Disruptive, Impulse-Control, and Conduct Disorders

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Our greatest fears lie in anticipation

"Our greatest fears lie in anticipation"

Honoré de Balzac

Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is characterized by a pervasive pattern of disregard for (or violation of) the rights of others. There may be a poor moral sense or conscience and a history of crime, legal problems, impulsivity, and aggressive behavior. One of the most important features of ASPD is the individual’s lack of remorse or guilt for the acts they have committed. While many individuals break the law and engage in antisocial behavior, it is not appropriate to assume that antisocial behaviors indicate the antisocial personality disorder. Individuals with ASPD do not feel as though they are doing anything wrong, necessarily, and are able to internally justify all of their behaviors and actions.

Though the word “antisocial” is often used to indicate someone who does not like interacting with others, or may be shy or reserved, these characteristics have little to nothing to do with ASPD, and should not necessarily be associated. ASPD is sometimes referred to as psychopathy or sociopathy, though the criteria might be slightly different depending on the method of diagnosis.

DSM-5 Diagnostic Criteria for Antisocial Personality Disorder

The DSM-5 describes ASPD as a pervasive pattern of disregard for, and violation of, the rights of others occurring since age 15, as indicated by three (or more ) of the following:

• Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest;
• Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure;
• Impulsivity or failure to plan ahead;
• Irritability and aggressiveness, as indicated by repeated physical fights or assaults;
• Reckless disregard for safety of one’s self or others;
• Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations; and
• Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

The individual must be at least 18 years old; there must be evidence of conduct disorder with onset before age 15; and the occurrence of antisocial behavior must not exclusively be during the course of schizophrenia or a bipolar manic episode.

Etiology of Antisocial Personality Disorder

ASPD seems to be caused by a combination of both genetic and environmental influences. Genetic influences draw on the temperament and the kind of personality a person is born with, and environmental influences include the way in which a person grows up and the experiences they have had. 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.

ASPD is seen in up to 30% of psychiatric outpatients. The prevalence of the disorder is even higher in selected populations, such as prisons, where there is a preponderance of violent offenders. Approximately 47% of male prisoners and 21% of female prisoners have ASPD. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug abuse treatment programs than in the general population. Furthermore, ASPD is diagnosed three times more frequently in men than in women.

Treatment of Antisocial Personality Disorder

ASPD is considered to be a difficult personality disorder to treat. Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts.

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