Antisocial Personality Disorder

What is it?

Personality disorders are deeply ingrained patterns of behavior that violate social norms and cause problems in interpersonal relationships. They are broken into three categories — Cluster A, B and C.

Personality disorders are previously known as axis two disorders — a group of conditions that impact a person’s function in relation to others. They are ego-syntonic, meaning a person with a personality disorder often doesn’t believe they have a problem. The disorder is consistent with their world view, perception of others and perception of themselves. They usually begin during a person's teenage years or early adulthood, and in some cases, become less obvious in middle age. It is common for people with one personality disorder to have symptoms of another.

Antisocial Personality Disorder, also called ASPD or sociopathy, is a Cluster B disorder. Cluster Bs are characterized by dramatic, emotional or erratic behavior. People with ASPD demonstrate a disregard for the rights and feelings of others, and may manipulate or deceive in order to get what they want. They lack empathy for the harm they cause, and may rationalize their actions by blaming others, lying or saying hardship is “a part of life.” 

ASPD often occurs alongside other mental health conditions including ADHD, borderline personality disorder, substance use disorders and impulse control disorders. It’s estimated that around 3% of the U.S. general population has ASPD. It’s six times more common in men than women.

What are the symptoms?

People with ASPD lack a moral compass, and are comfortable wronging others if it benefits them. They are likely to commit actions that get them into trouble with authority. Their actions are likely to hurt others around them. They may even deliberately target other people for their own personal gain. Some of the symptoms can be quite alarming and potentially harmful. At times, they may seem charming, but this is frequently a manipulation tactic. 

Additional symptoms include: 

• A disregard for right and wrong 
• Using charm or wit to manipulate others 
• Having issues with the law 
• Seeming arrogant or superior  
• Violating the physical or emotional rights of others 
• Lacking home or job stability 
• Demonstrating irritable, aggressive or violent behavior
• A lack of remorse for wrongdoing
• Being consistently irresponsible 
• Engaging in reckless or impulsive behavior 
• Acting deceitful 
• Having poor or abusive relationships
• Having childhood behavioral problems, such as a diagnosis of Conduct Disorder

What are some common warning signs?

ASPD is characterized by a disregard for other people and a lack of remorse for doing harm. Because of this, a loved one with ASPD might display noticeable symptoms at home, at work or in social settings. Pay attention to their actions, social habits and relationships with others. Ask yourself the following questions: 

• Are they highly competitive and willing to deceive others to get what they want? 
• Are they often irritable, aggressive or violent? 
• Are they emotionally or physically abusive to family members or romantic partners? 
• Do they engage in reckless behavior, such as drunk driving? 
• Do they struggle with substance abuse? 
• Can they be charming, but flip their demeanor quickly when they don’t get what they want? 
• Do they rarely demonstrate empathy for others? 
• As a child, did they have issues with harming animals, bullying other kids, theft or destruction of property? 
• Have they engaged in illegal/criminal activity?

None of these behaviors confirm a ASPD diagnosis, but they do hint at one. If you feel comfortable doing so, talk to your loved one about this behavior and why you’re concerned. Keep in mind that symptoms aren’t always obvious. People battling chronic mental health conditions often learn to hide their pain from others. It’s possible to appear outwardly fine, while facing mental difficulties in secrecy.

What causes ASPD?

The exact causes of ASPD are unknown. Doctors believe a range of factors play a role in its development, including being genetically predisposed (i.e. other family members struggle with ASPD or other mental disorders), having a history of trauma (such as being emotionally or physically abused as a child), or experiencing head trauma.

ASPD behavior has also been associated with decreased function in the prefrontal cortex.The prefrontal cortex is involved in important executive functions, including behavior inhibitions, planning ahead, determining consequences of action, and differentiating between right and wrong. 

How is it treated?

The primary treatment method for all personality disorders, ASPD included, is psychotherapy (aka talk therapy). Anger and violence management courses may be recommended as well. 

Medications are not commonly used to treat personality disorders. However, they may be recommended to address severe cases or symptoms that stem from co-occurring conditions. Common medications include anti-depressants such as SSRIs or SNRIs, and anti-anxiety medications (aka Benzodiazepines).

Treatment for ASPD can be successful, however, people often refuse to seek help because they don’t see their behavior as problematic. It is considered one of the most difficult personality disorders to treat because of the individual’s low or absent capacity for remorse and failure to see the impact that their actions have on others. Most treatment done for ASPD is for those in the criminal justice system who are required to enter therapy. 

It’s important to remember that treatment plans are personalized. If you’re seeking help, make sure you work one-on-one with a doctor to create a plan that fits your needs. Just because a medication or therapy helps someone else recover, doesn’t mean it’ll be the right solution for you. Don’t ever feel guilty about asking for help, taking meds or going to therapy. Addressing your mental health is a productive and courageous thing to do.

How can I help a loved one with ASPD?

Caring for someone with ASPD is not easy. You may struggle to trust them or even fear their emotional reactions in certain scenarios. It’s important to take care of yourself and receive counselling of your own if you feel you need it. 

It can also be hard to know how to support them. Do they want to talk about their behavior? Will they push you away if you try to help? There are no easy answers to these questions. Every person handles their mental health differently. That said, we all want to feel loved and supported. Showing someone that you’re invested in their wellbeing can make a world of difference. 

Here are some ways to do so: 

• Educate yourself: Read up on symptoms, treatment options, and healthy living recommendations. Try and understand what your loved one is going through so you are better equipped to talk to them about it. This will also make you a valuable resource when it comes time to find treatment. 
• Advocate treatment: Asking for help can be hard. Societal stigma often keeps people from opening up to others about their symptoms. Support your loved one by helping them research different treatment methods, or doctors in their area. If they’d like, go to a few sessions with them. Remind them that there’s nothing weird about getting help, and that you’re proud of them for following through. Remember that people with PPD are often reluctant to seek help, and that this conversation may be triggering for them.
• Set boundaries: You want to be understanding of their symptoms, but that doesn’t mean you have to put up with everything. Make rules for what you will and won’t tolerate. Stick to these boundaries and follow through on consequences when they’re broken. 

Be patient: Don’t take it personally if they lash out at you. They are battling something that’s very hard to overcome. Their distance has nothing to do with who you are as a person. Keep showing up for them even when it feels like it’s not helping. The act alone lets them know that they have people in their life who care.