Antisocial personality disorder

Signs & Symptoms

  • exploit, manipulate or violate the rights of others
  • lack concern, regret or remorse about other people’s distress
  • behave irresponsibly and show disregard for normal social behaviour
  • have difficulty sustaining long-term relationships
  • be unable to control their anger
  • lack guilt, or not learn from their mistakes
  • blame others for problems in their lives
  • repeatedly break the law

Criminal behaviour is a key feature of antisocial personality disorder, and there’s a high risk that someone with the disorder will commit crimes and be imprisoned at some point in their life.

Men with antisocial personality disorder have been found to be 3 to 5 times more likely to misuse alcohol and drugs and have an increased risk of dying prematurely as a result of reckless behaviour or attempting suicide. 
People are also more likely to have relationship problems during adulthood and be unemployed and homeless. 

A person with antisocial personality disorder will have a history of conduct disorder during childhood, such as truancy (not going to school), delinquency (crimes or substance misuse), and other disruptive and aggressive behaviours.

Antisocial personality disorder affects more men than women.

It’s not known why people develop the disorder, but both genetics and traumatic childhood experiences, such as child abuse or neglect, play a role.

As a result of these problems, social services may become involved with the child’s care.

Diagnosis

Treatments

To be diagnosed with antisocial personality disorder, a person will usually have a history of conduct disorder before the age of 15.

Antisocial personality disorder is diagnosed after rigorous psychological assessment.

A diagnosis can only be made if the person is aged 18 years or older and at least 3 of the following criteria apply:

  • repeatedly breaking the law
  • repeatedly being deceitful
  • being impulsive or incapable of planning ahead
  • being irritable and aggressive
  • having a reckless disregard for their safety or the safety of others
  • being consistently irresponsible
  • lack of remorse

These signs must not be part of a schizophrenic or manic episode – they must be part of the person’s everyday personality.

This behaviour usually becomes most extreme and challenging during the late teens and early 20s. It may improve by the time the person reaches their 40s.

Evidence suggests behaviour can improve over time with therapy, even if core characteristics such as lack of empathy remain. 

But antisocial personality disorder is one of the most difficult types of personality disorders to treat.

A person with antisocial personality disorder may also be reluctant to seek treatment and may only start therapy when ordered to do so by a court.

The recommended treatment for someone with antisocial personality disorder will depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug misuse.

The person’s family and friends will often play an active role in making decisions about their treatment and care.

In some cases, substance misuse services and social care may also need to be involved.

The National Institute for Health and Care Excellence (NICE) has published guidelines about the management and prevention of antisocial personality disorder.

Talking therapies

Cognitive behavioural therapy (CBT) is a talking therapy that aims to help a person manage their problems by changing the way they think and behave. Mentalisation-based therapy (MBT) is another type of talking therapy that's becoming more popular in the treatment of antisocial personality disorder. The therapist will encourage the person to consider the way they think and how their mental state affects their behaviour.

Medication

There's little evidence to support the use of medicine for treating antisocial personality disorder, although certain antipsychotic and antidepressant medicines may be helpful in some instances. Carbamazepine and lithium may help control symptoms such as aggression and impulsive behaviour, and a class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may improve anger and general personality disorder symptoms.

Democratic Therapeutic Communities

Evidence suggests community-based programmes can be an effective long-term treatment method for people with antisocial personality disorder, and is becoming popular in prisons. DTC is a social therapy that addresses risk of offending and emotional/psychological needs. It's based around therapy groups to focus on community issues, creating an environment where people contribute to the decisions.