What is antisocial personality disorder? Understanding the symptoms and causes

To many people, the term “antisocial” may mean someone doesn’t like big crowds and would rather spend time alone. This word usually has a different meaning in the field of psychology, though. Antisocial personality disorder (ASPD) can be defined as a severe, persistent mental health condition that can have serious effects on nearly every aspect of life. It’s generally marked by a distorted way of thinking, behaving, and relating to other people. People with ASPD may have no qualms about hurting others or acting in ways that society sees as immoral or unacceptable. A diagnosis of antisocial personality disorder is often based on a sustained pattern of behavior beginning in adolescence or childhood. Understanding the characteristics of ASPD may be crucial if you or someone you know is living with this personality disorder, and a licensed therapist can offer additional insight and support through in-person or online therapy sessions. 

What are personality disorders?

Personality disorders are generally considered mental health conditions, but they tend to differ from illnesses like depression and schizophrenia. According to the American Psychiatric Association, personality disorders usually involve ways of thinking, feeling, and behaving that are significantly different from what society expects and tolerates. 

Symptoms tend to persist throughout an individual’s life and can be very difficult to treat. People with personality disorders often don’t feel they need help — to them, their way of seeing and interacting with the world may seem natural and correct.

To qualify as a disorder, these personality differences must generally cause persistent distress or difficulties with functioning. They might make it hard to build close relationships, maintain steady employment, or interact with others in public settings, for example. In some cases, they may make it hard to have a healthy self-image or understand other people.

There are several different kinds of personality disorders, often classified into “clusters.” Antisocial personality disorder normally belongs to the cluster-B disorders, which typically involve dramatic, unpredictable, and inappropriate behavior. Experts believe that around 1% to 4% of the population may have ASPD.

Characteristics of antisocial personality disorder

Not everyone with ASPD displays the same symptoms. However, the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) identifies several key features that can define this disorder. 

A self-centered worldview

People with antisocial personality disorder tend to have difficulty seeing things from other people’s perspectives. They may see little reason to care about what anyone else wants, needs, or enjoys. Individuals with ASPD may derive their sense of self-worth mainly from their ability to get what they want and assert power over others.

Those with antisocial personality disorder rarely have much interest in goals that aren’t directly related to their own personal gain or gratification. They may also lack an internal sense of whether certain behaviors are morally or socially acceptable. 

Difficulty relating to others

Antisocial personality disorder may affect a person’s ability to form mutually respectful and caring relationships. Some people with this condition might develop strong bonds with a small number of like-minded people, but this tends to be the exception rather than the rule. For the most part, those with ASPD have shallow relationships based largely on what they think they can get from other people.

The most common form of interaction for an individual with a personality disorder may be marked by attempts to exploit, manipulate, and dominate others. This may be partly due to a limited ability to empathize. ASPD seems to limit the capacity to think about how one’s actions will affect others and to feel remorse for causing harm. 

Unscrupulous and reckless tendencies

Individuals with antisocial personality disorder tend to have little concern for the consequences of their actions, either for themselves or for others. This can manifest in several ways:

• Readily lying and deceiving to get what they want; displaying little guilt when their actions are discovered
• Manipulating others through techniques like charm, flattery, seduction, or playing on emotions
• Hostility and aggression, including holding grudges over small annoyances
• Lack of remorse when their actions cause others to be disadvantaged, upset, or hurt
• Lack of concern for the problems and feelings of others
• Irresponsible behavior, including neglecting duties and failing to follow through on promises
• Impulsive, spontaneous actions
• Disregard for laws and a propensity for criminal behavior
• Getting bored easily and using disruptions to relieve boredom
• Difficulty with long-term planning
• Engaging in risky behavior without concern for danger to themselves or others

Not everyone with ASPD exhibits all these traits, but in general, at least a few must be present to qualify for a diagnosis.

A sustained pattern of antisocial behavior

Diagnosing antisocial personality disorder usually requires evidence that the above characteristics have been present for some time. Mental health professionals typically look for a history of disregarding the wishes, well-being, and rights of other people. In a clinical sense, “antisocial behavior” indicates a persistent disregard for the rules and assumptions that enable society to function. 

To diagnose someone with ASPD, the individual must normally be at least 18 years old, but their history of disruptive behavior must have been present before age 15. In children and adolescents, these kinds of actions may be classified as conduct disorder (CD). This diagnosis typically implies more severe behavioral problems than simple misbehavior. Common signs may include repeated lying, theft, bullying, cruelty, property destruction, and physical or sexual violence. 

A young person who displays these symptoms may be at a significantly increased risk of developing antisocial personality disorder. According to some estimates, up to 50% of people with childhood conduct disorder later meet the criteria for ASPD.

ASPD can be a lifelong disorder. It can be common for people with this condition to consistently display instability in many aspects of their lives. For instance, they may have a hard time holding down a job, maintaining close relationships, and staying out of legal trouble, though criminal behavior often decreases later in life. 

What causes antisocial personality disorder?

ASPD may not have a single, clearly identifiable cause. Research on identical vs. fraternal twins suggests that genetics may be responsible for as much as 50% of the variance in symptoms of this condition. Still, the specific genes in question haven’t yet been identified. 

A person’s childhood environment and upbringing could also be a factor. Child abuse in particular appears to lead to a substantially increased risk of developing antisocial personality disorder. The severe trauma associated with mistreatment from a caregiver may interfere with a child’s ability to learn appropriate behavior or empathy.

If you or a loved one is witnessing or experiencing any form of abuse, please know that help is available. You can call the National Domestic Violence Hotline anytime at 1-800-799-SAFE (7233).

Researchers have found some evidence of neurological differences that may be associated with ASPD. Specifically, individuals with this mental health condition appear to have less brain tissue in the orbitofrontal cortex (OFC) and ventromedial prefrontal cortex (vmPFC). 

These areas of the brain are believed to be associated with impulse control, regulation of emotions, and the ability to weigh the positive and negative outcomes of actions. These deficits could partly explain why people with antisocial personality disorder seem to act without regard for consequences. The vmPFC may also be responsible for assessing the emotional responses of others, so its impairment could be linked to decreased empathy. 

Other brain areas that may have decreased size or function in people with antisocial personality disorder include the amygdala and angular gyrus. Since these areas are commonly active when people think through moral decisions, some researchers think that they may be involved in the lack of concern for ethical behavior seen in ASPD.

How to tell if someone has antisocial personality disorder

Only a licensed mental health professional can diagnose ASPD. Still, you may want to know whether someone in your life could have this disorder. Here are a few questions you can ask yourself:

• Does the person consistently manipulate and lie to me?
• When I discover they’ve done something wrong, do they show little shame or guilt?
• Do they frequently retaliate when I don’t do what they want?
• Are they prone to over-the-top anger in response to small inconveniences?
• When they no longer need something from me, do they seem to lose interest?
• Do other people’s pain, distress, and fear seem inconsequential to them?
• Is their behavior frequently impulsive and thoughtless?
  

Answering “yes” to several of these questions could be a sign that the person may have ASPD. It could also be a sign that they’re abusive. If you’re in a relationship with someone who makes you feel afraid or attempts to control you, the volunteers at the National Domestic Violence Hotline may be able to help. You can reach them any time by dialing 1-800-799-SAFE (7233).

It can be a good idea to talk to a therapist if you think you or someone you know might have ASPD. Compared to other mental health conditions, treating antisocial personality disorder can be difficult. Even so, therapy may help someone with ASPD better manage their behavior and nurture healthy relationships. 

Benefits of online therapy

If you’re experiencing complicated emotions after being subjected to manipulative or harmful behavior, you might want to consider online therapy. Many people find that receiving therapy over the internet enhances their sense of comfort and control, especially since they can attend sessions from their own homes. This could make it easier to discuss challenging experiences like those associated with ASPD.

Effectiveness of online therapy

While more research may be needed to evaluate the efficacy of online therapy for supporting those affected by individuals with ASPD, online therapy typically boasts a solid track record for treating many mental health concerns. In addition, a 2022 meta-analysis reported that online and in-person therapy tend to produce the same client outcomes.

Takeaway

Antisocial personality disorder is typically defined as a mental health condition marked by a lack of concern for behavioral norms and the well-being of others. It may also feature difficulties with empathy and self-control. ASPD is often a lifelong disorder that can be resistant to treatment and might impact multiple facets of an individual’s life. Genetic factors, neurological abnormalities, and traumatic childhood experiences may all contribute to ASPD. A licensed therapist can offer support and guidance if you live with or have been impacted by this disorder.