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Diseases and Conditions
Antisocial personality disorder
From MayoClinic.com
Special to CNN.com

Introduction

Antisocial personality disorder is a condition in which people show a pervasive disregard for the law and the rights of others. People with antisocial personality disorder may tend to lie or steal and often fail to fulfill job or parenting responsibilities. The terms "sociopath" and "psychopath" are sometimes used to describe a person with antisocial personality disorder.

Early adolescence is a critical time for the development of antisocial personality disorder. People who grow up in an abusive or neglectful environment are at higher risk, and adults who suffer from the disorder were usually showing behavioral problems before the age of 15. Antisocial personality disorder affects men three times as often as it does women and is much more prevalent in the prison population than in the general population.

Antisocial personality disorder is a chronic condition and represents one of the most difficult personality disorders to treat. However, psychotherapy and some medications may help alleviate symptoms. In many cases, the symptoms of antisocial personality disorder decrease as the person reaches middle age.

Signs and symptoms

The classic person with an antisocial personality is indifferent to the needs of others and may manipulate through deceit or intimidation. He or she shows a blatant disregard for what is right and wrong, may have trouble holding down a job, and often fails to pay debts or fulfill parenting or work responsibilities. They are usually loners.

People with antisocial personality disorder can be aggressive and violent and are likely to have frequent encounters with the law. However, some antisocial personalities may also possess a considerable amount of charm and wit.

Common characteristics of people with antisocial personality disorder include:

  • Persistent lying or stealing
  • Recurring difficulties with the law
  • Tendency to violate the rights of others (property, physical, sexual, emotional, legal)
  • Aggressive, often violent behavior; prone to getting involved in fights
  • Inability to keep a job
  • A persistent agitated or depressed feeling (dysphoria)
  • Inability to tolerate boredom
  • Disregard for the safety of self or others
  • A childhood diagnosis of conduct disorders
  • Lack of remorse for hurting others
  • Possessing a superficial charm or wit
  • Impulsiveness
  • A sense of extreme entitlement
  • Inability to make or keep friends

The intensity of symptoms tends to peak during the teenage years and early 20s and then may decrease over time. It's not clear whether this is a result of aging or an increased awareness of the consequences of reckless behavior. However, though a person with antisocial personality disorder might be less likely to commit crimes later in life, that person may continue to be an inadequate spouse or parent and an unreliable employee.

Causes

Your personality is the sum total of the way you think, feel, behave and react to your environment. When someone chronically feels or behaves in an inappropriate way, that person is likely suffering from a personality disorder.

The exact causes of antisocial personality disorder are unknown, but experts believe that both hereditary factors and environmental circumstances influence development of the condition.

A family history of the disorder — such as having an antisocial parent — increases your chances of developing the condition. A number of environmental factors within the childhood home, school and community also may contribute.

For example, many adults with antisocial personality disorder grew up in chaotic homes with constant family conflict or a lack of supervision. The parents may have been abusive alcoholics or drug addicts, and as a result the children may have difficulty developing emotional bonds. They have few healthy role models for behavior, and there are no rewards for socially acceptable actions. They may come to see the world as dangerous and unpredictable, and lash out as a result.

An overly punitive home or school environment also is a strong correlating factor. For example, a child who is spanked by a parent or scolded by a teacher may isolate himself and sulk alone — or fight back by committing vandalism or provoking an argument with a sibling or fellow student. When there are no clear rules for conduct and discipline, the child may believe punishment is meted out randomly and become unclear as to what behaviors are acceptable and unacceptable.

Risk factors

Personality development is affected by genetic tendencies as well as environmental factors, such as childhood experiences. Most factors that increase the risk of developing antisocial personality relate to genetics and an abusive or neglectful childhood environment.

  • Having suffered from child abuse
  • Having a childhood environment of deprivation or neglect
  • Having an antisocial parent
  • Having an alcoholic parent
  • Being involved in a group of peers that exhibit antisocial behavior
  • Having an attention-deficit disorder
  • Having a reading disorder

When to seek medical advice

If you're having thoughts about hurting yourself or others, seek help immediately at an emergency room.

If you suspect a friend or family member may suffer from antisocial personality, be on the lookout for certain symptoms. For example, the person may have trouble fulfilling work duties or financial obligations, and may act out violently or aggressively. You might gently suggest that the person seek medical attention, which may start with a primary care physician. That doctor may eventually seek a referral to a mental health professional.

Screening and diagnosis

There are no laboratory tests for personality disorders, and diagnosis comes after a thorough psychiatric evaluation. Your doctor will ask you questions about your symptoms and mental well-being and take a medical, psychiatric and social history. A physical examination will help rule out other conditions. You'll likely be referred to a mental health professional for further evaluation.

Diagnosis of antisocial personality disorder is generally reserved for people older than 18. However, a positive diagnosis requires identification of a conduct disorder before the age of 15. These conduct disorders include bullying, stealing, truancy, cruelty to animals, vandalism and running away from home.

A diagnosis also requires at least three of the following:

  • A failure to conform to social norms
  • Consistent deceitfulness
  • Impulsiveness or a failure to plan ahead
  • Irritability and aggressiveness
  • A consistent disregard for work and family obligations
  • A consistent disregard for the safety of self and others
  • A lack of regret or remorse

Complications

People with antisocial personality disorder are at an increased risk of:

  • Dying from a physical trauma, such as an accident
  • Drug and alcohol abuse
  • Suicide
  • Homicide
  • Other mental disorders such as depression, bipolar disorder and anxiety
  • Other personality disorders, particularly borderline and narcissistic personality disorders
  • Committing serious crimes that may result in imprisonment

Treatment

Antisocial personality disorders are considered one of the most difficult of all personality disorders to treat. People who suffer from the condition rarely seek treatment on their own and may only seek therapy when directed by a court. They may abuse or neglect to take any prescribed medications. In general, there has been little success in treating people with antisocial personality disorder, but there are approaches that may help alleviate symptoms:

  • Medications. People with antisocial personality disorder often suffer from associative conditions such as anxiety, depression, other mood disorders and substance abuse. Doctors may prescribe antidepressant or antipsychotic medications to help alleviate these conditions. Unfortunately, many people with antisocial personality disorder don't take their medications as prescribed.
  • Psychotherapy. This therapy can help people with antisocial personality disorder develop appropriate interpersonal skills and instill a moral code. A critical part of this therapy is developing and maintaining a strong therapist-patient relationship. This can be challenging, as the person is often angry, emotionally unstable, interpersonally inappropriate and prone to impulsive behavior. In some cases, doctors suggest group and family therapy when individual therapy has not been successful.

In some cases, where there's a risk of self-harm or harm to others, people with antisocial personality disorder may need hospitalization and supervision at all times.

Prevention

Because antisocial behavior has its roots in early adolescence, early intervention may help diminish the development of problem behaviors. As a parent or teacher, be on the lookout for antisocial children and take steps to help prevent or alleviate the behavior. These may include:

  • Reducing punitive methods of controlling behavior
  • Providing clear rules for conduct and discipline
  • Minimizing academic failures
  • Teaching critical social and interpersonal skills
  • Being consistent in applying consequences for bad behaviors
  • Teaching respect for others with ethnic, cultural or other differences

Coping skills

If you're a friend or family member of someone with antisocial personality disorder, it's important to learn to communicate with the person in a clear and nonpunitive manner, and help set definitive rules for social interactions.

October 09, 2006

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