Antisocial Personality Disorder

Antisocial Personality Disorder is a term that has replaced sociopathy, and psychopathy, in the DSM IV manual to describe a disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

• Failure to conform to social norms with respect to 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 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 indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

The individual is at least age 18 years.

There is evidence of Conduct Disorder with onset before age 15 years.

The occurrence of antisocial behavior is not exclusively during the course of Schizophrenia or a Manic Episode.

Diagnostic Features

Individuals with Antisocial Personality Disorder may frequently carry out acts that are criminal in nature, such as vandalism, stealing, or pursuing other illegal activity. People with this disorder disregard the feelings and rights of others. They are manipulative, deceiving and destructive for the sake of obtaining personal revenue/profit or pleasure (e.g., money, power).

Individuals with Antisocial Personality Disorder may be unconcerned about having mistreated or hurt someone else (e.g., “he didn’t feel a thing anyway”, “he had it coming”, “one less loser in the world”). They may blame the victims for being unwise, vulnerable, or deserving to be hurt; these individuals may downplay the destructive consequences of their actions; and/or be completely indifferent. They generally fail to improve or correct their behavior. They may rationalize that "only the strong survive", and that they are entitled to anything they wish at the expense of others.

They may egocentric and have an arrogant self-appraisal (e.g., other people are inferior and social norms don’t apply to them) and may appear overly opinionated, cocky, and self-absorbed. They may also appear charismatic, charming, and possess a flair with words (e.g., using sophisticated language that might impress people who are unfamiliar with a particular topic).

These individuals may also be highly promiscuous and manipulative with their partners. Individuals with Antisocial Personality Disorder may be negligent as parents, as evidenced by wasteful spending and drug abuse. These individuals often spend many years going in-and-out of prison. They are also more likely to die early, often by violent means (e.g., homicides, accidents, drug abuse), than individuals in the general population.

Course

Antisocial Personality Disorder is a chronic condition but becomes less pronounced as the person grows older, usually by the 40s and up. During this time, there is a gradual decrease in criminal behaviors and drug abuse.

Family and Background

Antisocial Personality Disorder is more common among biological relatives of those with the disorder than among the general population. The risk to biological relatives of females with the disorder tends to be higher than the risk to biological relatives of males with the disorder. Biological relatives of persons with this disorder are also at increased risk for a Somatization Disorder and Substance-Related Disorders.

Adoption studies have shown that both genetic and environmental factors contribute to the risk of this group of disorders. Both adopted and biological children of parents with Antisocial Personality Disorder have an increased risk of developing Antisocial Personality Disorder, Somatization Disorder, and Substance-Related Disorders. Adopted-away children resemble their biological parents more than their adoptive parents, but the adoptive family environment may influence the risk of developing Antisocial Personality Disorder.

Diagnostic criteria summarized from:

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.