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Antisocial personality disorder

Antisocial personality disorder
Antisocial personality disorder is a type of chronic mental illness in which a person's ways of thinking, perceiving situations and relating to others are abnormal — and destructive.
People with antisocial personality disorder typically have no regard for right and wrong. They may often violate the law and the rights of others, landing in frequent trouble or conflict. They may lie, behave violently, and have drug and alcohol problems. And people with antisocial personality disorder may not be able to fulfill responsibilities to family, work or school.
Antisocial personality disorder is sometimes known as sociopathic personality disorder. A sociopath is a particularly severe form of antisocial personality disorder.
Antisocial personality disorder symptoms may include:
  • Disregard for right and wrong
  • Persistent lying or deceit
  • Using charm or wit to manipulate others
  • Recurring difficulties with the law
  • Repeatedly violating the rights of others
  • Child abuse or neglect
  • Intimidation of others
  • Aggressive or violent behavior
  • Lack of remorse about harming others
  • Impulsive behavior
  • Agitation
  • Poor or abusive relationships
  • Irresponsible work behavior
The intensity of antisocial symptoms tends to peak during the 20s and then may decrease over time. It's not clear whether this is a result of aging or an increased awareness of the consequences of antisocial behavior. But while people with this disorder might be less likely to commit crimes against others later in life, they may still have trouble functioning in relationships, work or school.
If a loved one has antisocial personality disorder
It's unlikely you'll be able to convince a person with antisocial personality disorder that he or she has a problem — much less convince him or her to seek care. Make your own well-being your priority. Ask your doctor to refer you to a mental health provider who has experience helping families affected by antisocial personality disorder. A therapist familiar with this condition can help you learn how to cope — and stay safe.
Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It's the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood, shaped through an interaction of two factors:
  • Inherited tendencies, or genes. These are aspects of a person's personality passed on by parents, such as shyness or having a happy outlook. This is sometimes called temperament. It's the "nature" part of the nature vs. nurture debate.
  • Environment, or life situations. This is the surroundings a person grows up in, events that occurred, and relationships with family members and others. It includes such things as the type of parenting a person experienced, whether loving or abusive. This is the "nurture" part of the nature vs. nurture debate.
Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some people may have a genetic vulnerability to developing antisocial personality disorder — and life situations may trigger its actual development.
There may be a link between an early lack of empathy — understanding the perspectives and problems of others, including other children — and later onset of antisocial personality disorder. These personality problems may be inherited and identifying them early may help improve long-term outcomes.
Risk factors
Although the precise cause of antisocial personality disorder isn't known, certain factors seem to increase the risk of developing or triggering antisocial personality disorder, including:
  • Being diagnosed with childhood conduct disorder
  • A family history of antisocial personality disorder or other personality disorders or mental illness
  • Being subjected to verbal, physical or sexual abuse during childhood
  • Having an unstable or chaotic family life during childhood
  • Loss of parents through death or traumatic divorce during childhood
Complications and problems of antisocial personality disorder include:
  • Depression
  • Anxiety
  • Aggression or violence
  • Suicidal behavior
  • Reckless behavior
  • Risky sexual behavior
  • Child abuse
  • Alcohol or substance abuse
  • Gambling problems
  • Incarceration
  • Relationship difficulties
  • Social isolation
  • School and work problems
  • Strained relationships with health care providers
Tests and diagnosis
When doctors believe someone has antisocial personality disorder, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:
  • Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
  • Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a thyroid function check.
  • Psychological evaluation. A doctor or mental health provider asks about thoughts, feelings, relationships and behavior patterns. He or she asks about symptoms, including when they started, how severe they are, how they affect daily life and whether similar episodes have occurred in the past. They will also ask about thoughts of suicide, self-injury or harming others.
Pinpointing the type of personality disorder
It sometimes can be difficult to determine if symptoms point to antisocial personality disorder or another personality disorder, since some symptoms overlap more than one disorder. A key factor in diagnosing antisocial personality disorder is how the affected person relates to others. Someone with this condition is likely to act out and make other people miserable — while they, themselves, feel no remorse.
Diagnostic criteria
To be diagnosed with antisocial personality disorder, a person must meet the symptom criteria for that disorder listed in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.
Symptom criteria required for a diagnosis of antisocial personality disorder include:
  • Being at least 18 years old
  • Having had symptoms of conduct disorder before age 15, which may include such acts as stealing, vandalism, violence, cruelty to animals and bullying
  • Repeatedly breaking the law
  • Repeatedly conning or lying to others
  • Being irritable and aggressive, repeatedly engaging in physical fights or assaults
  • Feeling no remorse — or justifying behavior — after harming others
  • Having no regard for the safety of yourself or others
  • Acting impulsively and not planning ahead
A person with antisocial personality disorder is unlikely to provide an accurate account of these signs and symptoms. Instead, a doctor will gather evidence for the diagnosis by asking detailed questions about the affected person's interactions and daily life.
Treatments and drugs
Antisocial personality disorder is notoriously difficult to treat. People with this disorder may not even want treatment or think they need treatment. But because antisocial personality disorder is essentially a way of being, rather than a curable condition, affected people are likely to need close, long-term care and follow-up.
People with antisocial personality disorder may also need treatment for other conditions, such as depression, anxiety or thyroid disorders. Medical and mental health providers with experience treating antisocial personality disorder and commonly associated conditions are most likely to be helpful.
Those involved in treatment may include:
  • A family or primary care doctor
  • A psychiatrist
  • A psychotherapist
  • A pharmacist
  • Family members
  • Social workers
Treatment options
Several treatments are available for antisocial personality disorder. They include:
  • Psychotherapy
  • Stress and anger management skills
  • Medications
  • Hospitalization
The best treatment or combination of treatments depends on each person's particular situation and severity of symptoms.
Psychotherapy is the main way to treat antisocial personality disorder. Psychotherapy is a general term for the process of treating a condition by talking about it with a mental health provider.
Types of psychotherapy used to treat antisocial personality disorder may include:
  • Cognitive behavioral therapy. This type of therapy helps to uncover unhealthy, negative beliefs and behaviors and replace them with healthy, positive ones.
  • Psychodynamic psychotherapy. This approach aims to raise awareness of unconscious thoughts and behaviors and — by bringing them to light — change their negative impact.
  • Psychoeducation. This education-based therapy teaches about all aspects of a condition, including treatments, coping strategies and problem-solving skills.
Psychotherapy may be provided in individual sessions, in group therapy, or in sessions that include family or even friends. The right type of psychotherapy depends on each person's individual situation.
Skills for family members
If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself. Mental health professionals with experience managing this condition can help teach you skills to protect yourself from the aggression, violence and anger common to antisocial personality disorder. They can also recommend strategies for coping. Ask the people on 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.
There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. However, several types of psychiatric medications may help with certain conditions sometimes associated with antisocial personality disorder:
  • Antidepressant medications. Antidepressants may help improve depressed mood, anger, impulsivity, irritability or hopelessness.
  • Mood-stabilizing medications. As their name suggests, mood stabilizers can help even out mood swings or reduce irritability, impulsivity and aggression.
  • Anti-anxiety medications. These may help with anxiety, agitation or insomnia. But in some cases, they can increase impulsive behavior.
  • Antipsychotic medications. Also called neuroleptics, these may be helpful if symptoms include losing touch with reality (psychosis) or, in some cases, anxiety or anger problems are present.
Hospitalization and residential treatment programs
In some cases, antisocial personality disorder symptoms may be so severe that psychiatric hospitalization is required. Psychiatric hospitalization is generally recommended only when people aren't able to care for themselves properly or are in immediate danger of harming themselves or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.
There's no sure way to prevent antisocial personality disorder from developing in those at risk. Trying to identify those most at risk, such as children living with neglect or abuse, and offering early intervention may help. Getting appropriate treatment early, and sticking with it for the long term, may prevent symptoms from worsening.
Because antisocial behavior is thought to have its roots in childhood, parents, teachers and pediatricians may be able to spot early warning signs. While diagnosis of antisocial personality disorder generally isn't done before age 18, children at risk may have symptoms of conduct disorder, especially behavior that involves violence or aggression toward others, such as:
  • Stealing during confrontations, such as a mugging
  • Cruelty to people and animals
  • Fire-starting
  • Use of weapons
  • Sexual assault
  • Repeated lying
Early, effective and appropriate discipline, lessons in behavioral skills, and psychotherapy may help reduce the chance that at-risk children go on to become adults with antisocial personality disorder.
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