Antisocial Personality Disorder (ASPD): Symptoms, Diagnosis and Treatment

Psychopath, sociopath, or antisocial - all refer to a manipulative person with an alarming lack of conscience. And this personality isn't as uncommon as you may think.

What is Antisocial Personality Disorder?

APD (also called ASPD) is a psychological personality disorder characterized by lack of empathy or conscience, a difficulty controlling impulses and manipulative behaviors. This disorder is sometimes also referred to as psychopathy or sociopathy, however, Antisocial Personality Disorder is the clinical terminology used for diagnosis (APA 2000).

The term antisocial personality is commonly misunderstood as referring to someone who has poor social skills, but usually the opposite is true. Psychopaths can be charming, and are adept at focusing their cold, calculating efforts solely on self-gratification, typically at the expense of others (Hare 1999, Black 1999).

Subcriminal Psychopaths

We've heard of psychopaths in the news and seen them portrayed by Hollywood, but highly publicized cases of psychopathy are uncommon examples of this disorder. Only a minority of diagnosable psychopaths are murderers. Most victimize others via non-lethal means, manipulating, deceiving, and swindling the unsuspecting (Hare 1999, Black 1999).

Incidence of APD

The National Comorbidity Survey, using DSM-III-R criteria, found that 5.8% of males and 1.2% of females showed evidence of a lifetime risk for the disorder. However the prevalence in penitentiaries has been estimated to be much higher. Antisocial personality disorder also shows an elevated prevalence among patients in alcohol or other drug abuse treatment programs than in the general population.

The Psychopathic Emotional Deficit

Those with Antisocial Personality Disorder can almost be thought of as emotionally disabled in that they appear to experience a very limited range of human emotions. They know the difference between what society considers "right" and "wrong," but do not experience, and cannot empathize with, the feelings of suffering, remorse, elation and love that are normally part of the human experience. Research has shown that individuals with Antisocial Personality Disorder are also indifferent to the threat of physical pain and punishment in general, displaying no indications of fear when threatened (Millon 1998, Hare 1999). This begs the question, "Can a psychopath be rehabilitated?"

Diagnosis of APD

According to the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders), in order to be diagnosed with Antisocial Personality Disorder, a patient must have a persistent history of disregard for and violation of the others' rights, occurring since age 15, evidenced by three (or more) of the following seven traits:

* failure to conform to social norms (evidenced by repeated unlawful behaviors)

* deceitfulness, repeated lying, use of aliases, or manipulating others for personal profit or pleasure

* impulsivity or failure to plan ahead

* irritability and aggressiveness (repeated physical fights or assaults)

* reckless disregard for safety of self or others

* consistent irresponsibility (such as repeated failure to sustain consistent work behavior or honor financial obligations)

* lack of remorse, indifferent to or rationalizing having hurt, mistreated, or stolen from another

The Psychopathy Checklist

In addition to the diagnostic criteria of the DSM-IV, Dr. Robert Hare, an expert in psychopathy and author of Without Conscience: The Disturbing World of Psychopaths Among Us, developed a clinical tool for reliably identifying psychopaths. It is known as the Psychopathy Checklist (PCL), and is now widely used to professionally diagnose psychopathy.

Treatment and Prognosis of APD

There have been numerous, intensive programs designed to rehabilitate incarcerated psychopaths, but according to Dr. Hare, no program has yet proven to be effective. He notes that, in many cases, therapy can even help psychopaths hone their manipulative skills. Dr. Hare also points out that many psychopaths are not in prison, but are subcriminal, roaming free in society.

Adult psychopaths typically displayed antisocial behaviors as children, and their abnormalities of personality are deep-rooted and chronic. However, those with antisocial personality rarely see their characteristics as a problem, so voluntary treatment for this disorder is rarely sought. Robert Hare's advice-that we educate ourselves about psychopaths in order to better recognize and avoid these predators(Hare, 1999, Millon 1998).

Additional APD Resources

Black, D. (1999) Bad Boys, Bad Men: Confronting Antisocial Personality Disorder. Oxford University Press.

Hare, R. D. (1999) Without Conscience: The Disturbing World of the Psychopaths among Us. Guiford Press.

Millon, T. et al. (1998) Psychopathy: Antisocial, Criminal and Violent Behavior. Guiford Press.

American Psychiatric Association APA (2000) Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR).

* This article, originally published in Suite 101, summarizes information on APD and psychopathy. The contents of this article are not meant to be used for diagnosis and are not a substitute for professional help and counseling.