Antisocial Personality Disorder (ASPD) is a challenging mental health condition characterized by a long-term pattern of disregard for, and violation of, the rights of others. Individuals with this personality disorder often exhibit behaviors that are considered deviant by societal standards, which can lead to legal issues and strained relationships.
While introversion, asociality, and antisocial behavior are distinct concepts, ASPD is sometimes confused with them.
According to the American Psychiatric Association, ASPD falls under the broader category of Cluster B personality disorders. Personality disorders involve enduring patterns of inner experience and behavior that deviate markedly from the expectations of the individual’s culture. These patterns tend to be rigid, stable over time, and lead to distress or impairment.
Characteristics and Symptoms of Antisocial Personality Disorder
People with ASPD may have a history of conduct disorder in their childhood or adolescence, which includes behaviors such as aggression toward people or animals, destruction of property, and deceitfulness or theft. As adults, their recklessness and impulsive actions often emerge without consideration for the safety of themselves or others. They may engage in aggressive and irritable behaviors, frequently resulting in physical fights or assaults.
Adults with ASPD frequently exhibit signs of conduct disorder in childhood or early adolescence. Symptoms are normally at their worst in a person’s late teens and early twenties, but they may subside on their own over time.
Emotionally, individuals with antisocial personality disorder may display a lack of remorse for their actions, even when their behaviors cause harm. They often exhibit a charming or deceptive facade, using lies and manipulation to achieve personal goals.
Their emotional expression can be shallow, and they may use this to their advantage in social interactions. Despite a sometimes charming exterior, they may struggle with anger management and can become aggressive when criticized or confronted.
Substance Use and Abuse
Patients with ASPD are more likely to abuse drugs and alcohol because of their reckless and impulsive tendencies. Among personality disorders, ASPD has the highest likelihood of being associated with addiction.
Individuals with ASPD are more likely to take illegal drugs, contract blood-borne infections, develop HIV, have shorter periods of sobriety, and misuse oral medications due to their proclivity for addiction. They are also much more likely to abuse drugs or acquire an addiction at an early age. In addition to substance abuse, persons with ASPD are more likely to develop a gambling addiction.
Alcohol use disorder and substance abuse can intensify antisocial behaviors or increase the likelihood of legal issues and interpersonal conflict. Addressing substance use is often a critical component in the management of ASPD.
Social Cognition
People with ASPD may have difficulties mentalizing or understanding the mental states of others. They may also have a less than functional theory of mind, or the ability to attribute a mental state to oneself and others, but a limited understanding of how an aggressive action affects another person.
These factors could lead to violent and criminal behavior, as well as empathy impairments. Despite this, they may be skilled at social cognition, or the ability to process and store knowledge about others, which can aid in their ability to influence others.
ASPD is extremely prevalent among prisoners. People with ASPD are more likely to be convicted, serve more time in jail, and be charged with almost any offense.
The most common charges are assault and other forms of violent criminality. Arson and the destruction of others’ property are two actions that are frequently related with ASPD and impulsivity. Many people with ASPD also experienced conduct disorder in their youth, which was defined by a pervasive pattern of violent, criminal, defiant, and anti-social behavior.
Relationships
People with ASPD may have trouble maintaining or entering relationships. THey frequently have interpersonal connections that revolve around the exploitation and abuse of others.
People with antisocial personality disorder may be arrogant, think lowly and negatively of others, feel no regret for their damaging activities, and have a callous attitude toward those they have affected. Individuals with this personality disorder will typically exploit others in destructive ways for their own gain or enjoyment, with little remorse, and frequently manipulate and deceive other people.
Also frequently seen is risky sexual activities include having several sexual partners, seeing prostitutes, not using condoms consistently, trading sex for drugs, and engaging in unprotected sex frequently. Their reckless behavior generally jeopardizes their own safety and that of others.
Diagnosis Criteria
The assessment for ASPD typically involves a comprehensive evaluation by a psychiatrist or a qualified mental health professional. They must ensure that the individual meets the diagnostic criteria specified by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
To receive a diagnosis, an individual must exhibit a pervasive pattern of disregard for, and violation of, the rights of others, apparent since age 15 years, as indicated by at least three of the following behaviors:
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
- Impulsiveness or failure to plan ahead
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults
- Reckless disregard for safety of self or others
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
- Lack of remorse, as demonstrated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
The individual must be at least 18 years old, and there should be evidence of Conduct Disorder with onset before age 15 years. This history can be ascertained through interviews and questionnaires.
Millon’s Subtypes
Psychologist Theodore Millon proposed five kinds of ASPD. However, the DSM and ICD do not acknowledge these constructs. The five subtypes are:
Covetous antisocial: with negativistic features. Rapacious, begrudging, discontentedly yearning; hostile and domineering; envious, avaricious; pleasures more in taking than in having.
Nomadic antisocial: with schizoid and avoidant features. Drifters; roamers, vagrants; adventurers, itinerant vagabonds, tramps, wanderers; typically adapt easily in difficult situations, shrewd and impulsive. Mood centers on doom and invincibility.
Malevolent antisocial: with sadistic and paranoid features. Belligerent, mordant, rancorous, vicious, sadistic, malignant, brutal, resentful; anticipates betrayal and punishment; desires revenge; truculent, callous, fearless; guiltless; many dangerous criminals including serial killers.
Risk-taking antisocial: with histrionic features. Dauntless, venturesome, intrepid, bold, audacious, daring; reckless, foolhardy, heedless; unfazed by hazard; pursues perilous ventures.
Reputation-defending antisocial: with narcissistic features. Needs to be thought of as infallible, unbreakable, indomitable, formidable, inviolable; intransigent when status is questioned; overreactive to slights.
Causes and Risk Factors
Personality disorders are typically caused by the interaction of hereditary and environmental factors. Genetically, the intrinsic temperamental traits are determined by genetically driven physiology. Environmentally, factors include a person’s social and cultural experiences during childhood and adolescence, which include family relationships, peer influences, and social ideals.
Genetics
Genetic research on antisocial personality disorder reveals that it has a hereditary basis, possibly a substantial one. ASPD is more common in persons who are related to someone who has the condition. Twin studies, which are intended to distinguish between genetic and environmental factors, have found strong genetic influences on antisocial behavior and conduct disorder.
One gene that has shown particular promise in its link with ASPD is Monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norepinephrine. Several investigations on the gene’s relationship to behavior have found that variants of the gene that produce less MAO-A (such as the 2R and 3R alleles of the promoter region) are associated with aggressive conduct in men.
Another gene of interest in antisocial conduct and personality traits is SLC6A4, which encodes for the serotonin transporter and has been extensively studied for its links with other mental diseases. Genetic association studies have found that the short “S” allele is linked to impulsive antisocial conduct and ASPD in the inmate population.
A genome-wide association study published in 2016 discovered several additional gene possibilities for ASPD. Several of these gene possibilities are linked to attention-deficit hyperactivity disorder, with which ASPD is frequently associated. Furthermore, the study discovered that those who have four mutations on chromosome 6 are 50% more likely to acquire antisocial personality disorder than those who do not.
Environmental Factors
ASPD is closely comorbid with childhood emotional and physical abuse. Physical neglect also has a strong link to ASPD.
The manner in which a child bonds with its parents early in life is critical. Poor parental bonding as a result of abuse or neglect increases the likelihood of children developing antisocial personality disorder. There is also a link between parental overprotection and people developing ASPD. According to studies, those who have not been mistreated (particularly during childhood) are less prone to acquire ASPD.
Many studies indicate that the social and family environment contribute to the development of ASPD. The parents of these children exhibit antisocial behavior, which is then adopted by their offspring.
A lack of parental stimulation and compassion during early development might result in elevated cortisol levels and the absence of balancing hormones like oxytocin. This disturbs and overloads the child’s stress response mechanisms, which is thought to result in underdevelopment of the region of the brain responsible for emotion, empathy, and the ability to connect emotionally with other humans.
Neurological Factors
Antisocial behavior may be linked to a variety of neurological disorders, including brain trauma. Antisocial conduct is linked to reduced gray matter in the right lentiform nucleus, left insular cortex, and frontopolar cortex. The right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post-central cortex have all shown increased grey matter quantities.
Antisocial conduct is associated with reduced activity in the prefrontal cortex. Functional neuroimaging shows a stronger correlation than structural neuroimaging. The prefrontal cortex is engaged in a variety of executive processes, including behavior control, planning ahead, determining the repercussions of actions, and distinguishing between right and wrong.
Some researchers have questioned if the lower volume in prefrontal regions is connected with antisocial personality disorder or if they originate from co-morbid diseases, such as substance use disorder or childhood abuse.
Treatment and Management
ASPD is regarded as one of the hardest personality disorders to treat. Individuals with ASPD frequently lack motivation and fail to recognize the costs involved with antisocial behavior due to their very low or missing ability for remorse.
They may just fake regret rather than actually commit to change: they can be seductively charming and dishonest, manipulating staff and other patients during therapy. According to studies, outpatient therapy is unlikely to be beneficial, but the amount to which people with ASPD are completely resistant to treatment may be overestimated.
The majority of treatment for antisocial personality disorder is provided to persons in the criminal justice system who are incarcerated and get treatment as part of their sentence. Those with ASPD may only remain in therapy if mandated by an external source, such as parole restrictions. Residential programs that provide a structured and supervised setting, as well as peer confrontation, have been advocated.
Therapy for individuals with ASPD often centers on behavioral strategies aimed at reducing antisocial behaviors. Cognitive-behavioral therapy (CBT) is one such approach, which helps patients recognize negative patterns of thought and learn more adaptive behaviors and responses. In addition, some experts suggest interventions such as mentalization-based treatment, which aid individuals in better understanding and interpreting the thoughts and feelings of themselves and others.
Another promising therapy highlighted in research on ASPD is a practice-focused framework that tailors therapeutic interventions to the specific challenges and needs of those with the disorder. This individualized approach can lead to more effective management of symptoms and behaviors.
Therapists who work with people with ASPD may have strong negative views about patients who have a history of aggressive, exploitative, and abusive behaviors. Rather than attempting to instill a sense of conscience in these individuals, which is highly difficult given the nature of the condition, treatment techniques emphasize rational and utilitarian arguments against repeating past mistakes.
While no medications are specifically approved for ASPD, certain drugs may be prescribed to treat symptoms or co-occurring mental health conditions such as depression or anxiety. The decision-making around the pharmacological strategies often includes the consideration of risks, potential benefits, and the presence of other psychiatric disorders.
Long-term treatment planning should include strategies for prevention of risky behaviors and relapses, potentially involving a combination of the aforementioned medications with psychotherapeutic support. Consistent engagement with mental health professionals can create a structure that supports sustained management of the disorder.
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Last Updated on April 5, 2024