Antisocial personality disorder (ASPD)

People with antisocial personality disorder (ASPD) can be witty, charming, and fun to be around -- but they also lie and exploit others. ASPD makes people uncaring. Someone with the disorder may act rashly, destructively, and unsafely without feeling guilty when their actions hurt other people.

Modern diagnostic systems consider ASPD to include two related but not identical conditions: A "psychopath" is someone whose hurtful actions toward others tend to reflect calculation, manipulation and cunning; they also tend not to feel emotion and mimic (rather than experience) empathy for others. They can be deceptively charismatic and charming. By contrast, "sociopaths" are somewhat more able to form attachments to others but still disregard social rules; they tend to be more impulsive, haphazard, and easily agitated than people with psychopathy. ASPD is uncommon, affecting just 0.6% of the population.

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Cause of this disorder is unknown. A person’s genes and other factors, such as child abuse, may contribute to developing this condition. People with an antisocial or alcoholic parent are at increased risk. Far more men than women are affected. The condition is common among people who are in prison. Setting fires and animal cruelty during childhood are often seen in the development of antisocial personality. Some doctors believe that psychopathic personality (psychopathy) is the same disorder. Others believe that psychopathic personality is a similar but a more severe disorder.

Antisocial personality disorder affects more men than women. Experts don’t know for sure what causes it, but genetics and other biological factors are thought to play a role (especially in psychopathy), as can growing up in a traumatic or abusive environment (especially in sociopathy). Brain defects and injuries during developmental years may also be linked to ASPD, research shows.

Possibly because people with ASPD often break the law, a lot of prisoners have ASPD. As many as 47% of male inmates and 21% of female inmates have the disorder, research shows.

People with ASPD may often do the following:

  • Lie, con, and exploit others
  • Act rashly
  • Be angry, vain, and aggressive
  • Fight or assault other people
  • Break the law
  • Not care about the safety of others or themselves
  • Not show signs of remorse after hurting someone else
  • Fail to meet money, work, or social duties
  • Abuse drugs or alcohol

To be diagnosed with ASPD, a person would have to have shown symptoms before age 15. A diagnosis can’t be made until age 18, though. Symptoms are usually at their worst during a person’s late teenage years and in their 20s, but may improve on their own over time.

The disorder is hard to treat. People with ASPD rarely seek help on their own, because they often think they don’t need it.

When treatment is sought, behavioral therapy or psychotherapy in individual or group settings may help. Doctors sometimes use certain psychiatric medications like mood stabilizers or some atypical antipsychotics to treat symptoms like impulsive aggression. The FDA has not approved any medications specifically for antisocial personality disorder.

If someone close to you has ASPD, consider attending a support group, or seek help from a psychiatrist, social worker, or psychologist. You won’t be able to change your loved one’s behavior, but you can learn coping skills to help you set boundaries and protect yourself from harm.

Though antisocial personality disorder is difficult to treat, for some people, treatment and close follow-up over the long term may be beneficial. Look for medical and mental health professionals with experience in treating antisocial personality disorder.

Treatment depends on each person’s particular situation, their willingness to participate in treatment and the severity of symptoms.

Psychotherapy

Psychotherapy, also called talk therapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for substance abuse, and treatment for other mental health conditions.

But psychotherapy is not always effective, especially if symptoms are severe and the person can’t admit that he or she contributes to serious problems.

Medications

There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. Doctors may prescribe medications for conditions sometimes associated with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression. Drugs are usually prescribed cautiously because some have the potential for misuse.

The following lifestyles and home remedies might help you cope with antisocial personality disorder:

  • People with antisocial personality disorder often act out and make other people miserable — with no feeling of remorse. If you have a loved one with antisocial personality disorder, it’s critical that you also get help for yourself.
  • A mental health professional can teach you skills to learn how to set boundaries and help protect yourself from the aggression, violence and anger common to antisocial personality disorder. They can also recommend strategies for coping.
  • Seek a mental health professional who has training and experience in managing antisocial personality disorder. Ask your loved one’s treatment team for a referral. They may also be able to recommend support groups for families and friends affected by antisocial personality disorder.

If you have any questions, please consult with your doctor to better understand the best solution for you. 

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