Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is a personality disorder characterized by a history of continuous and chronic behaviour where there is disregard for and violation of the rights of others. Individuals repeatedly engage in unlawful activities (e.g. drug use, assault, or theft), endanger the well-being of others, and frequently lie. They tend to be aggressive and impulsive and may find it difficult to maintain employment for long. Contrary to the name, having antisocial personality does not mean the individual does not have friends; on the contrary, they may have a superficial charm and be very deceptive.

Epidemiology

There is a 12-month prevalence between 0.2-3.3% in the general population. In forensic populations, the prevalence can be > 50%.

Prognosis
Comorbidity
Risk Factors
History

The conceptualization of antisocial personality disorder dates back to the 1800s, and has its origins in society and the attitudes towards crime and civil liberties. The framework for the current approach to antisocial personality had its origins in 1939, when psychiatrist Dr. David Henderson began describing various types of antisocial behaviour beyond just criminal activity.[1]

Sociopath, psychopath, or antisocial personality?

These three terms are often used interchangeably. Antisocial personality disorder is a diagnosis in the DSM-5 and the ICD-10 (also called dissocial personality disorder in the ICD). Sociopathy is considered to be a synonym for antisocal personality. Psychopathy is not a clinical diagnosis in a medical setting per se, rather it is diagnosed using the Psychopathy Checklist—revised (PCL-R), created by Canadian psychologist Robert D. Hare.[2][3]

I'm so antisocial!

The term “antisocial” is often misused by the lay public (e.g - “I'm feeling so antisocial tonight! I don't want to go this party.”). What an individual actually mean to say is they are feeling “asocial,” or feeling indifferent to social activities. The term antisocial means “against society,” or behaviour that is actively hostile or harmful towards society, as in antisocial personality disorder.
Criterion A

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by 3 (or more) of the following:

  1. Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest
  2. Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
  3. Impulsivity or failure to plan ahead
  4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults
  5. Reckless disregard for safety of self or others
  6. Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behaviour or honour financial obligations
  7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another
Criterion B

The individual is at least age 18 years.

Criterion C

There is evidence of conduct disorder with onset before age 15 years.

Criterion D

The occurrence of antisocial behaviour is not exclusively during the course of schizophrenia or bipolar disorder.

Patients must be 18 years or older to be diagnosed with the antisocial personality. They typically have a history of conduct disorder in adolescence. Conduct disorder becomes antisocial personality disorder once an individual turns 18.

Mnemonic

The mnemonic CORRUPT can be used to remember the criteria for antisocial personality disorder.[4]

  • C - Cannot conform to the law
  • O - Obligations ignored
  • R - Reckless disregard for safety
  • R - Remorseless
  • U - Underhanded (deceitful)
  • P - Planning insufficient (impulsive)
  • T - Temper (irritable, aggressive)

Evidence is limited in this area. Cognitive behavioural therapy may be helpful in addressing specific symptoms such as impulsivity, interpersonal difficulties, and challenging behaviours.

There is little evidence for the use of medications. Some limited evidence exists to support the role of lithium or phenytoin in preventing impulsive aggression in those with antisocial personality.[5]

Personality Disorder Guidelines

Guideline Location Year PDF Website
World Federation of Societies of Biological Psychiatry (WFSBP) International 2009 - Link

Antisocial Personality Guidelines

Guideline Location Year PDF Website
National Institute for Health and Care Excellence (NICE) UK 2009 - Link