- Causes & Risk Factors
- More Information
What is the difference between antisocial personality disorder, sociopathy, and psychopathy?
Psychopathy and sociopathy, although not mental health disorders formally recognized by the American Psychiatric Association, are more severe forms of antisocial personality disorder. Specifically, in order for a medical professional to diagnose someone as a psychopath, a person must have a lack of remorse or guilt about their actions in addition to demonstrating antisocial behaviors. Other core symptoms of this condition include a severe lack of caring for others, a lack of emotion, overconfidence, selfishness, and a higher propensity for planned aggression compared to sociopaths or other people with antisocial personality disorder. They are more likely to be able to maintain steady employment and to seem to have normal relationships compared to sociopaths. Mental health providers believe psychopaths are born lacking the ability to feel guilt rather than being associated with a history of trauma (like abuse, neglect, or exposure to community violence). While statistics indicate that 50%-80% of incarcerated individuals have antisocial personality disorder, only 15% of those convicted criminals have been shown to have the more severe antisocial personality disorder type of psychopathy.
Psychopaths tend to be highly suspicious or paranoid, even compared to people with antisocial personality disorder. The implications of this suspicious stance can be dire, in that paranoid thoughts (ideations) tend to lead the psychopathic person to interpret all aggressive behaviors toward them, even those that are justified, as being arbitrary and unfair. A televised case study of a psychopath provided a vivid illustration of the resulting psychopathic anger. Specifically, the criminal featured in the story apparently abducted a girl and sexually abused her over the course of a number of days in an attempt to prove to investigating authorities that his stepdaughter's allegations that he sexually abused her were false.
Although people often use the terms psychopathy and sociopathy interchangeably, researchers describe sociopaths as having a higher tendency toward impulsive behaviors and angry outbursts and if they form any connection to other people it is usually with other sociopaths. They are also less likely to be able to maintain steady employment or to give the appearance of having normal relationships compared to psychopaths.
What are causes and risk factors of antisocial personality disorder?
One of the most frequently asked questions about antisocial personality disorder by both professionals and laypeople is whether it is genetic. Many wonder if it is hereditary, just as much as hair, eye, or skin color; if this were the case, children of antisocial people would be highly expected to become antisocial themselves, whether or not they live with the antisocial parent. Fortunately, human beings are just not that simple. Like all personality disorders, and most mental disorders, antisocial personality disorder tends to be the result of a combination of biologic/genetic and environmental factors.
Although there are no clear biological causes for this disorder, studies on the possible neurodevelopmental risk factors for developing antisocial personality disorder reveal that, in those with the illness, the part of the brain that is primarily responsible for learning from one's mistakes and for responding to sad and fearful facial expressions (the amygdala) tends to be smaller and respond less robustly to the happy, sad, or fearful facial expressions of others. That lack of response may have something to do with the lack of empathy that antisocial individuals tend to have with the feelings, rights, and suffering of others.
While some individuals may be more vulnerable to developing antisocial personality disorder because of their particular genetic background, that is thought to be a factor only when the person is also exposed to life events such as abuse or neglect that tend to put the person at risk for development of the disorder. Similarly, while there are some theories about the role of premenstrual syndrome (PMS) and other hormonal fluctuations in the development of antisocial personality disorder, the disorder cannot be explained as the direct result of such problems.
Other conditions that are risk factors for antisocial personality disorder include substance abuse, attention-deficit hyperactivity disorder (ADHD), reading disorder, or conduct disorder, which is diagnosed in children. People who experience a temporary or permanent brain dysfunction, often also called organic brain damage, are at risk for developing violent or otherwise criminal behaviors. Theories about the life experiences that increase the risk for developing antisocial symptoms in teenagers and adults provide important clues for its prevention. Examples of such life experiences include a history of prenatal drug exposure or malnutrition, childhood physical, sexual, or emotional abuse; neglect; deprivation or abandonment; associating with peers who engage in antisocial behavior; or a parent who is either antisocial or alcoholic.
What are antisocial personality disorder symptoms?
To understand antisocial personality disorder (ASPD or APD), it is necessary to learn what having any personality disorder involves. As defined by the Diagnostic and Statistical Manual for Mental Disorders (DSM-V, 2013), a personality disorder (PD) is a consistent, enduring pattern of inner experiences and behaviors that is significantly different from what is thought to be consistent with the individual's own social and cultural norms.
Mental health professionals group personality disorders based on a commonality of symptoms.
Cluster A personality disorders are those that include symptoms of social isolation, and/or strange, eccentric behavior. These disorders include
- paranoid personality disorder,
- schizotypal personality disorder,
- schizoid personality disorder.
Cluster B personality disorders are those that involve dramatic or erratic behaviors (counter-social behaviors). These personality disorders include
- antisocial personality disorder,
- borderline personality disorder,
- histrionic personality disorder,
- narcissistic personality disorder.
Cluster C personality disorders have difficulties with anxiety and inhibited behavior. These disorders include
- avoidant personality disorder,
- dependent personality disorder,
- obsessive compulsive personality disorder (OCD).
Antisocial personality disorder is specifically a persistent pattern of disregarding and violating the rights of others. Called dissocial personality disorder internationally, the United States-based Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) describes antisocial personality disorder as having diagnostic criteria of a pattern of inner experiences and behaviors that must include at least three of the following specific signs and symptoms:
- Repeatedly breaking laws, as evidenced by repeatedly engaging in behaviors that are grounds for arrest (for example, stealing, fire-setting, other destruction of property, assaults)
- Repeated deceitfulness in relationships with others, such as telling lies, using false names, or conning others for profit or pleasure
- Failure to think or plan ahead (impulsivity)
- Tendency to irritability, hostility, anger, and aggressiveness, as shown by repeatedly assaulting others or getting into frequent physical fights
- Disregard for their own safety or the safety of others, such that they have a lack of self-control and are prone to repeatedly engaging in risk-taking behaviors
- Persistent lack of taking responsibility, such as failing to establish a pattern of good work habits or keeping financial obligations
- A disregard for other people such that there is a lack of feeling guilty about wrongdoing
Additionally, a medical professional cannot diagnose antisocial personality disorder if the person only shows symptoms of antisocial personality disorder at the same time they are suffering from symptoms of schizophrenia or of bipolar disorder. Describing bipolar disorder as one of the exclusion criteria (diagnoses whose presence means that the diagnosis of antisocial personality disorder cannot be assigned) is a change from how this disorder was described in the previous diagnostic manual in the United States, the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision). The DSM-IV described having a manic episode as the exclusion criterion with schizophrenia, not having the depressive aspect of bipolar disorder as an exclusion criterion.
Intermittent explosive disorder is a recognized diagnosis whose symptoms involve aggression that is excessive in response to its trigger. People may mistake its symptoms for those of antisocial personality disorder. Misophonia, a newly described diagnosis not recognized in the DSM-V, has symptoms that include the sufferer responding to being provoked to anger and impulsive aggression by sights or sounds that are innocuous to most people. The aggression of this disorder may also be mistaken for antisocial personality disorder.
Antisocial personality disorder tends to occur in about 1% of women and 3% of men in the United States. Antisocial personality symptoms in women tend to include self-harm and more of the other symptoms of borderline personality disorder (BPD) than in men.
How is antisocial personality diagnosed?
There is no specific definitive test, such as a blood test, that can accurately assess whether a person has antisocial personality disorder. Mental health practitioners like psychiatrists, psychoanalysts, or clinical psychologists conduct a mental health interview that gathers information to look for the presence of the symptoms previously described. Due to the use of a mental health interview in making the diagnosis and the fact that this disorder can be quite resistant to treatment, it is important that the mental health practitioner know to assess the symptoms in the context of the person's culture so the individual is not assessed as having antisocial personality disorder when he or she does not. Unfortunately, research shows that many practitioners lack the knowledge, experience, and sometimes the willingness to factor cultural context into their assessments.
What are the treatments for antisocial personality disorder?
Another very common question asked is, can antisocial personality disorder be cured? While it can be quite resistant to change, research shows there are a number of effective treatments for this disorder. For example, teenagers who receive therapy that helps them change the thinking that leads to their maladaptive behavior (cognitive behavioral psychotherapy) experience a significant decrease the incidence of engaging in repeat antisocial behaviors.
On the other hand, attempting to treat antisocial personality disorder like other conditions is not often effective. For example, programs that have tried to use a purely reflective (insight-oriented talk therapy) approach to treating depression or eating disorders in people with antisocial personality disorder often worsen rather than improve outcomes in those individuals. In those cases, firm but fair behavior therapy to reward appropriate actions and programming that emphasizes teaching individuals with antisocial personality disorder the skills that one can use to live independently and productively within the rules and limits of society has been the more effective treatment for this condition. Family therapy that helps loved ones of people with antisocial personality disorder appropriately cope with the negative behaviors and promote the positive behaviors of the antisocial personality disorder sufferer can also be an important part of treatment for this condition.
While clinical trials indicate that medications do not directly treat the behaviors that characterize antisocial personality disorder, they can be useful in addressing conditions that co-occur with this condition. Specifically, depressed or anxious individuals who also have antisocial personality disorder may benefit from antidepressants like fluoxetine, escitalopram, or duloxetine, and those who exhibit impulsive anger may improve when given mood stabilizers like lithium, divalproex, or lamotrigine.
What are complications if antisocial personality disorder is not treated?
Some long-term societal costs of antisocial personality disorder, like the suffering endured by victims of the crimes committed by people with this disorder, are clear. However, when people with ASPD are the charismatic leaders of religious cults, the devastation they can create is often not known unless and until a catastrophe occurs. The multiple murders orchestrated by Charles Manson and the mass suicide that occurred at the command of the Reverend Jim Jones in Guyana in 1978 are just two such examples.
Individuals who suffer from antisocial personality disorder have a higher risk of abusing alcohol and other drugs and repeatedly committing crimes. Imprisonment is a potential consequence. People with antisocial personality disorder are also vulnerable to mood problems, such as major depression, anxiety, and bipolar disorder; having other personality disorders, especially borderline (BPD) and narcissistic personality disorders; self-mutilation and other forms of self-harm, as well as dying from homicide, suicide, or accident.
What is the prognosis of antisocial personality disorder?
Where can people find more information on antisocial personality disorder?
To find information on specialists who treat ASPD, visit
National Institute of Mental Health
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, Virginia: American Psychiatric Association, 2013.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Association, 2000.
Armelius, B.A., and T.H. Andreassen. "Cognitive-Behavioral Treatment for Antisocial Behavior in Youth in Residential Treatment." Cochrane Database Systems Review 17.4 Oct. 2007: CD 005650.
Azrin, N.H., B. Donohue, G.A. Teichner, et al. "A controlled evaluation and description of individual-cognitive problem solving and family-behavior therapies in dually-diagnosed conduct disordered and substance-dependent youth." Journal of Child and Adolescent Substance Abuse 11 (2001): 1-43.
Barnow, S., I. Ulrich, H.J. Grabe, H.J. Freyberger, and C. Spitzer. "The Influence of Parental Drinking Behavior and Antisocial Personality Disorder on Adolescent Behavioural Problems: Results of the Greifswalder Family Study." Alcohol and Alcoholism Advance Access, Oxford University Press, 8/1/07.
Bienenfeld, D. "Personality Disorders." eMedicine.com. July 17, 2008. <http://emedicine.medscape.com/article/294307-overview>.
Blackburn, R., and J.M. Lee-Evans. "Reactions of Primary and Secondary Psychopaths to Anger-Evoking Situations." British Journal of Clinical Psychology 24.2 May 1985: 93-100.
Blair, RJR. "Neurobiological Basis of Psychopathy." The British Journal of Psychiatry 182 (2003): 5-7.
Caldwell, M., J. Skeem, R. Salekin, and G.V. Rubroek. "Treatment Response of Adolescent Offenders With Psychopathy Features." Criminal Justice and Behavior 33.5 (2006): 571-596.
Caspi, A., J. McClay, T.E. Moffitt, J. Mill, J. Martin, I.W. Craig, A. Taylor, and R. Poulton. "Role of Genotype in the Cycle of Violence in Maltreated Children." Science 297.5582 Aug. 2, 2002: 851-854.
Compton, W.M., L.B. Cottler, J.L. Jacobs, A. Ben-Abdallah, and E.L. Spitznagel. "The Role of Psychiatric Disorders in Predicting Drug Dependence Treatment Outcomes." American Journal of Psychiatry 160 May 2003: 890-895.
Deeley, Q., E. Daly, S. Surguladze, N. Tunstall, G. Mezey, D. Beer, A. Ambikapathy, et al. "Facial Emotion Processing in Criminal Psychopathy. Preliminary Functional Magnetic Resonance Imaging Study." British Journal of Psychiatry 189 Dec. 2006: 533-539.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Treatment Revision. Washington, D.C.: American Psychiatric Association, 2000.
Dolan, M., and G. Davies. "Psychopathy and Institutional Outcome in Patients With Schizophrenia in Forensic Settings n the U.K." Schizophrenia Research 81.2-3 (2003): 277-281.
Foulks, E.F. "Commentary: Racial Bias in Diagnosis and Medication of Mentally Ill Minorities in Prisons and Communities." Journal of the American Academy of Psychiatry and the Law 32 (2004): 34-35.
Grekin, E.R., P.A. Brennan, S. Hodgins, and S.A. Mednick. "Male Criminals With Organic Brain Syndrome: Two Distinct Types Based on Age at First Arrest." American Journal of Psychiatry 158 July 2001: 1099-1104.
Harris, G.T., and M.E. Rice. "What Treatment Should Psychopaths Receive?" Cross Currents Spring 2006.
Hirstein, W. "What Is a Psychopath?" Psychology Today January 2013.
Liu, J. "Early health risk factors for violence: conceptualization, review of the evidence and implications." Aggressive Violent Behavior 16.1 (2011): 63-73.
Luntz, B.K., and C.S. Widom. "Antisocial Personality Disorder in Abused and Neglected Children Grown Up." American Journal of Psychiatry 151. 5 May 1994: 670-674.
Martens, W.H.J. "Antisocial and Psychopathic Personality Disorders: Causes, Course and Remission- A Review Article." International Journal of Offender Therapy and Comparative Criminology 44.4 (2000): 406-430.
Ogloff, J.R.P. "Psychopathy/Antisocial Personality Disorder Conundrum." Wiley Interscience Nov. 2005.
Pearson, C. "A Psychopath Unplugged." Neurological Correlates Mar. 19, 2008.
Simonoff, E., J. Elander, J. Holmshaw, A. Pickles, et al. "Predictors of Antisocial Personality: Continuities From Childhood to Adult Life." The British Journal of Psychiatry 184 (2004): 118-127.
Sjoberg, R.L., F. Ducci, C.S. Barr, T.K. Newman, L. Dell'Osso, M. Virkkunen, and D. Goldman. "A Non-additive Interaction of a Functional MAO-A VNTR and Testosterone Predicts Antisocial Behavior." Neuropsychopharmacology 33 (2008): 425-430.
Stockburger, S.J., and H.A. Omar. "Firesetting behavior and psychiatric disorders." In, Playing with Fire. H. Omar, C. Bowling, et al editors. Hauppauge, New York: Nova Science Publishers, Inc., 2014.
Verona, E., J. Sprague, and S. Javdani. "Gender and factor-level interactions in psychopathy: Implications for self-directed violence risk and borderline personality disorder symptoms." Personality Disorders: Theory, Research, and Treatment 3.3 July 2012: 247-262.
Virkkunen, M. "Self-mutilation in Antisocial Personality (Disorder). Acta Psychiatrica Scandinavica 54.5 Aug. 23, 2007: 347-352.
Westen, D., and J. Harnden-Fischer. "Personality Profiles in Eating Disorders: Rethinking the Distinction Between Axis I and Axis II." American Journal of Psychiatry 158 Apr. 2001: 547-562.
Top Antisocial Personality Disorder Related Articles
ADHD in ChildrenAttention deficit hyperactivity disorder (ADHD) causes the following symptoms in children: excessive activity, problems concentrating, and difficulty controlling impulses. Stimulant medications are the most common medication used to treat ADHD.
Alcoholism and Alcohol AbuseAlcoholism is a disease that includes alcohol craving and continued drinking despite repeated alcohol-related problems, such as losing a job or getting into trouble with the law. It can cause myriad health problems, including cirrhosis of the liver, birth defects, heart disease, stroke, psychological problems, and dementia. Counseling and a few medications can be effective for alcoholism treatment.
Anxiety DisordersAnxiety is a feeling of apprehension and fear characterized by symptoms such as trouble concentrating, headaches, sleep problems, and irritability. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults. Treatment for anxiety may incorporate medications and psychotherapy.
Bipolar DisorderBipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood-stabilizer medications, antidepressants, and psychotherapy.
What Is Bipolar Disorder? Symptoms, Manic Episodes, TestingBipolar disorder (formerly "manic depression") causes extreme mood shifts and manic episodes. Learn about bipolar 1, bipolar 2, and the meaning of bipolar disorder. Our experts define bipolar disorder, discuss bipolar symptoms, and describe bipolar medications that can help.
Borderline Personality Disorder (BPD)Borderline personality disorder is a serious mental illness characterized by pervasive instability in moods, interpersonal relationships, self-image, and behavior. This instability often disrupts family and work life, long-term planning, and the individual's sense of self-identity. Originally thought to be at the "borderline" of psychosis, people with borderline personality disorder (BPD) suffer from a disorder of emotion regulation.
CancerCancer is a disease caused by an abnormal growth of cells, also called malignancy. It is a group of 100 different diseases, and is not contagious. Cancer can be treated through chemotherapy, a treatment of drugs that destroy cancer cells.
DepressionDepression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Drug Abuse and AddictionDrug abuse and addiction is a chronic disease that causes drug-seeking behavior and drug use despite negative consequences to the user and those around him. Though the initial decision to use drugs is voluntary, changes in the brain caused by repeated drug abuse can affect a person's self-control and ability to make the right decisions and increase the urge to take drugs. Drug abuse and addiction are preventable.
Narcissistic Personality DisorderNarcissistic personality disorder (NPD) is a dramatic personality disorder that is characterized by a distorted self-image, preoccupation with success and power, and an abnormal love of self, which mask insecurity and a fragile self-esteem. Other symptoms include constantly seeking attention and admiration, setting unrealistic goals, exaggerating talents, self-centeredness, arrogant behavior, and an inability to recognize others' feelings. Though there is no known treatment for NPD, psychotherapy may be of some help.
PTSD QuizCan you have PTSD even if you've never been to war? Take the Posttraumatic Stress Disorder Quiz to learn about PTSD, who gets it, and why.
SchizophreniaSchizophrenia is a disabling brain disorder that may cause hallucinations and delusions and affect a person's ability to communicate and pay attention. Symptoms of psychosis appear in men in their late teens and early 20s and in women in their mid-20s to early 30s. With treatment involving the use of antipsychotic medications and psychosocial treatment, schizophrenia patients can lead rewarding and meaningful lives.
What's Schizophrenia? Symptoms, Types, Causes, TreatmentWhat is the definition of schizophrenia? What is paranoid schizophrenia? Read about schizophrenia types and learn about schizophrenia symptoms, signs, and treatment options.