Living with Antisocial Personality Disorder

A look at the signs and symptoms of ASPD, and how this mental health condition differs from psychopathy.

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There’s no question that mental health awareness is becoming more mainstream (finally!). Whether it be celebrities using their platforms to share their own stories and struggles, companies promoting a more balanced culture, or friends finally feeling comfortable discussing just how stressful life can be—understanding mental health is becoming more important to people. 

Mental health diagnoses for anxiety, depression, and substance use disorder are becoming increasingly common among our nation’s youth. Still, one condition that might not be as well recognized is antisocial personality disorder. 

What is antisocial personality disorder?

Antisocial personality disorder (ASPD) is defined by chronic manipulation and exploitation without remorse or regard for others. People with ASPD consistently lack regard for right and wrong and tend to ignore how their actions affect others.

The Diagnostic and Statistical Manual of Mental Disorders (DSM) first mentioned the term “antisocial personality” in 1968, where it described someone who is “grossly selfish, callous, irresponsible, impulsive, unable to feel guilt or to learn from experience and punishment, and has low frustration tolerance.” Since then, the DSM has elaborated on the diagnostic criteria for an antisocial personality disorder diagnosis to make it more personality-oriented and behavior-focused.

Research suggests that the rate of antisocial personality disorder in the U.S. might be between 0.5 to 3.5 percent of people, with a higher prevalence among men. Although the cause of ASPD is unknown, risk factors include a history of child abuse and antisocial or alcoholic parents. 

‍Antisocial behaviors typically begin during childhood, and nearly 80 percent of people with ASPD develop their first symptom by age 1. In fact, most people with antisocial personality disorder have a history of conduct disorder—a group of emotional and behavioral problems characterized by a disregard for others. Kids and teens with conduct disorder have trouble following the rules, show signs of aggression, and can even be physically violent.

Signs of antisocial personality disorder

Wondering how to tell if you or someone you know has antisocial personality disorder? Here are some of the signs:

• Good at flattery
• Can manipulate other people's emotions
• Break the law repeatedly
• Disregard the safety of self and others
• Issues with substance abuse
• Prone to lying, stealing, and fighting
• Show no guilt or remorse for hurtful actions
• Often angry or arrogant
• Blame others for their hurtful actions 

Is this the same thing as being a psychopath?

Research suggests that only about one-third of people with antisocial personality disorder are considered to be psychopaths. The term sociopath refers to a person diagnosed with antisocial personality disorder. In contrast, the term psychopathy refers to a set of personality traits and is not an official diagnosis. Most experts concur that there’s an overlap and a clear distinction between the two. 

Sociopaths and psychopaths are impulsive, manipulative, and reckless. However, sociopaths are capable of experiencing empathy and rationalizing behaviors that they know are wrong—while psychopaths lack a conscience and don't feel genuine compassion for others.

Are there other personality disorders?

The short answer is yes. Personality disorders—mental health conditions defined by patterns of thoughts, feelings, and behaviors that differ from the cultural norm—fall into three groups based on similar symptoms and characteristics. Antisocial personality disorder is part of Cluster B. Someone living with a Cluster B disorder may be dramatic, overly emotional, and unpredictable. 

In addition to antisocial personality disorder, other Cluster B personality disorders include:

• Borderline personality disorder
• Histrionic personality disorder
• Narcissistic personality disorder

Diagnosing antisocial personality disorder

Interestingly, antisocial personality disorder is the only personality disorder not diagnosable during childhood. To be officially diagnosed with ASPD by a mental health professional, a person must be at least 18 years old and have had symptoms of conduct disorder before they were 15. 

An antisocial personality disorder diagnosis also requires a person to meet at least three of the seven criteria listed below:

1. Failure to follow social norms and lawful behaviors, resulting in repeated acts that are grounds for arrest.  
2. Deceitfulness, shown through repeated lying, the use of aliases, or fooling others for personal profit or pleasure.
3. Impulsivity or failure to plan. 
4. Irritability, aggressive behavior, and prone to repeated physical fights.
5. Reckless disregard for the safety of themself or others. 
6. Consistent irresponsibility, shown by repeated failure to deliver consistent work behavior or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from others. 

Treating antisocial personality disorder

There’s no cure for antisocial personality disorder, but there are methods to help manage symptoms. The first is to diagnose and treat conduct disorder during childhood. Research suggests that early intervention may help reduce certain ASPD behaviors later in life for some people.

Another treatment option is cognitive behavioral therapy (CBT)—a type of talk therapy that helps people to identify and change destructive thoughts and behaviors. CBT is considered effective for various mental health conditions because it helps people recognize and shift the patterns that are holding them back from healing. For someone with ASPD, CBT might make them more mindful of some of their impulsive or reckless actions and behave in a way that’s considered to be more “socially acceptable.”

Tips for living with antisocial personality disorder

Most people with antisocial personality disorder have a history of conduct disorder. When you're diagnosed with ASPD, you may already understand how to manage the condition best. However, if you're still struggling or seeking additional ways to improve your health and relationships, below are four tips.

• Practice regular self-care. Self-care looks different for different people, but it should always work toward similar goals, mindfulness, building resilience, and better managing stress. Not sure where to start? Experiment with positive self-talk, eating healthy goods, getting enough sleep, and creative activities like journalism or cooking.
• Limit alcohol and drug use. This advice goes for anyone with a mental health condition—or anyone at all—but is especially useful for those with antisocial personality disorder. Generally speaking, people with ASPD have higher rates of alcohol abuse and dependence than people without ASPD. Moreover, research suggests that people with ASPD may be more prone to alcohol-related aggression.
• Follow your treatment plan. Programs such as Charlie Health's virtual IOP are tailored to each patient, meaning you have a treatment plan and care team specific to you and your condition. Even if you start to feel better, always consult your doctor before making any changes to your treatment plan.
• Educate your friends and family. Some of the symptoms of ASPD can make building and maintaining friendships difficult. Without context, symptoms like manipulation and angry outbursts might rub people the wrong way. Sharing information about ASPD with your loved ones, classmates, or coworkers can help them learn about the condition and why you sometimes act as you do.

Manage your symptoms with Charlie Health

If you or someone you know is living with antisocial personality disorder, Charlie Health can help. Our virtual Intensive Outpatient Program (IOP) is an evidence-based care option for teens and young adults who are experiencing mental health challenges, including personality disorders like avoidant personality disorder. 

Whether you're exploring treatment options for the first time or seeking extra support, Charlie provides individualized and evidence-based mental health care in a safe, supportive space.

Using therapeutic modalities like motivational interviewing, psychotherapy, and family involvement through weekly supported groups, individual therapy, and family therapy, Charlie Health has the experience and resources to help you manage your mental health disorder and live a more fulfilling life. 

‍Learn more today.