What Is Antisocial Personality Disorder?

Antisocial personality disorder (ASPD) is a mental health condition in which an individual persistently disregards and violates the rights of others with offensive or harmful behavior. Popular culture refers to ASPD as sociopathy. People with this condition tend to be impulsive and dishonest with no sense of guilt. They may be resistant to treatment because they are often unable to recognize and acknowledge that they have this problem.

Doctors do not know how to prevent antisocial personality disorder. However, early detection and intervention might help mitigate ASPD’s impact on a person’s life and relationships. 1st Step Behavioral Health in Delray Beach, FL, has many years of experience helping individuals move past ASPD, which often co-occurs with addiction. We are ready to help you make positive, lasting changes for yourself and those you love.

What Causes Antisocial Personality Disorder?

Doctors do not know exactly how antisocial personality disorder develops. But they believe that biological and environmental factors contribute to its onset. If people have antisocial parents or parents with substance use disorders, they are at a greater risk. Antisocial personality disorder affects 70% more men than women, and it is common among those who are incarcerated.

Biological Factors

The paper “Biological Explanations of Criminal Behavior”, published in Psychology, Crime & Law, reviews three neurobiological factors behind antisocial and criminal behavior:  psychophysiology, brain mechanisms, and genetics.

Psychophysiology

Psychophysiology is the study of arousal levels within individuals. Studies link impaired autonomic functioning, measured by heart rate and sweat rate, with increased antisocial behavior. Research also suggests that a low resting heart rate in the teen years is associated with a higher risk for criminal behavior in adulthood. Furthermore, antisocial behavior seems to reinforce impeded physiological activity.

Several hypotheses attempt to explain how disrupted autonomic functioning promotes antisocial behavior. The fearlessness premise holds that people with ASPD do not experience normal physiological responses to risky situations nor consequences. The sensation-seeking thesis maintains that people with ASPD engage in antisocial behavior to raise their arousal levels to a comfortable state.

The somatic marker theory is another explanation connecting autonomic dysfunction to ASPD is that individuals are unable to associate physiological responses with emotional states appropriately. This failure, called somatic aphasia, affects socialization processes that influence the development of a conscience. Impaired autonomic functioning also reduces emotional intelligence and impedes the development of moral emotions such as guilt, empathy, and shame.

Brain Mechanisms

Individuals exhibit decreased brain volumes in addition to dysfunction and connectivity in regions related to executive functions including morality, emotion regulation, and decision-making. At the same time, these people show greater volumes and abnormalities in the prefrontal and subcortical, “reward” regions of the brain.

Genetics

Researchers have observed connections between genes and environmental influences as well as gene-to-gene interactions in relation to antisocial behavior. Mounting evidence supports the possibility of the biological imprint of early life stressors and transgenerational traumatization. These epigenetic alterations can result in long-lasting ASPD symptoms. The interplay of certain dopamine genes appears to increase the risk of criminal inclinations as well.

What Are the Symptoms and Signs of Antisocial Personality Disorder?

People with ASPD may appear to be callous and inconsiderate of the feelings and rights of others. They are often extremely opinionated and may not be able to empathize with others. These individuals may seem to act as if they are not obligated to obey rules. Often, those who suffer from ASPD do not believe that they are accountable for their harmful actions. While some people with this disorder isolate themselves socially, some present a charming façade.

If you suspect that someone you care about has ASPD, check for these signs

  • Deceitfulness: using aliases; misleading others for personal pleasure or profit
  • Impulsiveness: behaving irrationally on a whim; failing to plan
  • Recklessness: lack of concern for safety or consequences for oneself or others
  • Aggression and irritability: fighting; instigating conflict
  • Lack of remorse: indifference to or justifying having violated someone else’s body, rights, or property
  • Irresponsibility: repeatedly failing to meet obligations or sustain consistent employment

Dual Diagnosis: Antisocial Personality Disorder and Addiction

The Substance Abuse and Mental Health Services Administration defines serious mental illness as an individual having a diagnosable mental, emotional, or behavioral disorder over the past year that causes drastic functional impairment and interferes with one or more major life activities. Dual diagnosis, also called co-occurring disorders or comorbidity, refer to the simultaneous presence of a mental health disorder and a substance use disorder. It’s not always clear which develops first, and one doesn’t always cause the other.

The National Institute on Drug Abuse offers 3 possibilities regarding the onset and progression of co-occurring illnesses. To some extent, they all play into how symptoms manifest. Firstly, substances of abuse can induce symptoms of another mental illness. In some cases, mental conditions may lead to substance abuse. As with ASPD, SUDs and other mental illnesses arise from factors such as genetics, brain deficits, or early exposure to trauma or stress.

Research indicates that people diagnosed with antisocial personality disorder are two times as likely to deal with SUD. These individuals are at greater risk of going to jail or dying by violence. However, they seldom seek treatment on their own; they are usually forced to by the legal system.

A person living with both conditions often finds it more difficult to attain recovery on their own. This is because interactions between the conditions affect the course of both. Since symptoms of SUD and mental illnesses overlap, diagnosis and treatment can be quite complex. Nonetheless, proper diagnosis is crucial for determining and implementing effective treatment. Failure to recognize and treat comorbidities makes lasting recovery unlikely

At 1st Step Behavioral Health, we have been helping people master the challenges of co-occurring disorders for decades. However your comorbidity has developed and progressed, we will guide you in learning how to overcome the diseases. You have hope here. Call us today for yourself or your loved one.

Is There a Cure for Antisocial Personality Disorder?

ASPD can be difficult to treat because people with this illness usually do not feel that they need help. In some cases, they seek treatment for symptoms such as anxiety, depression, anger, or SUD. These individuals are not likely to give an accurate picture of their signs and symptoms of ASPD; loved ones and friends may be able to render a clearer account with permission

People with ASPD have difficulty connecting their feelings and behaviors. They also distrust and dislike authority figures, including therapists. Fortunately, some aggressive and criminal symptoms diminish with age.

How Is Antisocial Personality Disorder Diagnosed?

Typically, diagnosis for ASPD is made for people 18 and older. A primary care provider may refer an individual to a mental health professional or treatment center after ruling out other medical conditions. Diagnosis of ASPD usually considers:

  • A psychological evaluation analyzing thoughts, behavioral pattern, relationships, and family history
  • Personal and medical history
  • Symptoms listed in the American Psychiatric Association’s manual, DSM-5 

What Are the Risk Factors of Antisocial Personality Disorder?

The risk of developing antisocial personality disorder appears to rise with the occurrence of certain factors, including:

  • Family history of ASPD or other mental health illnesses
  • Diagnosis of childhood conduct disorder or mental health condition
  • Childhood abuse or neglect
  • Unstable, chaotic, or violent upbringing

The DSM states that antisocial personality disorder cannot be diagnosed in people under 18 years of age. This is because the brain and personality are constantly evolving in the formative and developmental years. Many children and adolescents outgrow antisocial behaviors. However, people with ASPD often exhibit symptoms before age 15. 

How Does 1st Step Behavioral Health Treat Antisocial Personality Disorder?

The FDA has not approved any medications for treating ASPD, although doctors may authorize prescriptions for medicines to treat associated conditions such as depression and aggression. At 1st Step, we apply non-medicinal psychotherapy techniques to help individuals with ASPD. Using these forms of “talk therapy”, our team encourages people to open up and work through their thoughts, feelings, and behaviors. The goal is to uncover and replace negative thought patterns, which helps people maintain sobriety long after treatment.

Types of Psychotherapy Used at 1st Step Behavioral Health in South Florida

Psychotherapy is often helpful in treating co-occurring mental illnesses which tend to exacerbate substance abuse. Skilled therapists can deal with both issues simultaneously with dual diagnosis treatment. Your 1st Step therapist or counselor may use one or more of these types of psychotherapy:

  • Cognitive-behavioral therapy
  • Dialectical behavior therapy
  •  Interpersonal psychotherapy
  •  Family therapy 

Cognitive-Behavioral Therapy

Cognitive-behavioral therapy is goal-oriented psychotherapy based on the premise that thoughts and beliefs influence behavior. CBT shows people how to pinpoint and uproot any unhealthy perspectives they have concerning themselves and the world around them. They learn new ways of thinking by analyzing both the true and untrue beliefs they have about themselves and others.

Treatment centers like 1st Step Behavioral Health have successfully implemented CBT with children, adolescents, and adults of all ages. Practitioners and insurance companies prefer this technique because of its effectiveness in a short time period. Although timeframes differ according to the individual, CBT typically only requires 5 to 20 sessions.

Dialectical Behavior Therapy

Dialectical behavior therapy imparts new therapeutic skills to be mindful and present in the moment, control emotions, overcome negative feelings, and interact better with others. This protocol derives from the philosophical concept of dialectics, which is balancing opposites. The therapist teaches the individual how to replace “all or nothing” ways of thinking with “either-or” perspectives.

DBT treatment usually involves individual or group therapy sessions; some people participate in either or both. Therapists teach life skills and lead exercises, then they assign homework such as practicing mindfulness techniques. The time required depends on the needs of the person or group members, but group sessions often meet weekly for six months.

Interpersonal Psychotherapy (IPT)

Hundreds of studies attest to the effectiveness of interpersonal psychotherapy for a wide range of ages and mental disorders. IPT is another time-limited treatment that focuses on resolving symptoms, enhancing interpersonal functioning, and building social support. This therapy has a distinctive combination of theories, targets, tactics, and techniques that set it apart from other psychotherapies.

IPT treatment first deals with interpersonal deficiencies such as social isolation or involvement in a difficult relationship. Next, it guides individuals through unresolved grief. IPT also teaches people to cope with difficult life changes, including divorce or moving. Lastly, the therapy shows ways to handle interpersonal conflicts that arise from clashing expectations among partners, relatives, friends, or work associates. Structured individual or group sessions typically run from 12 to 16 weeks, with homework and continual assessments.

Family Therapy

Mental illness and addiction affect the whole family, so family therapy deals with the family as a unit. This psychotherapy is based on thinking of a family as a system. A change in any part impacts all the other parts. Family therapy can guide each person in making specific changes to foster healing for the entire family.

For treatment purposes, “family” is normally defined as a group of two or more of the most important people in an individual’s life. This group can include biological relatives, colleagues, neighbors, and others with enduring ties. Ideally, these people will learn how to support the family member in treatment and improve the entire family’s emotional health for everyone’s benefit.

Family therapy sessions typically involve the whole family; sometimes, the therapist meets with part of the family or individuals. Because each family is so unique, time requirements vary widely. Research indicates family therapy with individual treatment encourages medication adherence and reduces stress, psychiatric symptoms, and relapse rates for individuals in treatment. 

Find Help for Antisocial Personality Disorder at 1st Step Behavioral Health

If you recognize the signs of antisocial personality disorder in yourself or someone close to you, it may seem as if change is impossible. Take heart – hope is available here at 1st Step in South Florida. The right treatment from compassionate professionals at our center can make a world of difference in your life and the lives of those who care about you.

We are here to support you! Our aim is to show you how to reign in your emotions and begin your journey to a better, richer life. Contact us here 1st Step Behavioral Health for details on our treatment programs.

Reviewed for Medical & Clinical Accuracy by Brittany Polansky

Brittany PolanskyBrittany has been working in behavioral health since 2012 and is a Primary Clinician at our facility. She is an LCSW and holds a master’s degree in social work. She has great experience with chemical dependency and co-occurring mental health diagnoses as well as various therapeutic techniques. Brittany is passionate about treating all clients with dignity and respect, and providing a safe environment where clients can begin their healing journey in recovery.