Antisocial Personality Disorder: Symptoms, Causes, & Treatments

What Is Antisocial Personality Disorder (ASPD)?

Antisocial personality disorder (ASPD) is often referred to as sociopathy and is marked by impulsive and risky behaviors, manipulation, and a profound disregard for other people’s emotions and experiences. Those with ASPD tend to get into trouble with the law, intentionally ignore what is right, and show no remorse for their actions.

When Does ASPD Develop?

Adults with ASPD typically display antisocial behavior and antisocial personality disorder symptoms as children, often as early as eight years old.⁴ However, according to the DSM-5, a person must be 18 years old to be diagnosed and their behavior cannot only be present when other disorders, such as bipolar and schizophrenia, are in active phases.

While ASPD cannot be diagnosed before the age of 18, antisocial personality disorder often presents in children as oppositional defiant disorder (ODD) and/or conduct disorder (CD).¹

Antisocial Personality Disorder Vs. Psychopathy

The term psychopathy is often used synonymously with ASPD. There are differing perspectives on the usage of this terminology, but psychopathy is not considered a DSM-5 disorder.² Some believe that antisocial personality disorder is the same as psychopathy, while others believe psychopathy is a more severe form of ASPD.

Psychopathy is most commonly measured using the Psychopathy Checklist-Revised (PCL-R). Not all people meeting criteria for ASPD will score high enough on the PCL-5 to be classified as having psychopathy. However, those with psychopathy will likely always meet the criteria for ASPD.³

Signs & Symptoms of Antisocial Personality Disorder

People with ASPD intentionally upset others and manipulate them to their own benefit. There is not necessarily anything anyone else did to provoke this behavior and there are often no signs of remorse or feelings of guilt around their behaviors. Some traits common in those with ASPD include impulsivity and poor ability to maintain social connections.

Signs and symptoms of ASPD may include:¹

• Lack of understanding between right and wrong
• Frequent lying
• Lack of respect for others
• Manipulating others for personal gain
• A natural sense of superiority
• Criminal behaviors
• Hostility, aggression, or violence toward others or animals
• Inability to feel remorse or guilt for actions
• No regard for others’ well-being
• Irresponsible financially or in the workplace
• Lack of empathy
• Inability to maintain friends/relationships or hold down a job
• Testing the limits of the law

What Causes Antisocial Personality Disorder?

There are no distinct causes of antisocial personality disorder. As with all personality disorders, certain factors contribute to the genesis of a disordered personality, such as genetic and congenital vulnerabilities, life stressors, traumas, and neurological changes in brain functioning.

Genetic Factors

A family history of ASPS or a parent with this or another personality disorder may make one more likely to develop this condition in adulthood.

Environmental Factors

Children who are exposed to adverse childhood experiences are more likely to develop mental health issues and exhibit poor social behavior. Left untreated, this can develop into ASPD in adulthood.

Brain Development

Children who did not have proper brain development may also be at risk due to the lack of formation of parts of the brain responsible for reason, empathy, and problem-solving.

Diagnosis of ASPD

ASPD diagnosis commonly comes after a diagnosis of conduct personality disorder or oppositional defiant disorder, which are often diagnosed prior to age 18. A diagnosis can take time to get to due to many of the symptoms overlapping with poorly managed mood disorders and other mental health issues. To prevent a misdiagnosis, an ASPD diagnosis comes with very thorough assessments and long-term evidence of antisocial behaviors.

Complications of Living With ASPD

Living with ASPD can be complicated for both the person with the disorder and for any loved ones they may have.

Complications of living with ASPD can include:

• Spousal abuse
• Child abuse or neglect
• Substance abuse
• Incarceration
• Suicidal ideations
• Attempts to cause harm to others
• Co-occurring mental health conditions
• Financial, social, or academic problems
• Early death

Treatments for Antisocial Personality Disorder

Effectively treating personality disorders is notoriously difficult, and antisocial personality disorder is no exception. Many barriers impede the effective treatment of ASPD, such as poor personal insight, resistance to seeking treatment, and the inflexible stability of personality traits and temperaments.

Psychotherapy

Antisocial personality disorder therapies to consider include cognitive behavioral therapy (CBT) and mentalization based therapy (MBT). CBT helps to change the way a person thinks to modify behavior, but can only be effective if someone recognizes the idea that there is an issue with their thought process to begin with. MBT asks someone to consider the impact of their thought processes on their mental state, and how they impact behavior.

Democratic Therapeutic Communities (DCT)

DCT is an approach to group or family therapy that focuses on how someone with ASPD can reflect on their need to have destructive behaviors and what needs these behaviors are meeting (if any). It helps someone with ASPD understand their impact as well as learn about their own needs, and overtime, recognize socially healthy ways of getting their own needs met.

Medications

While there are no specific medications to treat ASPD, there are medications to treat some of the symptoms and emotions, such as aggression and anger, depression, and anxiety. Talk with a psychiatrist to learn more about medication options for ASPD.

How to Get Help for Antisocial Personality Disorder

If you or someone you care about is struggling with antisocial behaviors, and possibly ASPD, there are resources in the medical, mental health, and school counseling fields. Treatment for ASPD is typically covered by insurance. Finding a specialized provider for ASPD may prove difficult, but utilizing the directories provided by insurance companies may be a useful starting point.

Getting treatment for a disorder that a person does not know or cannot admit that they have is nearly impossible. This is why many people who seek treatment for ASPD have been mandated by law, or at the insistence of friends and family.

Living With & Managing ASPD Symptoms

While dealing with any personality disorder can be challenging, there are ways to help manage symptoms.

Below are tips for living with and managing ASPD symptoms:

• Treating underlying disorders: ASPD commonly co-occurs with other mental health conditions such as substance abuse and mood disorders. Addressing these issues throughout treatment can help you better navigate life with ASPD.
• Address your traumas: Working to heal past traumas, restructuring false schemas, and addressing maladaptive behaviors related to these are necessary parts of your treatment for ASPD.
• Taking responsibility: This means taking your medications, attending appointments, and fostering accountability.
• Find ways to manage emotions: Finding ways to manage stress, anger, and feelings of hatred toward others is important when living with ASPD.

Final Thoughts

It can be challenging to manage ASPD for yourself or someone you love, but there is hope that with treatment, symptoms can improve and change can occur. Talking with a therapist and having a support system are key, and together you and your therapist can come up with a treatment plan that can help you.