Antisocial Personality Disorder: Definition, Symptoms, Causes, Treatment, Prognosis

The human mind controls and conducts the behaviors that he/she exhibits in different situations and thus tackles or copes with the situation. However, when this coping with the situation becomes deeply ingrained and the person exhibits personality traits that are different in terms of social norms, it is called a personality disorder. It is a special kind of maladaptive pattern of behavior that in long-term situations affects the person’s ability to function in society and maintain relationships with others. It can be of different types and one such type is the Antisocial Personality Disorder.

Antisocial Personality Disorder is a type of chronic mental condition that manipulates the way of thinking, relating to others and perceiving situations, in some people. In long term cases, they can violate the rights of others and exploit their behavior, breaking the norms of social conducts that often lead to a dysfunctional and destructive nature, which is normally deemed as criminal.

Antisocial Personality Disorder or ASPD is, in simple words, a disorder in the personality of a person that leads him/her to think and behave in a destructive way. This destruction can be caused both to a stranger as well as to the person himself/herself.

Disregard for other people’s rights, inflated self-appraisal, being callous, cynical and contemptuous of the feeling of others are the most common symptoms of every single person suffering from Antisocial Personality Disorder or ASPD. To specify, they will have:

• Disregard and no empathy for what others might feel
• Inconsiderate to right and wrong
• Neglect or abuse a child
• Exploit or deceive others or persistently lie to others
• Easily agitated and irritated
• Extremely impulsive and hostile
• Manipulate others for personal gain and for personal pleasure
• Indulging in dangerous behavior and taking risks and reckless disregard for safety
• Take the path of misrepresentation, intimidation and dishonesty to violate the rights of others
• Absolutely irresponsible in terms of work behavior
• Excessive sense of superiority, egocentrism and exhibitionism
• Lack of remorse or guilt
• Failure to conform to social norms
• Recurring difficulties with law and disregard for law and order.

The Antisocial Personality Disorder can be seen to occur in 3% men of the general population all over the world, whereas it occurs in 1% of female population. It is a clear indication that this disorder occurs more in men than in women. According to the reports by Lees McRae College about 2.5 to 3.5 percent of people have Antisocial Personality Disorder or ASPD. Amongst all the prisoners all over the world, it is estimated that a little less than 50% have Antisocial Personality Disorder and, of all the people diagnosed with this disorder, 47% of them are found to have significant arrest records.

The Antisocial Personality Disorder is considered to be a lifelong condition that cannot be completely ‘cured’. However, with proper therapy and support provided to the patient with Antisocial Personality Disorder, significant changes in his/her attitude, behaviour and personality can be brought. The ‘improvement’ does not mean that you can change the lack of empathy or lessen its extent, but a sense of responsibility can be cultivated and impulsivity that most of the patients develop, can be controlled.

The cause of Antisocial Personality Disorder is still not clear or known. As it is a disorder of the personality, the factors that shape the personality are also the cause for the disorder. They are:

• Genetic Cause of Antisocial Personality Disorder: Genes are given much importance in forming or shaping the personality of a person. The inherited tendencies are prominent reasons for forming the temperament or personality. If the parents have had such tendencies of antisocial personality exhibition, the child is likely to develop ASPD.
• Environment: If a person has been born and brought up amidst antisocial and have seen antisocial activities as common incidents in day-to-day life, he or she is more likely to develop this Antisocial Personality Disorder.

Apart from these general causes, there are other reasons also for the development of Antisocial Personality Disorder. One such condition is the disruption in the central nervous system. This leads to the production of hormones that is instrumental in changing the normal patterns of behavior. The release of testosterone is considered to be the cause of generation of aggressiveness in the brain.

Along with this, there is also the possibility of traumatic brain injury as associated with Antisocial Personality Disorder or ASPD. Scientists highlighted that traumatic brain injury damages the prefrontal cortex of the brain and this leads to the inability of the person to take rational decisions as per the social norms.

Depending on the personality traits of the individuals suffering from Antisocial Personality Disorder, Theodore Millon differentiates each of the common traits by clubbing them in five separate subtypes of Antisocial Personality Disorder or ASPD. They are:

1. Nomadic: In this type, the individual is seen to roam like gypsy, vagabond, wanderer and tramp. They are often seen as misfits and dropouts and are cast aside. Most reside into this state of being due to a doomed and ill fate and as a result, they are not impulsively benign.
2. Malevolent: The individuals with this type of traits are often resentful and malignant and brutal, causing harm to others when faces trouble, anticipates punishment and betrayal. They are often guiltless and remorseless, absolutely callous and have no fear. The malevolent Antisocial Personality Disorder or ASPD patients often desire revenge.
3. Covetous: These individuals are often seen to feel intentionally deprived and denied. They are very envious to others and are avariciously greedy. Their discontented desire in yearning and in gaining things; rather than in possessing things often leads to stealing or deceiving tendencies. Raping is often a tendency in them.
4. Risk Taking: The individuals suffering from the risk taking Antisocial Personality Disorder or ASPD condition are often bold, reckless, dauntless, audacious, venturesome, daring, impulsive and intrepid. They often lead a hazardous, heedless and unbalanced life, with a tendency to pursue perilous ventures.
5. Reputation Defending: Persons with this particular subtype of Antisocial Personality Disorder or ASPD are often found to be unbreakable, indomitable, inviolable and infallible, when their status is questioned. Even at slightest issues, they react a lot in an invincible and formidable manner.

The most important difficulty of Antisocial Personality Disorder or ASPD is that it often leads to some other consequences and comorbidities and they are:

• Depressive disorder
• Substance-related disorders
• Histrionic personality disorder
• Anxiety disorders
• Narcissistic personality disorder
• Impulse control disorders
• Attention deficit hyperactivity disorder
• Sadistic personality disorder
• Borderline personality disorder
• Somatization disorder.

Apart from these medical conditions, the individuals with Antisocial Personality Disorder are often found to indulge themselves in physical violence, verbal onslaughts, and aggressive fights. Participation in gangs and behaving in a reckless manner are obvious consequences. This leads to engagement in gambling and gradual imprisonment. Risky sexual behavior and child abuse is also a consequence that is a result of their sadist personality. Due to all these reasons, even their personal relations get affected and as a result, the individuals with Antisocial Personality Disorder are found to reside into oblivion, depression and anxiety that pushes them to homicidal and suicidal tendencies.

Mental disorders are not physical illness and hence, no blood tests or physical diagnosis can determine it. Therefore, the only possible way to diagnose Antisocial Personality Disorder or ASPD is by going through the signs and symptoms of the personality traits and behavior of the individual thoroughly and carefully, by a trained, professional and experienced psychiatrist or psychologist. He/she may take the assistance of some equipment or questionnaire to go deep into the mind of the patient and determine what he/she feels and whether those conditions match with those of the Antisocial Personality Disorder or ASPD parameter.

Sometimes, the diagnosis is also assisted by a lab test to check if the blood of the patient contains alcohol, drug or other chemical contents to determine if the possible causes of the disorder exists or not. However, more than this, the psychological tests are more important in which the psychiatrist or psychologist tries to explore the thoughts, feelings, relationships, behavior patterns and family history.

However, the diagnosis process is conducted only if the patient matches the criteria of diagnosis as mentioned in the Diagnostic and Statistical Manual of Mental Disorders (DSM). They are:

• The patient must be 18 years old or above
• He or she must have conducted some antisocial activities as per the social norms such as cruelty to animals, stealing, violence, vandalism and bullying, within the age of 15
• Broken the law and order repeatedly
• Has engaged in fights and assaults
• Has been irritable and aggressive
• Has been impulsive time and again and indulged in risky acts
• Has no consideration of the safety of others

The only way to help the patients suffering from Antisocial Personality Disorder or ASPD is by giving them psychotherapy, especially cognitive behavioral therapy. In these therapies, they are engaged into a conversation to determine their inner most feelings, their likings, disliking and their hatreds and troubles. The therapist will help the patient with Antisocial Personality Disorder to overcome their traumatic experience or the cause of the disorder and also help them to understand the need to alter their personality.

Although the therapies can help the patients with Antisocial Personality Disorder a lot, it is not enough to completely ‘cure’ the disorder. There is, in fact, no ‘cure’ for Antisocial Personality Disorder. It can only be bettered. The family needs to assist in coping with their anger and aggression and rectifying their behavior and hence, along with the patients, their families are also given sessions. To deal with the expression of anger, a few drugs such as antipsychotics and antidepressants like carbamazepine and lithium, along with SSRI or selective serotonin reuptake inhibitors are given.

Thus, if a person is found to exhibit personality traits that match with antisocial behaviors, then it is very important that he or she is given assistance by these therapies and tried to bring him back to the main stream of life. The entire responsibility falls on the shoulders of the family members since the more the delay and no treatment is given, the more the patient’s conditions will become worse and lead him towards a doomed life.