Antisocial personality disorder
Antisocial personality disorder (ASPD) can affect people in various ways, such as a lack of empathy and insensitive behaviour. Here we take a look at the symptoms, causes, and the support available.
ASPD is a mental health condition that affects how an individual thinks, feels, and relates to others. ASPD, like other personality disorders, can range in severity. Generally speaking, many of those with the condition can come across as negligent and uncaring of other people's feelings.
The source of antisocial personality disorder is typically the result of a long, outstanding issue that could have occurred during the individual’s childhood. Educational, family, socio-economic and relationship problems can all contribute to the development of ASPD. Counselling can be a helpful way to work through some of the issues that may contribute to the condition.
We recognise that the system of personality disorder diagnosis can be considered controversial. It is completely your choice which term, if any, you want to use, knowing that your doctor or care team may use another.
The terms used on the Counselling Directory are those that are generally used in the UK, currently. We refer to these terms throughout, with the hope of reaching and supporting as many people as possible.
Living with someone who has ASPD
It might be difficult to live with someone who has ASPD as they can lack empathy towards others, which often sees sufferers labelled as callous and cynical. They may also come across as arrogant, refusing to do any work they perceive to be beneath them. Exaggerated behaviour and self-assurance are further traits associated with this mental health problem, and sufferers might display a superficial charm by using technical terms to impress others who aren’t as familiar with a topic as they are.
Is ASPD the same as narcissism?
ASPD and narcissistic personality disorder (NPD) share similar characteristics, such as the tendency to exploit others and a lack of empathy, but people with ASPD don’t usually envy others or need the same level of admiration as those with NPD.
It is also likely for people with ASPD to take advantage of any perceived weakness (soft-heartedness, caring or fairness) in a person for their own benefit. Lasting relationships are uncommon as people with ASPD tend to find intimacy difficult. If the person is in a long-term relationship, research would suggest that it may contain a degree of neglect, abuse (physical and/or verbal), or aggression, especially when under the influence of drugs or alcohol.
Often, people with ASPD will have grown up with parental inconsistencies and conflict in their lives. Their childhood may have consisted of a transfer of care on several occasions and, as a result of this, they are likely to fall into truancy, juvenile delinquency or substance abuse. They may also find it difficult to gain employment, buy a house, hold onto social relationships and take responsibility for situations. In some cases, people with ASPD may find themselves on the wrong side of the law which could see them imprisoned.
What are the common ASPD traits?
Individuals might display some antisocial characteristics, but won’t necessarily have ASPD. The majority will typically display a number of the following traits:
- uncaring personality
- depressive outlook on life
- anxious behaviour
- shifts blame onto others
- irresponsible behaviour
- manipulative behaviour
- anger towards others
- frequent lying or deception
In adolescence, a sufferer might have demonstrated antisocial behaviour, like setting fires or being cruel to animals. While these may be isolated incidents, they could also indicate an underlying problem. A diagnosis of ASPD for antisocial personality disorder, however, can only be made when a child turns 18, due to the significant changes that take place during the early teenage years.
What causes ASPD?
The cause of ASPD is still unknown, but there are many theories on factors that can contribute to the development of the condition. These include biological/genetic, social and psychological factors. These are thought of as a biopsychosocial model of causation.
Growing up in a household where there’s little supervision and no adult role models can contribute to the development of antisocial personality disorder. Typically, it is more prevalent in a society where positive behaviour isn’t reinforced or rewarded and where little support from the community is given to confront the behaviour.
In some cases of ASPD, the frontal lobe in the brain that controls planning and judgement appears different. Research has found distinct changes in the volume of brain structure that triggers violent behaviour. Individuals who have that type of brain function might find it more difficult to control their impulses, which may be the reason for their aggressive behaviour. Neurobiologists cannot claim for definite that these factors are a cause of ASPD as it could simply be a result of life experiences.
How the individual learns to deal with stress, their behaviour, personality development and the environment they grow up in can all contribute to the development of ASPD.
What are ASPD symptoms?
Symptoms may occur in childhood but become fully apparent in early adulthood. People sometimes use drugs or alcohol if they have an antisocial personality, which can intensify most symptoms. An individual who has ASPD might:
- show a lack of concern about another’s sorrow or anguish
- blame others for their own problems
- repeatedly break the law
- not learn from mistakes
- display a disregard for social norms
- be irresponsible
- exploit or manipulate other people’s good nature
- not being able to control their anger
- be depressed and suffer from anxiety
- be addicted to drugs and/or alcohol.
Although it is considered a lifelong problem, some ASPD symptoms, such as destructive behaviour, may decrease over time. The reason for this is unknown, but it might be down to ageing or the increased understanding of behaviour they demonstrate.
Diagnosing a personality disorder like ASPD is very difficult and should be carried out by a trained mental health professional. GPs are not usually trained to diagnose this condition but should be able to refer you to a specialist who can help.
One of the main difficulties in diagnosing ASPD is the overlapping conditions and related problems. These include:
- anxiety disorders
- other personality disorders
- post-traumatic stress disorder (PTSD)
- Ganser’s syndrome
The diagnosis of ASPD is typically based on both psychiatric and medical history. In order to meet the DSM (Diagnostic and Statistical Manual of Mental Disorders) criteria for ASPD, a person will also need to have had a conduct disorder before the age of 15. If an adult doesn’t meet the requirements to be diagnosed with ASPD, they might have a conduct disorder instead.
It is important to note that antisocial behaviour can appear as a symptom in other conditions. These need to be distinguished to make a true diagnosis. For example, if someone has a problem with substance abuse, they might lie to acquire money to fuel their habit. This doesn’t mean they have ASPD unless they have a history of antisocial behaviour in their childhood. Individuals who meet both sets of requirements for substance abuse and ASPD are given a dual diagnosis.
Support for ASPD
As with most personality disorders, the earlier the disorder is diagnosed and treated, the better. It’s rare that an individual with ASPD will seek out treatment on their own. So if you're concerned about a family member or a friend who displays a number of symptoms, asking them to talk to their GP to find out the best course of action would be advisable.
Treating ASPD is difficult because it’s not typically the sufferer who initiates the treatment - it might be a parent, guardian or even a court referral. The general aim of therapy sessions is to find a good reason for sufferers to work on the problem. A good incentive for individuals with ASPD to attend sessions is to let them know the end is in sight - if they keep their behaviour in check, therapy will be less frequent and will eventually stop. Measuring their behaviour, however, can be a tough task.
Cognitive behavioural therapy (CBT)
CBT aims to treat an individual’s behaviour and change the way they think. A therapist will analyse and discuss negative thought patterns and how these affect daily life. Essentially, they will try to help the individual to change them for the better.
For the behavioural approach, the therapist will examine the antisocial behaviours and will help the sufferer understand why they happen, and most importantly give advice on how they can be changed.
A key objective is to build a relationship with the individual so suggestions are not immediately dismissed. A person with ASPD is unlikely to have had many relationships throughout their life, so they may find it hard to trust others and discuss feelings.
Group therapy can help individuals identify maladaptive behaviour and offer support through the group dynamic. The group setting may be more effective for highlighting and treating insecurities than a one-to-one session by encouraging people to talk about their issues with others experiencing similar problems.
The aim of family therapy is to tend to the relationship that might have broken down because of the disorder. This type of therapy encourages family members to empathise with and help each other. It presents the opportunity to build on family strengths and make positive changes in their lives and relationships.
What should I be looking for in a counsellor or therapist?
At present, there are no regulations that stipulate what level of training or qualifications a counsellor needs for treating antisocial personality disorder. However, the National Institute for Health and Care Excellence (NICE) has developed a set of guidelines that provide advice about the recommended treatments, including the following:
- You may be offered psychological treatment in order to help you with problems such as impulsive and antisocial behaviour, and if you have problems relating to other people. Psychological treatment can help you to make positive changes to your thought processes and your behaviour.
- If you have a history of offending behaviour, you may be offered a psychological treatment (such as one called 'reasoning and rehabilitation') that can help you to reduce offending and other antisocial behaviour. People with very serious and extreme symptoms (such as psychopathy and severe personality disorder) may also be offered this treatment.
- You should not usually be offered medication just to treat antisocial personality disorder or for any related symptoms or behaviour, such as aggression, anger and impulsive behaviour. This is because there is little evidence that medication helps to relieve the symptoms of antisocial personality disorder and it may cause side effects.
Read the full NICE guidelines: Antisocial personality disorder
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