Antisocial personality disorder is a mental health condition. A person who has it displays a pattern of disregard for the rights of others. Common features include deceitful, manipulative, and criminal behavior.
Antisocial personality disorder is sometimes called sociopathy, though that is not a clinical term.
People with antisocial personality disorder sometimes lead typical, productive lives. However, they often have difficulties with relationships, emotions, and making decisions that will benefit themselves and others.
The prevalence is not clear, but according to some estimates, 1–4% of people have antisocial personality disorder. Males are up to 5 times more likely to receive a diagnosis than females.
This article provides an overview of antisocial personality disorder, including its symptoms, causes, treatments, and its relation to psychopathy.
Personality disorders are a group of mental health conditions that affect the way a person thinks, feels, and behaves. The symptoms of this type of disorder can undermine the ability to experience well-being and have typical relationships.
In a person with antisocial personality disorder, thoughts and behaviors are characterized by a disregard for — and violation of — the rights of others.
This often manifests as:
- deceitful or manipulative behavior for personal benefit
- criminal behavior
- a disregard for the safety and choices of others
- irresponsible actions
People with this condition also tend to show a lack of remorse. They may appear indifferent to the consequences of hurtful actions or rationalize the reasons for hurting, mistreating, or stealing from others.
This health issue is a cluster B personality disorder — one of a group of conditions that disrupt the emotions and lead to behaviors that many would consider extreme or irrational.
A person can receive a diagnosis of antisocial personality disorder from the age of 18, though there is evidence that the signs may present close to the age of 15.
Children and younger teens who show similar signs may receive a diagnosis of conduct disorder.
Anyone might act in a deceitful or manipulative way from time to time. In people with antisocial personality disorder, these actions are pervasive and inflexible. They appear in a variety of contexts, and the person often displays no remorse.
There are no clinical tests for antisocial personality disorder. Instead, the diagnosis is based on a person’s behaviors and thought processes.
Clinicians use the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) to diagnose mental health conditions, including antisocial personality disorder.
According to the DSM-5, a doctor can diagnose this disorder in someone who is at least 18 years old and who displays at least three of the following signs:
- Repeated antisocial actions: These might be actions that are grounds for an arrest in the person’s society, such as harassment, theft, or an illegal occupation.
- Deceitful behavior for personal gain: This might involve repeatedly lying or assuming false identities.
- Impulsive behavior: This can lead to sudden changes in jobs, housing, or relationships.
- Irritability and aggressive behavior: This might include frequent physical fights or assaults.
- A disregard for safety: This can apply to personal safety or the safety of others. It might include speeding, driving while intoxicated, having multiple accidents, or neglecting a child.
- Irresponsible actions: This might affect work or financial commitments.
- A lack of remorse: A person may, for example, rationalize or appear indifferent to the harm that they cause.
A person with antisocial personality disorder disregards the wishes, rights, and feelings of others. They may also use deceit and charm others for personal gain, which might involve obtaining money, sex, or power.
Their patterns of manipulation, aggression, and irresponsible behavior can make relationships very difficult.
People with antisocial personality disorder may also experience:
- dysphoria, a generalized dissatisfaction with life
- frequent tension
- feeling unable to tolerate boredom
- depressed moods
Also, people with some personality disorders, including antisocial personality disorder, may have a higher risk of attempting suicide than the general population.
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours per day at 800-273-8255. During a crisis, people who are hard of hearing can call 800-799-4889.
A person might receive an evaluation for antisocial personality disorder after being convicted of a crime or after seeking treatment for anxiety, depression, or chronic relationship problems.
However, most people with antisocial personality disorder do not seek treatment and do not receive a diagnosis.
A doctor does not base this diagnosis on a single action or a few events. Also, they do not make this diagnosis if the person’s patterns of behavior can be explained by other factors, such as substance misuse, trauma, or a cognitive disability.
It is important to note that not all people with antisocial personality disorder act on their emotions. Also, not all people who violate the rights of others have a mental health condition.
People with antisocial personality disorder may have other associated condtions, such as:
- anxiety disorders
- depressive disorders
- substance use disorders
- a gambling disorder or other problems with impulse control
They may also have characteristics that meet the diagnostic criteria for other personality disorders, especially the other cluster B disorders: borderline, narcissistic, and histrionic personality disorders.
Some researchers believe that psychopathy is a subtype of antisocial personality disorder. Others believe that psychopathy is a separate condition but that the two overlap.
The DSM-5 describes psychopathy as a variant of antisocial personality disorder. It defines psychopathy as marked by a lack of anxiety or fear and a dominant, bold style of interactions that can mask harmful behaviors.
Likewise, according to the National Institute for Health and Care Excellence, people with psychopathy or dangerous and severe personality disorder make up a small number of those with antisocial personality disorder.
At the same time, these individuals present a very high risk of harm to others and take up much of the services for people with antisocial personality disorder.
Researchers do not know the exact cause of antisocial personality disorder, but genetic, environmental, and cultural factors may all play a role in its development.
For example, heritability estimates range from 38–69%, and some environmental factors linked with this disorder include negative childhood experiences, such as physical abuse, sexual abuse, or neglect.
Childhood experiences of conduct disorder or attention deficit hyperactivity disorder, known as ADHD, are also linked with antisocial personality disorder.
Males are between 3 and 5 times more likely to receive a diagnosis than females.
Treatments aim to help the person manage feelings of anger, distress, anxiety, and depression. The goal is to reduce antisocial behaviors and actions, ultimately benefitting the individual and others around them.
The evidence base for these treatments is currently limited. Managing the symptoms can be difficult, and there is a relatively high rate of people stopping their treatment early.
People often benefit from approaches that address co-occurring conditions, such as depression, anxiety, and substance misuse.
Drug or alcohol use is likely to increase the risk of aggression and impulsivity. Treating any substance misuse can, therefore, have significant benefits.
In treating antisocial personality disorder:
- Psychotherapy can help a person work around disruptive thought patterns, behaviors, and ways of relating to others.
- Group-based therapy can help address impulsive actions, antisocial behavior, and challenges in relating to others. This may occur within community-based or institutional care.
- Mood stabilizers or selective serotonin reuptake inhibitors, known as SSRIs, may help with impulsive and aggressive behavior, and antipsychotic medications may address any paranoia.
However, no medication is specifically designed for antisocial personality disorder.
Friends, family members, and healthcare providers can find it very challenging to care for people with antisocial personality disorder.
The National Alliance on Mental Illness offer advice for family members and caregivers about how to support someone with a mental health condition while looking after oneself.
Antisocial personality disorder is a lifelong condition. A doctor can diagnose it starting at age 18, though its characteristics may become clear a few years earlier.
The severity of symptoms and associated crime tends to be highest in a person’s late teens, and it reduces with age, with a mean remitted age of 35 years old.
Research into the effectiveness of treatment for antisocial personality disorder is currently very limited, and what works for one person might not work for another. However, treatments may help a person manage their symptoms and relieve co-occurring conditions, such as substance misuse and depression.
Working with a caring therapist and being committed to making meaningful changes to behavior may increase the success of treatment.
As research continues, doctors are gaining a better understanding of this complex mental health condition and the most effective ways to care for the people who have it.