Antisocial Personality Disorder: Navigating Daily Life
Antisocial Personality Disorder (ASPD) is a particularly difficult type of personality disorder for both the afflicted and for those that come into their orbit. It is a Cluster B personality disorder characterized by a pervasive pattern of disregard for the safety and well-being of others. Individuals with ASPD frequently exhibit behaviors that are deceitful, manipulative, impulsive, and harmful. They can also exhibit a lack of remorse after hurting others.
This disorder is misunderstood due to the prevalence of misinformation spread in the media, especially in films and TV series about true crime. This article aims to illuminate this disorder, dispel any myths and misconceptions, treatment options, and strategies for supporting someone with the disorder while maintaining necessary boundaries.
Defining Characteristics of Antisocial Personality Disorder:
Those with Antisocial Personality Disorder have a pervasive disregard for the rights of others. This pattern starts to emerge in childhood or early adolescence and continues into adulthood. It is indicated by three (or more) of the following behaviors:
Failure to Conform to Social Norms:
They repeatedly engage in behaviors that are grounds for arrest. This can include destroying property, harassing others, stealing, and other criminal behavior.
Deceitfulness:
They may have a habit of lying repeatedly, using aliases, or conning others for personal profit or pleasure.
Impulsivity or Failure to Plan Ahead:
They make decisions without forethought and failing to consider the consequences of actions.
Irritability and Aggressiveness:
They get into frequent physical fights or assaults.
Reckless Disregard for Safety:
They consistently engage in dangerous activities without considering the safety of self or others.
Pattern of Irresponsibility:
They are unable to sustain consistent work behavior or honor financial obligations.
Lack of Remorse:
They exhibit indifference to or rationalize having hurt, mistreated, or stolen from another person.
We also take into account the following when diagnosing someone with ASPD:
– Age: The individual must be at least 18 years old.
– Conduct Disorder: There must be evidence of Conduct Disorder with onset before age 15. Conduct Disorder is a precursor to ASPD and involves a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated.
– Unrelated to Schizophrenia or Bipolar Disorder: The antisocial behavior must not occur exclusively during episodes of schizophrenia.
Causes and Risk Factors:
It is important to mention that child abuse and neglect are unique risk factors for the development of antisocial traits. Research shows that if a child experiences one or more of the following, they may be at risk of developing ASPD later in adulthood:
– Physical, emotional, or sexual abuse during childhood
– Neglect and lack of affection from parents or primary caregivers
– Inconsistent or harsh discipline, lack of supervision, parental conflict
– Growing up in a family with history of antisocial behavior, substance abuse, or mental illness
– Living in a low socioeconomic environment, exposure to community violence, and limited access to education and positive role models
– Chronic stress and instability in living conditions
Research on ASPD also shows that association with peers who engage in delinquent or antisocial behavior can influence similar behaviors and exacerbate tendencies.
On the neurobiological level, researchers have observed in individuals with ASPD that they have reduced gray matter and functional abnormalities in the prefrontal cortex – which controls impulse control, social behavior, and decision-making. They have also observed dysfunction in the amygdala, responsible for emotions and fear responses, which may contribute to the lack of empathy and increased aggression characteristic of someone with ASPD.
The relationship between psychopathy and antisocial personality disorder:
Psychopathy and antisocial personality disorder (ASPD) are related but distinct concepts. When assessing psychopathy, psychiatrists and trained practitioners will often use the Hare Psychopathy Checklist.
Psychopathy is often considered a more severe form of ASPD with additional traits. Many individuals with psychopathy meet the criteria for ASPD such as exhibiting patterns of shallow emotional responses and disregard for well-being and safety of others. However, not all individuals with ASPD have psychopathy.
The relationship between psychopathy and antisocial personality disorder is best understood on a spectrum. Psychopathy represents a more severe and extreme manifestation of the behaviors and traits found in ASPD.
Do all “psychopaths” and “sociopaths” commit crime?
Not everyone diagnosed with Antisocial Personality Disorder or psychopathy will commit crime or cause harm to others. In fact, many individuals with ASPD and psychopathy lead relatively normal lives and may even be successful in their careers. They may channel their traits into socially acceptable or even admired behaviors such as assertiveness and risk-taking in business. A successful entrepreneur with ASPD might be highly competitive and ruthless in business negotiations but are not breaking any laws.
There is also a significant body of research suggesting that a higher-than-average proportion of CEOs and other high-level executives exhibit psychopathic tendencies such as ruthlessness, fearlessness, and stress tolerance compared to the general population.1
There are ways to channel the inherent qualities of individuals with ASPD and Psychopathy into positive endeavors with the right guidance and support.
Treating Antisocial Personality Disorder:
ASPD is one of the more difficult mental disorders to treat. However, evidence shows that ASPD is not a lifelong disorder and can improve over time with therapy. Several approaches have been found to be somewhat effective:
Mentalization-Based Therapy (MBT):
MBT is a form of talk therapy / psychotherapy designed to help patients think before they react to their own feelings, or to the perceived feelings of others. Patients learn how to process their thoughts, feelings, and related behaviors differently and in a more healthy manner. Patients also learn how to think about the driving forces behind other people’s thoughts and behaviors in order to increase empathy and impulse control.
Cognitive Behavioral Therapy (CBT):
CBT is also a highly common form of talk therapy that explores distorted, ingrained thoughts and childhood trauma of those with ASPD. It has been successful in helping people with ASPD to reduce antisocial behaviors, have better impulse control and anger management, and become more aware of their emotions, destructive thoughts, and behaviors.
Medication:
While there is no medication specifically for ASPD, certain drugs can help manage symptoms such as irritability, impulsivity, and aggression. These may include antidepressants, mood stabilizers, or antipsychotics.
Treatment for Comorbodities:
ASPD often co-occurs with several other mental health conditions such as substance use disorder, mood disorders such as depression, anxiety disorders, obsessive-compulsive disorder, and more. This is why it is so important for an individual with ASPD to get evaluated by a professional to ensure they get the full picture.
Supporting Someone with ASPD While Taking Care of Yourself:
If you are close to someone with ASPD, you may find yourself constantly worried about them due to their unpredictable and sometimes aggressive behavior. There are specific strategies you can use to support them as well as yourself.
Encourage them to see a doctor:
If you have a child and you suspect that they are developing antisocial behaviors, it is recommended to bring them to a professional for evaluation and for guidance. Early evaluation can lead to early intervention, which is critical for better long-term outcomes. Parents can work with professionals to implement behavioral strategies and interventions that address problematic behaviors early on. Early intervention programs can help improve a child’s social skills, impulse control, and empathy. This can help prevent more severe issues later in life.
Avoid telling them or diagnosing them yourselves:
If it’s another fellow adult or peer, we would avoid telling them or diagnosing them yourself that they have ASPD as it can be inaccurate, damaging to the relationship, as well as propagate harmful misconceptions. Instead, encourage them gently to see a professional. Do not frame it as a way for them to get fixed. Rather, emphasize therapy as a way for them to improve their quality of life and have more control over their outcomes: “Therapy can help people with strategic thinking and have more control their emotions.”
Understand your own limits and be specific:
First, make a list of specific behaviors that you find unacceptable, such as lying, manipulation, or aggression. When you have an opportunity to do so, communicate your boundaries clearly and specifically. Vague statements are less likely to be understood and respected. Instead of saying: “Don’t be respectful,” you can say instead: “I need you to speak without raising your voice or using insulting language at me.”
Related to this point, clearly outline the consequences when someone pushes your limits. Ensure that the consequences are appropriate and enforceable. For example, if your loved one with ASPD has a habit of lying to you, you can say: “I feel disrespected when you lie to me, and I need honesty in our conversations. If you continue to lie to me, I will not be able to trust you and will need to distance myself from the relationship.”
Do not get drawn into arguments:
Do not get drawn into arguments. Keep the focus on the behavior and avoid attacking someone with ASPD verbally as they are less able to control their own emotions. You can say something like: “I understand you are upset but screaming with foul language is not acceptable. Let’s talk when we can both stay calm.”
Do not lose hope and remember that God has a plan for everyone:
There is a lot of harmful stigma attached to ASPD. Just because someone is diagnosed with ASPD does not mean all hope is lost. They are not doomed to a life of criminal activity and isolation. There are ways to channel characteristics often associated with ASPD such as risk-taking, strategic thinking/manipulation, and high self-confidence into productive and meaningful endeavors. They just need the proper guidance with the help of a trusted therapist or professional.
Remember, God has a plan for everyone and Satan will do everything to prevent His children from discovering it:
Jeremiah 29:11: “For I know the plans I have for you, declares the Lord, plans for welfare and not for evil, to give you a future and a hope.”
Ephesians 2:10: “For we are God’s handiwork, created in Christ Jesus to do good works, which God prepared in advance for us to do.”
Psalm 34:18: “The Lord is close to the brokenhearted and saves those who are crushed in spirit.”
This is why we should not give up hope on our loved ones who are suffering from ASPD. They are God’s handiwork with their own strengths and qualities – even if they may need more guidance and coaxing than others. To give up on them and wash our hands of them is to give into Satan’s temptation. They need prayer, grace, compassion, and the right guidance. The love and grace of Jesus Christ is larger and deeper than the struggle and conflicts that the symptoms of ASPD can cause. Let us ask for the filling of the Holy Spirit for our loved ones and for ourselves.
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1Babiak, P. (1995) ‘When Psychopaths go to Work: A Case Study of an Industrial Psychopath‘, Applied Psychology, vol. 44, no. 2, pp. 171 – 188.
