ConditionMental health & sleep
Antisocial Personality Disorder
Antisocial personality disorder (ASPD) is a long-term mental health condition marked by a persistent pattern of disregarding and violating other people's rights. People with ASPD often lie, act impulsively, break rules or laws, are irritable or aggressive, and show little guilt for harming others. It is diagnosed only in adults, and requires signs of conduct disorder before age 15. It affects roughly 1% to 4% of adults, more often men. Treatment is difficult but some approaches help, and symptoms often lessen with age.
Also called: ASPD, dissocial personality disorder, sociopathy (informal), psychopathy (related but not identical)
At a glance
- What it is
- A personality disorder involving persistent disregard for others' rights and feelings.
- Key signs
- Deceit, impulsivity, aggression, recklessness, irresponsibility and lack of remorse.
- Onset
- Conduct problems before 15; diagnosis at 18 or older.
- Causes
- A mix of genetic factors, early adversity, abuse and neglect, and brain differences.
- Treatment
- Structured psychological programs, treating substance use and coexisting conditions.
When to get help
Call 911 or go to the ER
- Threats or acts of violence toward others, or immediate danger to yourself or others: call 911 or your local emergency number
- Thoughts of suicide or self-harm: call or text 988 (US)
See a doctor within a day or two
- Escalating aggression, especially with heavy alcohol or drug use
- If you are being harmed or controlled by someone close to you: contact the National Domestic Violence Hotline (1-800-799-7233)
Book a routine appointment
- A pattern of repeated conflict with the law, work or relationships that you want to change
- A child or teenager with persistent aggression, cruelty, lying, theft or rule-breaking (possible conduct disorder)
- Substance use, depression or anxiety alongside antisocial traits
Signs and symptoms
The DSM-5-TR describes a pervasive pattern since age 15 of disregard for others' rights, shown by three or more of:
- Failure to follow laws and social norms, with repeated acts that could lead to arrest
- Deceitfulness: repeated lying, using aliases or conning others for profit or pleasure
- Impulsivity and failure to plan ahead
- Irritability and aggressiveness, including repeated fights or assaults
- Reckless disregard for the safety of self or others
- Consistent irresponsibility, such as failing to keep jobs or pay debts
- Lack of remorse: indifference to or rationalizing having hurt, mistreated or stolen from others
The person must be at least 18, have had conduct disorder beginning before age 15, and the behavior must not occur only during schizophrenia or bipolar disorder.
Many people with ASPD can be superficially charming, but relationships tend to be exploitative or unstable.
Sociopath, psychopath and ASPD
"Sociopath" and "psychopath" are not formal diagnoses.
| Term | Meaning |
|---|---|
| Antisocial personality disorder | Formal diagnosis based mainly on behaviors |
| Psychopathy | A research and forensic concept emphasizing emotional traits: shallow emotions, lack of empathy, grandiosity, manipulativeness; measured with tools such as the PCL-R |
| Sociopathy | An informal term, often used for antisocial behavior linked to environment and upbringing |
Most people with psychopathy meet criteria for ASPD, but only a minority of people with ASPD have high psychopathic traits.
Causes and risk factors
No single cause explains ASPD. Contributing factors include:
- Genetics: twin and adoption studies suggest a substantial inherited component.
- Childhood adversity: abuse, neglect, inconsistent or harsh parenting, parental substance use and household violence.
- Childhood conduct disorder and ADHD, especially when untreated.
- Brain differences in areas involved in emotion, impulse control and decision-making, such as the prefrontal cortex and amygdala.
- Male sex: ASPD is diagnosed about three times more often in men.
Conditions that often occur together
- Substance use disorders, especially alcohol, which are present in most people with ASPD
- Depression and anxiety
- ADHD
- Other personality disorders, particularly borderline and narcissistic
- Higher rates of injury, suicide attempts and early death
Diagnosis
A psychiatrist or psychologist makes the diagnosis after a detailed interview covering childhood behavior, relationships, work, legal history and substance use, often with information from family members or records. Structured assessment tools help. They also assess for depression, substance use, ADHD and risk to self and others. People with ASPD rarely seek help for the personality traits themselves; they more often come to attention through the legal system, substance use treatment or relationship problems.
Treatment
There is no medicine approved specifically for ASPD, and evidence for treatment is limited, but some approaches help.
- Group-based cognitive and behavioral programs focusing on problem-solving, impulse control and thinking skills, recommended by NICE, particularly in criminal justice settings.
- Mentalization-based treatment, which builds the ability to understand one's own and others' mental states, shows promise.
- Treating substance use reduces violence and offending.
- Medicines for coexisting conditions: for example, ADHD medicines, antidepressants, or mood stabilizers for aggression in some cases.
- Contingency management and structured supervision.
Prevention in childhood
The strongest evidence is for preventing ASPD by treating conduct problems early. Parent training programs and family therapy for children with conduct disorder reduce later antisocial behavior.
Outlook
ASPD is long-lasting, but antisocial behavior, particularly criminal behavior and aggression, often declines from the 40s onward. Outcomes are better when substance use is treated, stable work and relationships develop, and people engage with structured programs.
Support for families
Living with someone with ASPD can be harmful. Family members benefit from their own support and counseling, clear boundaries and safety planning. Anyone experiencing abuse can contact the National Domestic Violence Hotline at 1-800-799-7233.
Frequently asked questions
What are the main signs of antisocial personality disorder?
The main signs are repeated lying and manipulation, breaking rules or laws, impulsivity, irritability and aggression, recklessness, irresponsibility with work or money, and lack of remorse for hurting others. These must be long-standing and have started with conduct problems in childhood.
Is a sociopath the same as antisocial personality disorder?
Not exactly. "Sociopath" is an informal term, while antisocial personality disorder is a formal diagnosis. They describe overlapping patterns of antisocial behavior. Psychopathy is a related concept that focuses more on emotional traits such as lack of empathy and shallow emotions.
Can antisocial personality disorder be treated?
It is hard to treat, and people rarely seek help on their own. However, structured cognitive behavioral programs, treatment of substance use and treatment of coexisting conditions can reduce harmful behavior. Symptoms often lessen with age.
What causes antisocial personality disorder?
ASPD likely results from a combination of inherited traits and early life experiences, such as abuse, neglect, harsh or inconsistent parenting and exposure to violence. Childhood conduct disorder and ADHD increase the risk, especially when not treated.
Sources
This guide was written from current patient and clinical guidance, including:
- American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR), antisocial personality disorder
- NICE: Antisocial personality disorder, prevention and management (CG77)
- MedlinePlus (US National Library of Medicine): Antisocial personality disorder
- National Institute of Mental Health (NIMH): Personality disorders
- Mayo Clinic: Antisocial personality disorder