Antisocial Personality Disorder (ASPD)

Overview

  • More common in men than women

  • Variable course, with some improving with age and others ending in prison

Main Concepts:

  • Age >= 18

  • Evidence of conduct disorder before age 15, such as a history of truancy and fighting in childhood/adolescence

Notable Features:

High Yield:

  • Out of all personality disorders, this is the most resistant to treatment.

  • Tends to occur 5 times more commonly in first-degree relatives of males with the disorder

Other:

  • It is important to hold people legally responsible for their actions, including individuals with APD who break the law.

Definition

A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15. There needs to be evidence of conduct disorder with onset before age 15. The individual is, by definition, at least 18 years of age.

Criteria (3 or more):

  1. Failure to conform to social norms with respect to lawful behaviors

  2. Reckless disregard for safety of self or others

  3. Deceitfulness (e.g. repeated lying, use of aliases, conning others for profit or pleasure)

  4. Impulsivity

  5. Irritability and aggressiveness

  6. Consistent irresponsibility (e.g. failure to sustain consistent work behavior or honor financial obligations)

  7. Lack of remorse

Impulsivity, irritability, and aggression leads to fights and assaults. Individuals with ASPD tend to be physically aggressive. The purpose of this aggression is to intimidate or gain advantage over others.

These individuals are consistently irresponsible and are deceitful.

Arrogant self-appraisal, lack of remorse, and failure to accept responsibility for one's own behavior are characteristic of ASPD.

Diagnostics


Assessment

Unlike individuals with BPD, who can also exhibit manipulative and impulsive behavior, individuals with ASPD are motivated to exploit others for personal gain and do so without remorse.

People with IED also engage in acts of assaultive or destructive behavior, but these acts are not premeditated, and typically result in feelings of remorse.

Management

Treatment is very difficult. Medication serves no role unless there are concern for violence against self or others.

Psychotherapy may be used for milder forms, but monitor carefully for manipulation of the therapeutic relationship.

Treat comorbid psychiatric disorders like substance use and depression.