Antisocial personality disorder

What is antisocial personality disorder?

Antisocial personality disorder, like other personality disorders, is a longstanding pattern of behavior and experience that impairs functioning and causes distress.

By definition, people with antisocial personality disorder don't follow society's norms, are deceitful and intimidating in relationships, and are inconsiderate of the rights of others. People with this type of personality may take part in criminal activity. But if they do, they are not sorry for their hurtful deeds. They can be impulsive, reckless, and sometimes violent. This disorder is far more common and more apparent in men than women.

People with antisocial personality disorder generally do not value "playing by the rules." They do so only if they are threatened with punishment.

This attitude leads to a tendency to exploit others. They take advantage of the fairness or softheartedness of others, and they feel indifferent toward or even contemptuous of their victims.

A person with this disorder has little, if any, ability to be intimate with another person. Any lasting relationships are likely to involve some degree of abuse or neglect.

Yet people with this disorder are sometimes charming and can be good actors who use lies and distortion to keep relationships going. Some with antisocial personality disorder have no goal beyond the pleasure of deceiving or harming others.

People with antisocial personality disorder appear to care for no one but themselves. They may be able to understand the emotions of others, but they don't suffer any shame or guilt about the pain they may be causing. Instead, they use their knowledge of others' weaknesses to gain favors or to manipulate an outcome.

A person with this disorder usually does not take responsibility for any of his or her own suffering. He or she will blame others when things go badly. Many with this disorder do suffer, because they can be self-defeating, and never get to enjoy the many pleasures that come to people who are better able to have mutual and satisfying relationships.

People with this personality disorder can also have problems such as chronic boredom or irritability, psychosomatic symptoms, pathological gambling, alcohol and substance use, and a variety of mood or anxiety disorders. They have a higher risk of suicide. A significant number have had behavior problems or attention deficit hyperactivity disorder as children.

Antisocial personality disorder is probably caused by a combination of factors. Having any of these characteristics does not necessarily mean that a person has antisocial personality disorder.

• Influences from the environment. A chaotic family life contributes to the development of this personality disorder, especially where there has been little supervision from parents or other adult role models. The disorder also may be more common where the community is not supportive or provides little reward for positive behavior. In some situations, there may even be reinforcement for sociopathic behavior.
• Genetic (inherited) or biological factors. Antisocial personality traits do appear to be highly heritable. Researchers have also found certain physiological responses that may occur more frequently in people with antisocial personality disorder. For example, they have a comparatively flat response to stress. They seem to get less anxious than the average person. They seem to have a harder time maintaining daytime arousal. They also have a weak "startle reflex," the involuntary response to loud noises. This relative insensitivity may affect their ability to learn from reward and punishment.
• Brain anatomy. The frontal lobe, the area of the brain that governs judgment and planning, also appears to be different in people with antisocial personality disorder. Some researchers have found changes in the volume of brain structures that mediate violent behavior. People with this kind of brain function may thus have more difficulty restraining their impulses, which may account for the tendency toward more aggressive behavior. Neurobiologists cannot say with certainty that these variations in brain structure are a cause of antisocial personality. The variations could easily be the result of life experiences that are more common in people with this personality disorder rather than a cause.

Symptoms of antisocial personality disorder

People with antisocial personality disorder tend to have few symptoms. Rather, they cause discomfort or distress to others through socially unacceptable behavior and by being

• deceitful
• impulsive
• aggressive or irritable
• reckless
• irresponsible
• remorseless.

Diagnosing antisocial personality disorder

The diagnosis is made on the basis of a person's history, usually by a mental health professional. There are no laboratory tests to assist in diagnosing this disorder. Other psychiatric disorders, such as a mood or anxiety disorder, attention deficit hyperactivity disorder, or substance use disorders, may also be present.

Expected duration of antisocial personality disorder

Antisocial personality disorder often becomes less severe or even goes away as people get older.

Preventing antisocial personality disorder

There is no simple or widely used way to prevent this disorder.

However, early and intensive help for young children with severe behavioral problems can lower the incidence of antisocial personality disorder. An improvement in a child's early environment (by reducing abuse and unstable parenting) may also reduce risk, but doing this on a large scale is difficult.

Treating antisocial personality disorder

Many psychotherapy techniques have been proposed for treating antisocial personality disorder. Unfortunately, research does not indicate that any of the current treatments is particularly helpful for treating the personality disorder itself.

As a result, the choice of treatment is usually guided by a person's specific circumstances.

• In younger people, family or group psychotherapy may help to change destructive patterns of behavior, teach new vocational and relationship skills, and reinforce a person's social support.
• Psychotherapy also may help a person with this disorder learn to be more sensitive to the feelings of others and encourage new, socially acceptable and productive ways of thinking about one's goals and aims.
• Cognitive therapy attempts to change sociopathic ways of thinking.
• Behavior therapy uses reward and punishment to promote good behavior.

Medications can sometimes help specific symptoms, although again there is no medication that treats antisocial personality disorder itself. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), may decrease aggressiveness and irritability, particularly when anxiety, depression, or substance use are also present. In practice, medications are used to treat co-occurring conditions rather than the personality disorder directly.

There are many questions about how helpful any of these interventions can be in an illness where, by definition, people who are affected do not recognize that they have a problem. Treatment is more likely to help when started earlier in life. But it is difficult to change long-entrenched patterns of thinking and behavior. Some antisocial behaviors, particularly aggression and criminal activity, tend to decrease with age. But some personality characteristics may persist.

While the criminal justice system often serves to protect others from harm, incarceration does not reliably provide effective treatment and may, in some cases, reinforce antisocial behavior rather than reduce it.

When to call a professional

People with antisocial personality disorder generally do not acknowledge that they have a problem that requires treatment. When a pattern of antisocial behavior is noted, others can recommend or encourage treatment. However, treatment may only occur when a court imposes it.

Prognosis

The long-term outlook for antisocial personality disorder is highly variable. Although treatment can sometimes be successful, change is not likely to be rapid when antisocial behavior is severe. In such cases, resources of time and energy may be better spent in getting help for potential victims, especially those, such as spouses or family members, who live in close proximity to the person with the disorder.

Additional info

National Institute of Mental Health
https://www.nimh.nih.gov/

National Alliance on Mental Illness
https://www.nami.org/

American Psychiatric Association
https://www.psychiatry.org/

American Psychological Association
https://www.apa.org/