Antisocial personality disorder, sometimes called sociopathy, is a mental condition 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 antagonise, manipulate or treat others harshly or with callous indifference. They show no guilt or remorse for their behaviour. 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 fulfil responsibilities related to family, work or school.
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 behaviour
- 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 behaviour with no regard for the safety of self or others
- Poor or abusive relationships
- Failure to consider the negative consequences of behaviour or learn from them
- Being consistently irresponsible and repeatedly failing to fulfil 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 behaviour problems, such as:
- Aggression toward people and animals
- Destruction of property
- Serious violation of rules
Although antisocial personality disorder is considered lifelong, in some people, certain symptoms — particularly destructive and criminal behaviour — may decrease over time. But it’s not clear whether this decrease is a result of ageing or an increased awareness of the consequences of antisocial behaviour.
When to see a doctor
People with antisocial personality disorder are likely to seek help only at the urging of loved ones. If you suspect a friend or family member may have the disorder, you might gently suggest that the person seek medical attention, starting with a primary care physician or mental health professional.
Personality is the combination of thoughts, emotions and behaviours that makes every one 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
Certain factors seem to increase the risk of developing antisocial personality disorder, such as:
- Diagnosis of childhood conduct disorder
- A family history of antisocial personality disorder or other personality disorders or mental illness
- 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, consequences and problems of antisocial personality disorder may include, for example:
- Spouse abuse or child abuse or neglect
- Alcohol or substance abuse
- Being in jail or prison
- Homicidal or suicidal behaviours
- Having other mental health disorders such as depression or anxiety
- Low social and economic status, and homelessness
- Gang participation
- Premature death, usually as a result of violence
There’s no sure way to prevent antisocial personality disorder from developing in those at risk. Because antisocial behaviour is thought to have its roots in childhood, parents, teachers and paediatricians 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. Early, effective and appropriate discipline, lessons in behaviour modification, social and problem-solving skills, parent training, family therapy, and psychotherapy may help reduce the chance that at-risk children go on to become adults with antisocial personality disorder.
People with antisocial personality disorder are unlikely to believe they need help. However, they may seek help from their healthcare provider because of other symptoms such as depression, anxiety or angry outbursts or for treatment of substance abuse. 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 health 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, behaviour 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.
Though antisocial personality disorder is difficult to treat, 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, also called talk therapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for substance abuse, 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.
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. Drugs are usually prescribed cautiously because some 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. They 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 your appointment
If a medical evaluation rules out physical causes for your behaviour, your primary care doctor may make a referral to a psychiatrist. 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.
Credit: Mayo Clinic Staff, 4 August 2017.