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.
Symptoms
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.
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.
Causes
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
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.
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.
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:
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
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.
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.
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.
Medications
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:
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.
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.
Prevention
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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