What is antisocial personality disorder?
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. People with ASPD may experience difficulties with relationships, impulsive behaviour and understanding or responding to other people's feelings.
There is no single known cause of ASPD. A combination of genetic, psychological and environmental factors, including childhood experiences, family relationships and social circumstances, may contribute to its development. Counselling may help people explore some of the difficulties associated with the condition.
We recognise that personality disorder diagnoses and terminology can be controversial. In the UK, approaches to diagnosis are changing, with greater emphasis on personality disorder severity and individual personality traits rather than specific categories. However, terms such as antisocial personality disorder (ASPD) are still widely used.
We use terminology that people are likely to recognise when looking for information and support, while acknowledging that you may prefer different language to describe your experiences.
Living with someone who has ASPD
Living with someone who has ASPD can be challenging, particularly if they struggle to understand or respond to other people's feelings. They may come across as dismissive or overly self-assured, find it difficult to accept responsibility for their actions or become frustrated when things don't go their way. Some people may also display superficial charm or use confidence and persuasion to influence others.
What's the difference between ASPD and narcissism?
ASPD and narcissistic personality disorder (NPD) share similar characteristics, such as difficulties with empathy and a tendency to exploit others. However, people with NPD are more likely to seek admiration or validation from others, while ASPD is more closely associated with impulsive behaviour, disregard for social rules and the rights of others.
People with ASPD may sometimes take advantage of others for personal gain, which can create difficulties with trust and communication. Building and maintaining close relationships can also be challenging, particularly where impulsive behaviour, conflict or difficulties with empathy are involved. Research suggests that alcohol consumption may increase aggressive behaviour in some people with ASPD, potentially adding to relationship difficulties.
Difficult childhood experiences, including inconsistent parenting, family conflict or changes in care arrangements, may contribute to the development of ASPD. Behavioural difficulties, such as truancy, rule-breaking or substance misuse, may also emerge during childhood or adolescence. For some people, these difficulties continue into adulthood, affecting relationships, employment and financial stability, and potentially bringing them into contact with the criminal justice system.
What are common traits of ASPD?
People may display some antisocial characteristics without necessarily having ASPD. Those with the condition may demonstrate a number of the following traits:
- difficulty recognising or responding to others' feelings
- a tendency to blame others for their actions
- irresponsible or impulsive behaviour
- manipulative behaviour
- difficulty managing anger or frustration
- frequent lying or deception
- disregard for social rules or the rights of others.
In adolescence, someone with ASPD 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. ASPD is generally diagnosed in adults aged 18 or over. Antisocial behaviour during childhood or adolescence may be considered as part of the assessment, but it does not necessarily mean someone will develop ASPD.
What causes antisocial personality disorder?
The exact causes of ASPD are not fully understood, but a combination of genetic factors, life experiences and a person's environment may contribute to its development.
Social and environmental factors
It is thought that growing up in a household where there’s little supervision and no adult role models can contribute to the development of antisocial personality disorder.
Biological and genetic factors
In some people with ASPD, differences have been observed in areas of the brain involved in planning, judgement and decision-making, including the frontal lobe. Research has also identified differences in the structure and volume of certain brain regions associated with emotional regulation and behaviour. These differences may contribute to difficulties with impulse control and managing aggression. However, researchers have not established whether these brain differences contribute to the development of ASPD or are influenced by other factors, such as life experiences.
Psychological factors
Psychological factors, such as how someone learns to manage stress, cope with difficult emotions and respond to challenging situations, may also contribute to the development of ASPD.
What are the symptoms of ASPD?
Symptoms may begin during childhood or adolescence and continue into adulthood. Alcohol or substance misuse can sometimes make certain difficulties more pronounced. Someone with ASPD may:
- repeatedly break rules or the law
- act impulsively without considering the consequences
- have difficulty learning from negative experiences
- struggle to maintain responsibilities at work or home
- engage in behaviour that puts themselves or others at risk
- experience frequent conflict in their relationships
- have difficulty controlling anger or aggressive behaviour.
Some people with ASPD may also experience depression, anxiety or problems with alcohol or substance use, although these are not defining symptoms of the condition.
Although ASPD can be a long-term condition, some behaviours, particularly impulsive or aggressive behaviour, may become less pronounced with age. The reasons for this are not fully understood, and experiences vary between individuals.
How is ASPD diagnosed?
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:
- alcohol dependence
- anxiety disorders
- other personality disorders
- depression
- post-traumatic stress disorder (PTSD)
- schizophrenia.
The diagnosis of ASPD is typically based on both psychiatric and medical history. A diagnosis of ASPD involves assessing a person's current behaviour and their history, including evidence of conduct disorder before the age of 15.
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 misuse, 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 misuse and ASPD are given a dual diagnosis.
Treatment and support for ASPD
Getting appropriate support can help people with ASPD manage difficulties with behaviour, emotions and relationships. Some people may seek support themselves, while others may be encouraged to access treatment by family members, healthcare professionals or the criminal justice system. 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.
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 develop more helpful ways of thinking and responding.
For the behavioural approach, the therapist will examine the antisocial behaviours and will help the person with ASPD to 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 may find it difficult to build trust or discuss their feelings, so developing a supportive therapeutic relationship can be an important part of treatment.
Group therapy
Group therapy can help people recognise unhelpful patterns of behaviour and receive support from others. The group setting provides opportunities to discuss difficulties, share experiences and explore different ways of responding to situations.
Family therapy
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.
Finding a counsellor or therapist for ASPD
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.
NICE recommends considering psychological treatments to help people with ASPD manage difficulties such as impulsive behaviour and relationships. Specific approaches may also be offered to people with a history of offending behaviour. Medication is not routinely recommended for treating ASPD itself, although it may be prescribed for other mental health conditions.
For more information, read the NICE guidance on antisocial personality disorder.
When looking for a counsellor or therapist, consider asking about their experience supporting people with personality disorders and the approaches they use.
If you're living with ASPD or are concerned about someone close to you, seeking professional support can be a helpful first step. A therapist with experience of personality disorders may be able to help you explore difficult behaviours, manage emotions and navigate relationship challenges.
Find a therapist experienced in supporting people with antisocial personality disorder.
