Antisocial personality disorder

Overview

Antisocial personality disorder, sometimes called sociopathy, is a mental health condition in which a person consistently shows no regard for right and wrong and ignores the rights and feelings of others. People with antisocial personality disorder tend to purposely make others angry or upset and manipulate or treat others harshly or with cruel indifference. They lack remorse or do not regret their behavior.

People with antisocial personality disorder often violate the law, becoming criminals. They may lie, behave violently or impulsively, and have problems with drug and alcohol use. They have difficulty consistently meeting responsibilities related to family, work or school.

Symptoms

Symptoms of antisocial personality disorder include repeatedly:

Ignoring right and wrong.
Telling lies to take advantage of others.
Not being sensitive to or respectful of others.
Using charm or wit to manipulate others for personal gain or pleasure.
Having a sense of superiority and being extremely opinionated.
Having problems with the law, including criminal behavior.
Being hostile, aggressive, violent or threatening to others.
Feeling no guilt about harming others.
Doing dangerous things with no regard for the safety of self or others.
Being irresponsible and failing to fulfill work or financial responsibilities.

Adults with antisocial personality disorder usually show symptoms of conduct disorder before the age of 15. Symptoms of conduct disorder include serious, ongoing behavior problems, such as:

Aggression toward people and animals.
Destruction of property.
Lying and dishonesty.
Theft.
Serious violation of rules.

Antisocial personality disorder is considered a lifelong condition. But in some people, certain symptoms ― particularly destructive and criminal behavior ― may decrease over time. It's not clear whether this decrease is a result of the effect aging has on their mind and body, an increased awareness of the impact that antisocial behavior has had on their life, or other factors.

When to see a doctor

People with antisocial personality disorder are not likely to seek help on their own. If you suspect that a friend or family member may have the condition, you might gently suggest that the person seek help from a mental health provider and offer to help them find one.

Causes

Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It's the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood. It's likely shaped by inherited genes as well as life situations and experiences.

The exact cause of antisocial personality disorder isn't known, but:

Genes may make you vulnerable to developing antisocial personality disorder — and life situations, especially neglect and abuse, may trigger its development.
Changes in the way the brain functions may have resulted during brain development.

Risk factors

Certain factors seem to increase the risk of developing antisocial personality disorder, such as:

Diagnosis of childhood conduct disorder.
Family history of antisocial personality disorder or other personality disorders or mental health conditions.
Experiencing abuse or neglect during childhood.
Unstable or violent family life during childhood.

Men are at greater risk of having antisocial personality disorder than women are.

Complications

Complications and problems resulting from antisocial personality disorder may include:

Spouse abuse or child abuse or neglect.
Problems with alcohol or drugs.
Being in jail or prison.
Attempting suicide or trying to kill someone else.
Having other mental health conditions such as depression or anxiety.
Financial, educational or social problems.
Dying early, usually because of violence.

Prevention

There's no sure way to prevent antisocial personality disorder from developing in those at risk. Because antisocial behavior is thought to have its roots in childhood, parents, teachers and pediatricians may be able to see early warning signs. It may help to try to identify those most at risk, such as children who show signs of conduct disorder, and then offer early intervention.

Diagnosis

People with antisocial personality disorder are not likely to believe they need help. But they may seek help from their primary health care provider because of other symptoms such as depression, anxiety or angry outbursts. Or they may seek treatment for problems with alcohol or drug use.

People with antisocial personality disorder may not give an accurate description of their symptoms. A key factor in diagnosis is how the person relates to others. With permission, family and friends may be able to give helpful information.

After a medical exam to help rule out other medical conditions, the health care provider may make a referral to a mental health provider with experience in diagnosing and treating antisocial personality disorder.

Diagnosis of antisocial personality disorder is usually based on:

A mental health exam that includes talking about thoughts, feelings, relationships, behavior patterns and family history.
Symptoms.
Personal and medical history.

Antisocial personality disorder usually isn't diagnosed before age 18. But some symptoms may occur in childhood or the early teen years.

Identifying antisocial personality disorder early may help improve long-term outcomes.

Treatment

Antisocial personality disorder is challenging to treat, but for some people, treatment and close follow-up over the long term may help. Look for medical and mental health providers with experience in treating antisocial personality disorder.

Treatment depends on each person's situation, their willingness to participate in treatment and the severity of their symptoms.

Talk therapy

Talk therapy, also called psychotherapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for problems with alcohol or drugs, and treatment for other mental health conditions.

But talk therapy is not always effective, especially if symptoms are severe and the person can't admit that they contribute to serious problems.

Medications

There are no medicines specifically approved by the Food and Drug Administration (FDA) to treat antisocial personality disorder. Health care providers may prescribe medicines for conditions that sometimes occur along with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression.

Coping and support

Skills for family members

People with antisocial personality disorder often act out and cause others to suffer — with limited remorse. If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself.

A mental health provider can teach you skills to learn how to set boundaries and help protect yourself from the aggression, violence and anger common to antisocial personality disorder. The provider also can recommend strategies for coping.

Look for a mental health provider who has training and experience in managing antisocial personality disorder. Ask your loved one's health care provider for a referral. The provider may be able to recommend support groups for families and friends affected by antisocial personality disorder.

Preparing for an appointment

If a medical exam rules out physical causes for the behavior, the primary health care provider can make a referral to a mental health provider, such as a psychiatrist or psychologist.

Take a family member or friend along to your appointment, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with the provider that you don't think to bring up.

What you can do

Before your appointment, make a list of:

Any symptoms you or your family noticed, and for how long.
Key personal and medical information, including current physical or mental health conditions, personal or family history of mental health conditions, traumatic experiences, or major stressors.
All medicines, herbs, vitamins or other supplements you take, including the doses.
Questions you want to ask your provider to make the most of your appointment.

Some basic questions to ask include:

What is likely causing my symptoms?
What are other possible causes?
What treatments are most likely to work best for me?
How much can I expect my symptoms to improve with treatment?
How often will I need treatment, and for how long?
Are there medicines that can help? If so, what are the possible side effects?
Is there a generic option to the medicine you're recommending?
Are there any printed materials I can have? What websites do you suggest?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your mental health provider is likely to ask you some questions, such as:

What are your symptoms?
When did you or your family first notice these symptoms?
How are your symptoms affecting your life?
Have relatives or friends expressed concern about your behavior?
Do you have any close relationships?
If you're not satisfied with work, school or relationships, what do you think is causing your problems?
Have you ever thought about harming yourself or others? Have you ever actually done so?
Have any of your blood relatives, such as a parent or sibling, been diagnosed with or treated for mental health conditions?

Be ready to answer questions so that you'll have time to talk about what's most important to you.