Antisocial personality disorder (ASPD) is a mental health condition. A person with ASPD displays a pattern of disregard for the rights of others. Common features include deceitful, manipulative, and criminal behaviors.

Every person has a distinct personality, which involves how they think, behave, and act. Some people develop unhealthy and rigid thinking, emotional, and behavioral patterns that affect their work and relationships.

Individuals with ASPD do not follow social norms and show no regard for other people’s rights or feelings. People may sometimes refer to them as sociopaths.

This article provides an overview of antisocial personality disorder, including its symptoms, causes, and treatments. It also explains how ASPD relates to psychopathy.

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ASPD is a mental health condition characterized by behavioral patterns that involve lying, manipulating and exploiting other people, and violating their rights.

ASPD affects 1–4% of the population.

A person with ASPD has thoughts and behaviors 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

Individuals with ASPD do not show remorse for their behaviors, which may be criminal. They can appear indifferent to the consequences of hurtful actions or rationalize the reasons for hurting, mistreating, or stealing from others.

ASPD is one of the 10 personality disorders that the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, text revision (DSM-5-TR) lists. The manual classifies personality disorders into three clusters. ASPD is one of the four disorders in cluster B.

Cluster B personality disorders typically involve behaviors that many would consider unpredictable.

Anyone can be deceitful or manipulative from time to time. These behaviors are pervasive and inflexible in people with ASPD.

According to the DSM-5-TR, behaviors that may indicate ASPD include:

  • breaking social norms, including the law, repeatedly
  • displaying behaviors that are grounds for arrest
  • deceiving, stealing from, or manipulating others frequently for personal profit or pleasure
  • making spur-of-the-moment decisions
  • being irritable or aggressive
  • getting into physical fights
  • assaulting others, including domestic abuse
  • disregarding their own and others’ safety
  • showing consistent, extremely irresponsible behavior
  • struggling with commitments and financial responsibilities
  • showing no guilt or remorse
  • destroying property
  • harassing others
  • pursuing illegal occupations
  • blaming victims to rationalize their behavior
  • being arrogant or having an inflated sense of self
  • presenting as self-assured or cocky
  • showing superficial charm

These behavioral patterns can make relationships challenging and make it difficult for people with ASPD to keep a job.

People with ASPD tend to have a history of having many sexual partners, and many may never have sustained a monogamous relationship. They may also be irresponsible parents.

A 2018 population-based study found that among teens aged 12–14 years, direct aggression was predictive of ASPD.

Research also suggests that people with personality disorders may have a higher risk of attempting suicide than the general population.

Suicide prevention

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 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.

Click here for more links and local resources.

Healthcare professionals diagnose ASPD by carrying out a psychological evaluation. The person must show symptoms of having a pervasive pattern of disregard for and violation of the rights of others.

Although no recognized tests exist to diagnose the condition, doctors may request genetic and neuroimaging tests to look for potential causes of and patterns associated with ASPD.

Criteria

Healthcare professionals rely on the diagnostic criteria in the DSM-5-TR to diagnose ASPD. A person will only meet the criteria if they demonstrate at least three of the following:

  • failure to conform to societal norms
  • deceitfulness
  • impulsivity
  • irritability or aggressiveness
  • reckless disregard for the safety of themselves or others
  • consistent irresponsibility
  • lack of remorse

Minimum age for ASPD diagnosis

According to the DSM-5-TR, doctors cannot diagnose ASPD in childhood. A person must be at least 18 years old to receive a diagnosis of this condition.

However, signs should already be present before they reach the age of 18 years, with evidence of the onset of conduct disorder (CD) before 15 years of age.

The antisocial behavior also cannot occur exclusively during the course of a person’s schizophrenia or bipolar disorder.

Just because a person commits a crime, this does not mean that they have ASPD. The person should present with persistent and inflexible personality traits that cause distress or functional impairments.

When a person with a substance use disorder displays signs of ASPD, they will not receive a diagnosis unless these signs were present in childhood. However, the two conditions can co-occur.

People with ASPD may have other associated conditions, such as:

They may also have characteristics that meet the diagnostic criteria for other personality disorders, especially the other cluster B disorders:

The DSM-5-TR notes that individuals who receive a diagnosis of CD before the age of 10 years and also have attention deficit hyperactivity disorder (ADHD) have an increased risk of developing ASPD.

People may use the terms sociopath and psychopath interchangeably, although neither is an official diagnostic term. However, an older study suggests that sociopathy is more appropriate when a brain injury, neurological differences, or a belief system contributes to antisocial behavior.

Meanwhile, psychopathy refers to a defined set of traits, and experts almost exclusively investigate psychopathic traits within criminal populations.

The DSM-5-TR describes psychopathy as a variant of ASPD. It defines psychopathy as marked by:

  • deficient emotional responses
  • lack of empathy
  • poor behavioral control
  • a lack of anxiety or fear
  • a dominant, bold interpersonal style that can mask harmful behaviors
  • low levels of anxiousness and withdrawal
  • high attention-seeking
  • callousness

Some researchers believe that psychopathy is a subtype of ASPD with a more severe presentation. Researchers estimate that about one-third of those with ASPD meet the criteria for psychopathy.

A 2014 study contrasts the two conditions by their cause, noting that psychopathy may be a consequence of genetics or indirect factors such as trauma, while sociopathy is due to environmental factors such as poor parenting.

Learn more about the differences between psychopathy and sociopathy.

Researchers do not know the exact cause of ASPD, but genetic, environmental, and cultural factors may all play a role in its development.

According to the DSM-5-TR, ASPD is more common among first degree biological relatives, with heritability estimates in the range of 38–69%.

Some environmental factors linked with this disorder include adverse childhood experiences, such as neglect and physical and sexual abuse, and having CD and ADHD during childhood.

Males are three to five times more likely to receive a diagnosis of ASPD than females.

Treating ASPD is not straightforward. People with ASPD rarely seek treatment, usually only starting therapy when a court requires it.

There is a lack of evidence to support the effectiveness of psychological and pharmacological treatments for ASPD. However, medications can help with co-occurring conditions, such as aggressive behavior and impulsivity.

Managing the symptoms can be difficult, and there is a relatively high rate of people stopping their treatment early.

Drug or alcohol use is likely to increase the risk of aggression and impulsivity. Treating any substance misuse can, therefore, have significant benefits.

Treatment focuses on achieving specific short-term goals, such as avoiding negative consequences for illegal behavior, rather than trying to change the person.

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 relating to others. This type of therapy may take place within community-based or institutional care.

Friends, family members, and healthcare professionals can find it difficult to care for people with ASPD.

The National Alliance on Mental Illness offers advice for family members and caregivers on how they can support someone with a mental health condition while looking after themselves.

ASPD is a lifelong condition. A doctor cannot diagnose it until a person reaches the age of 18 years, but its characteristics may present a few years earlier.

The severity of the symptoms and associated crimes tends to be highest in a person’s late teens, improving as they reach their mid-30s.

Research suggests that those who present with antisocial behaviors at a later age show less severe behavioral problems. People with ASPD who have never been incarcerated or have only experienced short-term imprisonment have higher remission rates.

Antisocial personality disorder is a serious mental condition characterized by inflexible patterns of behavior that disregard other people’s feelings and rights.

There is no clear cause of ASPD, but a combination of genetic and environmental factors likely plays a role.

It is difficult to treat, primarily because people with the condition are unlikely to seek treatment. There is also still no established treatment protocol. However, treatments are available to help people manage the symptoms and relieve co-occurring conditions, such as aggression.

Working with a caring therapist and solid social support can help a person make meaningful changes to their behavior, complementing other treatments.