ANTISOCIAL PERSONALITY DISORDER FACT SHEET

Antisocial personality disorder is a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood. This pattern has also been referred to as psychopathy or sociopathy. Because deceit and manipulation are central features of this disorder, information for diagnosis should be acquired from sources collateral to the individual. Antisocial personality disorder is much more prevalent in males than in females, with a rate of about 3% of males, and 1% of females in the general population. Higher prevalence rates are associated with prison, forensic and substance abuse treatment settings. Adoption studies indicate that both genetic and environmental factors contribute to the risk of developing this disorder. Having a first degree biological relative with the disorder, and/or a history of child abuse or neglect, unstable or erratic parenting, or inconsistent parental discipline may increase risk.

What are the Symptoms and Course of Antisocial Personality Disorder?

For antisocial personality disorder to be diagnosed, the individual must be at least 18 years old.  There must have been exhibited a pervasive pattern of disregard for and violation of the rights of others since the individual was 15 years old, as shown by at least three of the following:

• Failure to conform to social norms of lawful behaviors by repeated performing criminal acts
• Deceitfulness, repeated lying, use of aliases, conning others for personal profit or pleasure
• Impulsivity or failure to plan ahead
• Irritability and aggressiveness, involvement in repeated physical fights or assaults
• Reckless disregard for safety of self or others
• Consistent irresponsibility, failure to sustain consistent work behavior or honor financial obligations
• Lack of remorse, indifference to or rationalizing having hurt, mistreated or stolen from another

The individual must also have shown evidence of conduct disorder prior to being 15 years old. Conduct disorder involves a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated. Behaviors characteristic of conduct disorder include aggression to people and animals, destruction of property, deceitfulness or theft, or serious violation of rules. Persons with antisocial personality disorder tend to be callous, cynical, and contemptuous of the feelings, rights, and sufferings of others. They may lack a realistic concern about their problems or future. Lack of remorse or empathy, inflated self-appraisal, and superficial charm may be predictive of recidivism in prison or forensic settings. Individuals with antisocial personality disorder may be irresponsible as parents, neglecting to care for a child in a way that puts the child in danger. The course of this disorder is chronic, but may become less evident or remit as the individual grows older, particularly by the fourth decade of life.

What are Effective Treatments?

Psychotherapy is nearly always the treatment of choice, however, effective psychotherapy for this disorder is limited. Individuals rarely seek treatment themselves, and are often mandated to therapy by a court or significant other. Treatment should focus on helping the individual understand the nature and consequences of the disorder so he can be helped to control his behavior. Lack of connection between feelings and behaviors is common in this population; psychotherapy can help the individual make the connection, and it can also help reinforce appropriate behavior. Persons with this disorder often have had few or no emotionally rewarding relationships in their lives; the therapeutic relationship can be one of the first if the individual can develop a sense of trust. Group and family therapy may also be beneficial, however, in group therapy care must be taken that sessions do not turn into how-to courses on criminal behavior. Community follow-up and support is essential to maintaining any treatment gains. Research does not support the use of medications for direct treatment of antisocial personality disorder, but medications may be effective in reducing aggression.

Sources:
DSM-IV-TR, American Psychiatric Association, Washington DC, 2000
Personality Disorders: Treatment of Antisocial Personality Disorder Mental Health Net