antisocial personality disorder

Due to tendencies toward recklessness and impulsivity,Semple D, Smyth R, Burns J, Darjee R, McIntosh A (2005). The Oxford Handbook of Psychiatry. Oxford, England: Oxford University Press. pp. 448–449. {{ISBN|978-0-19-852783-1}}.{{cite journal |last1=Skeem |first1=Jennifer L. |last2=Polaschek |first2=Devon L. L. |last3=Patrick |first3=Christopher J. |last4=Lilienfeld |first4=Scott O. |year=2011 |title=Psychopathic Personality |journal=Psychological Science in the Public Interest |volume=12 |issue=3 |pages=95–162 |doi=10.1177/1529100611426706 |pmid=26167886 |s2cid=8521465}} patients with ASPD are at a higher risk of drug and alcohol abuse.{{cite journal |last1=Rosenström |first1=Tom |last2=Torvik |first2=Fartein Ask |last3=Ystrom |first3=Eivind |last4=Czajkowski |first4=Nikolai Olavi |last5=Gillespie |first5=Nathan A. |last6=Aggen |first6=Steven H. |last7=Krueger |first7=Robert F. |last8=Kendler |first8=Kenneth S. |last9=Reichborn-Kjennerud |first9=Ted |year=2018 |title=Prediction of alcohol use disorder using personality disorder traits: A twin study |journal=Addiction |volume=113 |issue=1 |pages=15–24 |doi=10.1111/add.13951 |pmc=5725242 |pmid=28734091}}{{cite journal |last1=Widinghoff |first1=Carolina |last2=Berge |first2=Jonas |last3=Wallinius |first3=Märta |last4=Billstedt |first4=Eva |last5=Hofvander |first5=Björn |last6=Håkansson |first6=Anders |year=2019 |title=Gambling Disorder in Male Violent Offenders in the Prison System: Psychiatric and Substance-Related Comorbidity |journal=Journal of Gambling Studies |volume=35 |issue=2 |pages=485–500 |doi=10.1007/s10899-018-9785-8 |pmc=6517603 |pmid=29971589}}{{cite journal |last1=Rizeanu |first1=Steliana |year=2012 |title=The specificity of pathological gambling |journal=Procedia - Social and Behavioral Sciences |volume=33 |pages=1082–1086 |doi=10.1016/j.sbspro.2012.01.289 |doi-access=free}}{{cite journal |last1=Falck |first1=Russel S. |last2=Wang |first2=Jichuan |last3=Carlson |first3=Robert G. |year=2008 |title=Among long-term crack smokers, who avoids and who succumbs to cocaine addiction? |journal=Drug and Alcohol Dependence |volume=98 |issue=1–2 |pages=24–29 |doi=10.1016/j.drugalcdep.2008.04.004 |pmc=2564618 |pmid=18499357}} ASPD is the personality disorder most likely to be associated with addiction.{{cite journal |last1=Van Dongen |first1=Josanne D. M. |last2=Buck |first2=Nicole M. L. |last3=Barendregt |first3=Marko |last4=Van Beveren |first4=Nico M. |last5=De Beurs |first5=Edwin |last6=Van Marle |first6=Hjalmar J. C. |year=2015 |title=Anti-social personality characteristics and psychotic symptoms: Two pathways associated with offending in schizophrenia |journal=Criminal Behaviour and Mental Health |volume=25 |issue=3 |pages=181–191 |doi=10.1002/cbm.1923 |pmid=25078287}}{{cite journal |last1=Ma |first1=Chia-Hao |last2=Lin |first2=Kuan-Fu |last3=Chen |first3=Tzu-Ting |last4=Yu |first4=Yu-Fang |last5=Chien |first5=Hui-Fen |last6=Huang |first6=Wei-Lieh |year=2020 |title=Specific personality traits and associated psychosocial distresses among individuals with heroin or methamphetamine use disorder in Taiwan |journal=Journal of the Formosan Medical Association |volume=119 |issue=3 |pages=735–742 |doi=10.1016/j.jfma.2019.08.026 |pmid=31500938 |s2cid=202402587 |doi-access=free}}{{cite journal |last1=Gil-Miravet |first1=Isis |last2=Fuertes-Saiz |first2=Alejandro |last3=Benito |first3=Ana |last4=Almodóvar |first4=Isabel |last5=Ochoa |first5=Enrique |last6=Haro |first6=Gonzalo |year=2021 |title=Prepulse Inhibition in Cocaine Addiction and Dual Pathologies |journal=Brain Sciences |volume=11 |issue=2 |page=269 |doi=10.3390/brainsci11020269 |pmc=7924364 |pmid=33672693 |doi-access=free}} Individuals with ASPD are at a higher risk of illegal drug usage,{{cite journal |last1=Yang |first1=Mei |last2=Liao |first2=Yanhui |last3=Wang |first3=Qiang |last4=Chawarski |first4=Marek C. |last5=Hao |first5=Wei |year=2015 |title=Profiles of psychiatric disorders among heroin-dependent individuals in Changsha, China |journal=Drug and Alcohol Dependence |volume=149 |pages=272–279 |doi=10.1016/j.drugalcdep.2015.01.028 |pmc=4609506 |pmid=25680517}}{{cite journal |last1=Chiang |first1=SHU-Chuan |last2=Chan |first2=Hung-YU |last3=Chang |first3=Yuan-Ying |last4=Sun |first4=Hsiao-JU |last5=Chen |first5=WEI J. |last6=Chen |first6=Chih-KEN |year=2007 |title=Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan |url=http://ntur.lib.ntu.edu.tw//handle/246246/158890 |journal=Psychiatry and Clinical Neurosciences |volume=61 |issue=1 |pages=105–111 |doi=10.1111/j.1440-1819.2007.01618.x |pmid=17239047 |s2cid=2260942}} blood-borne diseases, HIV,{{cite journal |last1=Smith |first1=Rachel V. |last2=Young |first2=April M. |last3=Mullins |first3=Ursula L. |last4=Havens |first4=Jennifer R. |year=2017 |title=Individual and Network Correlates of Antisocial Personality Disorder Among Rural Nonmedical Prescription Opioid Users |journal=The Journal of Rural Health |volume=33 |issue=2 |pages=198–207 |doi=10.1111/jrh.12184 |pmc=5107178 |pmid=27171488}} shorter periods of abstinence, misuse of oral administrations, and compulsive gambling{{cite journal |last1=Szerman |first1=Nestor |last2=Ferre |first2=Francisco |last3=Basurte-Villamor |first3=Ignacio |last4=Vega |first4=Pablo |last5=Mesias |first5=Beatriz |last6=Marín-Navarrete |first6=Rodrigo |last7=Arango |first7=Celso |year=2020 |title=Gambling Dual Disorder: A Dual Disorder and Clinical Neuroscience Perspective |journal=Frontiers in Psychiatry |volume=11 |page=589155 |doi=10.3389/fpsyt.2020.589155 |pmc=7732481 |pmid=33329137 |doi-access=free}}{{cite journal |last1=Ortiz-Tallo |first1=M. |last2=Cancino |first2=C. |last3=Cobos |first3=S. |year=2011 |title=Pathological gambling, personality patterns and clinical syndromes |journal=Adicciones |volume=23 |issue=3 |pages=189–197 |doi=10.20882/adicciones.143 |pmid=21814707 |doi-access=free}}{{cite journal |last1=Nabi |first1=H. |last2=Kivimaki |first2=M. |last3=Zins |first3=M. |last4=Elovainio |first4=M. |last5=Consoli |first5=S. M. |last6=Cordier |first6=S. |last7=Ducimetiere |first7=P. |last8=Goldberg |first8=M. |last9=Singh-Manoux |first9=A. |year=2008 |title=Does personality predict mortality? Results from the GAZEL French prospective cohort study |journal=International Journal of Epidemiology |volume=37 |issue=2 |pages=386–396 |doi=10.1093/ije/dyn013 |pmc=2662885 |pmid=18263645}} as a consequence of their tendency towards addiction.{{cite journal |last1=Sargeant |first1=Marsha N. |last2=Bornovalova |first2=Marina A. |last3=Trotman |first3=Adria J.-M. |last4=Fishman |first4=Shira |last5=Lejuez |first5=Carl W. |year=2012 |title=Facets of impulsivity in the relationship between antisocial personality and abstinence |journal=Addictive Behaviors |volume=37 |issue=3 |pages=293–298 |doi=10.1016/j.addbeh.2011.11.012 |pmc=3270493 |pmid=22153489}} In addition, sufferers are more likely to abuse substances or develop an addiction at a young age.{{cite journal |last1=Akçay |first1=Bülent Devrim |last2=Akçay |first2=Duygu |year=2020 |title=What are the factors that contribute to aggression in patients with co-occurring antisocial personality disorder and substance abuse? |journal=Archives of Clinical Psychiatry (São Paulo) |volume=47 |issue=4 |pages=95–100 |doi=10.1590/0101-60830000000240 |s2cid=225475157 |doi-access=free}}

Due to ASPD being associated with higher levels of impulsivity,{{cite web |author=Mayo Clinic Staff |date=2 April 2016 |title=Overview- Antisocial personality disorder |url=http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/home/ovc-20198975 |access-date=12 April 2016 |website=Mayo Clinic}}{{cite web |date=29 July 2016 |title=Antisocial personality disorder: MedlinePlus Medical Encyclopedia |url=https://medlineplus.gov/ency/article/000921.htm |access-date=1 November 2016 |website=MedlinePlus |vauthors=Berger FK}}{{cite book |url=https://www.ncbi.nlm.nih.gov/books/NBK555205/ |title=Antisocial personality disorder: prevention and management |date=2013 |publisher=National Institute for Health and Care Excellence |series=National Institute for Health and Care Excellence: Guidelines |pmid=32208571}} suicidality,{{cite journal | doi=10.1016/j.drugalcdep.2010.09.021 | title=Psychopathic heroin addicts are not uniformly impaired across neurocognitive domains of impulsivity | year=2010 | last1=Vassileva | first1=Jasmin | last2=Georgiev | first2=Stefan | last3=Martin | first3=Eileen | last4=Gonzalez | first4=Raul | last5=Segala | first5=Laura | journal=Drug and Alcohol Dependence | volume=114 | issue=2–3 | pages=194–200 | pmid=21112701 | pmc=3062675 }}{{cite journal | doi=10.1016/j.jpsychires.2011.06.009 | title=Interacting mechanisms of impulsivity in bipolar disorder and antisocial personality disorder | year=2011 | last1=Swann | first1=Alan C. | last2=Lijffijt | first2=Marijn | last3=Lane | first3=Scott D. | last4=Steinberg | first4=Joel L. | last5=Moeller | first5=F. Gerard | journal=Journal of Psychiatric Research | volume=45 | issue=11 | pages=1477–1482 | pmid=21719028 | pmc=3195997 }}{{cite news|url=https://psychcentral.com/blog/differences-between-a-psychopath-vs-sociopath/|title=Differences Between a Psychopath vs Sociopath|date=12 February 2015|work=World of Psychology|access-date=18 February 2018|language=en-US}} and irresponsible behavior,{{cite journal | doi=10.2217/npy.11.69 | title=Antisocial personality and bipolar disorder: Interactions in impulsivity and course of illness | year=2011 | last1=Swann | first1=Alan C. | journal=Neuropsychiatry | volume=1 | issue=6 | pages=599–610 | pmid=22235235 | pmc=3253316 }}{{cite journal | doi=10.1080/17522439.2011.639901 | title=Antisocial personality disorder in people with co-occurring severe mental illness and substance use disorders: Clinical, functional, and family relationship correlates | year=2012 | last1=Mueser | first1=Kim T. | last2=Gottlieb | first2=Jennifer D. | last3=Cather | first3=Corrine | last4=Glynn | first4=Shirley M. | last5=Zarate | first5=Roberto | last6=Smith | first6=Melinda F. | last7=Clark | first7=Robin E. | last8=Wolfe | first8=Rosemarie | journal=Psychosis | volume=4 | issue=1 | pages=52–62 | pmid=22389652 | pmc=3289140 }}{{cite journal | doi=10.1037/0021-843X.115.1.121 | title=Marital interaction in alcoholic and nonalcoholic couples: Alcoholic subtype variations and wives' alcoholism status | year=2006 | last1=Floyd | first1=Frank J. | last2=Cranford | first2=James A. | last3=Daugherty | first3=Michelle Klotz | last4=Fitzgerald | first4=Hiram E. | last5=Zucker | first5=Robert A. | journal=Journal of Abnormal Psychology | volume=115 | issue=1 | pages=121–130 | pmid=16492103 | pmc=2259460 }} the condition is correlated with heightened levels of aggressive behavior,{{cite journal |last1=Ford |first1=Julian D. |last2=Gelernter |first2=Joel |last3=Devoe |first3=Judith S. |last4=Zhang |first4=Wanli |last5=Weiss |first5=Roger D. |last6=Brady |first6=Kathleen |last7=Farrer |first7=Lindsay |last8=Kranzler |first8=Henry R. |year=2009 |title=Association of psychiatric and substance use disorder comorbidity with cocaine dependence severity and treatment utilization in cocaine-dependent individuals |journal=Drug and Alcohol Dependence |volume=99 |issue=1–3 |pages=193–203 |doi=10.1016/j.drugalcdep.2008.07.004 |pmc=2745327 |pmid=18775607}} domestic violence,{{cite journal | doi=10.1016/j.jsr.2021.11.009 | title=Understanding mechanisms underlying the relationship between antisocial personality disorder and substance-impaired driving among young adults involved with the justice system as minors | year=2022 | last1=Wojciechowski | first1=Thomas | journal=Journal of Safety Research | volume=80 | pages=78–86 | pmid=35249630 | s2cid=247252508 | doi-access= }}{{cite journal | doi=10.1371/journal.pone.0229876 | doi-access=free | title=Impulsive and premeditated aggression in male offenders with antisocial personality disorder | year=2020 | last1=Azevedo | first1=Jacinto | last2=Vieira-Coelho | first2=Maria | last3=Castelo-Branco | first3=Miguel | last4=Coelho | first4=Rui | last5=Figueiredo-Braga | first5=Margarida | journal=PLOS ONE | volume=15 | issue=3 | pages=e0229876 | pmid=32142531 | pmc=7059920 | bibcode=2020PLoSO..1529876A }} illegal drug use, pervasive anger, and violent crimes.{{cite journal | doi=10.12740/PP/27823 | title=Personality traits of drivers serving a custodial sentence for drink driving | year=2015 | last1=Pawłowska | first1=Beata | last2=Rzeszutko | first2=Ewa | journal=Psychiatria Polska | volume=49 | issue=2 | pages=315–324 | pmid=26093595 | doi-access=free }}{{cite journal | doi=10.1016/j.jad.2012.06.027 | title=Antisocial personality disorder and borderline symptoms are differentially related to impulsivity and course of illness in bipolar disorder | year=2013 | last1=Swann | first1=Alan C. | last2=Lijffijt | first2=Marijn | last3=Lane | first3=Scott D. | last4=Steinberg | first4=Joel L. | last5=Moeller | first5=F. Gerard | journal=Journal of Affective Disorders | volume=148 | issue=2–3 | pages=384–390 | pmid=22835849 | pmc=3484175 }} This behavior typically has negative effects on their education, relationships,{{cite journal | doi=10.1002/cbm.740 | title=Moral cognitive correlates of empathy in juvenile delinquents | year=2009 | last1=Barriga | first1=Alvaro Q. | last2=Sullivan-Cosetti | first2=Marilyn | last3=Gibbs | first3=John C. | journal=Criminal Behaviour and Mental Health | volume=19 | issue=4 | pages=253–264 | pmid=19780022 }}{{cite journal | doi=10.1192/bjp.2020.69 | title=Gang membership and sexual violence: Associations with childhood maltreatment and psychiatric morbidity | year=2020 | last1=Coid | first1=Jeremy | last2=González | first2=Rafael A. | last3=Kallis | first3=Constantinos | last4=Zhang | first4=Yamin | last5=Liu | first5=Yuanyuan | last6=Wood | first6=Jane | last7=Quigg | first7=Zara | last8=Ullrich | first8=Simone | journal=The British Journal of Psychiatry | volume=217 | issue=4 | pages=583–590 | pmid=32338230 | pmc=7525108 }} and/or employment.{{cite journal | doi=10.12740/PP/59330 | title=Sexuality of dissocial persons | year=2016 | last1=Janus | first1=Marta | last2=Szulc | first2=Agata | journal=Psychiatria Polska | volume=50 | issue=1 | pages=187–196 | pmid=27086338 | doi-access=free }} Alongside this, sexual behaviors of risk such as having multiple sexual partners in a short period of time, seeing prostitutes, inconsistent use of condoms, trading sex for drugs, and frequent unprotected sex are also common.{{cite journal | doi=10.1093/schbul/sbj068 | title=Conduct Disorder and Antisocial Personality Disorder in Persons with Severe Psychiatric and Substance Use Disorders | year=2005 | last1=Mueser | first1=K. T. | last2=Crocker | first2=A. G. | last3=Frisman | first3=L. B. | last4=Drake | first4=R. E. | last5=Covell | first5=N. H. | last6=Essock | first6=S. M. | journal=Schizophrenia Bulletin | volume=32 | issue=4 | pages=626–636 | pmid=16574783 | pmc=2632266 }}{{cite journal | doi=10.3390/bs2030186 | doi-access=free | title=Psychiatric Disorders and Substance Use in Homeless Youth: A Preliminary Comparison of San Francisco and Chicago | year=2012 | last1=Quimby | first1=Ernika G. | last2=Edidin | first2=Jennifer P. | last3=Ganim | first3=Zoe | last4=Gustafson | first4=Erika | last5=Hunter | first5=Scott J. | last6=Karnik | first6=Niranjan S. | journal=Behavioral Sciences | volume=2 | issue=3 | pages=186–194 | pmid=25379220 | pmc=4217629 }}

Patients with ASPD have been documented to describe emotions with ambivalence and experience heightened states of emotional coldness and detachment.{{cite journal | doi=10.29252/nirp.ijpcp.24.1.44 | title=Comparison of Personality Correlates of Machiavellianism, Narcissism and Psychopathy (Dark Triad of Personality) in Three Factor Personality Model | year=2018 | last1=Mohammadzadeh | first1=Ali | last2=Ashouri | first2=Ahmad | journal=Iranian Journal of Psychiatry and Clinical Psychology | volume=24 | pages=44–55 | doi-access=free }} Individuals with ASPD, or who display antisocial behavior, may often experience chronic boredom.{{cite journal | doi=10.1176/appi.ajp.2008.07101660 | title=Prevalence and Correlates of Shoplifting in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) | year=2008 | last1=Blanco | first1=Carlos | last2=Grant | first2=Jon | last3=Petry | first3=Nancy M. | last4=Simpson | first4=H. Blair | last5=Alegria | first5=Analucia | last6=Liu | first6=Shang-Min | last7=Hasin | first7=Deborah | journal=American Journal of Psychiatry | volume=165 | issue=7 | pages=905–913 | pmid=18381900 | pmc=4104590 }}{{cite journal | doi=10.25122/jml-2021-0317 | title=Predictors of personality disorders in prisoners | year=2022 | last1=Yousefi | first1=Fayegh | last2=Talib | first2=Mansor Abu | journal=Journal of Medicine and Life | volume=15 | issue=4 | pages=454–461 | pmid=35646191 | pmc=9126463 | s2cid=249232159 | doi-access=free }} They may experience emotions such as happiness and fear less clearly than others.Omar, Hatim A. "Firesetting Behavior and Psychiatric Disorders".{{cite journal | doi=10.4088/JCP.08m04812gry | title=Prevalence and Correlates of Fire-Setting in the United States | year=2010 | last1=Blanco | first1=Carlos | last2=Alegria | first2=Analucia A. | last3=Petry | first3=Nancy M. | last4=Grant | first4=Jon E. | last5=Simpson | first5=H. Blair | last6=Liu | first6=Shang-Min | last7=Grant | first7=Bridget F. | last8=Hasin | first8=Deborah S. | journal=The Journal of Clinical Psychiatry | volume=71 | issue=9 | pages=1218–1225 | pmid=20361899 | pmc=2950908 }}{{cite journal |last1=Newberry |first1=Angela L. |last2=Duncan |first2=Renae D. |year=2001 |title=Roles of Boredom and Life Goals in Juvenile Delinquency1 |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.2001.tb02054.x |journal=Journal of Applied Social Psychology |volume=31 |issue=3 |pages=527–541 |doi=10.1111/j.1559-1816.2001.tb02054.x}} It is also possible that they may experience emotions such as anger and frustration more frequently and clearly than other emotions.{{cite journal |last1=Blaszczynski |first1=A. |last2=Steel |first2=Z. |last3=McConaghy |first3=N. |year=1997 |title=Impulsivity in pathological gambling: The antisocial impulsivist |url=https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.1997.tb03639.x |journal=Addiction |volume=92 |issue=1 |pages=75–87 |doi=10.1111/j.1360-0443.1997.tb03639.x |pmid=9060199}}

People with ASPD may have a limited capacity for empathy and can be more interested in benefiting themselves than avoiding harm to others.{{cite journal |last1=Chang |first1=Shou-An A. |last2=Tillem |first2=Scott |last3=Benson-Williams |first3=Callie |last4=Baskin-Sommers |first4=Arielle |year=2021 |title=Cognitive Empathy in Subtypes of Antisocial Individuals |journal=Frontiers in Psychiatry |volume=12 |page=677975 |doi=10.3389/fpsyt.2021.677975 |pmc=8287099 |pmid=34290630 |doi-access=free}}McCallum D (2001). Personality and dangerousness: genealogies of antisocial personality disorder. Cambridge, England: Cambridge University Press. {{ISBN|978-0-521-00875-4}}. {{OCLC|52493285}}. They may have no regard for morals, social norms, or the rights of others. People with ASPD can have difficulty beginning or sustaining relationships. It is common for the interpersonal relationships of someone with ASPD to revolve around the exploitation and abuse of others.Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Association. 2000. People with ASPD may display arrogance, think lowly and negatively of others, have limited remorse for their harmful actions, and have a callous attitude toward those they have harmed.

People with ASPD can have difficulty mentalizing, or interpreting the mental state of others.{{cite journal | doi=10.1371/journal.pone.0268818 | doi-access=free | title=Monitoring the emotional facial reactions of individuals with antisocial personality disorder during the retrieval of self-defining memories | year=2022 | last1=Lavallee | first1=Audrey | last2=Pham | first2=Thierry. H. | last3=Gandolphe | first3=Marie-Charlotte | last4=Saloppé | first4=Xavier | last5=Ott | first5=Laurent | last6=Nandrino | first6=Jean-Louis | journal=PLOS ONE | volume=17 | issue=6 | pages=e0268818 | pmid=35675301 | pmc=9176833 | bibcode=2022PLoSO..1768818L }}{{cite journal | doi=10.1186/s13063-020-04896-w | title=Mentalization for Offending Adult Males (MOAM): Study protocol for a randomized controlled trial to evaluate mentalization-based treatment for antisocial personality disorder in male offenders on community probation | year=2020 | last1=Fonagy | first1=Peter | last2=Yakeley | first2=Jessica | last3=Gardner | first3=Tessa | last4=Simes | first4=Elizabeth | last5=McMurran | first5=Mary | last6=Moran | first6=Paul | last7=Crawford | first7=Mike | last8=Frater | first8=Alison | last9=Barrett | first9=Barbara | last10=Cameron | first10=Angus | last11=Wason | first11=James | last12=Pilling | first12=Stephen | last13=Butler | first13=Stephen | last14=Bateman | first14=Anthony | journal=Trials | volume=21 | issue=1 | page=1001 | pmid=33287865 | pmc=7720544 | doi-access=free }} Alternately, they may display a perfectly intact theory of mind, or the ability to understand one's mental state, but have an impaired ability to understand how another individual may be affected by an aggressive action. These factors might contribute to aggressive and criminal behavior as well as empathy deficits.Newbury-Helps, John. Are difficulties in mentalizing associated with the severity of Antisocial Personality Disorder? University College London. Despite this, they may be adept at social cognition,Newbury-Helps, John. Offenders with Antisocial Personality Disorder Display More Impairments in Mentalizing. St Mary's Hospital, London: University College London. or the ability to process and store information about other people, which can contribute to an increased ability to manipulate others.{{cite journal | doi=10.1007/s10936-012-9237-z | title=The Emotional Lexicon of Individuals Diagnosed with Antisocial Personality Disorder | year=2013 | last1=Gawda | first1=Barbara | journal=Journal of Psycholinguistic Research | volume=42 | issue=6 | pages=571–580 | pmid=23337952 | pmc=3825036 }}{{cite journal | doi=10.21500/20112084.2903 | title=Differences in social cognition between male prisoners with antisocial personality or psychotic disorder | year=2017 | last1=Muniello | first1=Jessica | last2=Vallejos | first2=Miguel | last3=Díaz Granados | first3=Edith Aristizabal | last4=Bertone | first4=Matias Salvador | journal=International Journal of Psychological Research | volume=10 | issue=2 | pages=15–24 | pmid=32612761 | pmc=7110155 | s2cid=55567655 }}

ASPD is highly prevalent among prisoners. People with ASPD tend to be convicted more, receive longer sentences, and are more likely to be charged with almost any crime,{{cite journal |last1=Chaudhury |first1=Suprakash |last2=Ranjan |first2=Jaykumar |last3=Prakash |first3=Om |last4=Sharma |first4=Neelu |last5=Singh |first5=Amoolr |last6=Sengar |first6=KS |year=2015 |title=Personality disorder, emotional intelligence, and locus of control of patients with alcohol dependence |journal=Industrial Psychiatry Journal |volume=24 |issue=1 |pages=40–47 |doi=10.4103/0972-6748.160931 |pmc=4525430 |pmid=26257482 |doi-access=free }}"Antisocial personality disorder: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 4 July 2022.{{cite journal |last1=Metcalf |first1=Stacy |last2=Dickerson |first2=Kelli L. |last3=Milojevich |first3=Helen M. |last4=Quas |first4=Jodi A. |year=2021 |title=Primary and Secondary Variants of Psychopathic Traits in at-Risk Youth: Links with Maltreatment, Aggression, and Empathy |journal=Child Psychiatry & Human Development |volume=52 |issue=6 |pages=1060–1070 |doi=10.1007/s10578-020-01083-5 |pmid=33099658 |s2cid=225072146}} with assault and other violent crimes being the most common charges.{{cite journal |last1=Seid |first1=Muhammed |last2=Anbesaw |first2=Tamrat |last3=Melke |first3=Shishigu |last4=Beteshe |first4=Dawit |last5=Mussa |first5=Haydar |last6=Asmamaw |first6=Amare |last7=Shegaw |first7=Maregu |year=2022 |title=Antisocial personality disorder and associated factors among incarcerated in prison in Dessie city correctional center, Dessie, Ethiopia: A cross-sectional study |journal=BMC Psychiatry |volume=22 |issue=1 |page=53 |doi=10.1186/s12888-022-03710-y |pmc=8785502 |pmid=35073903 |doi-access=free }} Those who have committed violent crimes tend to have higher levels of testosterone than the average person,{{cite journal |vauthors=Archer J |date=February 1991 |title=The influence of testosterone on human aggression |url=https://onlinelibrary.wiley.com/doi/abs/10.1111/j.2044-8295.1991.tb02379.x |journal=British Journal of Psychology |volume=82 ( Pt 1) |issue=1 |pages=1–28 |doi=10.1111/j.2044-8295.1991.tb02379.x |pmid=2029601 |s2cid=26281585}} also contributing to the higher likelihood for men to be diagnosed with ASPD.{{cite journal |vauthors=Aromäki A, Lindman R, Erikson C |date=12 February 1999 |title=Testosterone, aggressiveness, and antisocial personality. Hormone Sensitivity and Bone Mineral Metabolism |journal=Aggressive Behavior |volume=25 |issue=2 |doi=10.1002/(SICI)1098-2337(1999)25:2<113::AID-AB4>3.0.CO;2-4}}{{Cite journal |last=Archer |first=John |date=February 1991 |title=The influence of testosterone on human aggression |url=https://onlinelibrary.wiley.com/doi/10.1111/j.2044-8295.1991.tb02379.x |journal=British Journal of Psychology |language=en |volume=82 |issue=1 |pages=1–28 |doi=10.1111/j.2044-8295.1991.tb02379.x |pmid=2029601 |s2cid=26281585}} The effect of testosterone is counteracted by cortisol, which facilitates the cognitive control of impulsive tendencies.{{cite journal |vauthors=Mehta PH, Josephs RA |date=November 2010 |title=Testosterone and cortisol jointly regulate dominance: evidence for a dual-hormone hypothesis |url=http://www.sciencedirect.com/science/article/pii/S0018506X10002412 |journal=Hormones and Behavior |volume=58 |issue=5 |pages=898–906 |doi=10.1016/j.yhbeh.2010.08.020 |pmid=20816841 |s2cid=16459329}}

Arson and the destruction of others' property are also behaviors commonly associated with ASPD.{{cite book |last1=Fisher |first1=KA |title=StatPearls |last2=Hany |first2=M |publisher=StatPearls Publishing |year=2022 |publication-place=Treasure Island (FL) |chapter=Antisocial Personality Disorder |pmid=31536279 |chapter-url=http://www.ncbi.nlm.nih.gov/books/NBK546673/}} Alongside other conduct problems, many people with ASPD had conduct disorder in their youth, characterized by a pervasive pattern of violent, criminal, defiant, and anti-social behavior.

Although behaviors vary by degree, individuals with this personality disorder have been known to exploit others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people.{{cite journal | doi=10.1017/s003329170003854x | title=The outcome of childhood conduct disorder: Implications for defining adult personality disorder and conduct disorder | year=1992 | last1=Zoccolillo | first1=Mark | last2=Pickles | first2=Andrew | last3=Quinton | first3=David | last4=Rutter | first4=Michael | journal=Psychological Medicine | volume=22 | issue=4 | pages=971–986 | pmid=1488492 | s2cid=25470721 }}Regier D, eds. (2013). Diagnostic and Statistical Manual of Mental Disorders (5 ed.). Washington, DC: American Psychiatric Association.{{ISBN|978-0-89042-555-8}}. While some do so with a façade of superficial charm, others do so through intimidation and violence.Hinshaw SP, Lee SS (2003). "Conduct and Oppositional Defiant Disorders" (PDF). In Mash EJ, Barkely RA (eds.). Child Psychopathology (2 ed.). New York City: Guilford Press. pp. 144–198. {{ISBN|978-1-57230-609-7}}.{{cite web|url=https://www.psychologytoday.com/conditions/antisocial-personality-disorder|title=Antisocial Personality Disorder|magazine=Psychology Today|publisher=Sussex Publishers|location=New York City|language=en|access-date=18 February 2018}} Individuals with antisocial personality disorder may deliberately show irresponsibility, have difficulty acknowledging their faults and/or attempt to redirect attention away from harmful behaviors.{{Cite journal |last=Tuvblad |first=Catherine |date=2013 |title=Genetic and environmental influence on antisocial behavior-PMC |journal=Journal of Criminal Justice |volume=41 |issue=5 |pages=273–276 |doi=10.1016/j.jcrimjus.2013.07.007 |pmc=3920596 |pmid=24526799}}

ASPD presents high comorbidity rates with various psychiatric conditions, particularly substance use and mood disorder. Individuals diagnosed with ASPD are significantly more prone to develop substance use disorder (SUDs), with studies showing that they are approximately 13 times more likely to be diagnosed with a SUD than those without ASPD. This population also faces increased risks for mood disorders, including a fourfold likelihood of experiencing major depressive disorder, as well as heightened risks for suicidal ideation and behaviors. Anxiety disorders, particularly post-traumatic stress disorder (PTSD) and social anxiety disorder, are also common comorbidities, affecting up to 50% of individuals with ASPD. These comorbidities often exacerbate the problems of those with ASPD, leading to more severe symptoms, complex treatment needs, and poorer clinical outcomes.{{Cite journal |last1=Werner |first1=Kimberly B. |last2=Few |first2=Lauren R. |last3=Bucholz |first3=Kathleen K. |date=April 2015 |title=Epidemiology, Comorbidity, and Behavioral Genetics of Antisocial Personality Disorder and Psychopathy |journal=Psychiatric Annals |language=en |volume=45 |issue=4 |pages=195–199 |doi=10.3928/00485713-20150401-08 |issn=0048-5713 |pmc=4649950 |pmid=26594067}}

When combined with alcoholism, people may show frontal brain function deficits on neuropsychological tests greater than those associated with each condition.{{cite journal | vauthors = Oscar-Berman M, Valmas MM, Sawyer KS, Kirkley SM, Gansler DA, Merritt D, Couture A | title = Frontal brain dysfunction in alcoholism with and without antisocial personality disorder | journal = Neuropsychiatric Disease and Treatment | volume = 5 | pages = 309–26 | date = April 2009 | pmid = 19557141 | pmc = 2699656 | doi = 10.2147/NDT.S4882 | doi-access = free }} Alcohol use disorder is likely caused by lack of impulse and behavioral control exhibited by antisocial personality disorder patients.{{cite journal | vauthors = Helle AC, Watts AL, Trull TJ, Sher KJ | title = Alcohol Use Disorder and Antisocial and Borderline Personality Disorders | journal = Alcohol Research: Current Reviews | volume = 40 | issue = 1 | pages = 1 | date = 2019 | pmid = 31886107 | pmc = 6927749 | doi = 10.35946/arcr.v40.1.05 | doi-broken-date = 9 February 2025 }}

Personality disorders are generally believed to be caused by a combination and interaction of genetics and environmental influences.{{cite web|url=https://www.mentalhealth.gov/what-to-look-for/personality-disorders/antisocial-personality-disorder|title=Antisocial Personality Disorder {{!}} MentalHealth.gov|website=mentalhealth.gov|language=en|access-date=18 February 2018}} People with an antisocial or alcoholic parent are considered to be at higher risk of developing ASPD.Molina BSG, Gnagy EM, Joseph HM, Pelham WE Jr. Antisocial Alcoholism in Parents of Adolescents and Young Adults With Childhood ADHD. J Atten Disord. 2020 Jul;24(9):1295-1304. doi: 10.1177/1087054716680074. Epub 2016 Nov 27. PMID 27895188; PMCID: PMC5446804. Fire-setting and cruelty to animals during childhood are also linked to the development of an antisocial personality disorder,{{Cite journal |last=Arehart-Treichel |first=Joan |date=2002-09-20 |title=Researchers Explore Link Between Animal Cruelty, Personality Disorders |url=https://psychnews.psychiatryonline.org/doi/10.1176/pn.37.18.0022a |journal=Psychiatric News |volume=37 |issue=18 |page=22 |language=en |doi=10.1176/pn.37.18.0022a}} along with being more common in males and among incarcerated populations. Although the causes listed correlate to the risk of developing ASPD, one factor alone is unlikely to be the only cause associated with ASPD and relating to a listed cause does not necessarily mean that a person should identify or be identified as having ASPD.{{Cite web |last=Black |first=Donald |date=December 2021 |title=6 Seeds of Despair: The Causes of Antisocial Personality Disorder |url=https://academic.oup.com/book/37208/chapter/327499190 |website=Oxford Academic|doi=10.1093/med/9780197616918.003.0006 |isbn=978-0-19-761691-8 }}

According to professor Emily Simonoff of the Institute of Psychiatry, Psychology and Neuroscience, there are many variables that are consistently connected to ASPD, such as: childhood hyperactivity and conduct disorder, criminality in adulthood, lower IQ scores, and reading problems.{{cite journal |vauthors=Simonoff E, Elander J, Holmshaw J, Pickles A, Murray R, Rutter M |date=February 2004 |title=Predictors of antisocial personality. Continuities from childhood to adult life |journal=The British Journal of Psychiatry: The Journal of Mental Science |volume=184 |pages=118–27 |doi=10.1192/bjp.184.2.118 |pmid=14754823 |doi-access=free}} Additionally, children who grow up with a predisposition of ASPD and interact with other delinquent children are likely to later be diagnosed with ASPD.{{cite journal |vauthors=Azeredo A, Moreira D, Figueiredo P, Barbosa F |date=December 2019 |title=Delinquent Behavior: Systematic Review of Genetic and Environmental Risk Factors |journal=Clinical Child and Family Psychology Review |volume=22 |issue=4 |pages=502–526 |doi=10.1007/s10567-019-00298-w |pmid=31367800 |s2cid=199055043}}{{cite journal |vauthors=Baglivio MT, Wolff KT, Piquero AR, Epps N |date=May 2015 |title=The relationship between adverse childhood experiences (ACE) and juvenile offending trajectories in a juvenile offender sample. |journal=Journal of Criminal Justice |volume=43 |issue=3 |pages=229–41 |doi=10.1016/j.jcrimjus.2015.04.012}}

Research into genetic associations in antisocial personality disorder suggests that ASPD has some or even a strong genetic basis. The prevalence of ASPD is higher in people related to someone with the disorder. Twin studies, which are designed to discern between genetic and environmental effects, have reported significant genetic influences on antisocial behavior and conduct disorder.{{cite journal | vauthors = Baker LA, Bezdjian S, Raine A | title = Behavioral Genetics: The Science of Antisocial Behavior | journal = Law and Contemporary Problems | volume = 69 | issue = 1–2 | pages = 7–46 | date = 1 January 2006 | pmid = 18176636 | pmc = 2174903 }}

In the specific genes that may be involved, one gene that has shown particular promise in its correlation with ASPD is the gene that encodes for monoamine oxidase A (MAO-A), an enzyme that breaks down monoamine neurotransmitters such as serotonin and norepinephrine. Various studies examining the gene's relationship to behavior have suggested that variants of the gene resulting in less MAO-A being produced (such as the 2R and 3R alleles of the promoter region) have associations with aggressive behavior in men.{{cite journal | vauthors = Guo G, Ou XM, Roettger M, Shih JC | title = The VNTR 2 repeat in MAOA and delinquent behavior in adolescence and young adulthood: associations and MAOA promoter activity | journal = European Journal of Human Genetics | volume = 16 | issue = 5 | pages = 626–34 | date = May 2008 | pmid = 18212819 | pmc = 2922855 | doi = 10.1038/sj.ejhg.5201999 | author-link4 = Jean Chen Shih }}{{cite journal | vauthors = Guo G, Roettger M, Shih JC | s2cid = 30271933 | title = The integration of genetic propensities into social-control models of delinquency and violence among male youths | journal = American Sociological Review | volume = 73 | issue = 4 | pages = 543–568 | date = August 2008 | doi = 10.1177/000312240807300402 | url = http://www.asanet.org/galleries/default-file/Aug08ASRFeature.pdf | access-date = 20 November 2016 | archive-url = https://web.archive.org/web/20160303202206/http://www.asanet.org/galleries/default-file/Aug08ASRFeature.pdf | archive-date = 3 March 2016 }}

This association is also influenced by negative experiences early in life, with children possessing a low-activity variant (MAOA-L) who have experienced negative circumstances being more likely to develop antisocial behavior than those with the high-activity variant (MAOA-H).{{cite journal | vauthors = Caspi A, McClay J, Moffitt TE, Mill J, Martin J, Craig IW, Taylor A, Poulton R | title = Role of genotype in the cycle of violence in maltreated children | journal = Science | volume = 297 | issue = 5582 | pages = 851–4 | date = August 2002 | pmid = 12161658 | doi = 10.1126/science.1072290 | s2cid = 7882492 | bibcode = 2002Sci...297..851C }}

• {{lay source |template=cite web|url= http://www.eurekalert.org/pub_releases/2002-08/uow-gmp072602.php|title =Gene may protect abused kids against behavior problems |date = August 1, 2002|website = EurekAlert!.org }}{{cite journal | vauthors = Frazzetto G, Di Lorenzo G, Carola V, Proietti L, Sokolowska E, Siracusano A, Gross C, Troisi A | title = Early trauma and increased risk for physical aggression during adulthood: the moderating role of MAOA genotype | journal = PLOS ONE | volume = 2 | issue = 5 | pages = e486 | date = May 2007 | pmid = 17534436 | pmc = 1872046 | doi = 10.1371/journal.pone.0000486 | bibcode = 2007PLoSO...2..486F | doi-access = free }} Even when environmental interactions (e.g., emotional abuse) are taken out of the equation, a small association between MAOA-L and aggressive and antisocial behavior remains.{{cite journal | vauthors = Ficks CA, Waldman ID | title = Candidate genes for aggression and antisocial behavior: a meta-analysis of association studies of the 5HTTLPR and MAOA-uVNTR | journal = Behavior Genetics | volume = 44 | issue = 5 | pages = 427–44 | date = September 2014 | pmid = 24902785 | doi = 10.1007/s10519-014-9661-y | s2cid = 11599122 }}

The gene that encodes for the serotonin transporter (SLC6A4), a gene that is heavily researched for its associations with other mental disorders, is another gene of interest in antisocial behavior and personality traits. Genetic association's studies have suggested that the short "S" allele is associated with impulsive antisocial behavior and ASPD in the inmate population.{{cite journal | vauthors = Aluja A, Garcia LF, Blanch A, De Lorenzo D, Fibla J | title = Impulsive-disinhibited personality and serotonin transporter gene polymorphisms: association study in an inmate's sample | journal = Journal of Psychiatric Research | volume = 43 | issue = 10 | pages = 906–14 | date = July 2009 | pmid = 19121834 | doi = 10.1016/j.jpsychires.2008.11.008 }}

However, research into psychopathy find that the long "L" allele is associated with the Factor 1 traits of psychopathy, which describes its core affective (e.g. lack of empathy, fearlessness) and interpersonal (e.g. grandiosity, manipulativeness) personality disturbances.{{cite journal | vauthors = Glenn AL | title = The other allele: exploring the long allele of the serotonin transporter gene as a potential risk factor for psychopathy: a review of the parallels in findings | journal = Neuroscience and Biobehavioral Reviews | volume = 35 | issue = 3 | pages = 612–20 | date = January 2011 | pmid = 20674598 | pmc = 3006062 | doi = 10.1016/j.neubiorev.2010.07.005 }} This is suggestive of two different forms of the disorder, one associated more with impulsive behavior and emotional dysregulation, and the other with predatory aggression and affective disturbance.{{cite journal | vauthors = Yildirim BO, Derksen JJ | title = Systematic review, structural analysis, and new theoretical perspectives on the role of serotonin and associated genes in the etiology of psychopathy and sociopathy | journal = Neuroscience and Biobehavioral Reviews | volume = 37 | issue = 7 | pages = 1254–96 | date = August 2013 | pmid = 23644029 | doi = 10.1016/j.neubiorev.2013.04.009 | url = https://www.researchgate.net/publication/236638079 | s2cid = 19350747 }}

Various other gene candidates for ASPD have been identified by a genome-wide association study published in 2016. Several of these gene candidates are shared with attention-deficit hyperactivity disorder, with which ASPD is often comorbid. The study found that those who carry four mutations on chromosome 6 are 50% more likely to develop antisocial personality disorder than those who do not.{{cite journal | vauthors = Rautiainen MR, Paunio T, Repo-Tiihonen E, Virkkunen M, Ollila HM, Sulkava S, Jolanki O, Palotie A, Tiihonen J | title = Genome-wide association study of antisocial personality disorder | journal = Translational Psychiatry | volume = 6 | issue = 9 | pages = e883 | date = September 2016 | pmid = 27598967 | pmc = 5048197 | doi = 10.1038/tp.2016.155 }}

Traumatic events can lead to a disruption of the standard development of the central nervous system, which can generate a release of hormones that can change normal patterns of development.{{cite web | vauthors = Black D | title = What Causes Antisocial Personality Disorder? | url = http://psychcentral.com/lib/2006/what-causes-antisocial-personality-disorder/ | website = Psych Central | access-date = 1 November 2011 | archive-date = 17 May 2013 | archive-url = https://web.archive.org/web/20130517070455/http://psychcentral.com/lib/2006/what-causes-antisocial-personality-disorder/ }}

One of the neurotransmitters that has been discussed in individuals with ASPD is serotonin, also known as 5-HT. A meta-analysis of 20 studies found significantly lower 5-HIAA levels (indicating lower serotonin levels), especially in those who are younger than 30 years of age.{{cite journal | title=A meta-analysis of serotonin metabolite 5-HIAA and antisocial behavior |vauthors=Moore TM, Scarpa A, Raine A | journal=Aggressive Behavior | year=2002 | volume=28 | pages=299–316 | doi=10.1002/ab.90027 | issue=4}}

While it has been shown that lower levels of serotonin may be associated with ASPD, there has also been evidence that decreased serotonin function is highly correlated with impulsiveness and aggression across a number of different experimental paradigms. Impulsivity is not only linked with irregularities in 5-HT metabolism but may be the most essential psychopathological aspect linked with such dysfunction.{{cite journal | vauthors = Olivier B | title = Serotonin and aggression | journal = Annals of the New York Academy of Sciences | volume = 1036 | issue = 3 | pages = 382–92 | date = December 2004 | pmid = 15817750 | doi = 10.1300/J076v21n03_03 | series = 3–4 }} Correspondingly, the DSM classifies "impulsivity or failure to plan ahead" and "irritability and aggressiveness" as two of seven sub-criteria in category A of the diagnostic criteria of ASPD.{{cite web |url=http://behavenet.com/node/21650|title=Diagnostic criteria for 301.7 Antisocial Personality Disorder |author=American Psychiatric Association |year=2000 |website=BehaveNet |publisher=Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision |access-date=8 July 2013}}

Some studies have found a relationship between monoamine oxidase A and antisocial behavior, including conduct disorder and symptoms of adult ASPD, in maltreated children.{{cite journal | vauthors = Huizinga D, Haberstick BC, Smolen A, Menard S, Young SE, Corley RP, Stallings MC, Grotpeter J, Hewitt JK | title = Childhood maltreatment, subsequent antisocial behavior, and the role of monoamine oxidase A genotype | journal = Biological Psychiatry | volume = 60 | issue = 7 | pages = 677–83 | date = October 2006 | pmid = 17008143 | doi = 10.1016/j.biopsych.2005.12.022 | s2cid = 12744470 }}

Antisocial behavior may be related to a number of neurological defects, such as head trauma.{{cite journal | vauthors = Séguin JR | title = Neurocognitive elements of antisocial behavior: Relevance of an orbitofrontal cortex account | journal = Brain and Cognition | volume = 55 | issue = 1 | pages = 185–97 | date = June 2004 | pmid = 15134852 | pmc = 3283581 | doi = 10.1016/S0278-2626(03)00273-2 }} Antisocial behavior is associated with decreased grey matter in the right lentiform nucleus, left insular, and frontopolar cortex. Increased volumes of grey matter have been observed in the right fusiform gyrus, inferior parietal cortex, right cingulate gyrus, and post-central cortex.{{cite journal | vauthors = Aoki Y, Inokuchi R, Nakao T, Yamasue H | title = Neural bases of antisocial behavior: a voxel-based meta-analysis | journal = Social Cognitive and Affective Neuroscience | volume = 9 | issue = 8 | pages = 1223–31 | date = August 2014 | pmid = 23926170 | pmc = 4127028 | doi = 10.1093/scan/nst104 }}

Intellectual and cognitive ability is often found to be impaired or reduced in the ASPD population.{{cite journal|vauthors=Sánchez de Ribera O, Kavish N, Katz IM, Boutwell BB|title=Untangling Intelligence, Psychopathy, Antisocial Personality Disorder, and Conduct Problems: A Meta–Analytic Review |journal=European Journal of Personality|volume=33|issue=5|pages=529–564 |date=1 September 2019|url=https://journals.sagepub.com/doi/full/10.1002/per.2207|doi=10.1002/per.2207|s2cid=202253144 }} Contrary to stereotypes in popular culture of the "psychopathic genius", antisocial personality disorder is associated with reduced overall intelligence and specific reductions in individual aspects of cognitive ability.{{cite journal|vauthors=Stevens MC, Kaplan RF, Hesselbrock VM|title=Executive–cognitive functioning in the development of antisocial personality disorder|journal=Addictive Behaviors|volume=28|issue=2|pages=285–300|date=March 2003|url=https://www.sciencedirect.com/science/article/abs/pii/S0306460301002325|doi=10.1016/S0306-4603(01)00232-5|pmid=12573679}} These deficits also occur in general-population samples of people with antisocial traits{{cite journal|vauthors=Unsworth N, Miller JD, Lakey CE, Young DL, Meeks JT, Campbell WK, Goodie AS|title=Exploring the relations among executive functions, fluid intelligence, and personality|journal=Journal of Individual Differences|volume=30|issue=4|pages=194–200|date=2009|url=https://psycnet.apa.org/record/2009-23196-003|doi=10.1027/1614-0001.30.4.194}} and in children with the precursors to antisocial personality disorder.{{cite journal|vauthors=Loney BR, Frick PJ, Ellis M, McCoy MG|title=Intelligence, Callous-Unemotional Traits, and Antisocial Behavior|journal=Journal of Psychopathology and Behavioral Assessment|volume=20|issue=1|pages=231–247|date=September 1998|doi=10.1023/A:1023015318156|s2cid=146174376|url=https://link.springer.com/article/10.1023/A:1023015318156}}

People that exhibit antisocial behavior tend to demonstrate decreased activity in the prefrontal cortex, and is more apparent in functional neuroimaging as opposed to structural neuroimaging.{{cite journal | vauthors = Yang Y, Raine A | title = Prefrontal structural and functional brain imaging findings in antisocial, violent, and psychopathic individuals: a meta-analysis | journal = Psychiatry Research | volume = 174 | issue = 2 | pages = 81–8 | date = November 2009 | pmid = 19833485 | pmc = 2784035 | doi = 10.1016/j.pscychresns.2009.03.012 }} Some investigators have questioned whether the reduced volume in prefrontal regions is associated with antisocial personality disorder, or whether they result from co-morbid disorders, such as substance use disorder or childhood maltreatment.{{cite journal | vauthors = Glenn AL, Johnson AK, Raine A | title = Antisocial personality disorder: a current review | journal = Current Psychiatry Reports | volume = 15 | issue = 12 | pages = 427 | date = December 2013 | pmid = 24249521 | doi = 10.1007/s11920-013-0427-7 | url = http://link.springer.com/10.1007/s11920-013-0427-7 | s2cid = 10578128 }} It is still considered an open question if the anatomical abnormality causes the psychological and behavioral abnormality, or vice versa.

Antisocial behavior is also associated with structural brain differences.{{Cite journal |last1=Raine |first1=Adrian |last2=Yang |first2=Y |date=2009 |title=Prefrontal structural and functional brain imaging findings in antisocial, violent, and psychopathic individuals: a meta-analysis |journal=Psychiatry Research |volume=174 |issue=2 |pages=81–88 |doi=10.1016/j.pscychresns.2009.03.012 |pmid=19833485 |pmc=2784035 }} Some of the major areas involved are areas of the prefrontal cortex, such as the right frontal and temporal cortices, the ventromedial prefrontal cortex, and the middle and orbitofrontal cortices. In these areas, a reduction in gray matter is seen in individuals with antisocial personality disorder, suggesting these structural differences may play a role in their behavior. Reduced gray matter volumes in these areas are in fact associated with a lack of emotional regulation, a lack of behavioral and response inhibition, and poor decision making among other affects.{{Cite journal |last1=Davidson |first1=R. J. |last2=Putnam |first2=K. M. |last3=Larson |first3=C. L. |date=2000-07-28 |title=Dysfunction in the neural circuitry of emotion regulation--a possible prelude to violence |url=https://pubmed.ncbi.nlm.nih.gov/10915615/ |journal=Science |volume=289 |issue=5479 |pages=591–594 |doi=10.1126/science.289.5479.591 |issn=0036-8075 |pmid=10915615|bibcode=2000Sci...289..591D }}{{Cite journal |last=Campbell |first=Thomas G. |date=2007-01-17 |title=The best of a bad bunch: the ventromedial prefrontal cortex and dorsal anterior cingulate cortex in decision-making |journal=The Journal of Neuroscience|volume=27 |issue=3 |pages=447–448 |doi=10.1523/jneurosci.4967-06.2007 |issn=1529-2401 |pmc=6672800 |pmid=17240549}}{{Cite journal |last1=Franklin |first1=Tamara B. |last2=Silva |first2=Bianca A. |last3=Perova |first3=Zinaida |last4=Marrone |first4=Livia |last5=Masferrer |first5=Maria E. |last6=Zhan |first6=Yang |last7=Kaplan |first7=Angie |last8=Greetham |first8=Louise |last9=Verrechia |first9=Violaine |last10=Halman |first10=Andreas |last11=Pagella |first11=Sara |last12=Vyssotski |first12=Alexei L. |last13=Illarionova |first13=Anna |last14=Grinevich |first14=Valery |last15=Branco |first15=Tiago |date=February 2017 |title=Prefrontal cortical control of a brainstem social behavior circuit |journal=Nature Neuroscience |language=en |volume=20 |issue=2 |pages=260–270 |doi=10.1038/nn.4470 |pmid=28067904 |pmc=5580810 |issn=1546-1726}}  Additionally, those with ASPD have shown decreased gray matter volumes in other brain areas such as the amygdala and insula, suggesting possible issues with emotional reactions to certain stimuli.{{Cite journal |last1=Aoki |first1=Yuta |last2=Inokuchi |first2=Ryota |last3=Nakao |first3=Tomohiro |last4=Yamasue |first4=Hidenori |date=August 2014 |title=Neural bases of antisocial behavior: a voxel-based meta-analysis |journal=Social Cognitive and Affective Neuroscience |language=en |volume=9 |issue=8 |pages=1223–1231 |doi=10.1093/scan/nst104 |issn=1749-5016 |pmc=4127028 |pmid=23926170}} People that exhibit antisocial behavior also tend to demonstrate decreased activity in the prefrontal cortex, as is apparent in functional neuroimaging.

Cavum septi pellucidi (CSP) is a marker for limbic neural maldevelopment, and its presence has been loosely associated with certain mental disorders, such as schizophrenia and post-traumatic stress disorder.{{cite journal | vauthors = Galarza M, Merlo AB, Ingratta A, Albanese EF, Albanese AM | title = Cavum septum pellucidum and its increased prevalence in schizophrenia: a neuroembryological classification | journal = The Journal of Neuropsychiatry and Clinical Neurosciences | volume = 16 | issue = 1 | pages = 41–6 | year = 2004 | pmid = 14990758 | doi = 10.1176/appi.neuropsych.16.1.41 }}{{cite journal | vauthors = May FS, Chen QC, Gilbertson MW, Shenton ME, Pitman RK | title = Cavum septum pellucidum in monozygotic twins discordant for combat exposure: relationship to posttraumatic stress disorder | journal = Biological Psychiatry | volume = 55 | issue = 6 | pages = 656–8 | date = March 2004 | pmid = 15013837 | pmc = 2794416 | doi = 10.1016/j.biopsych.2003.09.018 }}{{cite journal | vauthors = Raine A, Lee L, Yang Y, Colletti P | title = Neurodevelopmental marker for limbic maldevelopment in antisocial personality disorder and psychopathy | journal = The British Journal of Psychiatry | volume = 197 | issue = 3 | pages = 186–92 | date = September 2010 | pmid = 20807962 | pmc = 2930915 | doi = 10.1192/bjp.bp.110.078485 }} One study found that those with CSP had significantly higher levels of antisocial personality, psychopathy, arrests and convictions compared with controls.

Many studies suggest that the social and home environment contribute to the development of ASPD. Parents of children with ASPD may display antisocial behavior themselves, which are then adopted by their children. A lack of parental stimulation and affection during early development can lead to high levels of cortisol with the absence of balancing hormones such as oxytocin.

This disrupts and overloads the child's stress response systems, which is thought to lead to underdevelopment of the part of the child's brain that deals with emotion, empathy, and ability to connect to other humans on an emotional level. According to Dr. Bruce Perry in his book The Boy Who Was Raised as a Dog, "the infant's developing brain needs to be patterned, repetitive stimuli to develop properly. Spastic, unpredictable relief from fear, loneliness, discomfort, and hunger keeps a baby's stress system on high alert. An environment of intermittent care punctuated by total abandonment may be the worst of all worlds for a child."{{cite book |vauthors=Perry B, Szalavitz M |title = The Boy Who Was Raised as a Dog |publisher=Basic Books|year=2017|isbn=978-0-465-09445-5|location=New York|pages=123|orig-date=2006}}

Some hypothesize that parenting styles can affect how children experience and develop in their youth, and can have an impact on a child's diagnosis of ASPD.{{Cite journal |last=Álvarez-García |first=David |date=September 2016 |title=Parenting Style Dimensions As Predictors of Adolescent Antisocial Behavior |journal=Frontiers in Psychology |volume=7 |page=1383 |doi=10.3389/fpsyg.2016.01383 |pmid=27679591 |pmc=5020069 |doi-access=free }}{{Cite journal |last1=Francisco J P Cabrera |last2=Ana del Refugio C Herrera |last3=San J A Rubalcava |last4=Kalina I M Martínez |date=2017-06-02 |title=Behavior Patterns of Antisocial Teenagers Interacting with Parents and Peers: A Longitudinal Study |journal=Frontiers in Psychology |language=en |volume=8 |page=757 |doi=10.3389/fpsyg.2017.00757 |doi-access=free |pmid=28626430 |pmc=5455015 }}

ASPD is highly comorbid with emotional and physical abuse in childhood. Physical neglect also has a significant correlation to ASPD. The way a child bonds with its parents early in life is important. Poor parental bonding due to abuse or neglect puts children at greater risk for developing antisocial personality disorder.{{Cite journal |vauthors=Dargis M, Newman J, Koenigs M |date=September 21, 2015 |title=Clarifying the link between childhood abuse history and psychopathic traits in adult criminal offenders |journal=Personality Disorders |volume=7 |issue=3 |pages=221–228 |doi=10.1037/per0000147 |pmid=26389621 |pmc=4801766 }}{{Primary source inline|date=January 2025}} There is also a significant correlation with parental overprotection and people who develop ASPD.{{Cite journal |last1=Schorr |first1=Manuela Teixeira |last2=Quadors dos Santos |first2=Barbara Tietbohl Martins |last3=Feiten |first3=Jacson Gabriel |last4=Sordi |first4=Anne Orgler |last5=Pessi |first5=Cristina |last6=Diemen |first6=Lisia Von |last7=Passos |first7=Ives Cavalcante |last8=Telles |first8=Lisiers Elaine de Borba |last9=Hauck |first9=Simone |date=2021 |title=Association between childhood trauma, parental bonding and antisocial personality disorder in adulthood: A machine learning approach |journal=Psychiatry Research |volume=304 |issue=114082 |page=114082 |doi=10.1016/j.psychres.2021.114082 |pmid=34303948 |s2cid=235664980}}{{Primary source inline|date=January 2025}}

Those with ASPD may have experienced any of the following forms of childhood trauma or abuse: physical or sexual abuse, neglect, coercion, abandonment or separation from caregivers, violence in a community, acts of terror, bullying, or life-threatening incidents.{{Cite journal |last=Semiz |first=Umit B. |title=Childhood trauma history and dissociative experiences among Turkish men diagnosed with antisocial personality disorder |journal=Social Psychiatry and Psychiatric Epidemiology |year=2007 |volume=42 |issue=11 |pages=865–873 |doi=10.1007/s00127-007-0248-2 |pmid=17721668 |s2cid=32065022 |url=http://dx.doi.org/10.1007/s00127-007-0248-2}}{{Cite web |last=Duquesne University |date=January 4, 2021 |title=Childhood Trauma: Understanding How Trauma Impacts Mental Health and Wellness |url=https://onlinenursing.duq.edu/blog/childhood-trauma/}} Some symptoms can mimic other forms of mental illness, such as:

• post-traumatic stress disorder (symptoms of upsetting/terrifying memories of traumatic events)
• reactive attachment disorder (little to no response regarding emotional triggers)
• disinhibited social engagement disorder (roaming off with people you don't know without caregivers being informed)
• dissociative identity disorder (disconnection from self or environment){{Cite web |last=Children's Hospital of Philadelphia |title=Trauma and Stressor- related Disorders in Children |date=14 June 2017 |url=https://www.chop.edu/conditions-diseases/trauma-and-stressor-related-disorders-children}}{{Cite web |last=McLean |date=August 29, 2022 |title=Understanding Dissociative Identity Disorder |url=https://www.mcleanhospital.org/essential/did}}

The comorbidity rate of the previously listed disorders with ASPD tend to be much higher.{{Cite web |last=Sareen |first=Jitender |date=April 2023 |title=Posttraumatic stress disorder in adults: Epidemiology, Pathophysiology, Clinical manifestations, course assessment, and diagnosis |url=https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis/print#:~:text=Personality%20disorders%20–%20Patients%20with%20PTSD,compared%20with%20the%20general%20population. |website=UpToDate |access-date=10 May 2023 |archive-date=10 May 2023 |archive-url=https://web.archive.org/web/20230510153536/https://www.uptodate.com/contents/posttraumatic-stress-disorder-in-adults-epidemiology-pathophysiology-clinical-manifestations-course-assessment-and-diagnosis/print#:~:text=Personality%20disorders%20–%20Patients%20with%20PTSD,compared%20with%20the%20general%20population. |url-status=dead }}

The sociocultural perspective of clinical psychology views disorders as influenced by cultural aspects; since cultural norms differ significantly, mental disorders (such as ASPD) are viewed differently.{{cite journal | vauthors = Lock MP | title = Treatment of antisocial personality disorder | journal = The British Journal of Psychiatry | volume = 193 | issue = 5 | pages = 426; author reply 426 | date = November 2008 | pmid = 18978330 | doi = 10.1192/bjp.193.5.426 | doi-access = free }} Robert D. Hare suggested that the rise in ASPD that has been reported in the United States may be linked to changes in cultural norms, serving to validate the behavioral tendencies of many individuals with ASPD.{{cite book | vauthors = Stout M | title = The sociopath next door: the ruthless versus the rest of us | date = 2006 | publisher = Broadway Books | location = New York |isbn=978-0-7679-1582-3 | edition = 1st | url-access = registration | url = https://archive.org/details/sociopathnextdoo00stou }}{{rp|136}} While the rise reported may be in part a byproduct of the widening use (and abuse) of diagnostic techniques,{{cite book | vauthors = Sutker PB, Allain AN | chapter = Antisocial Personality Disorder | veditors = Sutker PB, Adams HE | title = Comprehensive Handbook of Psychopathology | pages = 445–490 | date = 2002 | publisher = Springer | location = Boston, MA |isbn=978-0-306-46490-4 | doi = 10.1007/0-306-47377-1_16 | edition = 3rd }} given Eric Berne's division between individuals with active and latent ASPD – the latter keeping themselves in check by attachment to an external source of control like the law, traditional standards, or religion{{cite book | last1 = Berne | first1 = Eric | title = A Layman's Guide to Psychiatry and Psychoanalysis | date = 1976 | publisher = Grove | location = New York, NY |isbn=978-0-394-17833-2 | edition = first | pages = 241–2}} – it has been suggested that the erosion of collective standards may serve to release the individual with latent ASPD from their previously prosocial behavior.{{rp|136–7}}

There is also a continuous debate as to the extent to which the legal system should be involved in the identification and admittance of patients with preliminary symptoms of ASPD.{{cite book | last1 = McCallum | first1 = David | title = Personality and Dangerousness: Genealogies of Antisocial Personality Disorder | date = 2001 | publisher = Cambridge Univ. Press | location = New York |isbn=978-0-521-00875-4 | page = 7 }} Controversial clinical psychiatrist Pierre-Édouard Carbonneau suggested that the problem with legal forced admittance is the rate of failure when diagnosing ASPD. He contends that the possibility of diagnosing and coercing a patient into prescribing medication to someone without ASPD, but is diagnosed with ASPD, could be potentially disastrous. But the possibility of not diagnosing ASPD and seeing a patient go untreated because of a lack of sufficient evidence of cultural or environmental influences is something a psychiatrist must ignore; and in his words, "play it safe".{{cite book|title=Forensic Uses of Clinical Assessment Instruments| vauthors = Archer R, Wheeler E |publisher=Routledge|year=2006|pages=247–250}}

{{Main|Conduct disorder}}

While antisocial personality disorder is a mental disorder diagnosed in adulthood, it has its precedent in childhood.{{cite book | vauthors = McCallum D |title=Personality and dangerousness: genealogies of antisocial personality disorder|date=2001|publisher=Cambridge University Press|location=Cambridge, England|isbn=978-0-521-00875-4|oclc=52493285}} The DSM-5's criteria for ASPD require that the individual have conduct problems evident by the age of 15. Persistent antisocial behavior, as well as a lack of regard for others in childhood and adolescence, is known as conduct disorder and is the precursor of ASPD.{{cite book|title= Diagnostic and Statistical Manual of Mental Disorders|edition= 4th|publisher=American Psychiatric Association|location= Washington, DC|date= 2000}} About 25–40% of youths with conduct disorder will be diagnosed with ASPD in adulthood.{{cite journal | vauthors = Zoccolillo M, Pickles A, Quinton D, Rutter M | title = The outcome of childhood conduct disorder: implications for defining adult personality disorder and conduct disorder | journal = Psychological Medicine | volume = 22 | issue = 4 | pages = 971–86 | date = November 1992 | pmid = 1488492 | doi = 10.1017/s003329170003854x | publisher = Cambridge University Press | s2cid = 25470721 }}

Conduct disorder (CD) is a disorder diagnosed in childhood that parallels the characteristics found in ASPD. It is characterized by a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate norms are violated by the child. Children with the disorder often display impulsive and aggressive behavior, may be callous and deceitful, may repeatedly engage in petty crime (such as stealing or vandalism), or get into fights with other children and adults.

This behavior is typically persistent and may be difficult to deter with either threat or punishment. Attention deficit hyperactivity disorder (ADHD) is common in this population, and children with the disorder may also engage in substance use.{{cite book|last1= Hinshaw|first1= Stephen P.|last2= Lee|first2= Steve S. |title= Child Psychopathology|url= https://books.google.com/books?id=uoKsJUd-73gC&pg=PA144|chapter= Conduct and Oppositional Defiant Disorders|chapter-url= https://leelab.psych.ucla.edu/wp-content/uploads/sites/44/2015/10/Hinshaw-and-Lee-2003-ODD-CD-Chapter.pdf|pages= 144–198|editor-last1=Mash|editor-first1= Eric J.|editor-last2= Barkely|editor-first2= Russell A.|edition= 2|publisher= Guilford Press|location= New York City|date= 2003|isbn=978-1-57230-609-7|author-link1= Stephen P. Hinshaw}}{{cite journal | vauthors = Lynskey MT, Fergusson DM | title = Childhood conduct problems, attention deficit behaviors, and adolescent alcohol, tobacco, and illicit drug use | journal = Journal of Abnormal Child Psychology | volume = 23 | issue = 3 | pages = 281–302 | date = June 1995 | pmid = 7642838 | doi = 10.1007/bf01447558 | publisher = Springer Science+Business Media | author-link2 = David M. Fergusson | s2cid = 40789985 }} CD is distinct from oppositional defiant disorder (ODD) in that children with ODD do not commit aggressive or antisocial acts against other people, animals, or property, though many children diagnosed with ODD are subsequently re-diagnosed with CD.{{cite journal | vauthors = Loeber R, Keenan K, Lahey BB, Green SM, Thomas C | title = Evidence for developmentally based diagnoses of oppositional defiant disorder and conduct disorder | journal = Journal of Abnormal Child Psychology | volume = 21 | issue = 4 | pages = 377–410 | date = August 1993 | pmid = 8408986 | doi = 10.1007/bf01261600 | s2cid = 43444052 }}

Two developmental courses for CD have been identified based on the age at which the symptoms become present. The first course is known as the "childhood-onset type" and occurs when conduct disorder symptoms are present before the age of 10. This course is often linked to a more persistent life course and more pervasive behaviors, and children in this group express greater levels of ADHD symptoms, neuropsychological deficits, more academic problems, increased family dysfunction, and higher likelihood of aggression and violence.{{cite journal | vauthors = Moffitt TE | title = Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy | journal = Psychological Review | volume = 100 | issue = 4 | pages = 674–701 | date = October 1993 | pmid = 8255953 | doi = 10.1037/0033-295x.100.4.674 | author-link = Terrie Moffitt }}

The second course is known as the "adolescent-onset type" and occurs when conduct disorder develops after the age of 10 years. Compared to the childhood-onset type, less impairment in various cognitive and emotional functions are present, and the adolescent-onset variety may remit by adulthood.{{cite journal | vauthors = Moffitt TE, Caspi A | title = Childhood predictors differentiate life-course persistent and adolescence-limited antisocial pathways among males and females | journal = Development and Psychopathology | volume = 13 | issue = 2 | pages = 355–75 | date = June 2001 | pmid = 11393651 | doi = 10.1017/s0954579401002097 | s2cid = 29182035 | author-link1 = Terrie Moffitt }} In addition to this differentiation, the DSM-5 provides a specifier for a callous and unemotional interpersonal style, which reflects characteristics seen in psychopathy and are believed to be a childhood precursor to this disorder. Compared to the adolescent-onset subtype, the childhood-onset subtype tends to have a worse treatment outcome, especially if callous and unemotional traits are present.{{cite journal | vauthors = Baumgärtner G, Soyka M | title = [DSM-5--what has changed in therapy for and research on substance-related and addictive disorders?] | journal = Fortschritte der Neurologie-Psychiatrie | volume = 81 | issue = 11 | pages = 648–54 | date = November 2013 | pmid = 24194058 | doi = 10.1159/000356537 | url = https://www.karger.com/ProdukteDB/miscArchiv/000/356/537/000356537_sm_eversion.pdf | access-date = 20 May 2017 | translator-last = Welsh | doi-access = free | translator-first = Susan }}

The main text of fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines antisocial personality disorder as being characterized by at least three of the following traits:

• Failure to conform to social norms and laws, indicated by repeatedly engaging in illegal activities.
• Deceitfulness, indicated by continuously lying, using aliases, or conning others for personal gain and pleasure.
• Exhibiting impulsivity or failing to plan ahead.
• Irritability and aggressiveness, indicated by repeatedly getting into fights or physically assaulting others.
• Reckless behaviors that disregard the safety of others.
• Irresponsibility, indicated by repeatedly failing to consistently work or honor financial obligations.
• Lack of remorse after hurting or mistreating another person.

In order to be diagnosed with antisocial personality disorder under the DSM-5, one must be at least 18 years old, show evidence of onset of conduct disorder before age 15, and antisocial behavior cannot be explained by schizophrenia or bipolar disorder.

{{TOC limit|3}}

{{Further|Alternative DSM-5 Model for Personality Disorders}}

In response to criticisms of the extant (Section II/DSM-IV) criteria for personality disorders, including their discordance with current models in the scientific literature,{{Citation needed|date=March 2025}} high comorbidity rate,{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American psychiatric association |isbn=978-0-89042-554-1 |edition=5th |location=Washington |pages=761}} overuse of some categories, underuse of others,{{Citation needed|date=March 2025}} as well as the use of the often most correct but uninformative personality disorder-not otherwise specified (PD-NOS) diagnosis, the DSM-5 Workgroup on personality disorders devised a dimensional model, called the Alternative DSM-5 Model for Personality Disorders (AMPD). This model bases diagnosis on the level of personality functioning as well as presence of pathological personality traits in a patient, rather than on a certain amount of descriptive criteria being met. Personality functioning comprises self functioning (identity and self-direction) and interpersonal functioning (empathy and intimacy), while pathological traits are such traits that are conducive to dysfunction.

The AMPD's category for antisocial personality disorder follows the general structure of the alternative model. Thus, criterion A specifies in which characteristic ways the four aspects of personality functioning are impacted by ASPD, two of which must be must be impaired to a "moderate or greater" level, while criterion B requires that at least six out of seven pathological traits be present in order for a diagnosis to be made. In the case of ASPD, the aforementioned traits belong to the domains of antagonism and disinhibition.{{Cite book |title=Diagnostic and statistical manual of mental disorders: DSM-5 |date=2013 |publisher=American psychiatric association |isbn=978-0-89042-554-1 |edition=5th |location=Washington |pages=764-765}}

In addition to the new criteria, the individual must be at least 18 years old, and meet the AMPD's general criteria for personality disorder, meaning that the traits must cause dysfunction or distress across time and a broad range of situations, and should not be better explained by another mental disorder, the pathophysiological effects of a substance, or a person's cultural or social background. Also included is a "with psychopathic traits" specifier modelled after the Fearless Dominance scale of the Psychopathic Personality Inventory, defined by low Anxiousness and Withdrawal and high Attention-Seeking. Researchers have also proposed the inclusion of Grandiosity and Restricted Affectivity to better capture psychopathy.{{cite journal | doi=10.1037/per0000179 | title=Examining the DSM–5 alternative personality disorder model operationalization of antisocial personality disorder and psychopathy in a male correctional sample | year=2016 | last1=Wygant | first1=Dustin B. | last2=Sellbom | first2=Martin | last3=Sleep | first3=Chelsea E. | last4=Wall | first4=Tina D. | last5=Applegate | first5=Kathryn C. | last6=Krueger | first6=Robert F. | last7=Patrick | first7=Christopher J. | journal=Personality Disorders: Theory, Research, and Treatment | volume=7 | issue=3 | pages=229–239 | pmid=26914324 }}{{cite journal |last1=Anderson |first1=Jaime L. |last2=Sellbom |first2=Martin |last3=Wygant |first3=Dustin B. |last4=Salekin |first4=Randall T. |last5=Krueger |first5=Robert F. |title=Examining the Associations Between DSM-5 Section III Antisocial Personality Disorder Traits and Psychopathy in Community and University Samples |journal=Journal of Personality Disorders |date=October 2014 |volume=28 |issue=5 |pages=675–697 |doi=10.1521/pedi_2014_28_134|pmid=24689766 }}{{cite journal | doi=10.1037/per0000006 | title=Antisocial personality disorder in DSM-5: Missteps and missed opportunities | year=2012 | last1=Lynam | first1=Donald R. | last2=Vachon | first2=David D. | journal=Personality Disorders: Theory, Research, and Treatment | volume=3 | issue=4 | pages=483–495 | pmid=23106185 }}

{{Main|Psychopathy}}

Psychopathy is commonly defined as a personality construct characterized partly by antisocial behavior, a diminished capacity for empathy and remorse, and poor behavioral controls.{{cite journal | vauthors = Skeem JL, Polaschek DL, Patrick CJ, Lilienfeld SO | title = Psychopathic Personality: Bridging the Gap Between Scientific Evidence and Public Policy | journal = Psychological Science in the Public Interest | volume = 12 | issue = 3 | pages = 95–162 | date = December 2011 | pmid = 26167886 | doi = 10.1177/1529100611426706 | url = http://www.psychologicalscience.org/index.php/publications/journals/pspi/psychopathy.html | s2cid = 8521465 }}{{cite journal | vauthors = Blair RJ | title = Neurobiological basis of psychopathy | journal = The British Journal of Psychiatry | volume = 182 | pages = 5–7 | date = January 2003 | pmid = 12509310 | doi = 10.1192/bjp.182.1.5 | doi-access = free }}{{cite web | url = http://www.merriam-webster.com/dictionary/psychopathy | title = Definition of psychopathy | author = Merriam-Webster Dictionary | access-date = 15 May 2013}}{{cite web | url = http://www.minddisorders.com/Flu-Inv/Hare-Psychopathy-Checklist.html | title = Hare Psychopathy Checklist | author = Encyclopedia of Mental Disorders | access-date = 15 May 2013}} Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL-R).{{cite book | vauthors = Hare RD | year = 2003 | title = Manual for the Revised Psychopathy Checklist | edition = 2nd | location = Toronto, ON, Canada | publisher = Multi-Health Systems }} "Psychopathy" is not the official title of any diagnosis in the DSM or ICD; nor is it an official title used by any other major psychiatric organizations. The DSM and ICD, however, state that their antisocial diagnoses are at times referred to (or include what is referred to) as psychopathy or sociopathy.{{cite web |title=Dissocial personality disorder – International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) |url=http://www.mentalhealth.com/icd/p22-pe04.html |archive-url=https://web.archive.org/web/20130911063127/http://www.mentalhealth.com/icd/p22-pe04.html |archive-date=11 September 2013 |access-date=8 April 2020}}{{cite book | title = DSM-IV-TR: Diagnostic and Statistical Manual of Mental Disorders | url = https://archive.org/details/diagnosticcriter0000unse | url-access = registration | date = 2000 | publisher = American Psychiatric Association Press Inc. | location = United States |isbn=978-0-89042-025-6 | edition = Fourth }}{{cite web | url = http://apps.who.int/classifications/icd10/browse/2016/en | publisher = World Health Organization | year = 2016 | title = International Statistical Classification of Diseases and Related Health Problems | edition = 10th }}

American psychiatrist Hervey Cleckley's work{{cite journal| vauthors = Horley J |s2cid=145719285 | title=The emergence and development of psychopathy|journal=History of the Human Sciences|volume=27|issue=5|pages=91–110|doi=10.1177/0952695114541864|year=2014 }} on psychopathy formed the basis of the diagnostic criteria for ASPD, and the DSM states ASPD is often referred to as psychopathy.{{cite book |last=Patrick |first=Christopher J. |url=https://books.google.com/books?id=OuNdrmHcJlgC |title=Handbook of Psychopathy |publisher=Guilford Press |year=2005 |isbn=978-1-60623-804-2}} However, critics argue ASPD is not synonymous with psychopathy as the diagnostic criteria are not the same, since criteria relating to personality traits are emphasized relatively less in the former. These differences exist in part because it was believed such traits were difficult to measure reliably and it was "easier to agree on the behaviors that typify a disorder than on the reasons why they occur".{{cite journal |last=Hare |first=Robert D. |author-link=Robert D. Hare |date=1 February 1996 |title=Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion |url=http://www.psychiatrictimes.com/dsm-iv/content/article/10168/54831 |journal=Psychiatric Times |location=New York City |publisher=UBM plc |volume=13 |issue=2 |url-access=registration |archive-url=https://web.archive.org/web/20130528053223/http://www.psychiatrictimes.com/dsm-iv/content/article/10168/54831 |archive-date=28 May 2013 |access-date=19 May 2017}}{{cite journal |author-link1=Robert D. Hare |vauthors=Hare RD, Hart SD, Harpur TJ |date=August 1991 |title=Psychopathy and the DSM-IV criteria for antisocial personality disorder |url=http://www.psych.utoronto.ca/~peterson/psy430s2001/Hare%20RD%20Psychopathy%20JAP%201991.pdf |journal=Journal of Abnormal Psychology |volume=100 |issue=3 |pages=391–8 |doi=10.1037/0021-843x.100.3.391 |pmid=1918618 |archive-url=https://web.archive.org/web/20070926115500/http://www.psych.utoronto.ca/~peterson/psy430s2001/Hare%20RD%20Psychopathy%20JAP%201991.pdf |archive-date=26 September 2007 |access-date=19 May 2017}}{{cite book |last1=Semple |first1=David |url=https://books.google.com/books?id=1MeRuoTs0loC |title=The Oxford Handbook of Psychiatry |last2=Smyth |first2=Roger |last3=Burns |first3=Jonathan |last4=Darjee |first4=Rajan |last5=McIntosh |first5=Andrew |publisher=Oxford University Press |year=2005 |isbn=978-0-19-852783-1 |location=Oxford, England |pages=448–449}}

Although the diagnosis of ASPD covers two to three times as many prisoners as the diagnosis of psychopathy, Robert Hare believes the PCL-R is better able to predict future criminality, violence, and recidivism than a diagnosis of ASPD. He suggests there are differences between PCL-R-diagnosed psychopaths and non-psychopaths on "processing and use of linguistic and emotional information", while such differences are potentially smaller between those diagnosed with ASPD and without. Additionally, Hare argued confusion regarding how to diagnose ASPD, confusion regarding the difference between ASPD and psychopathy, as well as the differing future prognoses regarding recidivism and treatability, may have serious consequences in settings such as court cases where psychopathy is often seen as aggravating the crime.

Nonetheless, psychopathy has been proposed as a specifier under an alternative model for ASPD. In the DSM-5, under "Alternative DSM-5 Model for Personality Disorders", ASPD with psychopathic features is described as characterized by "a lack of anxiety or fear and by a bold interpersonal style that may mask maladaptive behaviors (e.g., fraudulence)". Low levels of withdrawal and high levels of attention-seeking combined with low anxiety are associated with "social potency" and "stress immunity" in psychopathy.{{cite book|title= Diagnostic and Statistical Manual of Mental Disorders|year= 2013|publisher= American Psychiatric Association|isbn=978-0-89042-555-8|editor1-last= Kupfer|editor2-last= Regier|edition= 5|editor2-first= Darrell|editor1-first= David|location= Washington, DC|editor1-link= David Kupfer|url-access= registration|url= https://archive.org/details/diagnosticstatis0005unse}}{{rp|765}} Under the specifier, affective and interpersonal characteristics are comparatively emphasized over behavioral components.{{cite book |last=Nussbaum |first=Abraham |year=2013 |title=The Pocket Guide to the DSM-5 Diagnostic Exam |url=https://books.google.com/books?id=rEPy72wKdswC |location=Arlington|publisher= American Psychiatric Association |isbn=978-1-58562-466-9 |access-date=5 January 2014 }} Research suggests that, even without the "with psychopathic traits" specifier, these Section III criteria accurately capture the affective-interpersonal features of psychopathy, though the specifier increases coverage of the Interpersonal and Lifestyle facets of the PCL-R.

Theodore Millon suggested 5 subtypes of ASPD.{{cite book|last1=Millon|first1=Theodore |title=Personality Disorders in Modern Life|date=2000 |publisher=John Wiley & Sons, Inc.|location=Hoboken, New Jersey|isbn=978-0-471-23734-1|pages=158–161|edition=Second}}[http://millon.net/taxonomy/summary.htm Millon, Theodore – Personality Subtypes]. Millon.net. Retrieved on 7 December 2011. {{Webarchive|url=https://web.archive.org/web/20180301104112/http://www.millon.net/taxonomy/summary.htm |date=1 March 2018}} However, these constructs are not recognized in the DSM or ICD.

Elsewhere, Millon differentiates ten subtypes (partially overlapping with the above) – covetous, risk-taking, malevolent, tyrannical, malignant, disingenuous, explosive, and abrasive – but specifically stresses that "the number 10 is by no means special ... Taxonomies may be put forward at levels that are more coarse or more fine-grained."{{rp|223}}

ASPD is considered to be among the most difficult personality disorders to treat.{{cite book | vauthors = Gabbard GO, Gunderson JG | date = 2000 | title = Psychotherapy for Personality Disorders | journal = The Journal of Psychotherapy Practice and Research | volume = 9 | issue = 1 | pages = 1–6 | edition = First | publisher = American Psychiatric Publishing | pmid = 10608903 | pmc = 3330582 |isbn=978-0-88048-273-8 }}{{cite book | vauthors = Stone MH | year = 1993 | title = Abnormalities of Personality. Within and Beyond the Realm of Treatment | publisher = Norton |isbn=978-0-393-70127-2 }}{{Cite web |author-link=Substance Abuse and Mental Health Services Administration |date=2023 |title=Antisocial Personality Disorder |url=https://www.samhsa.gov/mental-health/antisocial-personality-disorder |access-date=January 24, 2024}}{{cite book|title=Abnormal psychology| vauthors = Nolen-Hoeksema S |isbn=978-0-07-803538-8|edition= Sixth|location=New York, NY|oclc=855264280|date = 2 December 2013}} Rendering an effective treatment for ASPD is further complicated due to the inability to look at comparative studies between psychopathy and ASPD due to differing diagnostic criteria, differences in defining and measuring outcomes and a focus on treating incarcerated patients rather than those in the community.{{cite book| vauthors = Meloy JR, Yakeley AJ |title=Antisocial personality disorder|date=2011}} Because of their very low or absent capacity for remorse, individuals with ASPD often lack sufficient motivation and fail to see the costs associated with antisocial acts. They may only simulate remorse rather than truly commit to change: they can be charming and dishonest, and may manipulate staff and fellow patients during treatment.{{cite book|author2-link=Andrew E. Skodol | vauthors = Oldham JM, Skodol AE, Bender DS | year = 2005 | title = The American Psychiatric Publishing Textbook of Personality Disorders | publisher = American Psychiatric Publishing |isbn=978-1-58562-159-0 }} Studies have shown that outpatient therapy is not likely to be successful, but the extent to which persons with ASPD are entirely unresponsive to treatment may have been exaggerated.{{cite journal | vauthors = Salekin RT | title = Psychopathy and therapeutic pessimism. Clinical lore or clinical reality? | journal = Clinical Psychology Review | volume = 22 | issue = 1 | pages = 79–112 | date = February 2002 | pmid = 11793579 | doi = 10.1016/S0272-7358(01)00083-6 }}

Most treatment done is for those in the criminal justice system to whom the treatment regimes are given as part of their imprisonment.{{cite journal | vauthors = McRae L | title = Rehabilitating antisocial personalities: treatment through self-governance strategies | journal = The Journal of Forensic Psychiatry & Psychology | volume = 24 | issue = 1 | pages = 48–70 | date = February 2013 | pmid = 24009471 | pmc = 3756620 | doi = 10.1080/14789949.2012.752517 }} Those with ASPD may stay in treatment only as required by an external source, such as parole conditions. Residential programs that provide a carefully controlled environment of structure and supervision along with peer confrontation have been recommended. There has been some research on the treatment of ASPD that indicated positive results for therapeutic interventions.{{cite book | last1 = Derefinko | first1 = Karen J. | first2 = Thomas A. | last2 = Widiger | chapter = Antisocial Personality Disorder | title = The Medical Basis of Psychiatry |year=2008|pages=213–226|doi=10.1007/978-1-59745-252-6_13|isbn=978-1-58829-917-8}}

Psychotherapy, also known as "talk" therapy, has been found to help treat patients with ASPD.{{cite news|url=http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/treatment/txc-20198986|title=Treatment – Mayo Clinic|work=Mayo Clinic|access-date=13 June 2017|language=en}} Schema therapy is also being investigated as a treatment for ASPD.{{cite journal|url=http://www.iafmhs.org/files/Bernstein.pdf |title=Schema Focused Therapy in Forensic Settings: Theoretical Model and Recommendations for Best Clinical Practice |journal=International Journal of Forensic Mental Health |year=2007 |volume=6 |issue=2 |pages=169–183 |doi=10.1080/14999013.2007.10471261 |last1=Bernstein |first1=David P. |last2=Arntz |first2=Arnoud |last3=Vos |first3=Marije de |hdl=11577/3237556 |s2cid=145389897 | archive-url = https://web.archive.org/web/20110726163913/http://www.iafmhs.org/files/Bernstein.pdf |archive-date=26 July 2011 }} A review by Charles M. Borduin features the strong influence of multisystemic therapy (MST) that could potentially improve this issue. However, this treatment requires complete cooperation and participation of all family members.{{cite journal | vauthors = Gatzke LM, Raine A | title = Treatment and prevention implications of antisocial personality disorder | journal = Current Psychiatry Reports | volume = 2 | issue = 1 | pages = 51–5 | date = February 2000 | pmid = 11122932 | doi = 10.1007/s11920-000-0042-2 | s2cid = 33844568 }} Some studies have found that the presence of ASPD does not significantly interfere with treatment for other disorders, such as substance use,{{cite journal | vauthors = Darke S, Finlay-Jones R, Kaye S, Blatt T | title = Anti-social personality disorder and response to methadone maintenance treatment | journal = Drug and Alcohol Review | volume = 15 | issue = 3 | pages = 271–6 | date = September 1996 | pmid = 16203382 | doi = 10.1080/09595239600186011 }} although others have reported contradictory findings.{{cite journal | vauthors = Alterman AI, Rutherford MJ, Cacciola JS, McKay JR, Boardman CR | title = Prediction of 7 months methadone maintenance treatment response by four measures of antisociality | journal = Drug and Alcohol Dependence | volume = 49 | issue = 3 | pages = 217–23 | date = February 1998 | pmid = 9571386 | doi = 10.1016/S0376-8716(98)00015-5 | doi-access = free }}

Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative,{{cite web|title=Antisocial personality disorder|url=http://www.nhs.uk/conditions/antisocial-personality-disorder/Pages/Introduction.aspx|website=NHS|access-date=11 May 2016}} and abusive behaviors.{{cite web|title=Antisocial personality disorder: prevention and management|url=https://www.nice.org.uk/guidance/cg77/chapter/Introduction|website=NICE|access-date=11 May 2016|date=March 2013|archive-date=11 June 2016|archive-url=https://web.archive.org/web/20160611084803/https://www.nice.org.uk/guidance/cg77/chapter/Introduction|url-status=dead}} Rather than attempt to develop a sense of conscience in these individuals, which is extremely difficult considering the nature of the disorder, therapeutic techniques are focused on rational and utilitarian arguments against repeating past mistakes. These approaches would focus on the tangible, material value of prosocial behavior and abstaining from antisocial behavior. However, the impulsive and aggressive nature of those with this disorder may limit the effectiveness of this form of therapy.{{cite book | last1 = Beck | first1 = Aaron T. | last2 = Freeman | first2 = Arthur | last3 = Davis | first3 = Denise D. | title = Cognitive Therapy of Personality Disorders | date = 2007 | publisher = Guilford Press | location = New York |isbn=978-1-59385-476-8 | edition = Second | url-access = registration | url = https://archive.org/details/cognitivetherapy0000beck }}

The use of medications in treating antisocial personality disorder is still poorly explored, and no medications have been approved by the FDA to specifically treat ASPD.{{cite web |url=http://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/diagnosis-treatment/treatment/txc-20198986 |title=Antisocial personality disorder: Treatments and drugs |author=Mayo Clinic staff |date=12 April 2013 |website=Mayo Clinic |publisher=Mayo Foundation for Medical Education and Research |access-date=17 December 2013}} A 2020 Cochrane review of studies that explored the use of pharmaceuticals in ASPD patients, of which eight studies met the selection criteria for review, concluded that the current body of evidence was inconclusive for recommendations concerning the use of pharmaceuticals in treating the various issues of ASPD.{{cite journal | vauthors = Khalifa NR, Gibbon S, Völlm BA, Cheung NH, McCarthy L | title = Pharmacological interventions for antisocial personality disorder | journal = The Cochrane Database of Systematic Reviews | volume = 2020 | pages = CD007667 | date = September 2020 | issue = 9 | pmid = 32880105 | doi = 10.1002/14651858.CD007667.pub3 | pmc = 8094881 }} Nonetheless, psychiatric medications such as antipsychotics, antidepressants, and mood stabilizers can be used to control symptoms such as aggression and impulsivity, as well as treat disorders that may co-occur with ASPD for which medications are indicated.{{Cite journal |last1=Brown |first1=Darcy |last2=Larkin |first2=Fintan |last3=Sengupta |first3=Samrat |last4=Romero-Ureclay |first4=Jose L. |last5=Ross |first5=Callum C. |last6=Gupta |first6=Nitin |last7=Vinestock |first7=Morris |last8=Das |first8=Mrigendra |date=2014 |title=Clozapine: an effective treatment for seriously violent and psychopathic men with antisocial personality disorder in a UK high-security hospital |journal=CNS Spectrums |volume=19 |issue=5 |pages=391–402 |doi=10.1017/S1092852914000157 |issn=1092-8529 |pmc=4255317 |pmid=24698103}}{{Cite web |title=Antisocial Personality Disorder: Beyond Keeping to Yourself |url=https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-disorder |access-date=2024-01-25 |website=Cleveland Clinic |language=en}}{{cite book | vauthors = Bucholz KK, Frey RJ, Edens EL | chapter = Antisocial Personality Disorder | date = 2009 | veditors = Korsmeyer P, Kranzler HR | title = Encyclopedia of Drugs, Alcohol & Addictive Behavior | edition = 3rd | volume = 1 | pages = 181–183 | location = Detroit, MI | publisher = Macmillan Reference USA }}{{cite journal| vauthors = Hatchett G |date=2015-01-01|title=Treatment Guidelines for Clients with Antisocial Personality Disorder|url=https://meridian.allenpress.com/jmhc/article/37/1/15/83299/Treatment-Guidelines-for-Clients-with-Antisocial|journal=Journal of Mental Health Counseling|language=en|volume=37|issue=1|pages=15–27|doi=10.17744/mehc.37.1.52g325w385556315|issn=1040-2861}}

Boys are almost twice as likely to meet all of the diagnostic criteria for ASPD than girls and they will often start showing symptoms of the disorder much earlier in life.{{cite book | vauthors = Fisher KA, Hany M | chapter = Antisocial Personality Disorder | date = 23 November 2019 | title = StatPearls [Internet]. | location = Treasure Island (FL) | publisher = StatPearls Publishing | pmid = 31536279 | chapter-url = https://www.ncbi.nlm.nih.gov/books/NBK546673/ }} Children that do not show symptoms of the disease through age 15 will almost never develop ASPD later in life. If adults exhibit milder symptoms of ASPD, it is likely that they never met the criteria for the disorder in their childhood and were consequently never diagnosed. Overall, symptoms of ASPD tend to peak in late teens and early twenties, but can often reduce or improve through age 40.

ASPD is ultimately a lifelong disorder that has chronic consequences, though some of these can be moderated over time. There may be a high variability of the long-term outlook of antisocial personality disorder. The treatment of this disorder can be successful, but it entails unique difficulties. It is unlikely to see rapid change especially when the condition is severe. In fact, past studies revealed that remission rates were small, with 27-31% of patients with ASPD seeing an improvement "with the most violent and dangerous features remitting". As a result of the characteristics of ASPD (e.g., displaying charm in effort of personal gain, manipulation), patients seeking treatment (mandated or otherwise) may appear to be "cured" in order to get out of treatment. According to definitions found in the DSM-5, people with ASPD can be deceitful and intimidating in their relationships.{{cite web |title=Antisocial Personality Disorder|url=https://www.health.harvard.edu/a_to_z/antisocial-personality-disorder-a-to-z|access-date=2020-12-13|website=Harvard Health Publishing|date=13 March 2019}} When they are caught doing something wrong, they often appear to be unaffected and unemotional about the consequences. Over time, continual behavior that lacks empathy and concern may lead to someone with ASPD taking advantage of the kindness of others, including their therapist.

Without proper treatment, individuals with ASPD could lead a life that brings about harm to themselves or others. This can be detrimental to their families and careers. Those with ASPD lack interpersonal skills (e.g., lack of remorse, lack of empathy, lack of emotional-processing skills).{{cite journal | vauthors = Mann FD, Briley DA, Tucker-Drob EM, Harden KP | title = A behavioral genetic analysis of callous-unemotional traits and Big Five personality in adolescence | journal = Journal of Abnormal Psychology | volume = 124 | issue = 4 | pages = 982–993 | date = November 2015 | pmid = 26595476 | pmc = 5225906 | doi = 10.1037/abn0000099 }}{{cite journal | vauthors = Habel U, Kühn E, Salloum JB, Devos H, Schneider F | title = Emotional processing in psychopathic personality. | journal = Aggressive Behavior| date = September 2002 | volume = 28 | issue = 5 | pages = 394–400 | doi = 10.1002/ab.80015 }} As a result of the inability to create and maintain healthy relationships due to the lack of interpersonal skills, individuals with ASPD may find themselves in predicaments such as divorce, unemployment, homelessness and even premature death by suicide.{{cite journal | vauthors = Mueser KT, Crocker AG, Frisman LB, Drake RE, Covell NH, Essock SM | title = Conduct disorder and antisocial personality disorder in persons with severe psychiatric and substance use disorders | journal = Schizophrenia Bulletin | volume = 32 | issue = 4 | pages = 626–36 | date = October 2006 | pmid = 16574783 | pmc = 2632266 | doi = 10.1093/schbul/sbj068 }}{{cite journal | vauthors = Krasnova A, Eaton WW, Samuels JF | title = Antisocial personality and risks of cause-specific mortality: results from the Epidemiologic Catchment Area study with 27 years of follow-up | journal = Social Psychiatry and Psychiatric Epidemiology | volume = 54 | issue = 5 | pages = 617–625 | date = May 2019 | pmid = 30506390 | doi = 10.1007/s00127-018-1628-5 | s2cid = 54221869 }} They also see higher rates of committed crime, reaching peaks in their late teens and often committing higher-severity crimes in their younger ages of diagnoses. Comorbidity of other mental illnesses such as depression or substance use disorder is prevalent among patients with ASPD. People with ASPD are also more likely to commit homicides and other crimes. Those who are imprisoned longer often see higher rates of improvement with symptoms of ASPD than others who have been imprisoned for a shorter amount of time.

According to one study, aggressive tendencies show in about 72% of all male patients diagnosed with ASPD. About 29% of the men studied with ASPD also showed a prevalence of pre-meditated aggression.{{cite journal | vauthors = Azevedo J, Vieira-Coelho M, Castelo-Branco M, Coelho R, Figueiredo-Braga M | title = Impulsive and premeditated aggression in male offenders with antisocial personality disorder | journal = PLOS ONE | volume = 15 | issue = 3 | pages = e0229876 | date = March 2020 | pmid = 32142531 | pmc = 7059920 | doi = 10.1371/journal.pone.0229876 | bibcode = 2020PLoSO..1529876A | doi-access = free }} Based on the evidence in the study, the researchers concluded that aggression in patients with ASPD is mostly impulsive, though there are some long-term evidences of pre-meditated aggressions. It often occurs that those with higher psychopathic traits will exhibit the pre-meditated aggressions to those around them. Over the course of a patient's life with ASPD, he or she can exhibit this aggressive behavior and harm those close to him or her.

Additionally, many people (especially adults) who have been diagnosed with ASPD become burdens to their close relatives, peers, and caretakers. Harvard Medical School recommends that time and resources be spent treating victims who have been affected by someone with ASPD, because the patient with ASPD may not respond to the administered therapies. In fact, a patient with ASPD may only accept treatment when ordered by a court, which will make their course of treatment difficult and severe. Because of the challenges in treatment, the patient's family and close friends must take an active role in decisions about therapies that are offered to the patient. Ultimately, there must be a group effort to aid the long-term effects of the disorder.{{cite web|date=2018-03-21|title=Antisocial personality disorder|url=https://www.nhs.uk/conditions/antisocial-personality-disorder/|access-date=2020-12-13|website=nhs.uk|language=en}}

The estimated lifetime prevalence of ASPD amongst the general population falls within 1% to 4%,{{Cite journal |last1=Lenzenweger |first1=Mark F. |last2=Lane |first2=Michael C. |last3=Loranger |first3=Armand W. |last4=Kessler |first4=Ronald C. |date=September 2007 |title=DSM-IV Personality Disorders in the National Comorbidity Survey Replication |journal=Biological Psychiatry |language=en |volume=62 |issue=6 |pages=553–564 |doi=10.1016/j.biopsych.2006.09.019|pmid=17217923 |pmc=2044500 }} skewed towards 6% men and 2% women.{{Cite journal |last1=Compton |first1=Wilson M. |last2=Conway |first2=Kevin P. |last3=Stinson |first3=Frederick S. |last4=Colliver |first4=James D. |last5=Grant |first5=Bridget F. |date=2005-06-15 |title=Prevalence, Correlates, and Comorbidity of DSM-IV Antisocial Personality Syndromes and Alcohol and Specific Drug Use Disorders in the United States: Results From the National Epidemiologic Survey on Alcohol and Related Conditions |url=http://article.psychiatrist.com/?ContentType=START&ID=10001331 |journal=The Journal of Clinical Psychiatry |volume=66 |issue=6 |pages=677–685 |doi=10.4088/JCP.v66n0602 |pmid=15960559 |issn=0160-6689}} The prevalence of ASPD is even higher in selected populations, like prisons, where there is a preponderance of violent offenders. It has been found that the prevalence of ASPD among prisoners is just under 50%.{{cite book |author=National Collaborating Centre for Mental Health (UK). |url=https://www.ncbi.nlm.nih.gov/books/NBK55333/ |title=Antisocial Personality Disorder: Treatment, Management and Prevention. |date=2010 |publisher=British Psychological Society |location=Leicester (UK) |chapter=Antisocial Personality Disorder |pmid=21834198}} According to one study (n=23000), the prevalence of ASPD in prisoners is 47% in men and 21% in women.{{cite journal |last1=Fazel |first1=Seena |last2=Danesh |first2=John |title=Serious mental disorder in 23,000 prisoners: a systematic review of 62 surveys |journal=The Lancet |date=2002-02-16 |volume=359 |issue=9306 |pages=545–550 |doi=10.1016/S0140-6736(02)07740-1 |pmid=11867106 |url=https://pubmed.ncbi.nlm.nih.gov/11867106/}} Thus, with only 27-31% of patients with ASPD seeing an improvement in symptoms over time, statistically around one third (33%) of male prisoners will not see any improvement in their symptoms, and are thus essentially prognostically hopeless. The corresponding percentage of female prisoners with statistically no chance of improvement in symptoms is around 15% or roughly one in six. Similarly, the prevalence of ASPD is higher among patients in alcohol or other drug (AOD) use treatment programs than in the general population, suggesting a link between ASPD and AOD use and dependence. As part of the Epidemiological Catchment Area (ECA) study, men with ASPD were found to be three to five times more likely to excessively use alcohol and illicit substances than those men without ASPD. There was found to be increased severity of this substance use in women with ASPD. In a study conducted with both men and women with ASPD, women were more likely to misuse substances compared to their male counterparts.{{cite book | vauthors = Robins LN, Tipp J, Przybeck T | chapter = Antisocial personality | title = Psychiatric Disorders in America. | veditors = Robins LN, Regier DA | location = New York | publisher = Free Press | date = 1991 | pages = 258–290 }}

Homelessness is also common amongst people with ASPD.{{cite journal | doi=10.1111/dar.12446 | title=Mental health disorders among homeless, substance-dependent men who have sex with men | year=2017 | last1=Fletcher | first1=Jesse B. | last2=Reback | first2=Cathy J. | journal=Drug and Alcohol Review | volume=36 | issue=4 | pages=555–559 | pmid=27516073 | pmc=5303689 }} A study on 31 youths of San Francisco and 56 youths in Chicago found that 84% and 48% of the homeless met the diagnostic criteria for ASPD respectively.{{cite journal | doi=10.1111/j.1399-5618.2011.00900.x | title=Criminal conviction, impulsivity, and course of illness in bipolar disorder | year=2011 | last1=Swann | first1=Alan C. | last2=Lijffijt | first2=Marijn | last3=Lane | first3=Scott D. | last4=Kjome | first4=Kimberly L. | last5=Steinberg | first5=Joel L. | last6=Moeller | first6=F Gerard | journal=Bipolar Disorders | volume=13 | issue=2 | pages=173–181 | pmid=21443571 | pmc=3151155 }} Another study on the homeless found that 25% of participants had ASPD.{{cite journal | doi=10.1186/s40479-015-0033-x | title=Personality disorders and violence: What is the link? | year=2015 | last1=Howard | first1=Richard | journal=Borderline Personality Disorder and Emotion Dysregulation | volume=2 | page=12 | pmid=26401314 | pmc=4579506 | s2cid=7048653 | doi-access=free }}

Individuals with ASPD are at an elevated risk for suicide. Some studies suggest this increase in suicidality is in part due to the association between suicide and symptoms or trends within ASPD, such as criminality and substance use.{{cite journal | vauthors = Verona E, Patrick CJ, Joiner TE | title = Psychopathy, antisocial personality, and suicide risk | journal = Journal of Abnormal Psychology | volume = 110 | issue = 3 | pages = 462–70 | date = August 2001 | pmid = 11502089 | doi = 10.1037/0021-843x.110.3.462 }} Children of people with ASPD are also at risk.{{cite journal | vauthors = Mok PL, Pedersen CB, Springate D, Astrup A, Kapur N, Antonsen S, Mors O, Webb RT | title = Parental Psychiatric Disease and Risks of Attempted Suicide and Violent Criminal Offending in Offspring: A Population-Based Cohort Study | journal = JAMA Psychiatry | volume = 73 | issue = 10 | pages = 1015–1022 | date = October 2016 | pmid = 27580483 | pmc = 5079483 | doi = 10.1001/jamapsychiatry.2016.1728 }} Some research suggests that negative or traumatic experiences in childhood, perhaps as a result of the choices a parent with ASPD might make, can be a predictor of delinquency later on in the child's life. Additionally, with variability between situations, children of a parent with ASPD may face consequences of delinquency if they are raised in an environment in which crime and violence is common. Suicide is a leading cause of death among youth who display antisocial behavior, especially when mixed with delinquency. Incarceration, which could come as a consequence of actions from a person with ASPD, is a predictor for suicide ideation in youth.{{cite journal | vauthors = Abram KM, Choe JY, Washburn JJ, Teplin LA, King DC, Dulcan MK | title = Suicidal ideation and behaviors among youths in juvenile detention | journal = Journal of the American Academy of Child and Adolescent Psychiatry | volume = 47 | issue = 3 | pages = 291–300 | date = March 2008 | pmid = 18216737 | pmc = 2945393 | doi = 10.1097/CHI.0b013e318160b3ce }}

The first version of the DSM in 1952 listed sociopathic personality disturbance. This category was for individuals who were considered "...ill primarily in terms of society and of conformity with the prevailing milieu, and not only in terms of personal discomfort and relations with other individuals."{{Cite book |url=https://ia800701.us.archive.org/10/items/dsm-1/dsm-1952.pdf |title=Diagnostic and Statistical Manual of Mental Disorders |publisher=American Psychiatric Association |year=1952 |edition=1st |location=Washington, D. C. |pages=38–39 |language=En |quote="Individuals to be placed in this category are ill primarily in terms of society and of conformity with the prevailing cultural milieu, and not only in terms of personal discomfort and relations with other individuals."}} There were four subtypes, referred to as "reactions": antisocial, dyssocial, sexual, and addiction. The antisocial reaction was said to include people who were "always in trouble" and not learning from it, maintaining "no loyalties", frequently callous and lacking responsibility, with an ability to "rationalize" their behavior. The category was described as more specific and limited than the existing concepts of "constitutional psychopathic state" or "psychopathic personality" which had a very broad meaning; the narrower definition was in line with criteria advanced by Hervey M. Cleckley from 1941, while the term sociopathic had been advanced by George Partridge in 1928 when studying the early environmental influence on psychopaths. Partridge discovered the correlation between antisocial psychopathic disorder and parental rejection experienced in early childhood.{{cite book|title=Chemical dependency and antisocial personality disorder: psychotherapy and assessment strategies| vauthors = Forrest G |date=1994|publisher=Haworth Press|isbn=978-1-56024-308-3|location=New York|oclc=25246264|url-access=registration|url=https://archive.org/details/chemicaldependen0000forr}}

The DSM-II in 1968 rearranged the categories and "antisocial personality" was now listed as one of ten personality disorders but still described similarly, to be applied to individuals who are: "basically unsocialized", in repeated conflicts with society, incapable of significant loyalty, selfish, irresponsible, unable to feel guilt or learn from prior experiences, and who tend to blame others and rationalize.{{cite book|title = Diagnostic and Statistical Manual of Mental Disorders (DSM-II)|publisher = American Psychiatric Association|year = 1968|location = Washington, D. C.|pages = 43|url = http://www.germantownschools.org/faculty/kkorek/Handouts/Abnormal_Psychology/dsm-ii.pdf|archive-url = https://web.archive.org/web/20141101230009/http://www.germantownschools.org/faculty/kkorek/Handouts/Abnormal_Psychology/dsm-ii.pdf|archive-date = 1 November 2014}} The manual preface contains "special instructions" including "Antisocial personality should always be specified as mild, moderate, or severe." The DSM-II warned that a history of legal or social offenses was not by itself enough to justify the diagnosis, and that a "group delinquent reaction" of childhood or adolescence or "social maladjustment without manifest psychiatric disorder" should be ruled out first. The dyssocial personality type was relegated in the DSM-II to "dyssocial behavior" for individuals who are predatory and follow more or less criminal pursuits, such as racketeers, dishonest gamblers, prostitutes, and dope peddlers (DSM-I classified this condition as sociopathic personality disorder, dyssocial type). It would later resurface as the name of a diagnosis in the ICD manual produced by the WHO, later spelled dissocial personality disorder and considered approximately equivalent to the ASPD diagnosis.[https://books.google.com/books?id=C-fXBNTlk7wC International Handbook on Psychopathic Disorders and the Law], Volume 1, Alan Felthous, Henning Sass, 15 April 2008, e.g. Pgs 24 – 26

The DSM-III in 1980 included the full term antisocial personality disorder and, as with other disorders, there was now a full checklist of symptoms focused on observable behaviors to enhance consistency in diagnosis between different psychiatrists ('inter-rater reliability'). The ASPD symptom list was based on the Research Diagnostic Criteria developed from the so-called Feighner Criteria from 1972, and in turn largely credited to influential research by sociologist Lee Robins published in 1966 as "Deviant Children Grown Up".{{cite journal | vauthors = Kendler KS, Muñoz RA, Murphy G | title = The development of the Feighner criteria: a historical perspective | journal = The American Journal of Psychiatry | volume = 167 | issue = 2 | pages = 134–42 | date = February 2010 | pmid = 20008944 | doi = 10.1176/appi.ajp.2009.09081155 }} However, Robins has previously clarified that while the new criteria of prior childhood conduct problems came from her work, she and co-researcher psychiatrist Patricia O'Neal got the diagnostic criteria they used from Lee's husband the psychiatrist Eli Robins, one of the authors of the Feighner criteria who had been using them as part of diagnostic interviews.{{cite book|url=https://books.google.com/books?id=9AqPs9ootqoC|title=The DSM-IV Personality Disorders|editor-first1=W. John|editor-last1=Livesley|publisher=Guilford Press|year=1995|page=135|isbn=978-0-89862-257-7 }}

The DSM-IV maintained the trend for behavioral antisocial symptoms while noting, "This pattern has also been referred to as psychopathy, sociopathy, or dyssocial personality disorder" and re-including in the 'Associated Features' text summary some of the underlying personality traits from the older diagnoses. The DSM-5 has the same diagnosis of antisocial personality disorder. The Pocket Guide to the DSM-5 Diagnostic Exam suggests that a person with ASPD may present "with psychopathic features" if he or she exhibits "a lack of anxiety or fear and a bold, efficacious interpersonal style".

{{Columns-list|colwidth=40em|

• Gaslighting
• Animal abuse
• Anti-social behaviour order

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{{Reflist}}

{{Refbegin}}

• {{cite book | vauthors = Millon T, Davis RD | chapter = Ten Subtypes of Psychopathy | veditors = Millon T | title = Psychopathy: Antisocial, Criminal and Violent Behavior | date = 1998 | publisher = Guilford Press | location = New York, NY |isbn=978-1-57230-344-7 }}
• {{cite journal |doi=10.1177/0306624X8903300202|title=The Role of Manipulation in the Antisocial Personality |year=1989 |last1=Hofer |first1=Paul |journal=International Journal of Offender Therapy and Comparative Criminology |volume=33 |issue=2 |pages=91–101 |s2cid=145103240 }}

{{Refend}}

{{Wiktionary|antisocial}}

• [https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/antisocial-personality-disorder-aspd#v25246713 DSM-V-TR criteria + additional information]
• [http://www.behavenet.com/antisocial-personality-disorder#301 DSM-IV-TR Criteria for Antisocial personality disorder]
• [https://www.psychiatrictimes.com/view/psychopathy-and-antisocial-personality-disorder-case-diagnostic-confusion Psychopathy and Antisocial Personality Disorder: A Case of Diagnostic Confusion]

{{Medical condition classification and resources

| DiseasesDB =

| ICD10 = {{ICD10|F|60|2|f|60}}

| ICD9 = {{ICD9|301.7}}

| ICDO =

| OMIM =

| MedlinePlus = 000921

| eMedicineSubj =

| eMedicineTopic =

| MeshID = D000987

|ICD11={{ICD11|6D11.2}}}}

{{ICD-10 personality disorders}}

{{Psychopathy}}

{{Authority control}}

{{DEFAULTSORT:Antisocial personality disorder}}

Category:Anti-social behaviour

Category:Behavioural sciences

Category:Cluster B personality disorders

Category:Criminology

Category:Forensic psychology

Category:Psychopathy