What is Antisocial Personality Disorder?

Being social is a basic part of the human experience. It allows us to make connections with others, build strong relationships and flourish in a complex world. Social interaction is the filling that holds societies together by facilitating the trading of ideas, feelings, and assistance. When viewed through the lens of human evolution socialisation has been the fundamental nature of our species. Human beings are social beings by nature, we have evolved from our ancestors who lived in groups and relied on each other for cooperation and mutual assistance for survival.

Our social nature has been very vital in overcoming environmental challenges, sharing knowledge, as well as in building complicated cultures & societies. The ability to establish meaningful connections with others, show empathy and participate in a larger community improves individual well-being and ensures the existence of our species. Furthermore, social behaviour helps create a sense of belongingness and purposefulness that is essential for psychological well-being as well as personal fulfilment.

It allows people to share ideas, and emotions that enable them to offer emotional support to one another and the development of shared cultural values that give meaning to human existence. In this regard, being social goes beyond being an advantage but becomes a basic part of humanity thereby aligning personal interests with the overall welfare of society and sustainment or continuance of mankind.

However, for some people, engaging in healthy social interactions becomes extremely difficult which in some cases can result in antisocial personality disorder (ASPD). ASPD is a mental health condition marked by long-term disregard for other people’s rights and an absence of empathy or regret for one’s actions. Those who have ASPD often show no regard for other people’s emotions or well-being around them and employ manipulative tactics, exploitation and at times violent conduct towards achieving their interests.

Symptoms and Diagnostic Criteria

According to the Fifth Edition of the Diagnostic and Statistical Manual for Mental Disorders (DSM-5), ASPD is a pervasive pattern of disregard for and violation of the rights of others that emerges typically in childhood or early adolescence and persists into adulthood. ASPD symptoms include:

• Repetitive violation of other’s rights with no regret.
• Lack of conformity to social norms and laws/ rules.
• Dishonesty and manipulating others for personal gain.
• Sometimes failing to meet financial or work commitments consistently,
• Impulsiveness, reckless neglect for one’s own safety and the safety of others.
• Inability to understand or demonstrate concern about other people’s feelings.

For an ASPD diagnosis, one must be at least 18 years old and must have had conduct disorder before age 15. Conduct disorder is a precursor to ASPD characterized by a child’s aggression leading them towards destruction as well as breaking rules. Additionally, disorders are very not categorical.

These criteria are set for better understanding but are not absolute, the manifestation and behavioural representation still may vary widely from one individual to another, one may show some symptoms but not others or even some additional symptoms that may not the part of the diagnostic criteria. As clinicians one needs to be very skilled and thorough, lay man should avoid making self-diagnoses or diagnoses for others around.

Prevalence and Risk Factors

The prevalence of ASPD in the Indian sample is 5.17% (Gupta S, et al.). This disorder is seen much higher in men than women. In previous literature, the prevalence of APD is 2-3% in most Western societies and is 4–5 times more prevalent among men than women (Coid, 2003). depending on the method of diagnosis and sample characteristics. Several factors have been implicated as influencing the development of ASPD, they include:

• Parental genetic factors
• Maltreatment during childhood
• Childhood unstable or violent family environment
• Having been diagnosed with conduct disorder during childhood.

It should be emphasized that having these risk factors does not mean that one will become an antisocial personality. Because many people have such risks yet do not develop an ASPD, while others may develop it without having any obvious risks. Both nature and nurture can influence its development and persistence.

Comorbidities and Complications

ASPD often coexists with other mental health issues like substance use disorders (SUDs), mood disorders including major depressive disorder (MDD) and bipolar disorder (BD)-such as depression- as well as anxiety disorders. Comorbidity has implications for treatment planning and managing ASPD. Individuals with antisocial personality are more likely to experience negative outcomes such as;

• Legal problems and imprisonment
• Poverty and employment instability
• Suicide, homicide or accidental death.
• Difficulties in intimate relationships and isolation from society

Examples of Behavioural Signs of Antisocial Personality Disorder

Antisocial Personality Disorder (ASPD) manifests through a group of behavioural indicators observable in everyday life. These may include a pervasive disregard for societal norms and legal boundaries, coupled with a marked lack of empathy and manipulative tendencies (American Psychiatric Association, 2013). Individuals with ASPD often exhibit impulsivity, aggression, and a propensity for reckless behaviour, frequently engaging in activities that jeopardize their safety or that of others. Irresponsibility, particularly in occupational and financial domains, is common, as is a notable absence of remorse for harmful actions (Black, 2015).

Interpersonal relationships are typically characterized by superficiality and exploitation, with affected individuals displaying difficulty in forming and maintaining meaningful connections. Chronic deceit, arrogance, and a constant pursuit of stimulation further complicate social interactions. It is crucial to note that while these behavioural patterns may be indicative of ASPD, a formal diagnosis necessitates a comprehensive evaluation by a qualified mental health professional (as mentioned in the above section as well), as similar behaviours may be associated with other psychiatric conditions or psychosocial factors (Crego & Widiger, 2015).

Example from the cinema

The Joker

Heath Ledger’s portrayal of the Joker in “The Dark Knight” is considered one of the best cinematic performances. The Joker exhibits numerous examples of antisocial behaviour, including a willingness to use human lives as tools to achieve his goal of upsetting the social order. He takes joy in committing crimes and has an intense disregard for human rights.

Treatment and Management

Treating individuals with antisocial personality disorder (ASPD) is difficult because they usually have no self-awareness and are very resistant to change. Nonetheless, there are several treatments used in overcoming ASPD symptoms such as:

• Medication that might help them manage concurrent conditions or specific symptoms like aggression and impulsivity.
• Psychotherapy, especially cognitive-behavioural therapy (CBT), assists people with ASPD in developing empathy, enhancing impulse control and acquiring better-coping mechanisms
• Contingency management is a technique that involves rewarding positive behaviours as well as punishing negative ones for antisocial behaviours

However, treatment for ASPD is often a long-term process, progress may be slow or minimal. Finally, however, this may necessitate ongoing support for the person’s treatment gains. Additionally, individuals with ASPD may require ongoing support and monitoring to maintain any gains made during treatment.

Antisocial personality disorder is a complex psychological condition that has far-reaching implications for an individual’s life as well as those around him or her. Nevertheless, despite available treatments for it being known, the illness can be difficult to handle due to a lack of insight and refusal to change most of its sufferers.

By understanding the symptoms, risk factors, and treatment approaches associated with ASPD, mental health professionals and the general public can work towards reducing the stigma surrounding this disorder and promoting more effective interventions. With compassion, support, and evidence-based treatment, individuals with ASPD can learn to manage their symptoms and lead more fulfilling lives.

Further Readings

• Crego, C., & Widiger, T. A. (2015). Psychopathy and the DSM. Journal of Personality, 83(6), 665-677.
• Black, D. W. (2015). The Natural History of Antisocial Personality Disorder. The Canadian Journal of Psychiatry, 60(7), 309-314.
• Glenn, A. L., Johnson, A. K., & Raine, A. (2013). Antisocial Personality Disorder: A Current Review. Current Psychiatry Reports, 15(12), 427.
• Werner, K. B., Few, L. R., & Bucholz, K. K. (2015). Epidemiology, Comorbidity, and Behavioral Genetics of Antisocial Personality Disorder and Psychopathy. Psychiatric Annals, 45(4), 195-199.
• De Brito, S. A., & Hodgins, S. (2009). Antisocial Personality Disorder. In M. M. Mueser & D. V. Jeste (Eds.), Clinical Handbook of Schizophrenia (pp. 375-384). The Guilford Press.

FAQs

1. What is Antisocial Personality Disorder?

Antisocial Personality Disorder is a mental health condition characterized by a persistent pattern of disregard for, and violation of, the rights of others. It typically begins in childhood or adolescence and continues into adulthood. People with ASPD often display a lack of empathy, manipulative behaviour, and disregard for societal norms and laws.

2. Can Antisocial Personality Disorder be treated?

While ASPD is challenging to treat, some interventions can help manage symptoms. Psychotherapy, particularly cognitive-behavioural therapy, can be beneficial. In some cases, medications may be prescribed to address specific symptoms like aggression or impulsivity. However, treatment outcomes often depend on the individual’s willingness to engage in therapy and their motivation to change.

3. Is Antisocial Personality Disorder the same as psychopathy?

While often confused, ASPD and psychopathy are not identical. ASPD is a broader diagnostic category in the DSM-5, while psychopathy is a more specific construct that includes additional traits like superficial charm and lack of remorse. All psychopaths would likely meet the criteria for ASPD, but not all individuals with ASPD are psychopaths.

4. What causes Antisocial Personality Disorder?

The exact causes of ASPD are not fully understood, but it’s believed to result from a complex interaction of genetic and environmental factors. Risk factors include childhood abuse or neglect, unstable family life, and a family history of mental health disorders. Some studies also suggest that differences in brain structure and function may play a role in the development of ASPD.