Antisocial personality disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at March 31, 2016
StartDiseasesAntisocial personality disorder

Antisocial personality disorder or ASPD is a mental disorder that distorts a person's thought processes, altering their perception of other people and situations. Those affected typically have no sense of right and wrong, and disregard the feelings, rights, and wishes of other people.


Definition & Facts

Those affected typically treat others poorly by antagonizing, manipulating or being harsh to people around them. People with ASPD often break the law without guilt or remorse. People with ASPD are often not able to fulfill their responsibilities due to drug abuse and alcohol abuse. Men are more affected by women and it is estimated that 3.6% of American adults have ASPD.

Symptoms & Complaints

There are many varying symptoms for antisocial personality disorder. There is often a gross disregard for right and wrong with a consistent habit of lying and deceiving other people. Manipulation is common, especially in order to achieve a certain personal gain or pleasure.

It is common for people with ASPD to have a sense of superiority and be very egocentric. Violence and aggression often lead to legal troubles. With a lack of empathy for others, people with ASPD are often involved in abusive relationships. These symptoms may begin as early as childhood, but are fully clear between the ages of 20 and 40. In children, common symptom are bullying, cruelty to animals, explosions of anger, poor performance in school, and social isolation.


Personality disorders such as ASPD are caused by a combination of genetic factors and environmental factors. Some people might be genetically pre-disposed to develop ASPD, and it may be ultimately triggered by life situations. Although the exact cause of ASPD is unknown, a family history of ASPD, childhood abuse, an unstable household, a childhood trauma, and substance abuse in the childhood household are common risk factors.

Diagnosis & Tests

Medical and psychological tests can be conducted when ASPD is suspected. These tests generally include a physical examination and lab tests to rule out other issues, as well as a psychological evaluation. A mental health physician will explore the behavior patterns, thoughts, relationships, feelings, and family history. This may include some personality tests as well.

The doctor will ask about symptoms, their onset, their severity, how daily life is affected, and whether this is a recurring problem. The doctor will also inquire about suicidal thoughts, self-harm or violent behavior towards others.

A person who has ASPD is not likely to give accurate information about their symptoms. Due to this, doctors often consult the family and friends of the patient as well. It can be difficult to decide if ASPD is the correct diagnosis versus another personality disorder, because some symptoms are present in more than one disorder.

One must meet the criteria of symptoms in the Diagnostic and Statistical Manual of Mental Disorders in order to be diagnosed with ASPD. The symptoms include being 18 years or older, having a previous conduct disorder, a history of breaking the law and lying, a history of aggression and assault, acting impulsively, and having no regard for people's safety.

Treatment & Therapy

ASPD requires treatment, although oftentimes is difficult to treat. People who are affected often do not want, or think they need, treatment. Patients may also need treatment for other mental conditions such as anxiety or depression. A mental health professional is likely to be able to come up with the optimal mix of prescription drugs and therapy to help each patient.

Psychotherapy is not effective if the patient refuses to believe there is a problem but can be very helpful to patients who are open to it. There are no specific medications for ASPD, however, there are several types of psychiatric medications that can help with certain symptoms or conditions that are associated with ASPD.

Antipsychotics, anti-anxiety, and antidepressants can be prescribed cautiously, due to their potential for misuse. It is important for the loved ones of patients to get help for themselves as well. Mental health professionals can teach family members to learn about setting boundaries and protection from aggression, anger, and violence that commonly come along with ASPD.

Prevention & Prophylaxis

Getting treatment early may prevent ASPD symptoms from worsening. Parents, teachers and pediatricians are the most likely to see early warning signs in children. While the ASPD diagnosis is not given before the age of 18, at-risk children may act violent or aggressive toward their peers through bullying, stealing, cruelty, assault, lying, and poor academic performance.

It is important to provide effective discipline and support early on in the child's life and to teach lessons in proper behavior as well as provide talk therapy and family therapy when needed. These interventions may reduce the chance of children who are at risk for ASPD developing the disorder as adults.