Antisocial personality disorder

Date Updated: 12/10/2019

Overview

Antisocial personality disorder, sometimes called sociopathy, is a mental disorder in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. People with antisocial personality disorder tend to antagonize, manipulate or treat others harshly or with callous indifference. They show no guilt or remorse for their behavior.

Individuals with antisocial personality disorder often violate the law, becoming criminals. They may lie, behave violently or impulsively, and have problems with drug and alcohol use. Because of these characteristics, people with this disorder typically can't fulfill responsibilities related to family, work or school.

Symptoms

Antisocial personality disorder signs and symptoms may include:

Disregard for right and wrong
Persistent lying or deceit to exploit others
Being callous, cynical and disrespectful of others
Using charm or wit to manipulate others for personal gain or personal pleasure
Arrogance, a sense of superiority and being extremely opinionated
Recurring problems with the law, including criminal behavior
Repeatedly violating the rights of others through intimidation and dishonesty
Impulsiveness or failure to plan ahead
Hostility, significant irritability, agitation, aggression or violence
Lack of empathy for others and lack of remorse about harming others
Unnecessary risk-taking or dangerous behavior with no regard for the safety of self or others
Poor or abusive relationships
Failure to consider the negative consequences of behavior or learn from them
Being consistently irresponsible and repeatedly failing to fulfill work or financial obligations

Adults with antisocial personality disorder typically show symptoms of conduct disorder before the age of 15. Signs and symptoms of conduct disorder include serious, persistent behavior problems, such as:

Aggression toward people and animals
Destruction of property
Deceitfulness
Theft
Serious violation of rules

Although antisocial personality disorder is considered lifelong, in some people, certain symptoms — particularly destructive and criminal behavior — may decrease over time. But it's not clear whether this decrease is a result of aging or an increased awareness of the consequences of antisocial behavior.

When to see a doctor

People with antisocial personality disorder are unlikely to seek help on their own. If you suspect that a friend or family member may have the disorder, you might gently suggest that the person seek help from a mental health professional and offer to help them find one.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It's the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood, shaped through an interaction of inherited tendencies and environmental factors.

The exact cause of antisocial personality disorder isn't known, but:

Genes may make you vulnerable to developing antisocial personality disorder — and life situations may trigger its development
Changes in the way the brain functions may have resulted during brain development

Risk factors

Certain factors seem to increase the risk of developing antisocial personality disorder, such as:

Diagnosis of childhood conduct disorder
Family history of antisocial personality disorder or other personality disorders or mental health disorders
Being subjected to abuse or neglect during childhood
Unstable, violent or chaotic family life during childhood

Men are at greater risk of having antisocial personality disorder than women are.

Complications

Complications, consequences and problems of antisocial personality disorder may include, for example:

Spouse abuse or child abuse or neglect
Problems with alcohol or substance use
Being in jail or prison
Homicidal or suicidal behaviors
Having other mental health disorders such as depression or anxiety
Low social and economic status and homelessness
Premature death, usually as a result of violence

Prevention

There's no sure way to prevent antisocial personality disorder from developing in those at risk. Because antisocial behavior is thought to have its roots in childhood, parents, teachers and pediatricians may be able to spot early warning signs. It may help to try to identify those most at risk, such as children who show signs of conduct disorder, and then offer early intervention.

Diagnosis

People with antisocial personality disorder are unlikely to believe they need help. However, they may seek help from their primary care provider because of other symptoms such as depression, anxiety or angry outbursts or for treatment of substance misuse.

People with antisocial personality disorder may not provide an accurate account of signs and symptoms. A key factor in diagnosis is how the affected person relates to others. With permission, family and friends may be able to provide helpful information.

After a medical evaluation to help rule out other medical conditions, the primary care provider may make a referral to a mental health professional for further evaluation.

Diagnosis of antisocial personality disorder is typically based on:

A psychological evaluation that explores thoughts, feelings, relationships, behavior patterns and family history
Personal and medical history
Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Though typically antisocial personality disorder isn't diagnosed before age 18, some signs and symptoms may occur in childhood or the early teen years. Usually there is evidence of conduct disorder symptoms before age 15.

Identifying antisocial personality disorder early may help improve long-term outcomes.

Treatment

Antisocial personality disorder is difficult to treat, but for some people, treatment and close follow-up over the long term may be beneficial. Look for medical and mental health professionals with experience in treating antisocial personality disorder.

Treatment depends on each person's particular situation, their willingness to participate in treatment and the severity of symptoms.

Psychotherapy

Psychotherapy, also called talk therapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for alcohol or substance misuse, and treatment for other mental health conditions.

But psychotherapy is not always effective, especially if symptoms are severe and the person can't admit that he or she contributes to serious problems.

Medications

There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. Doctors may prescribe medications for conditions sometimes associated with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression. Certain drugs are usually prescribed cautiously because they have the potential for misuse.

Coping and support

Skills for family members

People with antisocial personality disorder often act out and make other people miserable — with no feeling of remorse. If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself.

A mental health professional can teach you skills to learn how to set boundaries and help protect yourself from the aggression, violence and anger common to antisocial personality disorder. He or she can also recommend strategies for coping.

Seek a mental health professional who has training and experience in managing antisocial personality disorder. Ask 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.

Preparing for an appointment

If a medical evaluation rules out physical causes for your behavior, your primary care provider may make a referral to a mental health professional, such as a psychiatrist or psychologist.

Take a family member or friend along to your appointment, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with the doctor that you don't think to bring up.

What you can do

Before your appointment, make a list of:

Any symptoms you or your family noticed, and for how long
Key personal and medical information, including current physical or mental health conditions, personal or family history of mental illness, traumatic experiences, or major stressors
All medications you take, including the names and doses of any medications, herbs, vitamins or other supplements
Questions you want to ask your doctor to make the most of your appointment

Some basic questions to ask your doctor include:

What is likely causing my symptoms?
What are other possible causes?
What treatments are most likely to be effective for me?
How much can I expect my symptoms to improve with treatment?
How often will I need treatment, and for how long?
Are there medications that can help? Is so, what are the possible side effects?
Is there a generic alternative to the medication you're prescribing?
Are there any printed materials I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

What are your symptoms?
When did you or your family first notice these symptoms?
How are your symptoms affecting your life?
Have relatives or friends expressed concern about your behavior?
Do you have any close relationships?
If you're not satisfied with work, school or relationships, what do you think is causing your problems?
Have you ever thought about harming yourself or others? Have you ever actually done so?
Have any of your blood relatives, such as a parent or sibling, been diagnosed with or treated for mental illness?

Be ready to answer these questions to reserve time to go over points you want to spend more time on.