What is Antisocial Personality Disorder?
Antisocial Personality Disorder (ASPD) is a condition that starts in childhood and continues into adulthood. It involves a pattern of disregarding and violating the rights of others. People with ASPD lack empathy, manipulate others, and often don’t feel guilty for their actions. They struggle to form stable relationships and often have problems in social and work settings. They also frequently get into legal trouble due to their failure to learn from the consequences of their behavior. Conduct disorder in children can lead to ASPD in adulthood, and psychopathy is a severe form of ASPD with an increased risk of violence. The understanding of ASPD dates back to the 19th century, and the DSM introduced ASPD in 1980. ASPD is classified in Cluster B of personality disorders, which includes disorders marked by dramatic and unpredictable behaviors. However, the cluster system has limitations in addressing personality disorders.
What Causes Antisocial Personality Disorder?
Antisocial Personality Disorder (ASPD) is believed to develop due to a combination of genetic, environmental, and psychological factors. Research is still limited, but it is thought that a person’s genes, childhood experiences, and surrounding environment all contribute to the development of ASPD. Factors such as trauma, socioeconomic conditions, and parenting styles can shape a person’s temperament, which in turn influences their personality. Studies suggest a genetic component to ASPD, as well as a link to impulsivity and violent behaviors. Exposure to harmful substances during fetal development and the influence of violent media are also debated as potential factors.
Risk Factors and Frequency for Antisocial Personality Disorder
ASPD, or Antisocial Personality Disorder, is a condition seen in about 2% to 3% of the general population. However, these numbers don’t include people who are in jail or institutions. Past studies show that about 80% of male inmates and 60% of female inmates used to have ASPD, but recent data suggests that these numbers have gone down to around 35% in prisons due to stricter sentencing laws.
According to the National Epidemiologic Survey on Alcohol and Related Conditions, males are around three to five times more likely to have ASPD than females. If someone has a problem with alcohol misuse, the chances of them having ASPD can range from 16% to 49%. Homeless people may also be more likely to have ASPD, possibly because of difficulty paying rent, holding a job, and struggling with substance use. Generally, those with ASPD tend to have a lower socioeconomic status and less education, with more cases of ASPD seen in those with lower IQs and reading levels.
On top of that, it’s common for those with ASPD to also have other conditions, such as:
- Substance use disorders
- Mood and anxiety disorders
- Attention deficit hyperactivity disorder (ADHD)
- Learning disorders
- Gambling disorders
- Other personality disorders, like Borderline Personality Disorder (BPD)
Signs and Symptoms of Antisocial Personality Disorder
Antisocial personality disorder (ASPD) can manifest in various ways, so it’s important to understand the person’s medical and social history. To diagnose ASPD, evidence of a behavioral disorder in childhood is necessary. Common signs of ASPD in childhood include fighting, stealing, setting fires, cruelty to animals, behavioral problems at school, poor academic performance, and running away from home. When evaluating adults for ASPD, asking about experiences with the juvenile detention system or early criminal activity can be helpful. As a person with ASPD gets older, their behaviors may continue in more age-appropriate ways, such as poor job performance, lack of responsibility, frequent job changes, manipulation, promiscuity, unstable relationships, and partner abuse. Evaluating a person for ASPD involves considering various antisocial actions, from lying to extreme behaviors like sexual assault or murder. A mental status examination is crucial during a psychiatric evaluation for ASPD, as individuals with ASPD may try to manipulate or lie. The examination should assess appearance, behavior, speech, affect, thought content, perceptions, thought process, cognition, insight, and judgment and impulse control.
Testing for Antisocial Personality Disorder
To diagnose Antisocial Personality Disorder (ASPD), doctors need to observe a patient’s behavior over time and in different situations. However, in some cases, a faster diagnosis may be made if the disorder contributes to hospitalizations or relapse of other mental health issues. Psychological testing can be helpful if there is limited information about a patient’s history or if they do not consent to an interview. Tools like the MMPI or PPI can aid in diagnosing ASPD by measuring personality function and traits. A formal diagnosis of ASPD requires meeting specific criteria outlined in the DSM-5-TR, including consistent disregard for others’ rights from a young age. The person must also be at least 18 years old and show evidence of conduct disorder before the age of 15. Antisocial behavior should not be solely a symptom of other disorders.
Treatment Options for Antisocial Personality Disorder
Early intervention is the most effective and least expensive treatment for conduct disorder in children, which can prevent the development of antisocial personality disorder (ASPD). Patients often seek help after their challenging behaviors have caused stress for others. Case management can provide necessary resources for individuals with ASPD. Drug therapy alone has limited evidence for treating ASPD, so initial treatment should focus on addressing additional psychiatric conditions. Second-generation antipsychotic medication may be beneficial for violent behavior, but no FDA-approved medications specifically treat ASPD. Psychotherapy and family therapy can be helpful, but results vary. Hospitalization is generally not beneficial for those with ASPD. Clinicians should be aware of their own biases when treating ASPD patients.
What else can Antisocial Personality Disorder be?
When a doctor is trying to diagnose Antisocial Personality Disorder (ASPD), they might consider a variety of other conditions that have similar symptoms. These include:
- Borderline Personality Disorder (BPD)
- Substance use disorders
- Psychotic or mood disorders
- Intermittent explosive disorder
- Temporal lobe epilepsy
- Brain tumor
- Stroke
- Single acts of misbehavior
- Narcissistic Personality Disorder (NPD)
- Misconduct caused by substance abuse
It’s important to note that the behaviors associated with ASPD often overlap with other mental health conditions. This makes it crucial for doctors to determine if ASPD exists on its own or alongside another mental health condition.
For example, irritability and aggression can also be signs of psychotic or bipolar disorders. But unlike these disorders, ASPD is not characterized by decreased need for sleep, nor does it respond well to medication. Furthermore, the intense moods of mania and psychosis are usually brief, while ASPD symptoms are long-lasting and inflexible.
ASPD differs from momentary misbehavior as the latter is not consistent with antisocial traits typically present in ASPD. Meanwhile, Intermittent explosive disorder involves violent and destructive behavior, but doesn’t occur alongside a history of conduct disorder or social impairment, which are often seen in ASPD.
ASPD can be distinguished from Borderline Personality Disorder (BPD) as BPD often includes inner turmoil such as fear of being abandoned, issues with self-identity, and frequent mood changes. In contrast, Narcissistic Personality Disorder (NPD) individuals are usually not aggressive and tend to be more empathetic, distinguished from ASPD. Habitual drug and alcohol use can also lead to antisocial behaviors. However, the difference lies in the fact that ASPD symptoms persist irrespective of whether the individual is intoxicated or sober.
What to expect with Antisocial Personality Disorder
ASPD is generally a lifelong disease that is difficult to treat. Approximately 25% of girls and 40% of boys who are diagnosed with conduct disorder eventually develop ASPD. As they get older, between 27% to 31% improve, mostly those with the most violent and threatening behaviors. The severity and frequency of crimes also decrease as these patients age, as the highest crime rates are found among younger individuals. Previous studies show that the condition ends for 12% to 27% of people, although many continue to show symptoms and some never improve.
If a patient’s condition does improve, it generally happens around the age of 35. Those who had fewer symptoms originally tend to have a better chance of improving. People who started showing signs of antisocial behavior later in life usually have less severe behavioral issues. Moreover, people who have either never been to prison or have spent a long time in prison seem to improve more than those who are behind bars for shorter periods. Factors that predict better outcomes include getting older when the symptoms first appear, having good connection to their community, job stability, and being happily married.
Possible Complications When Diagnosed with Antisocial Personality Disorder
People with a personality disorder are more likely to attempt suicide than those without such disorders. It’s crucial for these individuals, especially those with Antisocial Personality Disorder (ASPD), to be regularly checked for suicidal thoughts. ASPD also increases the likelihood of death due to different reasons such as ignoring medical conditions, not following treatment plans, or not having sufficient health insurance. The risk of accidental death, suicide, or homicide is also higher in individuals with ASPD.
It is common for people with personality disorders to also have problems with substance use, although it is not entirely clear which specific personality disorders are most associated with specific substance use disorders. Because people with ASPD typically engage in high-risk sexual behavior and substance use, they should get regular medical check-ups. These regular check-ups can help identify and manage potential health problems, which might include:
- Sexually transmitted infections
- Infectious diseases like hepatitis C from injecting drugs
- Injuries or physical trauma caused by reckless behavior.
Preventing Antisocial Personality Disorder
ASPD, or antisocial personality disorder, is a lifelong condition characterized by a lack of consideration for others, manipulation, and a lack of guilt. Symptoms typically emerge during childhood or adolescence and become fully noticeable by the late 20s or early 30s. This disorder can disrupt various aspects of a person’s life, including relationships, school, and work. People with ASPD often struggle to maintain steady employment, engage in illegal activities, and manipulate others for personal gain. They have difficulty forming stable personal relationships and lack empathy, remorse, and the ability to learn from negative experiences. ASPD is caused by a combination of genetic, socioeconomic, and brain development factors. Treatment often involves addressing coexisting mental health disorders and creating a safe and supportive therapy environment. Medication may have mixed results. Family involvement can be beneficial, and evaluations of quality of life can help improve functioning. Symptoms of ASPD may improve with age, especially if the person is older when the disorder presents, has strong community ties, stable employment, and a supportive marital relationship. However, people with ASPD are at a higher risk of death by suicide, homicide, or accidents and require careful monitoring by healthcare professionals.
