What Is Antisocial Personality Disorder? Symptoms, Causes, Diagnosis, Treatment
In popular culture, people with antisocial personality disorder (ASPD) are often referred to as “sociopaths,” a term that conjures up images of mass murderers or creepy thrillers about highly manipulative individuals who thrive on hurting other people.
While there are people with antisocial personality disorder who fit those stereotypes, and while a very high percentage of violent offenders in prison have antisocial personality disorder, the American Psychiatric Association (APA) does not refer to people with antisocial personality disorder as sociopaths, nor does it equate the two terms.
Personality disorders are conditions involving long-term patterns where a person’s feelings, self-perception, and behavior stray substantially from their society and culture.
An estimated 9 percent of U.S. adults have a personality disorder diagnosis, according to the National Institute of Mental Health. (1) An estimated 3.6 to 4.3 percent of people in the United States have the mental health condition known as antisocial personality disorder, according to research published in the Journal of Clinical Psychiatry. (2,3)
A defining trait of antisocial personality disorder is a lack of empathy and a disregard for others, generally. A person with antisocial personality disorder has little concern for other people and is willing to violate their rights. They usually have no respect for social norms and laws and may believe they are “above the law.” They will frequently lie, manipulate other people, and may risk the health or lives of other people. And they do not feel any guilt or remorse for these actions, per the APA. (4)
Nonetheless, millions of people with the condition live mostly normal-looking lives. But while they may not commit violent crimes or even break the law, they most likely use others for their gain or have no problem hurting others.
Signs and Symptoms of Antisocial Personality Disorder
Early symptoms of antisocial personality disorder may show up in childhood or adolescence. Behaviors before age 18 that are associated with a later diagnosis of antisocial personality disorder include:
- Showing cruelty to animals
- Intentionally setting fires
- Frequently breaking rules for no obvious reason
- Engaging in vandalism
- Having difficulty making friends
In adulthood, people with antisocial personality disorder intentionally harm others and show no evidence of guilt or remorse for the harm they cause. Other behaviors associated with the disorder include:
- Frequently lying
- Acting impulsively
- Flattering others to gain something
- Frequently getting in fights
- Committing physical or sexual assault
- Expressing pleasure in others’ suffering
Learn More About Symptoms of Antisocial Personality Disorder
Causes and Risk Factors of Antisocial Personality Disorder
The cause of ASPD is unknown, but certain genetic and environmental factors are thought to increase the likelihood of a person having it, per the National Library of Medicine. (5) Risk factors include:
- History of child abuse
- Parent with a drug or alcohol dependence disorder
- Parent with antisocial personality disorder (4)
- Family conflict
- Mutations in one's genes
- Poverty (6)
How Is Antisocial Personality Disorder Diagnosed?
There is no blood test, brain scan, or other objective test that can be used to diagnose antisocial personality disorder. Like nearly all mental health conditions, antisocial personality disorder is diagnosed by meeting criteria laid out in the Diagnostic and Statistical Manual on Mental Disorders.
The most recent edition is the fifth (DSM-5), published in 2012, but clinicians might also use the fourth edition (DSM-IV) criteria in making a diagnosis. The clinician will evaluate a person by asking a series of questions about their symptoms, including how long those symptoms have existed and how severe they are. (5)
The DSM-IV criteria require a person to be at least 18 years old and have shown evidence of conduct disorder before age 15. They should show “disregard for and violation of the rights of others” by demonstrating at least three of seven behaviors, including harming others, lying, breaking rules, and lacking remorse. They should also show this behavior outside of any possible schizophrenia or bipolar disorder diagnosis.
The DSM-5 criteria are more complex and nuanced. They require evidence of serious deficits in a person’s personality and in their relationships with other people. The DSM-5 also requires them to show manipulativeness, intentional dishonesty, no regard for others, and aggression or hostility toward others.
People with antisocial personality disorder show these characteristics across time and different situations, and these behaviors do not result from their social circumstances, the physical effects of substance use, or another mental disorder or medical condition.
Learn More About How Antisocial Personality Disorder Is Diagnosed
The Antisocial Personality Disorder Test?
Just as there's no diagnostic blood work or imaging for ASPD, there's no test one can take to determine whether they have ASPD. Search the internet, though, and you'll find ASPD "tests" or questionnaires about your personality, based on the criteria that mental health professionals use to help diagnose ASPD. These tests generally caution that they're only for "educational" purposes and cannot take the place of a psychological evaluation by a mental health professional.
Can Children Have Antisocial Personality Disorder?
Children can exhibit antisocial behaviors, and signs of the disorder typically begin in childhood or the early teen years, but a person cannot be diagnosed with antisocial personality disorder until they are at least 18 years old. (4) People who show symptoms of antisocial personality disorder before age 18 are usually diagnosed with conduct disorder.
Duration of Antisocial Personality Disorder
Because ASPD is challenging to treat, it's hard to gauge how the condition may improve over time. Personality disorders are lifelong patterns of behavior and there's no cure for ASPD. Still, according to the National Institutes of Health, ASPD symptoms tend to peak during late adolescence and one's late twenties. By one's forties, symptoms may improve or lessen on their own. (5) Aggressive and criminal behaviors, in particular, may decrease with age, notes the Cleveland Clinic. (7)
Treatment Options for Antisocial Personality Disorder
Antisocial personality disorder is extremely difficult to treat, largely because people who have it often do not seek out or want treatment. Sometimes a court will order a person to receive treatment.
Behavioral treatments that reward socially acceptable behavior and provide negative consequences for illegal or inappropriate behavior can be partly effective. Talk therapy is another option for people with antisocial personality disorder.
Often, a person with antisocial personality disorder will have other conditions that require treatment, such as a substance use disorder or another mental health condition.
For people who have committed violent crimes, imprisonment can reduce the harm they can cause to others. But research has shown that violent offenders with antisocial personality disorder have a hard time learning from their mistakes and do not respond to punishment. They can have poorer working memory and are often unable to change their behavior even after being shown what the consequences will be. (8)
It is unclear whether or not people with antisocial personality disorder have the potential for empathy. Some research suggests that they can feel empathy but may need to switch it on, in a sense, suggesting a possible avenue of future research for treatment. (9)
Learn More About Treatment of Antisocial Personality Disorder
Is Antisocial Personality Disorder Preventable?
No, there's currently no way to prevent ASPD, although societal changes to reduce risk factors, such as poverty and child abuse, could help in reducing the number of people with this disorder. Also, as the Cleveland Clinic notes, early detection and intervention might help reduce the severity of this disorder and the harm this condition can cause family and friends. (7)
Complications of Antisocial Personality Disorder
Antisocial personality disorder is directly linked to breaking rules and criminal behavior, so people with this personality disorder are at high risk for committing crimes and serving prison time. They have a higher risk for committing violence against others, but ASPD is also linked to self-harm, as those with the disorder have higher risk for dying by suicide, and for dying from accidents or violence related to their actions. (5,10)
They also have a higher risk for using illegal drugs or developing dependence on drugs, alcohol, or other substances. (10)
Research has shown a higher risk of physical health problems among people with antisocial personality disorder, including heart disease, gastrointestinal disease, liver disease, arthritis, overall disability, emergency department visits, and hospitalizations. (1,11)
People with antisocial personality disorder are more likely to experience divorce or other separation from their spouse, homelessness, unemployment, and financial dependence on others or on government programs. (12)
Learn More About Life Consequences of Antisocial Personality Disorder
Research and Statistics: Who Has Antisocial Personality Disorder?
There appears to be a large gender difference in terms of who is likely to be diagnosed with ASPD. (5) Two studies suggested that about 4.5 or 6.8 percent of men have antisocial personality disorder, while both estimated that 0.8 percent of women have it. Lower estimates have been found in European studies, with ASPD in approximately 1 to 1.3 percent in men and up to 0.2 percent in women. (13)
When compared with society as a whole, people in prison are much more likely to have ASPD. One study which looked at the prison population worldwide estimated that 47 percent of incarcerated men and 21 percent of women have antisocial personality disorder. (13)
Related Conditions of Antisocial Personality Disorder
People with antisocial personality disorder are more likely to have depression or an anxiety disorder than the general population, particularly among women with antisocial personality disorder. (14) Other mental health conditions more common in people with antisocial personality disorder include post-traumatic stress syndrome, borderline personality disorder, bipolar disorder, and schizophrenia-related disorders. (1)
Resources on Antisocial Personality Disorder
For clear, concise information on personality disorders in general, and antisocial personality disorder in particular, check out the National Institutes of Health's MedlinePlus.
American Psychiatric Association
As the world's leading psychiatric organization, the APA promotes effective treatment for people with mental illness, improving mental health education, and access to care. The APA also publishes and periodically revises the Diagnostic and Statistical Manual of Mental Disorders (DSM), the authoritative guide to diagnosing mental disorders.
This nonprofit works to promote mental health, especially early interventions (which may be beneficial when it comes to ASPD), and meet the needs of those living with mental illness.
Run by mental health professionals, this site offers information on mental health conditions, including personality disorders, as well as online support groups and community forums for people with mental health disorders and those dealing with the consequences of having a loved one with a mental health disorder.
In addition to the magazine, which was launched in 1967, Psychology Today's website provides a wealth of information on mental health, as well as a directory where you can search for a therapist.
Editorial Sources and Fact-Checking
- Personality Disorders. National Institute of Mental Health. November 2017.
- Goldstein RB, Chou SP, Saha TD, et al. The Epidemiology of Antisocial Behavioral Syndromes in Adulthood: Results From the National Epidemiologic Survey on Alcohol and Related Conditions-III. Journal of Clinical Psychiatry. January 2017.
- Grant BF, Hasin DS, Stinson FS, et al. Prevalence, Correlates, and Disability of Personality Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. July 2004.
- Comparison of DSM-IV and DSM-5 Criteria for Personality Disorders. American Psychiatric Association. 2012.
- Antisocial Personality Disorder. MedlinePlus. April 9, 2020.
- Conduct Disorder. MedlinePlus. April 9, 2020.
- Antisocial Personality Disorder. Cleveland Clinic. November 20, 2017.
- De Brito SA, Viding E, Kumari V, et al. Cool and Hot Executive Function Impairments in Violent Offenders With Antisocial Personality Disorder With and Without Psychopathy. PloS One. June 20, 2013.
- Meffert H, Gazzola V, den Boer JA, et al. Reduced Spontaneous But Relatively Normal Deliberate Vicarious Representations In Psychopathy. Brain. August 2013.
- Antisocial Personality Disorder: Outlook/Prognosis. Cleveland Clinic. November 20, 2017.
- Goldstein RB, Dawson DA, Chou SP, et al. Antisocial Behavioral Syndromes and Past-Year Physical Health Among Adults in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Clinical Psychiatry. March 2008.
- Goldstein RB, Dawson DA, Smith SM, et al. Antisocial Behavioral Syndromes and Three-Year Quality of Life Outcomes in United States Adults. Acta Psychiatrica Scandinavica. August 2012.
- Antisocial Personality Disorder: Treatment, Management and Prevention. NICE Clinical Guidelines. British Psychological Society. 2010.
- Zoccolillo M. Co-occurrence of Conduct Disorder and Its Adult Outcomes With Depressive and Anxiety Disorders: A Review. Journal of the American Academy of Child and Adolescent Psychiatry. May 1992.