What is Antisocial Personality Disorder?
Antisocial Personality Disorder, often called sociopathy or psychopathy due to both being seen as subsets of Antisocial Personality Disorder (though which applies depends on the symptoms), is a mental health disorder in which a person has a long-standing pattern of exploiting, manipulating, or violating the rights of others. Antisocial Personality Disorder often begins in childhood or the teen years and pervades into adulthood.
People who have Antisocial Personality Disorder usually lack empathy (the ability to understand and appreciate the emotions of others), lean towards being cynical and callous, often scornful of the emotions, feelings, rights, and suffering of others. Those with Antisocial Personality Disorder may feel that they are above everyone else, that ordinary work is beneath them; they may have loudly-voiced opinions and come across as cocky or arrogant.
Even as they are contemptuous of the feelings of others, they may come across as charming, using expansive language to impress those around them, even as they exploit their personal and sexual relationships.
Symptoms of Antisocial Personality Disorder:
Those affected by Antisocial Personality Disorder may exhibit the following signs and symptoms:
- Sense of right and wrong is skewed or ignored
- Prone to lying and deception
- Shows a lack of remorse about harming others
- Violates the rights of others
- Frequent agitation
- Episodes of aggressive or violent behavior
- Tendency toward child abuse or neglect
- Tendency toward partner abuse or difficult relationships
- Chronic legal problems
- Uses charm or wit to manipulate others
- Intimidates people
- Difficulties holding down a job or acting responsibly at work
Causes of Antisocial Personality Disorder:
As is the case with many personality disorders, the precise cause for Antisocial Personality Disorder is unknown. Most medical professionals believe that Antisocial Personality Disorder is caused by a mixture of genetics, social factors and psychological factors, rather than one single cause.
Childhood abuse, a prior diagnosis of conduct disorder, unstable or chaotic early family life, or the loss of a parent during childhood are often risk factors associated with Antisocial Personality Disorder.
Subtypes Of Antisocial Behavior:
Theodore Milton identified five subtypes for antisocial behavior; however, someone with Antisocial Personality Disorder may experience none or many of these subtypes:
- Malevolent Antisocial - includes paranoid, sadistic traits.
- Covetous Antisocial - variation of the pure pattern wherein the individual feels that life has been excessively unfair.
- Risk-Taking Antisocial - includes histrionic traits.
- Reputation-Defending Antisocial - includes narcissistic traits.
- Nomadic Antisocial - includes schizoid, avoidant features.
Prevalence of Antisocial Personality Disorder:
Antisocial Personality Disorder is more common in men than women. Out of the general population, 3% of men and 1% of women are diagnosed with Antisocial Personality Disorder. The prevalence of Antisocial Personality Disorder is higher in certain populations - such as prisons.
One study indicated that 47% of the male prisoners and 21% of the female prisoners have Antisocial Personality Disorder. Antisocial Personality Disorder is seen in 3-30% of psychiatric outpatient settings.
DSM-IV Diagnostic Criteria for Antisocial Personality Disorder:
The Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM IV-TR), defines antisocial personality disorder (in Axis II Cluster B) as:
A) A pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three or more of the following:
- Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest.
- Deception, as indicated by repeatedly lying, use of aliases, or conning others for personal profit or pleasure.
- Impulsiveness or failure to plan ahead.
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
- Reckless disregard for safety of self or others.
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
- Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.
B) The individual is at least age 18 years.
C) There is evidence of conduct disorder with onset before age 15 years.
Diagnosis of Antisocial Personality Disorder:
Personality disorders, like Antisocial Personality Disorder, are not usually diagnosed by a general family practitioner. Instead, personality disorders should be diagnosed by a mental health professional like a psychologist or psychiatrist.
However, many people with Antisocial Personality Disorder do not seek out medical treatment or a diagnosis unless the disorder begins to significantly impact their lives.
A diagnosis of Antisocial Personality Disorder is made when a trained medical health professional compares symptoms and detailed history to the DSM-IV criteria for Antisocial Personality Disorder.
Treatment of Antisocial Personality Disorder:
It's unfortunate that Antisocial Personality Disorder is often grossly misunderstood by the public as well as mental health professionals. The stigma of labels like "sociopath" and "psychopath" means that those with Antisocial Personality Disorder often are discriminated against in the mental health community, especially since the pervasive lack of remorse may come across as not having any feelings whatsoever. This can greatly hinder diagnosis and treatment.
The treatment of choice for Antisocial Personality Disorder is psychotherapy, often coupled with treatment of other co-morbid diagnoses with medication.
Many people with Antisocial Personality Disorder do not actively seek out treatment unless they are court-ordered or demanded by a significant other. This may make motivation to get better difficult.
Individuals with Antisocial Personality Disorder are not easily motivated to change their patterns of behaviors, but it may be done. Threats are almost never a good motivator for those with Antisocial Personality Disorder, but intensive approaches to draw connections between a person's actions and their feelings may help. Emotions are a key aspect of treatment, as those with Antisocial Personality Disorder have very few emotionally-rewarding relationships. Reinforcing any emotions - aside from anger - is important, as expressing emotions is a sign of progress that the therapy may be working.
Often, the most effective way for a person with Antisocial Personality Disorder to learn better coping skills is to face up to the consequences of their behavior. This may include the court system and/or jail, but may be an excellent motivating factor in the person's treatment.
Medications may be used to treat co-morbid conditions, but there are no indications that medications will help to treat Antisocial Personality Disorder.
Self-help groups designed specifically for those with Antisocial Personality Disorder may be very helpful, as those with Antisocial Personality Disorder often feel more at ease discussing feelings and behaviors with their peers in a supported environment. However, it must be made clear that the group therapy is not a place to brag about exploits and behaviors.
Additional Resources for Antisocial Personality Disorder:
Aftermath: Surviving Psychopathy - dedicated to educating the public regarding the nature of psychopathy and its cost to individuals and society. We seek to support the families and victims of those with psychopathy.
“Suffering Souls”: An article in The New Yorker about understanding psychopathy.
Out of the Fog provides information and support for those with a loved one who has a personality disorder.