullying.
- Repeatedly breaking the law.
- Conning others.
- Lack of remorse after harming others.
- Disregard for the safety of yourself or others.
- Impulsive behavior.
Treatments and drugs
Antisocial personality disorder is notoriously difficult to treat. People with this disorder may not even want treatment or think they need treatment. But because antisocial personality disorder is essentially a way of being, rather than a curable condition, affected people are likely to need close, long-term care and follow-up.
People with antisocial personality disorder may also need treatment for other conditions, such as depression, anxiety or thyroid disorders. Medical and mental health providers with experience treating antisocial personality disorder and commonly associated conditions are most likely to be helpful.
Those involved in treatment may include:
- A family or primary care doctor
- A psychiatrist
- A psychotherapist
- A pharmacist
- Family members
- Social workers
Several treatments are available for antisocial personality disorder. They include:
- Stress and anger management skills
The best treatment or combination of treatments depends on each person's particular situation and severity of symptoms.
Psychotherapy is the main way to treat antisocial personality disorder. Psychotherapy is a general term for the process of treating a condition by talking about it with a mental health provider.
Types of psychotherapy used to treat antisocial personality disorder may include:
- Cognitive behavioral therapy. This type of therapy helps to uncover unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
- Psychodynamic psychotherapy. This approach aims to raise awareness of unconscious thoughts and behaviors and — by bringing them to light — change their negative impact.
- Psychoeducation. This education-based therapy teaches about all aspects of a condition, including treatments, coping strategies and problem-solving skills.
Psychotherapy may be provided in individual sessions, in group therapy, or in sessions that include family or even friends. The right type of psychotherapy depends on each person's individual situation.
Skills for family members
If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself. Mental health professionals with experience managing this condition can help teach you skills to protect yourself from the aggression, violence and anger common to antisocial personality disorder. They can also recommend strategies for coping. Ask the people on your loved one's treatment team for a referral. They may also be able to recommend support groups for families and friends affected by antisocial personality disorder.
There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. However, several types of psychiatric medications may help with certain conditions sometimes associated with antisocial personality disorder:
- Antidepressant medications. Antidepressants may help improve depressed mood, anger, impulsivity, irritability or hopelessness.
- Mood-stabilizing medications. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression.
- Anti-anxiety medications. These may help with anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior.
- Antipsychotic medications. Also called neuroleptics, these may be helpful if symptoms include losing touch with reality (psychosis) or, in some cases, anxiety or anger problems are present.
Hospitalization and residential treatment programs
In some cases, antisocial personality disorder symptoms may be so severe that psychiatric hospitalization is required. Psychiatric hospitalization is generally recommended only when people aren't able to care for themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.
There's no sure way to prevent antisocial personality disorder from developing in those at risk. Trying to identify those most at risk, such as children living with neglect or abuse, and offering early intervention may help. Getting appropriate treatment early, and sticking with it for the long term, may prevent symptoms from worsening.
Because antisocial behavior is thought to have its roots in childhood, parents, teachers and pediatricians may be able to spot early warning signs. While diagnosis of antisocial personality disorder generally isn't done before age 18, children at risk may have symptoms of conduct disorder, especially behavior that involves violence or aggression toward others, such as:
- Stealing during confrontations, such as a mugging
- Cruelty to people and animals
- Use of weapons
- Sexual assault
- Repeated lying
Early, effective and appropriate discipline, lessons in behavioral skills, and psychotherapy may help reduce the chance that at-risk children go on to become adults with antisocial personality disorder.