Antisocial Personality Disorder (ASPD)

What is antisocial personality disorder (ASPD)?

Antisocial personality disorder (ASPD) is a mental health condition that can affect the way you think and interact with others and lead you to:

• Manipulate or deceive people.
• Exploit or take advantage of someone else for your own benefit.
• Disregard the law or the rights of other people.
• Feel no remorse for your actions.

It’s common for people diagnosed with ASPD to show a lack of respect toward others, break the law, ignore the consequences of their actions or refuse to take responsibility. ASPD can be dangerous since you’re at a high risk of causing physical or emotional harm to yourself and those around you.

Antisocial personality disorder is one of many personality disorders. Personality disorders affect the way you think or behave.

How common is antisocial personality disorder?

Antisocial personality disorder affects an estimated 1% to 4% of adults in the U.S.

What are the symptoms of antisocial personality disorder?

Symptoms of antisocial personality disorder may include:

• Physical aggression, hostility or violence toward others.
• Reckless or impulsive behavior.
• Breaking the law or disregarding rules and social norms.
• Feeling angry, more powerful or better than others.
• Using wit, flattery and charm to manipulate, lie or deceive others for personal gain or enjoyment.
• Not taking responsibility for actions or behaviors.
• Not showing remorse, regret or concern for behaviors.

Antisocial personality disorder may look different for each person who experiences it. You might lean more toward certain behaviors than others.

If at any point, you feel the urge to hurt yourself or others, reach out for help. Contact a healthcare provider or call the Suicide and Crisis Lifeline by dialing or texting 988 (U.S.). Someone is available to talk with you 24 hours a day, seven days a week. If you or a loved one is in immediate danger, call 911 or your local emergency services number.

What age does antisocial personality disorder develop?

Antisocial personality disorder usually begins before age 15. The initial diagnosis is conduct disorder. Children with conduct disorder show a pattern of aggressive or disobedient behavior that can harm others. They may lie, steal, ignore rules or bully other children. Two behaviors that are warning signs of ASPD during childhood are setting fires and animal cruelty.

Sometimes parents or healthcare providers miss the signs of conduct disorder. The signs may overlap with other conditions, like:

• Attention-deficit/hyperactivity disorder (ADHD).
• Depression.
• Oppositional defiant disorder (ODD).

When a conduct disorder diagnosis occurs and treatment begins early in childhood, there’s a chance the behaviors may not continue into adulthood. If they do, the diagnosis becomes antisocial personality disorder after age 18.

Studies suggest that symptoms of ASPD are the worst between ages 20 to 40 and tend to improve after age 40.

What causes antisocial personality disorder?

Healthcare providers aren’t sure of the exact cause of antisocial personality disorder. Research suggests it may involve many different factors, from your genetic composition to certain experiences you had growing up. One leading factor is brain biology. You may have abnormal levels of serotonin in your brain. Serotonin is a chemical that regulates your mood and feelings of happiness. Changes to the amount of serotonin in your brain may cause antisocial personality disorder behaviors.

Is antisocial personality disorder genetic?

Your genetic makeup may make it more likely for you to develop antisocial personality disorder. Research is ongoing to learn more about how your genes can contribute to this condition, but the exact genes responsible are yet to be identified. Studies found that your risk increases if you have a biological relative with ASPD.

What are the risk factors for antisocial personality disorder?

Antisocial personality disorder can affect anyone. You may be more at risk of developing the condition if you:

• Had a conduct disorder diagnosis before age 15.
• Are assigned male at birth (AMAB).
• Experienced trauma or abuse in early childhood.
• Experience substance use disorder (SUD) or have a biological relative who has the condition.
• Have a history of mental health conditions in your biological family.
• Have a lower academic performance compared to your peers.
• Spent time in jail or prison.

What are the complications of antisocial personality disorder?

Antisocial personality disorder is a dangerous, often life-threatening condition to the affected person and others around them. It can lead to the following complications:

• Abuse or cruelty.
• Neglect.
• Suicide.
• Substance use disorder.
• Alcohol use disorder.
• Arrest and incarceration.
• Health complications.
• Other mental health conditions (depression, anxiety, etc.).
• Inability to meet personal, social, work or academic commitments.

How is antisocial personality disorder diagnosed?

A healthcare provider who specializes in mental health conditions, like a psychologist or psychiatrist, will diagnose antisocial personality disorder. They’ll perform a psychological evaluation. This is a method to evaluate a person’s thoughts and behaviors which look for patterns that relate to antisocial personality disorder. Providers refer to the diagnostic criteria listed in the fifth edition of the Diagnostic and Statistical Manual of Mental Illnesses, or DSM-5-TR (in the latest version, “TR” stands for “text revision”). This is the American Psychiatric Association’s professional guide to mental health conditions.

Most people who experience antisocial personality disorder don’t seek a diagnosis on their own. A mental health evaluation is usually requested by a court of law.

Antisocial personality disorder test

No self-assessment, blood test or imaging exam can diagnose antisocial personality disorder. If certain signs or behaviors raise a red flag, seek medical attention. You may first choose to see a primary care physician (PCP). They’ll consider your health history, perform a physical exam and assess your symptoms. Your provider will refer you to see a psychiatrist or psychologist for a mental health evaluation, which leads to an ASPD diagnosis.

Differential diagnosis for antisocial personality disorder

A differential diagnosis is a way for your healthcare provider to distinguish between several health conditions that share similar symptoms. Certain conditions can mimic antisocial personality disorder, so your healthcare provider may refer to the following conditions before making an official diagnosis:

• Borderline personality disorder (BPD), or unstable moods and manipulative behavior.
• Narcissistic personality disorder (NPD), or an inflated sense of self-importance.
• Substance use disorder, or a dependence on drugs or alcohol.

How is antisocial personality disorder treated?

Your healthcare providers may recommend the following treatment for antisocial personality disorder:

• Medications: Medications can help treat symptoms like aggression and mood changes.
• Psychotherapy: Cognitive behavioral therapy (CBT) is a type of counseling that focuses on changing your thinking and behavior. Therapy can help you see how your behavior affects others. You may benefit from individual therapy, group therapy or family therapy.

Your healthcare provider might recommend a combination of medications and psychotherapy. In addition, they may offer treatment for any other underlying health conditions like substance use disorder.

Antisocial personality disorder is difficult to treat clinically because you might not recognize that your behaviors and thoughts are harmful. It’s common to feel reactive or upset when someone offers to help. Understand that treatment is available to you when you’re ready to accept it. It isn’t easy to do, but treatment can keep you safe and protect those around you.

What medications treat antisocial personality disorder?

There isn’t a single, FDA-approved medication for antisocial personality disorder. Medication can help you manage aggression, depression or erratic moods. Your healthcare provider may recommend:

• Antidepressants, which can regulate serotonin levels in your brain. Examples include sertraline and fluoxetine.
• Antipsychotics, which can regulate violent behavior or aggression. Examples include risperidone and quetiapine.
• Mood stabilizers, which help manage severe changes in mood or behavior. Examples include lithium and carbamazepine.

Can antisocial personality disorder be prevented?

There isn’t a way to prevent antisocial personality disorder. If conduct disorder is detected and diagnosed during childhood, there’s a chance that early treatment could reduce your risk of developing ASPD as an adult.

What’s the outlook for antisocial personality disorder?

Antisocial personality disorder is a lifelong condition. Symptoms are usually most severe around age 20 and sometimes improve by age 40. Research is ongoing to learn more about why symptoms change as we age.

While participating in treatment, your outlook may be positive, but you’ll need to continue treatment throughout your life to prevent complications. Understandably, treatment isn’t easy for ASPD. It takes a lot of energy and effort to make personal changes. Stopping treatment can cause your symptoms to worsen, which puts you at risk of harming yourself and others.

Does antisocial personality disorder go away?

There’s no cure for antisocial personality disorder. Managing the condition is possible with treatment, which is lifelong. The right treatment may help you adjust your behavior and reduce harm to those around you. Maintaining healthy relationships and having a support system are key factors in managing ASPD long-term.

When should I see a healthcare provider?

If you or someone you know has any of the following symptoms, seek medical attention right away:

• Extreme mood changes.
• Self-harm.
• Suicidal thoughts.
• Violent behavior.

You can call or text the Suicide and Crisis Lifeline at 988. This hotline connects you to a network of local crisis centers that provide free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, seven days a week. In an emergency, call 911 or your local emergency services number.

What questions should I ask my healthcare provider?

Questions to ask your healthcare provider include:

• What type of treatment do you recommend?
• Are there side effects of treatment?
• Do I need to continue treatment if I feel better?
• What type of therapy do you recommend?
• How often do I need to participate in therapy?

A note from Cleveland Clinic

Many people think of antisocial personality disorder as not liking the company of others and preferring to be alone. Rather, ASPD is a serious mental health condition. You may act without thinking about the consequences of your behaviors or how they affect others. Often, a diagnosis and treatment happen under a court’s order as the result of unlawful behaviors. This can be a life-saving measure. Understand that treatment isn’t a punishment. With the care and support of those around you, treatment is available to help you feel better.