Last reviewed Sat 25 November 2017
By Zawn Villines
Reviewed by Timothy J. Legg, PhD, CRNP
Popular books, such as The Sociopath Next Door, have popularized the idea of a sociopath as a person who lacks a conscience or empathy.
However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) does not use the term “sociopathy” to describe a mental health condition.
Antisocial personality disorder is the closest diagnosis to sociopathy. Although movies and television shows may present people with this condition as dangerous sociopaths, people with antisocial personality disorder can lead normal, productive lives.
However, they may also struggle with relationships, understanding emotions, and making good decisions. In this article, we look at the signs and symptoms of this mental health condition.
What is antisocial personality disorder?
Antisocial personality disorder is characterized by a lack of empathy and manipulative or dangerous behavior.
Personality disorders are a group of mental illnesses that alter the way a person thinks, feels, and behaves. People with other mental health conditions, such as depression, may experience symptoms that undermine their ability to feel good or to have normal relationships.
Personality disorders, by contrast, affect a person’s entire personality and their ability to function in culturally “normal” ways across many contexts.
Antisocial personality disorder is a personality disorder that impedes a person’s ability to care about the feelings and needs of others. People with this condition may harm others, engage in criminal behavior, or consider the needs of others only when doing so benefits them.
Everyone ignores other people’s feelings sometimes, and most people can be manipulative, selfish, or uncaring from time to time. For people with antisocial personality disorder, this disregard for others is a hallmark of their condition rather than an occasional oversight.
Antisocial personality disorder is part of a group of personality disorders called Cluster B disorders. These disorders are characterized by unusual emotional behavior that tends to disrupt relationships and lead to unstable patterns of relating to others.
Other Cluster B disorders include:
- narcissistic personality disorder
- borderline personality disorder
- histrionic personality disorder
Children cannot be diagnosed with antisocial personality disorder. Children with a pattern of disregarding the rights and needs of others may be diagnosed with a conduct disorder.
Signs and symptoms
Antisocial personality disorder may cause a person to have a lack of inhibition or concern for others, which may make them more likely to break the law.
A person cannot be diagnosed with antisocial personality disorder based on a single action. Behaviors that are explained by something else, such as addiction, trauma, or a cognitive disability, will also not be diagnosed as antisocial personality disorder.
People with antisocial personality disorder struggle to follow or understand social rules about how to interact with others.
They fail to see other people as beings worthy of consideration, kindness, or rights. They may not feel empathy or guilt.
However, not all people with antisocial personality disorder act on these emotions, nor do all people who violate the rights of others have a mental health condition.
A person might be evaluated for antisocial personality disorder after interacting with police, seeking treatment for chronic relationship problems, or being involved in a negative experience with a child or partner.
There are no clinical tests for antisocial personality disorder. Instead, the diagnosis is based on a person’s symptoms.
To diagnose a person with antisocial personality disorder, the individual must show the following symptoms:
- making decisions based on one’s own needs and desires, without considering the needs of others
- lacking concern for the needs, feelings, or pain of others, and lacking remorse after hurting others
- exploiting others in relationships, making it difficult to have relationships
- using lies, domination, or intimidation to control others
- exhibiting manipulative behavior, including using charm or ingratiation for one’s own benefit
- exhibiting dishonest or fraudulent behavior
- not being concerned about how others feel; some people with antisocial personality disorder enjoy sadistic behavior, such as hurting others
- feeling hostility, anger, or aggression, particularly in response to relatively small problems
- lacking inhibitions, which may cause a person to disobey rules, abandon their commitments, or take unnecessary risks
Causes and risk factors
While the exact cause of antisocial personality disorder is unknown, genetic, environmental, and cultural factors may all play a role in its development.
People who are exposed to childhood trauma, whose parents have a personality disorder, or whose parents had an alcohol addiction appear to be more vulnerable to developing antisocial personality disorder. It also affects more men than women.
Treatment
Psychotherapy may help people with antisocial personality disorder understand the emotions of others.
A person with antisocial personality disorder may only seek treatment when a court orders them to do so, or when they experience serious consequences, such as incarceration or the loss of an important relationship.
Most people with antisocial personality disorder are never diagnosed and do not seek treatment.
Treatment for antisocial personality disorder focuses on helping a person work around their disruptive thought patterns, behaviors, and ways of relating to others. This usually involves psychotherapy.
Therapy focuses on helping people with antisocial personality disorder understand other people’s emotions. A therapist may work with a person to find better ways to deal with aggression or to understand how aggressive or manipulative behavior can be harmful.
There is no medication specifically designed for antisocial personality disorder. However, additional symptoms, such as depression, anxiety, or substance abuse, can be reduced with medication and make psychotherapy more effective.
Outlook
There is no cure for antisocial personality disorder, but treatment can help a person control their symptoms.
There is limited research on the effectiveness of treatment for antisocial personality disorder, and what works for one person might not work for another.
During treatment, a person with antisocial personality disorder will learn to manage their own feelings and impulses and adopt culturally appropriate behaviors. This can be challenging, as they must learn behaviors that most people take for granted, such as caring about the pain of loved ones.
A partnership with a caring therapist and a commitment to making meaningful behavioral changes can increase the success rate of treatment.
Antisocial personality disorder remains poorly understood. People with this condition are often vilified as serial killers or criminals, even though many never harm anyone.
As research continues, doctors may gain a better understanding of this challenging mental health condition.