Mental health condition
Medical condition
Antisocial personality disorder (ASPD) is a personality disorder defined by a chronic pattern of behavior that disregards the rights and well-being of others. People with ASPD often exhibit behavior that conflicts with social norms, leading to issues with interpersonal relationships, employment, and legal matters. The condition generally manifests in childhood or early adolescence, with a high rate of associated conduct problems and a tendency for symptoms to peak in late adolescence and early adulthood.
The prognosis for ASPD is complex, with high variability in outcomes. Individuals with severe ASPD symptoms may have difficulty forming stable relationships, maintaining employment, and avoiding criminal behavior, resulting in higher rates of divorce, unemployment, homelessness, and incarceration. In extreme cases, ASPD may lead to violent or criminal behaviors, often escalating in early adulthood. Research indicates that individuals with ASPD have an elevated risk of suicide, particularly those who also engage in substance misuse or have a history of incarceration. Additionally, children raised by parents with ASPD may be at greater risk of delinquency and mental health issues themselves.
Although ASPD is a persistent and often lifelong condition, symptoms may diminish over time, particularly after age 40, though only a small percentage of individuals experience significant improvement. Many individuals with ASPD have co-occurring issues such as substance use disorders, mood disorders, or other personality disorder. Research on pharmacological treatment for ASPD is limited, with no medications approved specifically for the disorder. However, certain psychiatric medications, including antipsychotics, antidepressants, and mood stabilizers, may help manage symptoms like aggression and impulsivity in some cases, or treat co-occurring disorders.
The diagnostic criteria and understanding of ASPD have evolved significantly over time. Early diagnostic manuals, such as the DSM-I in 1952, described “sociopathic personality disturbance” as involving a range of antisocial behaviors linked to societal and environmental factors. Subsequent editions of the DSM have refined the diagnosis, eventually distinguishing ASPD in the DSM-III (1980) with a more structured checklist of observable behaviors. Current definitions in the DSM-5 align with the clinical description of ASPD as a pattern of disregard for the rights of others, with potential overlap in traits associated with psychopathy and sociopathy. ;templatestyles src="Template:TOC limit/styles.css" / ;
Symptoms and behaviors.
Due to tendencies toward recklessness and impulsivity, patients with ASPD are at a higher risk of drug and alcohol abuse. ASPD is the personality disorder most likely to be associated with addiction. Individuals with ASPD are at a higher risk of illegal drug usage, blood-borne diseases, HIV, shorter periods of abstinence, misuse of oral administrations, and compulsive gambling as a consequence of their tendency towards addiction. In addition, sufferers are more likely to abuse substances or develop an addiction at a young age.
Due to ASPD being associated with higher levels of impulsivity, suicidality, and irresponsible behavior, the condition is correlated with heightened levels of aggressive behavior, domestic violence, illegal drug use, pervasive anger, and violent crimes. This behavior typically has negative effects on their education, relationships, and/or employment. Alongside this, sexual behaviors of risk such as having multiple sexual partners in a short period of time, seeing prostitutes, inconsistent use of condoms, trading sex for drugs, and frequent unprotected sex are also common.
Patients with ASPD have been documented to describe emotions with ambivalence and experience heightened states of emotional coldness and detachment. Individuals with ASPD, or who display antisocial behavior, may often experience chronic boredom. They may experience emotions such as happiness and fear less clearly than others. It is also possible that they may experience emotions such as anger and frustration more frequently and clearly than other emotions.
People with ASPD may have a limited capacity for empathy and can be more interested in benefiting themselves than avoiding harm to others. They may have no regard for morals, social norms, or the rights of others. People with ASPD can have difficulty beginning or sustaining relationships. It is common for the interpersonal relationships of someone with ASPD to revolve around the exploitation and abuse of others. People with ASPD may display arrogance, think lowly and negatively of others, have limited remorse for their harmful actions, and have a callous attitude toward those they have harmed.
People with ASPD can have difficulty mentalizing, or interpreting the mental state of others. Alternately, they may display a perfectly intact theory of mind, or the ability to understand one's mental state, but have an impaired ability to understand how another individual may be affected by an aggressive action. These factors might contribute to aggressive and criminal behavior as well as empathy deficits. Despite this, they may be adept at social cognition, or the ability to process and store information about other people, which can contribute to an increased ability to manipulate others.
ASPD is highly prevalent among prisoners. People with ASPD tend to be convicted more, receive longer sentences, and are more likely to be charged with almost any crime, with assault and other violent crimes being the most common charges. Those who have committed violent crimes tend to have higher levels of testosterone than the average person, also contributing to the higher likelihood for men to be diagnosed with ASPD. The effect of testosterone is counteracted by cortisol, which facilitates the cognitive control of impulsive tendencies.
Arson and the destruction of others' property are also behaviors commonly associated with ASPD. Alongside other conduct problems, many people with ASPD had conduct disorder in their youth, characterized by a pervasive pattern of violent, criminal, defiant, and anti-social behavior.
Although behaviors vary by degree, individuals with this personality disorder have been known to exploit others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people. While some do so with a façade of superficial charm, others do so through intimidation and violence. Individuals with antisocial personality disorder may deliberately show irresponsibility, have difficulty acknowledging their faults and/or attempt to redirect attention away from harmful behaviors.
Comorbidity.
ASPD presents high comorbidity rates with various psychiatric conditions, particularly substance use and mood disorder. Individuals diagnosed with ASPD are significantly more prone to develop substance use disorder (SUDs), with studies showing that they are approximately 13 times more likely to be diagnosed with a SUD than those without ASPD. This population also faces increased risks for mood disorders, including a fourfold likelihood of experiencing major depressive disorder, as well as heightened risks for suicidal ideation and behaviors. Anxiety disorders, particularly post-traumatic stress disorder (PTSD) and social anxiety disorder, are also common comorbidities, affecting up to 50% of individuals with ASPD. These comorbidities often exacerbate the problems of those with ASPD, leading to more severe symptoms, complex treatment needs, and poorer clinical outcomes.
When combined with alcoholism, people may show frontal brain function deficits on neuropsychological tests greater than those associated with each condition. Alcohol use disorder is likely caused by lack of impulse and behavioral control exhibited by antisocial personality disorder patients.
Causes.
Personality disorders are generally believed to be caused by a combination and interaction of genetics and environmental influences. People with an antisocial or alcoholic parent are considered to be at higher risk of developing ASPD. Fire-setting and cruelty to animals during childhood are also linked to the development of an antisocial personality disorder, along with being more common in males and among incarcerated populations. Although the causes listed correlate to the risk of developing ASPD, one factor alone is unlikely to be the only cause associated with ASPD and relating to a listed cause does not necessarily mean that a person should identify or be identified as having ASPD.
According to professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience, there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores, and reading problems. Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD.
Genetic.
Research into genetic associations in antisocial personality disorder suggests that ASPD has some or even a strong genetic basis. The prevalence of ASPD is higher in people related to someone with the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behavior and conduct disorder.
In the specific genes that may be involved, one gene that has shown particular promise in its correlation with ASPD is the gene that encodes for monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norepinephrine. Various studies examining the gene's relationship to behavior have suggested that variants of the gene resulting in less MAO-A being produced (such as the 2R and 3R alleles of the promoter region) have associations with aggressive behavior in men.
This association is also influenced by negative experiences early in life, with children possessing a low-activity variant (MAOA-L) who have experienced negative circumstances being more likely to develop antisocial behavior than those with the high-activity variant (MAOA-H). Even when environmental interactions (e.g., emotional abuse) are taken out of the equation, a small association between MAOA-L and aggressive and antisocial behavior remains.
The gene that encodes for the serotonin transporter (SLC6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behavior and personality traits. Genetic association's studies have suggested that the short "S" allele is associated with impulsive antisocial behavior and ASPD in the inmate population.
However, research into psychopathy find that the long "L" allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e.g. lack of empathy, fearlessness) and interpersonal (e.g. grandiosity, manipulativeness) personality disturbances. This is suggestive of two different forms of the disorder, one associated more with impulsive behavior and emotional dysregulation, and the other with predatory aggression and affective disturbance.
Various other gene candidates for ASPD have been identified by a genome-wide association study published in 2016. Several of these gene candidates are shared with attention-deficit hyperactivity disorder, with which ASPD is often comorbid. The study found that those who carry four mutations on chromosome 6 are 50% more likely to develop antisocial personality disorder than those who do not.
Physiological.
Hormones and neurotransmitters.
Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development.
One of the neurotransmitters that has been discussed in individuals with ASPD is serotonin, also known as 5-HT. A meta-analysis of 20 studies found significantly lower 5-HIAA levels (indicating lower serotonin levels), especially in those who are younger than 30 years of age.
While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5-HT metabolism but may be the most essential psychopathological aspect linked with such dysfunction. Correspondingly, the DSM classifies "impulsivity or failure to plan ahead" and "irritability and aggressiveness" as two of seven sub-criteria in category A of the diagnostic criteria of ASPD.
Some studies have found a relationship between monoamine oxidase A and antisocial behavior, including conduct disorder and symptoms of adult ASPD, in maltreated children.
Neurological.
Antisocial behavior may be related to a number of neurological defects, such as head trauma. Antisocial behavior is associated with decreased grey matter in the right lentiform nucleus, left insular, and frontopolar cortex. Increased volumes of grey matter have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post-central cortex.
Intellectual and cognitive ability is often found to be impaired or reduced in the ASPD population. Contrary to stereotypes in popular culture of the "psychopathic genius", antisocial personality disorder is associated with reduced overall intelligence and specific reductions in individual aspects of cognitive ability. These deficits also occur in general-population samples of people with antisocial traits and in children with the precursors to antisocial personality disorder.
People that exhibit antisocial behavior tend to demonstrate decreased activity in the prefrontal cortex, and is more apparent in functional neuroimaging as opposed to structural neuroimaging. Some investigators have questioned whether the reduced volume in prefrontal regions is associated with antisocial personality disorder, or whether they result from co-morbid disorders, such as substance use disorder or childhood maltreatment. It is still considered an open question if the anatomical abnormality causes the psychological and behavioral abnormality,