Antisocial personality disorder
Personality disorders are mental health conditions thatfr affect how someone thinks, perceives, feels or relates to others.
Antisocial personality disorder is a particularly challenging type of personality disorder, characterised by impulsive, irresponsible and often criminal behaviour.
Someone with antisocial personality disorder will typically be manipulative, reckless and not care for other people's feelings.
However, like other personality disorders, the disorder is on a spectrum – so it can range in severity from occasional bad behaviour, to repeatedly breaking the law and committing serious crimes. Psychopaths are considered to have a severe form of antisocial personality disorder.
What are the signs of antisocial personality disorder?
Someone with antisocial personality disorder may:
exploit, manipulate or violate the rights of others (they can be good at flattery and turn on the charm)
lack concern, regret or remorse about other people's distress
behave irresponsibly and show disregard for normal social behaviour
have difficulty sustaining long-term relationships
not be able to control their anger
lack guilt, or not learn from their mistakes
blame others for problems in their lives
break the law repeatedly
As children they may have displayed ruthless and immoral behaviour, such as cruelty to animals and starting fires.
A diagnosis of antisocial personality disorder is made after a psychological assessment. It can only be made if the person is aged at least 18 and at least three of the following apply:
repeatedly breaking the law
repeatedly being deceitful
being impulsive or incapable of planning ahead
being irritable and aggressive
having a reckless disregard for their safety or the safety of others
being consistently irresponsible
lack of remorse
These signs must not be part of a schizophrenic or manic episode – rather they are part of that person's everyday personality.
This behaviour becomes most extreme and challenging during the late teens and early 20s, and may improve by the time the person reaches their 40s.
Who is at risk?
Antisocial personality disorder affects far more men than women.
It's not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences (such as child abuse or neglect) are believed to play a role.
Someone with antisocial personality disorder will typically have an antisocial or alcoholic parent, and will have grown up with harsh, inconsistent parenting.
What are the risks associated with the condition?
There's a high risk that someone with antisocial personality disorder will commit crimes and be imprisoned at some point in their life.
Men with antisocial personality disorder have been found to be three to five times more likely to abuse alcohol and misuse drugs than those without the disorder, and are at high risk of accidentally injuring themselves or committing suicide.
Many will be unemployed and/or homeless.
How is antisocial personality disorder treated?
It used to be thought that antisocial personality disorder was a lifelong disorder, but that's not always true – it can be treated.
Evidence suggests that with therapy, behaviour can improve over time, even if core characteristics (such as lack of empathy) remain.
However, antisocial personality disorder is one of the hardest personality disorders to treat. Also, it's rare that someone with antisocial personality disorder will seek treatment on their own – they may only start therapy when required to by a court.
The main treatment is psychotherapy, which involves talking to a trained therapist about feelings that the person has about themself and other people, particularly family and those close to them. Cognitive behavioural therapy is one of the most common types of psychotherapy used – the above link will take you to detailed information about this.
Family and friends of the person may be involved in decisions about their treatment and care. Substance misuse services and social care may also need to be involved.
Some antipsychotics and antidepressants may help people with antisocial disorder, although there's no strong evidence to support the use of medication in antisocial personality disorder. The antipsychotic drugs carbamazepine and lithium may help aggression and impulse control, and a class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may improve anger and personality disorder symptoms in general.
The National Institute for Health and Care Excellence (NICE) recently published guidelines on how people with antisocial personality disorders should be treated. Read the NICE guidelines on treating antisocial personality disorder.
About personality disorders
Personality disorders affect how someone thinks, perceives, feels or relates to others. They range from mild to severe.
The signs typically emerge in adolescence and persist into adulthood. People with personality disorders often have other mental health problems, especially depression and substance misuse.
Personality disorders may be associated with genetic and family factors, and experiences of distress or fear during childhood – such as neglect or abuse – are common.
Treatment usually involves a course of psychological therapy.