Antisocial Personality Disorder (ASPD) is a pervasive pattern of disregard for and violation of the rights of others. ASPD patients would often tend to put other people’s lives in danger and, more importantly, show no remorse for their actions. They have difficulty following the law and are unable to have consistent employment. They are also deceptive, manipulative, and incapable of forming stable relationships.

Signs and symptoms usually begin at age 15. Males are three to five times more likely to suffer from ASPD than do women. Substance abuse has also been found to have an association, and it is more prevalent to people who have lower reading levels and IQ.

Experts agree that the precise reason for ASPD remains unknown; however, genetics and environment seem to play a role. Events such as adverse childhood experiences, conduct disorder, and attention deficit hyperactivity disorder (ADHD) are factors to having ASPD. Currently, research is looking at the role of the 2p12 region of chromosome 2 and variation within AVPR1A [these genes are molecules found in every single cell in our body] in the people who have ASPD.

People with ASPD usually violate the laws, repeatedly lie, con others for profit or pleasure. For these reasons, they are usually involved in physical fights and assaults. They also disregard the safety of others and repeatedly lose jobs. Finally, they lack remorse for their harmful actions.

Other associated features that are common to people with ASPD are the following:

• Lack of empathy, callous, cynical, contemptuous of feelings, rights, and sufferings of others;
• Excessively opinionated, self-assured, cocky;
• Those who scam other people;
• Irresponsible and exploitative in their sexual relationships;
• Many sexual partners;
• Never have sustained a monogamous relationship;
• Irresponsible as parents where their children are malnourished and sickly. They are dependent on neighbors and they squander the money of the family;
• Fail to be self-supporting;
• They die by violent means for example suicide, homicide, accidents, or problems with impulse control.

According to DSM V, to clinically diagnose ASPD the patient must have the following symptoms since age 15, must be at least 18 years old, and at least three out of seven must be fulfilled of the following criteria: 

• Fails to abide laws, such as performing acts that are grounds for arrest;
• Deceitful, repeated lying, use of aliases, or conning others for pleasure or personal profit;
• Impulsive or fails to plan;
• Irritability and aggressiveness, often with physical fights or assaults;
• Reckless disregard for the safety of self or others;
• Consistently irresponsible, failure to sustain consistent work behavior, or honor monetary obligations;
• Lack of remorse, being indifferent to or rationalizing having hurt, mistreated, or stolen from another person.

Further, there must be observed conduct disorder that begins before age 15. Lastly, the occurrence of antisocial behavior is not exclusively seen during schizophrenia or bipolar episodes.

Treatment

As of today, no drugs have been proven to be effective against ASPD, but doctors can prescribe drugs to treat co-occurring conditions, for example schizophrenia. These drugs include:

• risperidone; 
• quetiapine;
• sertraline;
• lithium;
• carbamazepine.

Doctors may also prescribe oxcarbazepine and carbamazepine to aid with impulsivity, while bupropion and atomoxetine are prescribed for associated ADHD.

Experts believe that early treatment intervention with conduct disorder in children is one of the effective ways for children acquiring an antisocial personality. Research has shown that childhood conduct disorder is a reliable prognosticator of adulthood ASPD. However, when the personality has become established, aside from medications to control the symptoms, cognitive behavioral therapy (CBT) can be employed to change a patient’s thinking and behavior. The therapy can be given either to the individual, or by group or family.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Fisher KA, Hany M. Antisocial Personality Disorder. [Updated 2022 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546673/