Antisocial personality disorder (ASPD) is a complex mental health issue often tied to psychopathy and sociopathy. The disorder is often poorly understood and misrepresented, leading to stigma. The disorder is characterized by the failure to conform to social norms, which is why it’s often associated with violent crimes. But depictions often focus on the most extreme cases of violence. However, many people with antisocial personality disorder can be law-abiding citizens; others may get in trouble for nonviolent crimes like theft and fraud.
Learn more about antisocial personality disorder and how it relates to psychopathy and sociopathy.
What Are ASPD, Psychopathy, and Sociopathy?
Antisocial personality disorder is a mental health issue that’s characterized by a general lack of understanding or concern with the thoughts and feelings of other people. As a personality disorder, ASPD involves a deeply rooted pattern of behavior that persists for a long time. The lack of empathy or understanding for other people’s feelings can manifest in several ways, impulsive recklessness or calculating manipulation. ASPD, like many mental health issues, is complex and involves many different variations on the same disorder.
Antisocial personality disorder is often associated with other terms, including psychopathy and sociopathy. The term psychopath is particularly stigmatized and often associated with cases of criminal insanity and violent crimes. All three of these terms are related, but they aren’t interchangeable.
Antisocial personality disorder is a diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM), and it describes a clinical disorder that can be treated. Psychopathy and sociopathy are terms used to describe a set of traits that often point to ASPD. Since ASPD can manifest in different ways, terms like sociopath or psychopath can be used to describe the different traits someone with ASPD might have. Some consider psychopathy and antisocial personality disorder as the same thing, but others argue that they are different. It’s important to note that the three terms were developed separately from one another, not as a cohesive categorization tool. So, there is some debate over the definitions and use of these terms. If you have psychopathic or sociopathic traits, it may help inform treatment and therapy, but both may lead to the same diagnosis of ASPD.
What Is Psychopathy?
The concept of psychopathy was originally developed by psychologist Robert Hare in his studies on inmates in 1941. The term was originally used to describe and predict violent criminal behavior. It was not necessarily intended to diagnose and treat mental health issues. Instead, it was used in the field of forensics. Hare developed a checklist called the Psychopath Checklist Revised to help identify psychopathy. Today, psychopathy may be used to describe a subset of people with antisocial personality disorder.
Psychopathy is generally based on biology and innate traits rather than learned or developed traits. The description of a psychopath is often cold and calculating with a lack of emotion. Because psychopaths are often calculating and manipulative, they are generally thought of as less impulsive. Not every person with psychopathic traits is involved in criminal activity. However, when they do commit crimes, they may be more likely to commit more severe crimes.
What Is Sociopathy?
Sociopathy may be associated with environmental factors like childhood trauma. They tend to be more emotional and have trouble regulating moods. As a result, they may be less manipulative when interacting with others. They may lack the social skills to fit into groups and find themselves on the fringes of society. Rather than being cold and calculating, they may be more impulsive. They may have trouble maintaining a single job or relationship for very long, and they may be prone to emotional outbursts. If they commit crimes, they may be less likely to engage in violence and more likely to commit less severe crimes like theft.
Sociopaths and psychopaths may be prone to lying, irritability, and a lack of remorse. But sociopaths may not be able to blend in with society as well as psychopaths. Sociopaths may be able to experience some limited emotions and form emotional attachments with some people. On the other hand, psychopaths may be unable to form any emotional attachments. Any relationship is a means to an end or use for personal gain. A sociopath may be less able to separate emotions from their actions, and they may not be totally without a moral conscience.
Both psychopaths and sociopaths tend to violate social conventions, but they may do them for different reasons. Psychopaths don’t experience the full range of emotions and disconnect their emotions from their actions. Sociopaths may be unable to control their emotions effectively, causing them to act inappropriately in social situations. Sociopaths may be more common than psychopaths. While psychopathy is thought to be a biological issue in the brain that leads to psychological impairment, sociopathy is thought to be a learned behavior.
How is Antisocial Personality Disorder Diagnosed?
In order to be diagnosed with antisocial personality disorder, the DSM lists specific signs and symptoms that must be experienced. One of the unique qualifiers involves age requirements. Symptoms have to be present from the age of 15, but you can’t receive an accurate diagnosis until the age of 18. ASPD is a long-lasting disorder, but some people may display some of the ASPD symptoms when they’re going through difficult times in their life. However, if these symptoms are present from a young age and last a long time, they’re unlikely to be caused by a period of stress or trauma.
An ASPD diagnosis will also involve at least three of the following symptoms to happen at the same time. It’s common for people to display one of these symptoms at some point in their lives or more than one symptom at different points throughout their life. However, that may not necessarily mean they have ASPD. However, multiple symptoms at the same time may signal a more serious disorder.
Here are the signs and symptoms of antisocial personality disorder as listed in the DSM:
- Failure to conform to social norms. A person with the disorder may have trouble conforming to social conventions. This may include the cultural rules of social interaction and working with other people. But it may also include breaking the law and having little regard for rules and authority. Repeated actions that would call for arrest may point to ASPD.
- Deceitfulness and lying. People with ASPD often have a compulsion to lie. They may also lie as a way to manipulate others. They may use aliases, engage in scams, or lie for personal gain. In some cases, they may be compelled to lie for personal pleasure or to exercise power over others.
- Irritability and aggression. These symptoms may come with a history of physical fights or assault charges. It may also involve domestic abuse. There are several issues that may cause bursts of anger and aggression, but people with ASPD often don’t show remorse for angry outbursts.
- Reckless disregard for safety. This may include disregard for your personal safety or the safety of other people. Reckless actions may involve speeding or drunk driving, risky sexual activity, or keeping hazardous living situations.
- Consistent irresponsibility. Irresponsibility is often identified by the failure to keep or maintain employment or fulfill financial obligations. Despite being cognitively and physically capable of work, a person with ASPD may be unwilling to work or unable to conform to conventional rules or authority that would be necessary at work.
- No remorse. Someone with ASPD may justify any harm or inconvenience done to another person. They may explain that it isn’t a big deal or that the person deserved how they were treated.
What Are the Complications of ASPD?
Antisocial personality disorder can have serious consequences in a person’s life. Since the disorder involves the inability to understand or experience a full range of emotions and to empathize with others, it can cause a person to clash with other people at multiple levels of society. For some, it may involve the inability to form close relationships and trouble making emotional connections. This may cause them to feel unsupported and isolated, which can result in issues like depression. The tendency toward aggression may cause them to clash with people in interpersonal relationships and authority figures.
Irritability and the failure to conform to social norms may cause them to clash with people at work or get in fights with their employer. They may find it difficult to maintain employment, or they may quit jobs they feel is beneath them. This can lead to the common symptoms of ASPD that cause chronic irresponsibility and a failure to uphold commitments and fulfill obligations.
It’s also common for people with ASPD to have issues that lead to legal troubles, arrests, and prison time. Aggression and fights may lead to assault charges. Neglect of serious responsibilities like legal obligations or even the neglect of children may cause serious legal problems.
Here are some consequences that may be caused by antisocial personality disorder:
- Spouse or child abuse
- Child neglect
- Substance use disorders
- Jail or prison time
- Inability to maintain employment
- Suicidal behavior
- Homicidal behavior
- Depression or anxiety
- Financial problems and homelessness
- Being the victim of violence
It’s important to note that some of these issues may happen to someone who does not have any issues with antisocial behavior. However, if a lifestyle of antisocial behavior from childhood contributes to many of these issues over many years, it could be rooted in ASPD.
Are People with ASPD Dangerous?
There is a common myth that all people with ASPD are violent and dangerous. While people with ASPD may be more prone to aggression and violence, not everyone with the disorder has these traits. While some may get into fights or physical altercations, others may be more prone to fraud, manipulation, theft, and other nonviolent offenses. People who are better at fitting into society may be able to learn how to adapt to social norms to blend in. Even if they don’t feel the emotional pull toward conforming to social norms that others do, they can fake it or adapt to fit in. This may also allow them to charm or manipulate people.
On the other hand, some may be less able to control their emotions or fake social competency. This may cause them to be less manipulative but more likely to have emotional outbursts or moments of anger or aggression. However, they may also be able to form genuine emotional bonds with some people, even if their emotional range is limited.
It can be challenging to be close to someone with ASPD. You may find it challenging to emotionally connect with a family member with the disorder, and you may frequently find yourself in conflict with them. Most people with the disorder aren’t dangerous, but they may be manipulative in ways that are self-serving and sometimes damaging to others. Some people with ASPD can forge emotional connections that are limited.
If someone in your family has ASPD, it’s important to know that the disorder is treatable. Encouraging a loved one to get treatment may be difficult, but doing so may lead to better coping and integration with society.
How Common Is Antisocial Personality Disorder?
In the general population, antisocial personality disorder is fairly rare. However, the estimated numbers are high enough to be significant. Around 3% of men in the general population have antisocial personality disorder. It’s most common among men, but women can experience it, too. Around 1% of women have it. ASPD is more common among people with substance use disorders and people in long-term incarceration. Research estimates that as much as 80% of prisoners may have the disorder. Your likelihood of experiencing ASPD symptoms spike between 24 to 44 years old and begins to decline around 45 to 65 years old.
The disorder usually starts by age 8, and around 80% of people with ASPD experience their first symptoms by age 11. It has to start by at least the age of 15 to be definitively diagnosed as ASPD. Children who don’t show ASPD symptoms by age 15 aren’t known to develop the disorder. That’s because antisocial personality disorder is thought to be rooted in genetic and early developmental causes.
Developing symptoms of ASPD later in life may be caused by something else and better explained by another disorder. Boys tend to develop symptoms before girls. Children that are diagnosed with ASPD will have a history of conduct disorder (CD), which is an emotional and behavioral disorder that causes disruptive and violent behavior in children.
People don’t have to have been diagnosed with conduct disorder as a child to be diagnosed with ASPD, but they do have to have a history of conduct disorder symptoms. Conduct disorder is a significant risk factor for ASPD, with 25% of girls and 40% of boys with CD meeting the criteria for ASPD later in life. At the same time, adults that display antisocial symptoms that don’t have a history of CD tend to have milder cases.
Antisocial Personality Disorder with Other Mental Health Problems
Antisocial personality disorder is associated with many other co-occurring problems, including major depressive disorder, bipolar disorder, anxiety disorders, substance use disorders, gambling, and sexual disorders. Substance use disorders may be among the most common co-occurring issues alongside ASPD. As many as 73% or more people with ASPD also have a substance use disorder. Anxiety disorders are also very common, affecting around 50% of people with ASPD. Comorbid mental health issues may feed into one another, causing ASPD to worsen. In many cases, these issues have to be addressed together.
What Causes Antisocial Personality Disorder?
The cause of many behavioral and psychological disorders is difficult to pinpoint. There is no laboratory test or physical examination that can diagnose antisocial personality disorder, and it’s difficult to find a single definitive cause for the disease. Like most mental health problems, the cause may come from multiple sources. ASPD seems to be rooted in both biological and environmental causes.
Genetics and ASPD
Biological causes refer to genetics and your family history. It may be possible to pass down genes that contribute to antisocial symptoms. Scientists identify genetic risk factors by studying twins and adopted children. Identical twins share the same genetic makeup and share many of the same traits that are passed down through genes. This can show what is called heritability, which is often expressed in a percentage that measures how much genes account for differences in human traits. Twin studies showed an ASPD heritability of 50%. That means your genes make up 50% of your chance of having ASPD. However, it’s not the only factor. Not everyone that has parents or grandparents with ASPD will have it themselves.
Twins may go through similar environmental experiences, so environmental and developmental factors are ruled out by studying twins that grew up in separate households or by studying adopted children. Children that are adopted will have the genes of one set of parents, but they grow up with another set of parents. A study in 1974 looked at the adopted children of women that committed crimes and likely had antisocial traits.
They compared them to a control group of adopted children. The study found that all the adoptees went through similar environmental factors growing up, but the children of convicted women had a higher rate of antisocial personality disorder. The study concluded by saying, “The findings point to the importance of interactions between genetic and environmental factors in the development of antisocial personality.”
Environment and ASPD
Since genetics only account for around 50% of your risk factors for developing antisocial personality disorder, that means another 50% is caused by other factors like developmental and environmental causes. Environmental factors can also significantly increase your risk factors for ASPD. Environmental factors can include your family and household environment, your school, your neighborhood, and the experiences you have in your life. Significant events that occur during childhood can influence your development.
There are several environmental risk factors that are associated with antisocial personality disorder. However, it’s important to note that a proven association doesn’t necessarily mean that these are all definitive causes of the disorder. Still, they may contribute to a person’s overall risk of antisocial personality disorder. These risk factors may include:
- Smoking during pregnancy
- Malnutrition during development
- Parents with substance use disorder
- Childhood trauma
Trauma is a significant factor that’s often associated with ASPD. A 2015 study looked at 162 men that were in inpatient treatment for severe mental illness, including antisocial personality disorder. Around 32.1% reported experiencing childhood trauma before the age of 15. The men in that group were 2.8 times more likely to have engaged in violent acts in the six months prior than men who didn’t have an issue of childhood trauma. The study also found that children with a history of antisocial personality disorder from childhood were more likely to have also experienced childhood trauma and to engage in violence than those without a history of antisocial behavior.
Is Antisocial Personality Disorder Difficult to Treat?
Many mental health treatment professionals consider antisocial personality disorder a difficult problem to treat. In some cases, stigma and some risks associated with antisocial personality disorder cause clinics to avoid treating the disorder.
Because ASPD may cause people to be manipulative, untruthful, and sometimes aggressive, some professionals may avoid taking on cases that involve this disorder. However, there are treatment options that may be effective for many people with ASPD. Treatment often includes talk therapy and behavioral therapies to help identify problems and find coping mechanisms. Because ASPD often comes with other comorbid issues like substance use problems, treatment may often address those issues.