What is Antisocial Personality Disorder?

Antisocial personality disorder (ASPD) is an early onset mental condition where an individual exhibits behavioural traits that are not only harmful to themselves but also to the people around them. These traits are narcissistic in nature and can often be undiagnosed. 

Mental disorders can be a taboo topic and are often  not addressed earlier due to fear of judgement and discrimination in society. As these disorders have a neurological cause,  that is often due to an imbalance of chemicals, there is nothing to be ashamed of and help is available. 

Overview

Antisocial personality disorder is a mental disorder that exhibits an array of behavioural traits that are exploitative, irresponsible, impulsive and guiltless in nature. In most cases, this disorder has a hereditary basis. However, there are also environmental factors such as chronic exposure to abuse or neglect. 

The affected individuals are often at danger as the symptoms can lead to self harm tendencies (such as suicide) and also engaging in criminal activities. These individuals are often at risk of developing diseases such as Hepatitis C and human immunodeficiency virus disease (HIV which can lead to AIDS) as they also engage in irresponsible sexual behaviour. 

In most of the cases of ASPD there are concurrent medical disorders that may worsen the prognosis of the disease such as bipolar disorder, anxiety disorders, somatic symptom disorder, substance abuse and gambling addiction.¹ 

Owing to its harmful effects, not only to the patient but also to those around them, it is important  that the traits of this disorder are identified, assessed and treated through a comprehensive treatment plan that includes psychological therapies and pharmacologic innervations.

Causes of antisocial personality disorder

ASPD has been categorised as a multifactorial disease that has genetic and environmental factors. 

Genetic factors 

Genetic factors play a role in 69% of ASPD diagnosis. One genetic factor is a variance in the enzyme  monoamine oxidase A (MAOA). This enzyme plays a role in three major neurotransmitter systems:

1. Dopamine System - Acts on mood, motivation and reward
2. Serotonin system- Regulates mood, sleep, digestion and sexual health
3. Epinephrine (Norepinephrine) System- Controls our fight or flight response 

This enzyme breaks down these neurotransmitters to regulate their levels in the brain and there are two variants: the low activity variant (MAOA-L) which is associated with ASPD and the high activity variant (MAOA-H).²  

Environmental factors 

Adverse childhood experiences such as abuse, neglect, and poor socioeconomic conditions can lead to a negative outlook of society. 

Furthermore, disorders such as attention deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD) and conduct disorder (CD) can form a basis for behavioural patterns that make an individual socially distant and give them a negative outlook of society.³ 

 During intrauterine life and early infancy, maternal exposure to some of these things can have an affect on someone, increasing their chances of developing ASPD:   

• Substance abuse  
• Smoking  
• Anxiety
• Poor nourishment 
• Exposure to heavy metal 

It is also important to take in consideration what type of people  a child is surrounded by as that can have its own implications.³ 

Signs and symptoms of antisocial personality disorder

People with ASPD often engage in deceitful and unlawful behaviour that are prone to cause harm to others and they might not feel guilty or remorseful for their actions. These behaviours are highly related to the traits that are observed in narcissistic personality disorders as they also show traits of being indifferent and inconsiderate to others.

The other common signs of ASPD are as follows:

1. Manipulative behaviour for personal gains
2. A tendency to develop a charming, witty or arrogant personality
3. No concern regarding their safety
4. Are easily  irritable, angry or impulsive
5. Frequent engagement in monetary, legal or employment troubles
6. Rationalising  their own behaviour at the expense of others
7. Lack of empathy, guilt or remorse

Management and treatment for antisocial personality disorder

There are many different treatment options available to help someone with ASPD.  For the best results in terms of a reduction in symptoms, early intervention and a good support system alongside a professional is important. 

Psychotherapy is often the first line of treatment and includes the following:

1. Cognitive Behaviour Therapy (CBT) - This is the most effective therapy as it involves sessions that focus on changing the thinking patterns and behaviour of an individual
2. The Incredibles Years Program - This program focuses on developing positive relationships between children and caregivers, that eventually lead to reduction in development of behavioural patterns linked to ASPD
3. Multisystemic Therapy (MST) - A group based therapy involving families of teenagers, who are between the age of 13 to 17, that addresses any criminal and illegal behaviour the person might be involved in, in order to break the cycle
4. Functional Family Therapy (FFT) - A family based therapy that focuses on children between the age of 11 to 18 who are at risk  to developing  behavioural traits that are harmful
5.  There is currently no cure for ASPD. However, the following is a list of medications that can be  prescribed to treat the underlying symptoms that  occur with ASPD:⁴
   • Antipsychotics such as Risperidone or Quetiapine
   • Antidepressants such as selective serotonin reuptake inhibitors (SSRI), sertraline  or fluoxetine
   • Mood stabilisers such as lithium or carbamazepine
   • Anticonvulsants such as oxcarbazepine or carbamazepine which can be used to treat impulsivity 

FAQs

How is antisocial personality disorder diagnosed?

The doctor will ask about a person’s medical history, followed by a physical examination and a psychological assessment .

The DSM-5 diagnostic criteria is followed for the evaluation of ASPD.⁴ 

1.  A pattern of behaviour that relates to the violation and disregard of the laws that are established for the welfare of the society that includes three or more of the following symptoms since the age of 15 years,
   • Prohibition of laws that are harmful and forms ground of arrest
   • Constant lying, deceitfulness and forming aliases that are based on grounds of personal motives of profit and pleasure
   • Impulsiveness or failing to plan things
   • Aggressiveness and irritability that often leads to physical assaults to others
   • Irresponsible behaviour towards work and monetary obligations
   • Indifferent attitude or rationalising own behaviour with wit and charm

2. An individual is minimum of 18 years
3. Evidences of conduct disorder that have been diagnosed before the age of 15
4. Antisocial behaviour should not be due to schizophrenia or bipolar disorder

Can antisocial personality disorder be prevented?

Early interventions during childhood and as a teenager have shown positive results in improving the symptomatic traits of ASPD individuals. These interventions include various therapies and activities that involve the family for support.  

Abstaining from substance abuse, or exposure to chaotic environments can prevent the symptoms from aggravating.Thus providing a positive, compassionate and friendly environment is beneficial. 

At what age does antisocial personality disorder develop?

ASPD shows early development in life usually by the age of 8 years and is often diagnosed as childhood conduct disorder that eventually  develops to ASPD by the age of 18 years.This condition exhibits improvement in behavioural traits with age.⁵

Who is at risk of antisocial personality disorder?

Individuals who are diagnosed with conditions such as childhood conduct disorder, have a family history of mental disorders, have been subjected to childhood abuse and neglect, and those who are exposed to chaotic environments at an early age are usually more prone.

How common is antisocial personality disorder?

The occurrence rate of ASPD is 1-4% in the general population and is 3 times more likely to be observed  in people assigned male at birth than those assigned female at birth. This disorder is observed more in people with substance abuse and exhibits age related change in behavioural patterns.⁴

When should I see a doctor?

You should see a doctor if you are worried that you, or someone you know displays any of the symptoms or behavioural traits discussed previously. One of the major challenges is addressing the issue and discussing it with a  therapist; however, the earlier intervention is the key to help people with ASPD. 

Summary

ASPD has various behavioural and neurobiological traits and it follows a chronic pattern of behaviour that affects the personal relations of the person as well as their interactions with society at large.

It is important for the people surrounding the affected individual to ask for help from a professional as early as possible, so they can get treated quickly.