ADHD Comorbidities & Related Conditions

What is Antisocial Personality Disorder? ASPD Symptoms, Causes & Treatments

Antisocial personality disorder (ASPD) symptoms include impulsivity, deceitfulness, and aggression. Here, understand this Cluster B personality disorder — its signs, causes, and treatments.

Growing up, I got spanked a lot. Spanking is counterproductive for kids with ADHD. It actually escalates a problem and makes things worse. It really wasn't the appropriate way to go for our children and I wish we hadn't reverted to that technique, knowing my kids now. Make sure that you are in control when you are disciplining, and be certain the punishment fits the crime, so to speak. Consistency between parents is really important. When one parent does things one way and another parent does things another way, it creates instability for children. 
Growing up, I got spanked a lot. Spanking is counterproductive for kids with ADHD. It actually escalates a problem and makes things worse. It really wasn't the appropriate way to go for our children and I wish we hadn't reverted to that technique, knowing my kids now. Make sure that you are in control when you are disciplining, and be certain the punishment fits the crime, so to speak. Consistency between parents is really important. When one parent does things one way and another parent does things another way, it creates instability for children. 

What is Antisocial Personality Disorder?

Antisocial Personality Disorder (ASPD) is characterized by a pattern of disregard for the rights of others that leads to deceitfulness, impulsivity, and remorselessness. Individuals with ASPD are also likely to commit unlawful and potentially violent acts.

ASPD affects about 1% to 4% of the population, and it is one of four Cluster B personality disorders, which include borderline personality disorder, narcissistic personality disorder, and histrionic personality disorder1.

ASPD Symptoms

ASPD may be diagnosed only after age 18, but the Diagnostic and Statistical Manual of Mental Disorders (DSM) stipulates that symptoms must have occurred since age 15, with evidence of conduct disorder (CD) with onset before age 15. At least three of the following symptoms must be apparent to merit an ASPD diagnosis:

  • Disrespect for laws manifesting in the commission of acts that are grounds for arrest
  • Deceitfulness
  • Impulsivity
  • Irritability and/or aggressiveness, potentially leading to fights or assaults
  • Disregard for safety of self and others
  • Irresponsibility, such as failure to meet financial obligations
  • Lack of remorse, shown by being indifferent to or rationalizing harming others2

ASPD: Other Signs

Though the DSM-5 symptoms above are used to diagnose ASPD, the following associated features may help clinicians support a diagnosis. These can include3:

  • Arrogance. People with ASPD may consider themselves superior and they may broadcast their strong opinions loudly, widely, and often.
  • Superficial charm. People with ASPD may use charm and wit to get what they want out of others.
  • Lack of empathy. Along with arrogance and superficial charm, lack of empathy is considered a hallmark of psychopathy and may be indicative of a poorer prognosis.
  • Promiscuity. People with ASPD may have difficulty sustaining a monogamous relationship and have multiple sexual partners.
  • Child neglect. Due to their irresponsibility, people with ASPD may be neglectful parents, which may manifest in ill or malnourished children.
  • Impulse control disorders (ICDs). ICDs, including oppositional defiant disorder (ODD), intermittent explosive disorder, pyromania, and kleptomania, commonly co-occur with ASPD. Patterns of hostility, aggression, and violence are commonplace.

[Self-Test: Antisocial Personality Disorder]

Causes of ASPD

  • Genetics. Estimates of ASPD’s heritability vary, but approximately half of the variance can be attributed to genetics, with the other half being explained by other factors4.
  • Abuse. Childhood sexual and physical abuse have been associated with the development of ASPD. Abuse creates distrust and hostility that can lead to ASPD.
  • Environment. Up to 20% of those diagnosed with ASPD come from families with a multigenerational history of problem behaviors such as criminality and violence. Children raised in these environments may also be more likely to experience traumatic events5.

CD, ADHD, and ASPD

ASPD has been correlated with certain childhood disorders, most notably conduct disorder, which features in the DSM-5 criteria6. However, attention deficit hyperactivity disorder (CD) (ADHD) has also been correlated with ASPD, especially when impulsive symptoms dominate or in conjunction with conduct disorder7.

ASPD, Psychopathy, and Sociopathy

Though ASPD is often conflated with sociopathy and psychopathy, they are distinct terms with different definitions. Sociopathy is a term formerly used to describe ASPD, but is no longer used by clinicians or the American Psychological Association, though it is sometimes used by researchers and the general public when referring to a pattern of antisocial behavior including lack of empathy and deceit.
Psychopathy is not a DSM-5 diagnosis, but it is a useful term to describe someone with a specific constellation of traits that predict crime, violence, and manipulative behavior. Psychopathic traits include8:

  • Superficial charm
  • Grandiosity
  • Remorselessness
  • Parasitic lifestyle
  • Promiscuity
  • Many types of criminal offense
  • Juvenile delinquency
  • Short temper
  • Conning people

Though APD and psychopathy overlap, researchers consider the two conditions distinct. Only one-third of people with APD meet criteria for psychopathy, and some psychopathic traits, such as boldness and grandiosity, are more characteristic of other Cluster B personality disorders9. Though academic opinions vary on the specific distinctions between APD and psychopathy, there is agreement that the conditions identify two different, but related, phenomena.

[Read: What is Narcissistic Personality Disorder?]

Treating ASPD

There is no conclusive data on the best interventions for ASPD, though a few have had promising early results, including10:

There are no medications approved to treat ASPD, however medications may be prescribed for co-occurring mood or anxiety disorders.

Antisocial Personality Disorder: Next Steps

Sources:

1Werner, 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. https://doi.org/10.3928/00485713-20150401-08
2American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 659 https://doi.org/10.1176/appi.books.9780890425596
3American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 660, 661 https://doi.org/10.1176/appi.books.9780890425596
4Mason, D.A., Frick, P.J. The heritability of antisocial behavior: A meta-analysis of twin and adoption studies. J Psychopathol Behav Assess 16, 301–323 (1994). https://doi.org/10.1007/BF02239409
5Matt DeLisi, Alan J. Drury, Michael J. Elbert,The etiology of antisocial personality disorder: The differential roles of adverse childhood experiences and childhood psychopathology, Comprehensive Psychiatry, Volume 92, 2019, https://doi.org/10.1016/j.comppsych.2019.04.001.
6American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). 659 https://doi.org/10.1176/appi.books.9780890425596
7Storebø OJ, Simonsen E. The Association Between ADHD and Antisocial Personality Disorder (ASPD): A Review. Journal of Attention Disorders. 2016;20(10):815-824. doi:10.1177/1087054713512150
8Hare, Robert D., Harpur, Timothy, J., Hakstian, A.R., Forth, Adelle E., and Hart, Stephen D. (1990). The Revised Psychopathy Checklist: Reliability and Factor Structure. Psychological Assessment, 2(3), 338-341.
9Abdalla-Filho, E., & Völlm, B. (2020). Does every psychopath have an antisocial personality disorder?. Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999), 42(3), 241–242. https://doi.org/10.1590/1516-4446-2019-0762
10Gibbon, S., Khalifa, N. R., Cheung, N. H., Völlm, B. A., & McCarthy, L. (2020). Psychological interventions for antisocial personality disorder. The Cochrane database of systematic reviews, 9(9), CD007668. https://doi.org/10.1002/14651858.CD007668.pub3

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