Antisocial Personality Disorder: What Are The Diagnostic Criteria And Symptoms?

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5), published by the APA, establishes diagnostic criteria used by mental health professionals to help diagnose mental health disorders accurately. 

Medical professionals estimate that 0.6 to 3.6% of adults are affected by antisocial personality disorder and that it is also three times more prevalent in men compared to women. Those living with ASPD may have co-occurring mental health conditions like anxiety, depression, or substance use disorders. Those with antisocial personality disorder tend to have different emotional responses and may have difficulty valuing the feelings or needs of others. People with antisocial personality disorder may struggle to follow a societal moral code and act illegally or in risky ways. 

Diagnostic criteria of antisocial personality disorder (ASPD)

According to the DSM-5, antisocial personality disorder is defined as a pervasive pattern of disregard for and violation of the rights of others (which may have been occurring since at least age 15) as indicated by three (or more) of the following symptoms:

• Failure to conform to social norms concerning lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
• Impulsivity or failure to plan
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults
• Having no regard for the safety of self or others or exhibiting the behavior of violent offenders
• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
• Lack of remorse, or inability to feel guilt, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another

Some adults diagnosed with antisocial personality disorder (ASPD) may have a history of antisocial behavior conduct disorder or oppositional defiance diagnosis before the age of 15. ASPD may also fall under the classification of “antisocial behavioral syndromes,” though this term is not widely used.

Symptoms of ASPD

Impairments in both self-perception and interpersonal personalities are present, as well as pathological traits in many people with ASPD. Symptoms may begin in adolescence or early adulthood and continue over many years. 

Other symptoms someone with antisocial personality disorder may exhibit are:

• Acting kind, exhibiting superficial charm or lying to resolve personal goals or means 
• Exuding a sense of superiority or arrogance
• Partaking in impulsivity and being prone to taking risks or engaging in dangerous behavior with little regard for how it may affect others
• A potential history of criminal behavior (whether or not they’ve been subject to the criminal justice system)
• A lack of empathy or compassionate feelings towards others or a situation
• Hostile, aggressive behavior, emotional abuse, or violence
• Being dishonest or lying to people in the general population
• A shaky moral code or belief system and a difficulty following societal norms 
• Being irresponsible
• An inability to maintain healthy relationships
• A lack of regard for rules
• The signs of substance use disorder (sometimes incorrectly referred to as “substance abuse disorder,” “substance abuse,” or “drug and alcohol abuse”)

If you or a loved one is experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Getting a diagnosis of antisocial personality disorder

If you or someone you love exhibits these symptoms, you may seek professional help. Studies have shown that those with ASPD have a higher risk of premature death, so it may be important to get a diagnosis and subsequent treatment. After an initial conversation and evaluation, a mental health professional may look for the following criteria to render a diagnosis of antisocial personality disorder (ASPD):

• Significant impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning
• One or more pathological personality traits
• The impairments in personality are stable across time and consistent in situations
• The personality impairments are not better understood as a regular part of a developmental stage social environment, or other environmental factors
• Substance use or a medical condition is not the only cause

Once antisocial personality disorder has been diagnosed, the mental health professional may recommend therapy or another effective treatment. 

There are several other personality disorders listed in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition besides ASPD, including bipolar disorder, borderline personality disorder, and obsessive-compulsive disorder. Therefore, only a mental health professional specializing in personality disorders can properly diagnose ASPD and provide a treatment plan. Research shows that ASPD is treatable, and more treatment research is coming out yearly. 

The diagnostic process for ASPD

You may choose to visit a primary care professional before getting mental health care. After a medical evaluation is performed to help rule out any possible medical conditions, a primary care provider may refer you to a mental health professional for further evaluation of symptoms.  

The diagnosis of antisocial personality disorder is generally based upon a psychological evaluation that explores one’s thoughts, feelings, behavior patterns, relationships, and family history.

The Diagnostic and Statistical Manual of Mental Disorders 5th Edition outlines criteria for diagnosing personality disorders like antisocial personality disorder. The diagnostic standard for each personality disorder includes differing symptoms. Being truthful about all symptoms you experience may help the diagnostic process go more smoothly and aid in the most accurate results.  

According to the DSM, personality disorders are organized into three clusters labeled type a, type b, and type c. Antisocial personality disorder falls under cluster b, which includes disorders characterized by “erratic or dramatic behavior and engagement in extremely impulsive, theatrical, illegal, and promiscuous behaviors.”

The expertise of the psychologist or psychiatrist can play a significant role in the accuracy of the diagnosis. Consider researching licensed mental health care professionals to find one specializing in treating or diagnosing personality disorders. Reviewing clinical training, licensure, and patient reviews may assist in choosing a licensed psychiatrist, psychologist, therapist, or counselor.

Features of sociopathy as a medical term

The diagnosis criteria for antisocial personality disorder is used to establish someone with sociopathic tendencies or sociopathic personality disorder. Sociopathy is not a clinical diagnosis but a term used to describe characteristics under the ASPD diagnostic label. 

The following criteria are listed in the DSM-5 for a diagnosis of antisocial personality disorder.

Significant impairments in personality functioning

Several factors can identify impairments in personality functioning:

• Identity: Egocentrism; self-esteem derived from personal gain, power, or pleasure
• Self-Direction: Goal setting based on personal gratification—little to no regard for social standards, such as lawful or reasonable ethical behavior

Significant impairments in interpersonal functioning

Impairments in interpersonal functioning can include the following:

• Empathy: A lack of concern for the feelings, needs, or suffering of others— lack of remorse after hurting or mistreating another
• Intimacy: Difficulty having mutually intimate relationships, as exploitation may be a primary means of relating to others. This behavior is commonly recognized as deceit or intimidation to control others.

Antagonism 

Antagonism might be characterized by the following:

• Manipulation: The use of deception to influence or control others; use of seduction, charm, glibness, or ingratiation to achieve one’s needs 
• Deceitfulness: Dishonesty and fraudulence; misrepresentations of self; “stretching” the truth when relating events
• Callousness: Lack of concern for the feelings or problems of others; lack of guilt or remorse about the adverse effects of one’s actions on others; aggression; sadism
• Hostility: Persistent angry feelings; anger or irritability in response to mistreatment or insults; inconsiderate, spiteful, or vengeful

Lack of inhibition 

Lack of inhibition may be characterized by the following:

• Irresponsibility: Disregard for and failure to honor financial and other obligations or commitments; lack of respect for and lack of follow-through on agreements and promises
• Impulsivity: Acting in the spur of the moment in response to immediate stimuli; acting on a momentary basis without a plan or consideration of possible outcomes; difficulty establishing and following through with plans
• Risk-taking: Engagement in dangerous, risky, and potentially self-damaging activities, unnecessarily and without regard for consequences; boredom, proneness, and thoughtless initiation of activities to counter boredom; lack of concern for one’s limitations and denial of the reality of the personal danger
• The difficulties with personality functioning or personality trait expression may be relatively stable across time and consistent across situations. For a diagnosis to be made, the professional may check to ensure the personality trait expressions are not better understood as standard for the individual’s developmental stage or social and cultural environmental factors. 

Sociopathic traits in ASPD and NPD

Narcissistic personality disorder (NPD) and antisocial personality disorder (ASPD) are two different personality disorders. However, the two conditions have some traits in the diagnostic criteria. For example, failure to conform to social norms and a lack of feelings of empathy or guilt are characteristics of both.  

Research cites that NPD is characterized by a grandiose sense of self and pathological self-centeredness, whereas ASPD may only include a disregard for the rights of others. However, some people with ASPD also have NPD. 

Treatment for personality disorders like ASPD

Although there is currently no specific cure for antisocial personality disorder, many mental health professionals believe that psychotherapy may be effective for some people. Psychotherapy may focus on helping a person learn to manage negative thoughts and behaviors and build more effective communication and interpersonal skills. Often, the first goal of treatment may be to implement measures that reduce the impulse to engage in harmful or risky behaviors.

Another type of therapy that may be beneficial is called reward therapy. Reward therapy involves giving individuals a reward when they engage in healthy behaviors. Reward therapy may allow those with ASPD to respond to the instant gratification of their wants. Instant gratification may make certain behaviors beneficial to them. 

Current studies show that there may be medications in the works in the near future for ASPD. Current FDA-approved medications, such as anxiety meds or remedies for anger management, may also be prescribed to someone with ASPD. Talk to your mental health practitioner or primary care physician if you’re considering medication. 

Counseling for personality disorders 

Although there is no current “cure” for ASPD, treatment options are available, and treatment may be effective in managing and living with symptoms. Counseling may be one valuable method for those with a personality disorder such as ASPD. 

Studies indicate that many individuals feel more comfortable in their own homes. Someone with ASPD may benefit from trying online therapy, which allows you to see a practitioner through a video call, phone call, or messaging. If you struggle with the social aspect of treatment, online therapy is an option.  

Online therapy platforms such as BetterHelp provide therapists knowledgeable in personality disorders who may be able to answer some of your questions or support you in learning new skills. 

Read below for counselor reviews from users who have reached out with similar concerns in the past. 

Counselor reviews 

“Dr. Anstadt is helping me figure out how to live a quality life. His wisdom and knowledge are helping me navigate my negative thoughts and dig out where they are coming from, which is what I need. I can’t recommend him enough.”

“Kristen helps me to see my life and myself from a different perspective. I tell her about my experiences, and she is able to hone into another side of the story that I couldn’t get working things out on my own. And I had tried for a very long time. As someone particularly skeptical of counseling in general, it has been refreshing to speak and work with someone who genuinely recognizes that I am seeking help but reluctant to take it. Her patience and consistent inquiry have been the greatest asset for me, and I appreciate my time with her.”