Antisocial personality disorder

Antisocial personality disorder, often abbreviated to ASPD, is a mental disorder defined by a chronic pattern of behavior that disregards the rights and well-being of others. People with ASPD often exhibit behavior that conflicts with social norms, leading to issues with interpersonal relationships, employment, and legal matters. The condition generally manifests in childhood or early adolescence, with a high rate of associated conduct problems and a tendency for symptoms to peak in late adolescence and early adulthood.

The prognosis for ASPD is complex, with high variability in outcomes. Individuals with severe ASPD symptoms may have difficulty forming stable relationships, maintaining employment, and avoiding criminal behavior, resulting in higher rates of divorce, unemployment, homelessness, and incarceration. In extreme cases, ASPD may lead to violent or criminal behaviors, often escalating in early adulthood. Research indicates that individuals with ASPD have an elevated risk of suicide, particularly those who also engage in substance misuse or have a history of incarceration. Additionally, children raised by parents with ASPD may be at greater risk of delinquency and mental health issues themselves.

Although ASPD is a persistent and often lifelong condition, symptoms may diminish over time, particularly after age 40, though only a small percentage of individuals experience significant improvement. Many individuals with ASPD have co-occurring issues such as substance use disorders, mood disorders, or other personality disorder. Research on pharmacological treatment for ASPD is limited, with no medications approved specifically for the disorder. However, certain psychiatric medications, including antipsychotics, antidepressants, and mood stabilizers, may help manage symptoms like aggression and impulsivity in some cases, or treat co-occurring disorders.

The diagnostic criteria and understanding of ASPD have evolved significantly over time. Early diagnostic manuals, such as the DSM-I in 1952, described “sociopathic personality disturbance” as involving a range of antisocial behaviors linked to societal and environmental factors. Subsequent editions of the DSM have refined the diagnosis, eventually distinguishing ASPD in the DSM-III (1980) with a more structured checklist of observable behaviors. Current definitions in the DSM-5 align with the clinical description of ASPD as a pattern of disregard for the rights of others, with potential overlap in traits associated with psychopathy and sociopathy.