- Antisocial personality disorder
- Talking therapies
- Democratic therapeutic communities (DTC)
- Understanding Antisocial Personality: The Stigma Tied to ASPD — GoodTherapy.org Therapy Blog
- How Common Is ASPD?
- Asocial vs Antisocial
- What Is Antisocial Personality Disorder?
- Treatment for Antisocial Personality Disorder
- Antisocial Personality Disorder: Causes, Symptoms & Treatment
- How common is antisocial personality disorder (ASPD)?
- Is having antisocial personality disorder (ASPD) the same as being a sociopath?
- At what age does antisocial personality disorder (ASPD) develop?
- What are the signs and symptoms of antisocial personality disorder (ASPD)?
- What is a differential diagnosis?
- Are there medications for antisocial personality disorder (ASPD)?
- How can psychotherapy help antisocial personality disorder (ASPD)?
Antisocial personality disorder
Personality disorders are mental health conditions that affect how someone thinks, perceives, feels or relates to others.
Antisocial personality disorder is a particularly challenging type of personality disorder characterised by impulsive, irresponsible and often criminal behaviour.
Someone with antisocial personality disorder will typically be manipulative, deceitful and reckless, and will not care for other people's feelings.
other types of personality disorder, antisocial personality disorder is on a spectrum, which means it can range in severity from occasional bad behaviour to repeatedly breaking the law and committing serious crimes.
Psychopaths are considered to have a severe form of antisocial personality disorder.
Visit the Mind website for more information about signs of antisocial personality disorder.
A person with antisocial personality disorder may:
- exploit, manipulate or violate the rights of others
- lack concern, regret or remorse about other people's distress
- behave irresponsibly and show disregard for normal social behaviour
- have difficulty sustaining long-term relationships
- be unable to control their anger
- lack guilt, or not learn from their mistakes
- blame others for problems in their lives
- repeatedly break the law
A person with antisocial personality disorder will have a history of conduct disorder during childhood, such as truancy (not going to school), delinquency (for example, committing crimes or substance misuse), and other disruptive and aggressive behaviours.
Antisocial personality disorder affects more men than women.
It's not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences, such as child abuse or neglect, are thought to play a role.
A person with antisocial personality disorder will have often grown up in difficult family circumstances.
One or both parents may misuse alcohol, and parental conflict and harsh, inconsistent parenting are common.
As a result of these problems, social services may become involved with the child's care.
These types of difficulties in childhood will often lead to behavioural problems during adolescence and adulthood.
Criminal behaviour is a key feature of antisocial personality disorder, and there's a high risk that someone with the disorder will commit crimes and be imprisoned at some point in their life.
Men with antisocial personality disorder have been found to be 3 to 5 times more ly to misuse alcohol and drugs than those without the disorder, and have an increased risk of dying prematurely as a result of reckless behaviour or attempting suicide.
People with antisocial personality disorder are also more ly to have relationship problems during adulthood and be unemployed and homeless.
To be diagnosed with antisocial personality disorder, a person will usually have a history of conduct disorder before the age of 15.
Antisocial personality disorder is diagnosed after rigorous psychological assessment.
A diagnosis can only be made if the person is aged 18 years or older and at least 3 of the following criteria apply:
- repeatedly breaking the law
- repeatedly being deceitful
- being impulsive or incapable of planning ahead
- being irritable and aggressive
- having a reckless disregard for their safety or the safety of others
- being consistently irresponsible
- lack of remorse
These signs must not be part of a schizophrenic or manic episode – they must be part of the person's everyday personality.
This behaviour usually becomes most extreme and challenging during the late teens and early 20s. It may improve by the time the person reaches their 40s.
In the past, antisocial personality disorder was thought to be a lifelong disorder, but that's not always the case and it can sometimes be managed and treated.
Evidence suggests behaviour can improve over time with therapy, even if core characteristics such as lack of empathy remain.
But antisocial personality disorder is one of the most difficult types of personality disorders to treat.
A person with antisocial personality disorder may also be reluctant to seek treatment and may only start therapy when ordered to do so by a court.
The recommended treatment for someone with antisocial personality disorder will depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug misuse.
The person's family and friends will often play an active role in making decisions about their treatment and care.
In some cases, substance misuse services and social care may also need to be involved.
The National Institute for Health and Care Excellence (NICE) has published guidelines about the management and prevention of antisocial personality disorder.
Cognitive behavioural therapy (CBT) is sometimes used to treat antisocial personality disorder.
It's a talking therapy that aims to help a person manage their problems by changing the way they think and behave.
Mentalisation-based therapy (MBT) is another type of talking therapy that's becoming more popular in the treatment of antisocial personality disorder.
The therapist will encourage the person to consider the way they think and how their mental state affects their behaviour.
Democratic therapeutic communities (DTC)
Evidence suggests community-based programmes can be an effective long-term treatment method for people with antisocial personality disorder, and is becoming increasingly popular in prisons.
DTC is a type of social therapy that aims to address the person's risk of offending, as well as their emotional and psychological needs.
It's based around large and small therapy groups and focuses on community issues, creating an environment where both staff and prisoners contribute to the decisions of the community.
There may also be opportunities for educational and vocational work.
The recommended length of treatment is 18 months, as there needs to be enough time for a person to make changes and put new skills into practice.
Self-motivation is another important factor for acceptance on to this type of scheme. For example, the person must be willing to work as part of a community, participate in groups, and be subject to the democratic process.
The Ministry of Justice has more information about DTC in its guide to working with offenders with personality disorder.
There's little evidence to support the use of medicine for treating antisocial personality disorder, although certain antipsychotic and antidepressant medicines may be helpful in some instances.
Carbamazepine and lithium may help control symptoms such as aggression and impulsive behaviour, and a class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may improve anger and general personality disorder symptoms.
Personality disorders affect how someone thinks, perceives, feels or relates to others. They range from mild to severe.
The signs typically emerge in adolescence and persist into adulthood. People with personality disorders often have other mental health problems, particularly depression and substance misuse.
Personality disorders may be associated with genetic and family factors, and experiences of distress or fear during childhood, such as neglect or abuse, are common.
Although personality disorders may run in families, psychopathy is thought to have a higher genetic component.
Treatment for personality disorders usually involves a course of psychological therapy.
Understanding Antisocial Personality: The Stigma Tied to ASPD — GoodTherapy.org Therapy Blog
Antisocial personality (ASPD) is one of the cluster B personality disorders, which typically involve emotional, impulsive, or dramatic thoughts and actions.
This group of personality disorders is also significant because it includes borderline personality disorder (BPD) and narcissistic personality disorder, in addition to ASPD.
These issues, and personality disorders in general, are among the most stigmatized mental health conditions.
Colloquially, many people use the terms psychopath and sociopath interchangeably with antisocial personality. A common assumption is that all people who have ASPD are incapable of emotion and feeling and will eventually commit violent crimes and harm others.
It’s true many people living with ASPD typically don’t feel remorse or guilt.
They may also lack empathy, struggle to understand the emotions of other people, or experience frequent legal issues, due to a tendency toward impulsive and often dangerous or illegal actions.
But sociopathy isn’t a mental health diagnosis, and not every person with ASPD will hurt other people or engage in violent acts.
It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist. In therapy, people can develop interpersonal skills along with coping techniques for impulsivity and aggression.
These tools can benefit people who want to improve relationships and avoid illegal or dangerous activity and behaviors that harm others.
It’s possible for people who have ASPD to avoid actions that could harm others, especially when they have support from a compassionate therapist.
How Common Is ASPD?
The estimated prevalence of ASPD may vary depending on the study and criteria used. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), between around 0.2 and 3.3% of the population has ASPD in a given 12 month period. This condition is only diagnosed in people over the age of 18.
More than 90% of people diagnosed with ASPD also live with another mental health issue. Substance abuse is the most common co-occurring condition.
Research suggests ASPD occurs much more frequently in men diagnosed with alcohol use disorder. Higher prevalence is also seen in prison settings, as well as population samples from impoverished areas.
Other common co-occurring issues are anxiety and depression.
Though ASPD is far less common in women than it is in men, some research has suggested when ASPD develops in women, the condition may become more severe. Women living with ASPD are even more ly to abuse substances than men living with ASPD. However, research also indicates antisocial behavior may persist longer in men. Men who have ASPD also have an increased risk of early death.
Aggressive and violent behavior in childhood, such as that seen with conduct disorder, can be an indicator for ASPD.
Not all children who have conduct disorder will go on to develop ASPD, but a history of conduct disorder is one of the diagnostic criteria for ASPD. These symptoms must appear before the age of 15.
Parental neglect, abuse, or inconsistency and a lack of stability from primary caregivers can all increase the risk that a child with conduct disorder will develop ASPD.
Asocial vs Antisocial
It’s not uncommon to hear antisocial used to refer to people who prefer to be on their own and avoid spending a lot of time with others.
But “asocial” is a more accurate way to define this lack of interest in social interaction.
Asocial can describe a general disinterest in society and engagement with others, but it doesn’t indicate a person harbors any ill will or negative intent toward others.
Antisocial, on the other hand, goes beyond a general dis or avoidance of society and community. People who meet criteria for a diagnosis of ASPD typically feel hostile toward other people.
Even those who don’t have actively hostile feelings toward others may care very little for the safety, general well-being, and feelings of most other people.
It’s also not uncommon for people who have antisocial traits to have significant disregard for their own safety.
It’s important to note that these feelings don’t necessarily translate to violent tendencies.
Studies of people in prison do reveal high rates of ASPD, but this condition occurs on a spectrum, and not everyone living with the condition becomes violent or dangerous.
Research has also observed that some people who display antisocial traits may have developed these behaviors in order to survive and protect themselves when growing up in difficult circumstances.
Many people use psychopathy as a synonym for ASPD, but this usage isn’t accurate. Psychopathy can best be considered a severe form of ASPD, rather than the most characteristic presentation of the condition.
Most people who meet criteria for psychopathy according to the Psychopathy Checklist – Revised (PCL – R) do also meet criteria for ASPD.
But only about 10% of people diagnosed with ASPD also meet criteria for psychopathy.
What Is Antisocial Personality Disorder?
At the core of ASPD lies a consistent lack of regard for the rights of others, which generally includes impulsive, irresponsible, and reckless behavior.
People may take action without considering potential consequences and experience little or no remorse for harm caused by their behavior.
Theft, manipulation, and other deceit are common, and people living with ASPD also tend to rationalize or minimize their actions.
Antisocial behavior can include violent or criminal acts, but people living with ASPD aren’t always aggressive or violent. Similarly, while many people with ASPD lack empathy, this isn’t always the case.
People living with ASPD often struggle to develop or maintain meaningful relationships, and they may cause emotional harm to their partners; but it’s still possible for people with ASPD to feel love and empathy, often for a select few people such as children, partners, or close family members.
Abuse, neglect, or absent caregivers can increase risk for ASPD when other factors are present, particularly early onset conduct disorder. In people who develop ASPD, early childhood mistreatment can reinforce the belief that no one else will look out for them, so they should do whatever they can to look after themselves and get their needs met. This belief commonly occurs with ASPD.
In recent years, a few people with ASPD have written about their experience living with the condition. This may have had a small effect on the stigma surrounding the condition, but many people still struggle to accept that ASPD doesn’t always mean a person is violent or “evil.
” The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need.
Negative attitudes from caregivers and educators may begin early on, often when children first display signs of conduct disorder.
The stigma associated with personality disorders, ASPD in particular, may make it even more difficult for people who want to improve to get the help they need.One study of 202 kindergarten teachers found teachers were most ly to have a harsh response toward aggressive children.
But negative attitudes, or writing children off as troublemakers or delinquents, can reinforce ideas such as, “I’m bad,” “I’ll never amount to anything,” or “No one cares what happens to me,” from early childhood.
Some experts believe this can increase the chances aggressive behavior and disregard for others will continue and worsen.
Treatment for Antisocial Personality Disorder
Not everyone considers ASPD a mental health issue. Research has shown that many people believe people with this condition are:
- Impossible to treat
Having a mental health issue doesn’t absolve a person of responsibility for their actions, but it’s an important factor in understanding why some people behave the way they do. When stigma perpetuates the idea of a group of people as evil, positive change becomes even more difficult to achieve.
Specific characteristics associated with ASPD, such as self-sufficiency, a tendency to externalize problems, disdain for authority, and general hostility, also make it less ly people with ASPD will ever reach out for help, complicating treatment and decreasing the chance of improvement.
When people with ASPD do enter treatment, it’s more often to get help for a co-occurring condition or because a legal authority or family member has steered them toward therapy. Among those who do get help, many drop treatment early. Negative attitudes among therapists or ineffective treatment methods can contribute to this.
It’s important for people with ASPD to work with therapists who offer compassionate support and are willing to try a range of approaches to find the most effective treatment.
In many cases, people with antisocial traits can learn skills to cope with their condition and avoid acting in ways that negatively affect others.
When people with a dual diagnosis seek treatment, it’s essential for therapists to recognize the ways ASPD can contribute to and worsen other mental health symptoms.
A key factor in successful therapy for ASPD is recognizing individual fault. People living with ASPD who can’t admit or accept their actions are harmful or that they have a role in the harm they’ve caused may not be able to improve.
One approach to treatment that’s shown some promise is mentalization-based therapy. This approach helps people explore their state of mind, including emotions, desires, and feelings toward others.
Once they better understand their thoughts, they can use this understanding to address impulses and control them.
Some research suggests schema therapy, an approach that helps people work to identify and address maladaptive behavior patterns and develop more effective ways of relating, may also be helpful for people with ASPD. It’s effective for other personality disorders, including BPD and narcissistic personality, and some research suggests people are less ly to drop this type of therapy than other approaches.
Research has shown treatment can help improve many of the behaviors associated with ASPD when a person is willing to work toward change.
It’s important for future research to continue exploring the most helpful types of treatment for ASPD to increase the chances of people with the condition improving with treatment.
Successful treatment can not only improve well-being and quality of life for people with ASPD, it can also have a positive impact on the people in their lives.
If you or a loved one is struggling with the effects of ASPD, know that help is available. Begin your search for a trained, compassionate counselor at GoodTherapy.
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders, fifth edition. Arlington, VA: American Psychiatric Association.
- Antisocial personality disorder. (2017, November 20). Cleveland Clinic. Retrieved from https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-disorder
- Antisocial personality disorder. (2018, May 25). NHS. Retrieved from https://www.nhs.uk/conditions/antisocial-personality-disorder
- Arbeau, K. A., & Coplan, R. J. (2007). Kindergarten teachers’ beliefs and responses to hypothetical prosocial, asocial, and antisocial children. Merrill-Palmer Quarterly, 53(2), 291-318. doi: 10.1353/mpq.2007.0007
- Brians, P. (2016, May 17). Asocial. Retrieved from https://brians.wsu.edu/2016/05/17/asocial
- Brill, A. (2017, June 16). Life with antisocial personality disorder (ASPD). Retrieved from https://www.mind.org.uk/information-support/your-stories/life-with-antisocial-personality-disorder-aspd/#.XMY0wJNKjOT
- British Psychological Society. (2010). Antisocial personality disorder: Treatment, management, and prevention. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK55333
- Hesse, M. (2010). What should be done with antisocial personality disorder in the new edition of the diagnostic and statistical manual of mental disorders (DSM-V)? BMC Medicine, 8, 66. doi: 10.1186/1741-7015-8-66
- Mayo Clinic Staff. (2017, August 4). Antisocial personality disorder. Retrieved from https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/drc-20353934
Antisocial Personality Disorder: Causes, Symptoms & Treatment
Antisocial personality disorder (ASPD) is a mental health condition. People with ASPD show a lack of respect toward others. They don’t follow socially accepted norms or rules. People with ASPD may break the law or cause physical or emotional harm to the people around them. They may disregard consequences or refuse to take responsibility for their actions.
ASPD is one of many personality disorders. Personality disorders affect the way someone thinks or behaves.
How common is antisocial personality disorder (ASPD)?
Research suggests that ASPD affects about 1% to 4% of people in the U.S.
Is having antisocial personality disorder (ASPD) the same as being a sociopath?
Sometimes the terms “sociopath” or “sociopathy” get used to describe ASPD. Healthcare providers don’t use these terms as clinical diagnoses. But traits of ASPD and sociopathy overlap, including a general lack of conscience.
There is no single cause of ASPD, but the following factors may increase a person’s risk of developing the disorder:
- Biology: People with ASPD may have unusual levels of serotonin. Serotonin is a chemical in the brain that regulates our mood and feelings of happiness.
- Environment: Trauma or abuse early in childhood increases the risk of developing ASPD later in life.
- Genetics: There may be some genetics factors that can predispose some individuals to develop ASPD. However, there is no one genetic factor that is thought to be responsible for the condition.
- Lifestyle: About half of people with ASPD also have problems with drug or alcohol abuse.
- Sex: Men are more ly than women to develop ASPD.
At what age does antisocial personality disorder (ASPD) develop?
Traits of ASPD usually develop during late childhood or the early teen years. Before age 18, the condition gets diagnosed as conduct disorder. Children with conduct disorder may lie, steal, ignore rules or bully other children.
Sometimes parents or healthcare providers miss the signs of conduct disorder. The signs may overlap with other conditions attention-deficit/hyperactivity disorder (ADHD), depression or oppositional defiant disorder.
When children get diagnosed and treated early, the condition may not continue into adulthood. If the behavior does continue, the diagnosis becomes antisocial personality disorder at age 18.
What are the signs and symptoms of antisocial personality disorder (ASPD)?
People with antisocial personality disorder may:
- Be physically aggressive.
- Behave recklessly.
- Blame others for their problems.
- Break the law.
- Destroy property.
- Manipulate or deceive others.
- Show no remorse for hurtful actions.
There is no blood test or imaging exam that can diagnose ASPD. A healthcare provider will consider your health history, perform a physical exam and assess your symptoms.
You may see a healthcare provider who specializes in mental health disorders. A psychiatrist or psychologist evaluates your behavior. They look for patterns of:
- Disregard for the rights of others.
- Impulsive actions with no concern for consequences.
- Irresponsible or reckless actions.
What is a differential diagnosis?
A differential diagnosis means distinguishing between several health conditions with similar symptoms. Certain disorders may mimic ASPD, so it’s important for your healthcare provider to make the right diagnosis. These disorders include:
There is no set treatment for ASPD. Therapies such as medication or psychotherapy may help control specific behaviors, though. Studies suggest that symptoms of ASPD are worst around ages 24 to 44, then tend to improve after age 45.
Are there medications for antisocial personality disorder (ASPD)?
Medication generally only helps people with aggression, depression or erratic moods alongside ASPD. Your healthcare provider may recommend:
How can psychotherapy help antisocial personality disorder (ASPD)?
Cognitive behavioral therapy is a type of counseling that focuses on changing a person’s thinking and behavior. Therapy for ASPD may help people think about how their behavior affects others. Someone with ASPD may benefit from individual therapy, group therapy or family therapy.
There isn’t a way to prevent ASPD. But if conduct disorder gets caught early in childhood, therapy may prevent the development of ASPD in adulthood.
There is no cure for antisocial personality disorder. People generally manage the condition throughout their lives. But medication and therapy can help you cope with certain aspects of the disorder. The right treatment may help you adjust your behavior and reduce harm to those around you. Maintaining healthy relationships and a support system are key factors in managing ASPD long term.
If you or someone you know has any of the following symptoms, seek medical attention right away:
- Extreme changes in mood.
- Suicidal thoughts.
- Violent behavior.
You can call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a network of local crisis centers that provide free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. In an emergency, call 911.
A note from Cleveland Clinic
ASPD causes people to act without thinking how they're affecting others. Someone with ASPD may break rules or laws. They often show no remorse and take no responsibility.
Psychotherapy and certain medications may help people with ASPD. With treatment, they may be able to control their thoughts and behavior.
Healthcare providers, such as psychiatrists and psychologists, do thorough assessments to diagnose ASPD. They can recommend the right treatment plan.