Antisocial personality disorder
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.
We appreciate that the feelings and behaviours associated with personality disorders are very difficult to live with, and everyone deserves understanding and support. We recognise the diversity in understanding of experiences and preferences around terms individuals may wish to use. We are also aware that some professionals disagree with the system of personality disorder diagnosis, and that some people given the diagnosis find it unhelpful and stigmatising.
The terms used on 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.
All personality disorders are mental health conditions that affect how an individual thinks and relates to others. Antisocial personality disorder (ASPD), like other personality disorders, can range in severity. Some people with the disorder might exhibit sporadic examples of bad behaviour, while those on the other end of the ASPD spectrum might repeatedly commit serious crimes. Generally speaking, many of those with the condition tend to come across as negligent and uncaring of others' 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 – all of which can be helped with counselling or therapy.
On this page, we will explore what it’s like to live with ASPD, as well as common symptoms and causes of the condition. We will also outline how a diagnosis is made, and what types of antisocial personality disorder treatment are available.
Living with antisocial personality disorder
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 and may refuse to do any work that they perceive to be beneath them. Cockiness 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.
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 sufferers tend to find intimacy difficult. If a sufferer is in a long-term relationship, research would suggest that it may contain a degree of neglect and/or abuse (physical and/or verbal).
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 a number of 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.
Antisocial personality disorder traits
Individuals might display some antisocial characteristics, but won’t necessarily have ASPD. The majority of sufferers will typically display a number of the following traits:
- uncaring personality
- depressive outlook on life
- anxious behaviour
- shifts blame on to others
- irresponsible behaviour
- manipulative behaviour
- anger towards others.
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 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.
Antisocial personality disorder causes
The cause of antisocial personality disorder 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, and 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 antisocial personality disorder as it just could simply be a result of life experiences.
How the individual learns to deal with stress, their behaviour, personality development and the influence of the environment they grow up in can all contribute to the development of ASPD.
Antisocial personality disorder symptoms and diagnosis
Antisocial personality disorder 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 be 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 antisocial personality disorder 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 antisocial personality disorder 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 antisocial personality disorder 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.
When is it time to seek help for antisocial personality disorder?
As with most personality disorders, the earlier the disorder is diagnosed and treated, the better. It’s very rare that an individual with ASPD will seek out treatment on his or her own. So if you are concerned about a family member or a friend who displays a number of antisocial personality disorder symptoms, asking them to talk to their GP to find out the best course of action would be advisable.
Antisocial personality disorder treatment
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 sufferers 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.
CBT aims to treat an individual’s behaviour and change the way he or she thinks. A therapist will analyse and discuss negative thought patterns and how they 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 offers 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.
People who suffer from ASPD are usually brought to therapy by a family member or loved ones. The aim of this 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 happens if ASPD is not treated?
Antisocial personality disorder can result in a low quality of life, leading sufferers to substance abuse, addiction and even imprisonment. As well as the personal risks, there is a societal cost too. Family relationships are often the first to be affected, but over time the personality disorder may get worse, affecting other members of the community who frequent the same pubs or shops and eventually anyone the sufferer come into contact with.
What should I be looking for in a counsellor or psychotherapist?
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) have 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 no evidence that medication helps to relieve the symptoms of antisocial personality disorder and it may cause side effects.
Read the full NICE guidelines:
- Personality disorders
- Avoidant personality disorder
- Borderline personality disorder (BPD)
- Dependent personality disorder
- Histrionic personality disorder
- Narcissistic personality disorder
- Obsessive-compulsive personality disorder
- Paranoid personality disorder
- Schizoid personality disorder
- Schizotypal personality disorder