Antisocial Personality Disorder

Like with some other mental health disorders, symptoms of antisocial personality disorder may range in severity between individuals. Still, there are several common traits that mental health professionals look for when diagnosing ASPD, including the following.

Lack of empathy

People with ASPD can have difficulty understanding or experiencing empathy for others' feelings and perspectives, making it challenging to form genuine emotional connections.

Manipulation

People with ASPD can believe they are superior to others, be highly opinionated, and use their charm to manipulate others to follow their agenda or desires. 

Deceitfulness 

People with ASPD may be skilled at lying and manipulating others to achieve their goals or to avoid accountability. Individuals with ASPD may have a diminished capacity to feel remorse or guilt, which can affect their social interactions and personal relationships.

Impulsivity

Individuals with ASPD may act on their impulses without considering the consequences, potentially leading to risky behaviors and legal troubles.

Irresponsibility

These individuals may have difficulty fulfilling obligations (including monetary obligations), maintaining stable employment, or following through with commitments. 

Aggressiveness and irritability

Some (though not all) individuals with ASPD display aggressive and violent behaviors, including physical fights or assaults.

Lack of remorse

People with ASPD, at times, show little to no remorse for their actions, even when they have harmed others. They may rationalize their behaviors to avoid responsibility for the damage or pain they've caused.

Unlawful behaviors 

Some people with ASPD may habitually engage in illegal activities, including, but not limited to, stealing or using an alias to deceive others for personal profit.

History of conduct disorder

Some people with ASPD have a childhood history of conduct disorder² before 15 years of age. Conduct disorder is often a precursor to ASPD, characterized by similar behavioral problems but occurring during childhood or adolescence.

Other diagnostic criteria for ASPD

Below are additional criteria for ASPD: 

• The individual must be 18 years or older.
• The behaviors must remain, overall, consistent concerning time and circumstance.
• Symptoms must manifest independently from an individual's socio-cultural influences or stage of development.
• The symptoms must not be exclusively present during schizophrenic or bipolar episodes.
• The behavior must be unrelated to a medical condition, such as a severe head injury or degenerative neurological condition.
• Symptoms must be unconnected to the physiological side effects of drugs, medications, or other substances.

Not all individuals with antisocial behavior or traits have antisocial personality disorder. Diagnosing ASPD involves a thorough assessment by a qualified mental health professional, considering the individual's history, behaviors, and adherence to specific diagnostic criteria outlined in the DSM-V.

While there is no evidence for a specific etiology of ASPD, experts believe a few potential origins, indicators, and risk factors are involved. For example, although more current research is required for a conclusion, some studies implicate a genetic connection to behaviors associated with ASPD, such as impulsivity, aggression, and emotional regulation.

Genetic differences 

A 2010 study on behaviors in seven-year-old twins suggested a relationship between antisocial behavior and differences in genes that affect dopamine and serotonin functioning in the brain. 

Research also indicates a potential connection between ASBD and genetic indicators influencing hormones that are a typical driver of social behavior. 

Traumatic early life experiences

Evidence suggests that early life experiences and environmental factors significantly influence the development of conduct disorder and antisocial personality disorder later in life. The severity of adverse childhood experiences such as abuse, neglect, and maltreatment often correlates to the severity of ASPD behaviors in adulthood.

Neurobiological factors

Neurobiological factors like brain structure and neurotransmitter imbalances have been associated with antisocial behaviors. For example, abnormalities in the prefrontal cortex, responsible for decision-making and impulse control, have been observed in individuals with ASPD.

Other identified risk factors for ASPD include familial history of antisocial personality disorder, exposure to substance use disorder by a parent or caregiver, and close relationships with individuals with antisocial personality disorder during adolescence.

The treatment objectives for ASPD are multifaceted and often tailored to the individual's unique circumstances. Treatment seeks to support individuals in managing the rage and anger often associated with the disorder, treat comorbid conditions like anxiety and depression, assist the client in living safely and productively in society, and reduce symptom severity. 

ASPD is often linked to childhood trauma³ or adverse experiences. As part of a comprehensive treatment plan, therapy can help the individual explore these past experiences to process and heal from unresolved trauma contributing to their antisocial behaviors.

Treatment success may depend on the individual's willingness to engage in the process. ASPD is considered a chronic mental health condition, so there is no current cure. However, there are various approaches to managing the symptoms and improving the quality of life for those with the disorder. Treating Antisocial Personality Disorder presents unique challenges, as individuals may vary in their recognition of the disorder and engagement with treatment; however, tailored therapeutic approaches can lead to significant improvements.

Medication

While there is no specific medication to treat ASPD itself, serotonin reuptake inhibitors (SSRIs) and mood stabilizers may be prescribed to manage co-occurring conditions like depression, anxiety, or aggression. Aggressive behavior is also treatable with certain antipsychotics, and anticonvulsants are sometimes prescribed for impulsivity. Consult your primary care professional or a psychiatrist before starting, changing, or stopping medication for any condition.

Other treatments for APSD

Individuals diagnosed with antisocial personality disorder might present treatment challenges due to their pervasive and persistent symptoms, which can lead to profound deficits in day-to-day functioning.   

As such, people with ASPD may benefit from specific skills training, such as: 

• Anger management
• Impulse control
• Communication 
• Social skills 
• Occupational skills 

Individuals may receive assistance in successfully functioning in society and sustaining healthy relationships through community outreach programs and resource centers available in some cities.  

Treating antisocial personality disorder can be difficult, as people with ASPD often do not recognize a problem with their behavior and may resist seeking help. Often, individuals with ASPD receive a diagnosis and treatment when they seek assistance for a co-occurring mental disorder or undergo a court-ordered assessment. 

Self-care 

Self-care and lifestyle changes may be beneficial for people living with a personality disorder alongside treatment from a licensed behavioral specialist. A few behavioral changes that may be beneficial include the following:

• Eating a healthier diet
• Exercising frequently
• Stretching 
• Practicing meditation or mindfulness
• Learning about healthy relationship behaviors 
• Journaling about feelings
• Doing self-reflection exercises, such as self-inquiry from RO-DBT 

Prompt therapeutic intervention can be vital for individuals with ASPD to better understand their thoughts, emotions, and behaviors. By developing insight and self-awareness, they may start to recognize the impact of their actions on themselves and others and learn to take responsibility for their behaviors. 

Therapy also provides an avenue for personal growth where clients can learn healthier coping strategies and develop emotional regulation skills, reducing the risk of engaging in harmful behaviors. A trained mental health professional can carry out a proper diagnosis and treatment plan for ASPD. If you or someone you know is showing signs of antisocial personality disorder but do not want to seek support in person, you can also seek guidance from an online therapy platform like BetterHelp. 

For a list of organizations and associations that help individuals with antisocial and other personality disorders, visit the Personality Disorders Awareness Network (PDAN) website.

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7. 

Please see our Get Help Now page for more immediate resources.

Research into the etiology of antisocial personality disorder has revealed that its causes may include a combination of genetics and environmental influences. However, little else is known about other indicators and potential treatments due to a shortage of current research into the condition.

However, some promising publications on the disorder may expose new ways to treat ASPD effectively. For example, a 2021 article in the American Journal of Psychotherapy describes how mentalization-based treatment in group psychotherapy can help violent offenders by segregating the individual's affect from the thought process that can cause antisocial behavior. This focus on mentalizing in a group may illuminate the connection between thoughts and behavior and form supportive bonds to illustrate how the individual's behavior affects others. 

Some studies show clinical interest in using oxytocin to manage antisocial personality disorder and its symptoms. A 2019 literature review of thirty-six studies explored the evidence that manipulating oxytocin levels has the same benefits for individuals with ASPD as those without, most notably improved social interaction, empathy, trust, and coping with stress. 

The findings were ultimately inconclusive because more quality, thorough, extensive sample-sized studies are required. Still, with further investigation, researchers have hope that the therapeutic use of oxytocin can help individuals with ASPC live more well-adjusted lives and maintain healthier relationships.

Men are three times more likely to be diagnosed with ASPD

Antisocial personality disorder (ASPD) is estimated to affect between .6% and 3.6% of adults, and it is three times more common among cisgender men than cisgender women.¹ Further research is needed to understand the prevalence of ASPD across a broader spectrum of gender identities.

¹American Psychiatric Association

Below are a few more statistics on antisocial personality disorder:

• Antisocial personality disorder occurs in roughly 0.6% to 3.6% of adults in the US. 
• ASPD occurs approximately six times more often in men than women. 
• 80% of people diagnosed with ASPD display symptoms by the age of 11.
• Although antisocial personality disorder is often challenging to treat, numerous psychological and behavioral therapies have demonstrated success rates from 25% to 62% across various patient groups.