Antisocial Personality Disorder (ASPD)

What is antisocial personality disorder?

Antisocial personality disorder (ASPD), also known as sociopathy, involves a persistent pattern of callousness toward others and a disregard for social norms and laws. People with this disorder are sometimes called sociopaths.

Depending on the severity of the disorder, people with ASPD tend to have difficulty exhibiting empathy or caring about others. A weak conscience or moral compass allows them to deceive and manipulate those around them. They can also be hostile and impulsive, and they may not feel remorse for their actions. People with ASPD are prone to self-destructive acts and may experience frequent legal troubles.

Unsurprisingly, those considered sociopaths also tend to have poor relationships with friends, family, and romantic interests. If your loved one has ASPD, you may find yourself persistently hurt by their lack of concern. They may lie about finances, for example, or steal from you whenever it serves them. You might have a difficult time knowing when to trust them and when to push them away. You may even live in fear that their actions could cause you physical harm.

A person with ASPD is unlikely to seek help for their condition. It’s more common that they’ll refuse to take responsibility for their behavior, and simply brush off the damage they’ve caused to those around them. However, they may seek treatment as part of a court-ordered punishment, or if they experience hardships due to their self-destructive behavior.

By understanding more about ASPD, you can learn to identify sociopaths, set boundaries to protect yourself, and offer guidance to a loved one seeking help.

Symptoms of antisocial personality disorder

Some estimates show that ASPD appears in 1 to 4 percent of the population. But how can you tell if someone is a sociopath? According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), if someone has this disorder, they will exhibit three or more of the following seven symptoms before 15 years of age:

1. A disregard for social norms when it comes to laws. Someone with ASPD may regularly steal or break traffic laws without concern.
2. Deceitfulness. They are quick to lie to you and others. They may con people out of money or simply withhold information, leaving you in the dark about their actions.
3. Impulsive behavior. Someone with ASPD may suddenly walk off a job on a whim, or engage in binge drinking and risky sexual behavior, for example.
4. Aggression. They may often seem irritable or lash out in verbally or physically abusive ways. You might see them throw things against walls or erupt in bouts of name-calling and swearing.
5. Disregard for their own safety and the safety of others. A person with ASPD might have a habit of driving recklessly or carelessly handling firearms.
6. Irresponsibility. They may not bother to pay back borrowed money or show up in court, and may walk away from such responsibilities with a sense of entitlement or arrogance.
7. Lack of remorse. They seem indifferent to the pain or inconvenience any of the above has caused to others.

Similar and co-occurring disorders

ASPD is categorized as a cluster B personality disorder, along with:

• Histrionic personality disorder (HPD)
• Borderline personality disorder (BPD)
• Narcissistic personality disorder (NPD)

These personality disorders are characterized by volatile emotions and unpredictable behavior. They can co-occur with one another, leading to a more complicated diagnosis and treatment path.

For example, people with borderline personality disorder often have an intense fear of abandonment. But, like people with ASPD, they also have difficulty with impulse control.

People with narcissistic personality disorder have low empathy and can be exploitative of others—problems that are also present in ASPD. However, narcissists tend to be less outwardly aggressive, and more focused on gaining admiration from others than sociopaths.

Other co-occurring disorders

Aside from other personality disorders, ASPD can also co-occur with conditions such as attention deficit hyperactivity disorder (ADHD) and substance abuse. Co-occurring disorders can make a sociopath’s behavior even more unpredictable.

ADHD. Of course, most people with ADHD diagnoses aren’t sociopaths. However, having ADHD can be a risk factor for developing this personality disorder, and impulsivity can be a major feature of both conditions.

Addiction and substance abuse. Research shows that having ASPD significantly increases the risk of experiencing a substance use disorder. Sociopathic individuals are more likely to disregard the legal and health consequences of heavy drug and alcohol use.

[Read: Dual Diagnosis: Substance Abuse and Mental Health]

Anxiety disorders. Many people with ASPD also suffer from an anxiety disorder. When these disorders co-occur, the person is more likely to experience distress and suicidal ideation.

Post-traumatic stress disorder (PTSD). Reckless decision-making that comes with ASPD increases the risk of experiencing a traumatic incident, such as an accident or violent altercation. PTSD develops when the mind and body have difficulty moving on from a traumatic event.

Schizophrenia. ASPD can co-occur with schizophrenia, a disorder that affects the way a person perceives reality. However, as is the case with ADHD, it’s important to note that most people who suffer from schizophrenia are not violent or sociopaths.

What causes antisocial personality disorder?

A combination of genetic and environmental factors may increase a person’s risk of ASPD or sociopathy.

There doesn't seem to be a specific gene that makes someone a sociopath. Some research shows that genes that affect serotonin and dopamine—chemicals associated with happiness and pleasure—may be a factor. Variations in these genes could lead to aggression, impulsiveness, and emotional dysfunction.

Men are three to five times more likely to receive an ASPD diagnosis than women. As well as gender, life experiences may also have a role to play. A history of being physically abused may put you at increased risk of developing antisocial traits.

Cluster B personality disorders, including ASPD, may also be linked to an insecure attachment style. Your attachment style is the result of early experiences with your primary caregiver, and this affects how you think about and approach relationships. If you have an insecure attachment, it’s likely that your caregiver was unable to provide consistent comfort or regularly meet your needs.

Professional treatment

Due to the nature of the disorder, someone with ASPD may not recognize they have a problem and take an active approach to finding professional treatment. However, if you do decide to seek help, there are options available, including therapy, and medication for related conditions.

Cognitive behavior therapy (CBT) can be very useful for improving social functioning, strengthening relationships, and reducing aggressiveness. This type of therapy involves exploring how your thoughts and feelings influence behavior, and then making appropriate adjustments. For example, during CBT sessions, as someone with ASPD you might learn how to challenge an ingrained assumption that other people can't be trusted.

Mentalization. An approach originally intended to address borderline personality disorder, might also decrease aggression in antisocial personality disorder. Mentalization involves thinking about how different mental states affect behavior. During treatment, a clinician may ask you to recount a past confrontation and describe your emotional state during that confrontation. They may then encourage you to reflect on how the other person may have viewed and felt about the conflict. This kind of exercise can be useful for empathy building. Mentalization-based sessions can also take place in a group setting, which can help participants feel less isolated and encourage compassion.

Treating co-occurring disorders. Variations of CBT can be useful in treating ADHD in adults, substance use disorders, and PTSD. However, other therapeutic solutions might also be incorporated, such as eye movement desensitization and reprocessing (EMDR) therapy for anxiety, PTSD, and trauma. Anger management classes might also help someone with ASPD control their temper.

Medication

There aren’t any medications that will specifically address ASPD. However, some medications can help you manage certain symptoms:

• Anticonvulsants, which are typically used to treat seizures, can help reduce impulsive behavior in people with ASPD.
• Antipsychotics, such as risperidone and quetiapine, can be used to treat aggressiveness.
• Selective serotonin reuptake inhibitors (SSRI), a type of antidepressant, can also be prescribed to reduce a person’s aggressive behavior.

Medication may also help to manage comorbid conditions. Co-occurring ADHD, for example, could be treated with medication such as atomoxetine and bupropion. Because people with ASPD are at increased risk of substance abuse, though, a health care provider might take extra care in prescribing drugs that are potentially addictive.

How to cope if a loved one has ASPD

If your loved one has ASPD, you may live in constant fear of their unpredictable behavior. Will they erupt in a bout of rage during a conversation? Will they steal your car and disappear for days? Will you receive a call from the police or a hospital with bad news? While you can't control your loved one's volatile or erratic behavior, there are some steps that can help you cope.

Don't take their actions personally. Your loved one’s personality disorder isn’t about you. They don’t lie to you because you’re gullible, and they don’t say hurtful things because you deserve it. Acknowledge that they’re dealing with a personality disorder, and try not to take their actions personally. Do your best to separate your sense of self-esteem from their behavior.

Recognize and escape abuse. It’s crucial to recognize abuse in a relationship and take steps to keep yourself safe. Remember that abuse doesn’t always involve physical violence. Emotional and verbal abuse can come in the form of name-calling, shaming, intimidation, and controlling behavior.

Encourage them to seek treatment. It’s unlikely that a person with ASPD will seek treatment on their own, but you can try to nudge them in that direction. Point out the ways in which their disorder is negatively affecting their life, whether that includes the financial burden of legal issues or the health effects of their impulsive behavior. Depending on the situation, it might be best to avoid talking about the personality disorder itself, and instead encourage them to seek help for related issues, such as substance abuse.

[Read: How to Help Someone with a Mental Illness Accept Treatment]

Set boundaries. Boundaries can help protect you from your loved one’s poor decisions and reckless behavior. Be clear when setting boundaries and let them know the actions that won't be tolerated and why. You might say, “I feel disrespected when you yell at me. Please don't raise your voice at me again.”

Enforce boundaries. It’s not enough to just set boundaries; you also need to enforce them. Let your loved one know the consequences of stepping over a boundary. You might say, “If you lie to me again, I’ll take a break from this relationship.” Only state consequences that you’re willing to follow through on.

Find support. If you rely solely on a loved one with ASPD for support, you could be setting yourself up for continual disappointment or pain. Acknowledge the areas in which the person has repeatedly let you down, whether it’s handling money or respecting your feelings. Temper your expectations in these areas and turn to other friends or family members who can meet those needs.

If you need to widen your support network, take steps to connect with new people. Support groups can help you meet people who are dealing with similar problems, which can help you feel understood and give you tips for better coping strategies.

If you need help for ASPD

Not everyone with ASPD is unaware of their condition. If you recognize the symptoms in yourself and want to improve your life and relationships, talking to a professional therapist should be a priority. However, there are also steps you can take on your own to improve how you cope with ASPD.

In addition to following the tips, it’s important to build supportive relationships to help you address any insecure attachment issues, which often contribute to personality disorders.

[Read: How Attachment Styles Affect Adult Relationships]

Forming bonds with securely attached individuals can help you to both recognize your own negative behaviors, and adopt healthier habits.

Tip 1: Practice empathy

Empathy allows you to better understand another person's perspective and be in touch with their emotions.

Become a better listener. During conversation, aim to really understand the other person’s situation and emotions. Try to put yourself in their shoes and see the world from their perspective. Ask for clarification and offer feedback, when necessary.

[Read: Empathy: How to Feel and Respond to the Emotions of Others]

Practice reading nonverbal cues. People can communicate a lot through their body language. Are they flashing a fake smile? Are they tense? Learning to interpret nonverbal cues is also a way to better tune into another person’s emotional state.

Be vulnerable. Maybe you’ve learned to protect yourself by hiding behind a wall of indifference. That wall also prevents you from fully connecting to others. Be willing to share your fears, anxieties, and hardships with people you trust.

Tip 2: Improve emotional intelligence (EQ)

EQ is your ability to understand and manage your emotions in a healthy, constructive way. By working on your emotional intelligence, you can also strengthen your relationships and decision-making.

Use mindfulness to cultivate self-awareness. Mindfulness is about acknowledging present sensations and emotions without being judgmental. It can help you better assess your feelings and identify negative thought patterns that lead to destructive behavior. Recognizing insecurity and shame, for example, may help you better address fits of anger that stem from those emotions.

Take a mindful approach to interactions. You can also use mindfulness to improve your focus during conversations with others. Set aside personal judgments and criticisms while the other person is talking. Instead, be present and stay tuned in to their body language, tone, and words. 

Practice conflict resolution skills. You won’t always be on the same page as the people around you. You might disagree on how to complete a task, for example, or even have opposing wants and needs. Learning to compromise on issues and forgive others for their actions can help effectively resolve conflicts while strengthening relationships.

Tip 3: Address substance abuse issues

Substance abuse often goes hand in hand with ASPD. Drugs and alcohol can worsen your physical and mental health as well as weaken your relationships.

Learn to identify triggers. These are situations or feelings that lead you to abuse substances. For example, you might be more likely to drink when you're around certain people. Once you know your triggers, you can better predict and prepare to resist cravings.

Aim to manage stress. Rather than turn to drugs or alcohol to unwind from stressful situations, find healthier ways to manage stress, such as relaxation practices like meditation, deep breathing, or exercise.  

Find purpose. Engage with meaningful hobbies and interests, whether they include playing sports, practicing an instrument, or building practical skills. Boredom and a sense of emptiness can trigger or maintain substance abuse.

Tip 4: Calm anger and impulsivity

Angry outbursts and impulsive actions can put you and others in harm’s way. Whether you pick fights that result in injuries, or lose your savings with a risky financial decision, your behavior can be severely damaging. It can also impact your relationships, making it harder for friends and family to trust you.

Identify your anger warning signs. You likely experience certain physical symptoms leading up to an emotional outburst. You may feel your jaw clenching, notice tension in your shoulders, or experience tightness in your chest, for example. Once you recognize your warning signs, you can take steps to diffuse your anger.

Take steps to cool down. Have an action plan in mind for when you notice your anger warning signs. This plan could include anything from a deep breathing exercise to calm you down to a brisk walk that helps you release pent-up energy. Experiment with different strategies to determine what works best for you.

[Read: Anger Management]

Delay decision-making. Establish a rule for yourself that involves waiting a certain amount of time before making important decisions. If you're thinking about quitting your job, for example, rather than walk off in a moment of frustration, commit to thinking over your options for a full 24 hours.

Coping with ASPD involves acknowledging and addressing your weaknesses as well as finding the right support. It’s not easy, but things can change. Despite the symptoms of antisocial personality disorder, you can still receive and give love, tame your vices, and build meaningful connections with others.

Last updated or reviewed on October 11, 2023