Antisocial Personality Disorder
What Is It?
A personality disorder - as distinguished from a personality trait or style - is a longstanding, maladaptive pattern of behavior and experience that impairs functioning and causes distress.
There is no clear dividing line between a personality style and a disorder. Personality characteristics may change or become exaggerated when a person is stressed.
Antisocial personality disorder is characterized by failure to conform to society's norms, deceit or intimidation in relationships, and failure to show consideration for the rights of others. People with this type of personality sometimes have a history of criminal activity with an absence of remorse for their hurtful deeds. They can be impulsive, reckless and sometimes violent. This disorder is far more common and more serious in men than women.
The absence of a moral compass may stem from a belief that only threats of punishment, rather than internalized values, cause people to play by the rules. The belief leads to a tendency toward exploiting others, taking advantage of their fairness or soft-heartedness, and feeling indifferent or frankly contemptuous of their victims. People with this disorder have little, if any, capacity for intimacy. Any enduring relationships involve abuse or neglect and an inability to be accountable for anything they have done. Yet they can have a superficial capacity to be ingratiating or charming or sometimes are good actors who use lies and distortion to keep relationships going. Some with antisocial personality disorder have no goal beyond the pleasure in being deceptive or sadistic.
The disorder is further characterized by emotional shallowness. A lack of empathy, shame or guilt makes people with antisocial personality disorder ill equipped to understand the suffering they cause.
In this disorder, by definition, the person is likely to take no responsibility for any of his or her own suffering. He or she will blame others when things go badly. Many with this disorder are self-defeating and live lives devoid of many pleasures that come to people who are better able to have mutual and satisfying relationships.
People with this personality disorder can have related problems, such as chronic boredom or irritability, psychosomatic symptoms, alcohol and substance abuse, and a variety of mood or anxiety disorders. They have a higher risk of suicide. A significant number have had problems with conduct disorder or attention deficit as children.
A chaotic family life with a lack of supervision may be involved in the development of this personality disorder. The disorder also may be more common where the community is unsupportive and provides little opportunity to be rewarded for positive behavior.
The environment, though, is not the only cause of this disorder. A number of biological factors controlling temperament make an important contribution to the formation of this personality type. For example, people with antisocial personality disorder have a less robust response to stress or a diminished startle reflex, the involuntary response to loud noises or other stimuli. This may affect their ability to learn from reward and punishment. The frontal lobe, the area of the brain that governs judgment and planning, also appears to be different in people with antisocial personality disorder. There also may be neurochemical differences that account for the tendency toward more impulsive and aggressive behavior.
A person with antisocial personality disorder tends to have few symptoms, but causes discomfort or distress to others through socially unacceptable behavior and by being:
- Aggressive or irritable
The diagnosis is made on the basis of history, usually by a mental-health professional. There are no known laboratory tests to assist in diagnosing this disorder. Other psychiatric disorders, such as a mood or anxiety disorder, attention deficit disorder or substance abuse, may also be present.
All personality disorders are lifelong patterns.
There is no known way to prevent this disorder. An improvement in a person's social environment may reduce the severity of the problem, especially if changes are made early in life.
Many types of psychotherapy techniques have been used to treat antisocial personality disorder. In younger people, family or group psychotherapy may help change destructive patterns of behavior, teach new vocational and relationship skills, reinforce supportive structures, promote empathy and encourage new, socially acceptable and productive ways of thinking about one's goals and aims. Cognitive therapy attempts to change sociopathic ways of thinking. Behavior therapy uses reward and punishment to promote good behavior. In some cases, symptoms can be treated with medication. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), may decrease aggressiveness and irritability. They are useful if anxiety or depression is present, or if either is contributing to substance abuse.
There are many questions about how helpful any of these interventions can be. Treatment is more likely to be successful if it is started earlier in life, but long-entrenched patterns of thinking and behavior are difficult to change. For some, the tendency toward aggression and irritability decreases with age, but underlying personality characteristics may persist.
The criminal justice system may help to protect others who are victims of antisocial behavior. Depending on a variety of factors, corrections systems may promote antisocial behavior or may provide an opportunity for rehabilitation.
People with antisocial personality disorder generally do not acknowledge that they have a problem that requires treatment. When a pattern of antisocial behavior is noted, others can recommend or encourage treatment.
The prognosis for antisocial personality disorder is highly variable. In one study, about half of people diagnosed with antisocial personality disorder were either improved or had no psychiatric symptoms many years later. However, change is not likely to be rapid when antisocial behavior is prominent and active. Any change that occurs may be measurable only after years or decades.