We often hear people refer to someone as anti-social simply because they are shy and might find it difficult to interact with strangers. However, in clinical terms that is not quite what antisocial means. Antisocial personality disorder is an official diagnosis defined in the DSM-5. Moreover, it is often linked to crime and other antisocial behaviours. So, what exactly is antisocial personality disorder and is it really linked to criminal behaviour? Let’s find out!

This article will cover:

·       What is antisocial personality disorder?

·       Is ASPD linked to crime?

·       Can it be treated?

What is antisocial personality disorder?

Firstly, let’s define what a personality disorder is. According to the DSM-5 [1], a personality disorder is an ‘enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the individual’s culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment.

In the DSM-5 personality disorders are categorised into 3 clusters, based on the similarities in their manifestations.

Cluster A

·   Paranoid personality disorder

·   Schizoid personality disorder

·   Schizotypal personality disorder

Cluster B

·   Antisocial personality disorder

·   Borderline personality disorder

·   Histrionic personality disorder

·   Narcissistic personality disorder

Cluster C

·   Avoidant personality disorder

·   Dependent personality disorder

·   Obsessive personality disorder

DSM-5 Criteria for Antisocial PD:

A.    A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:

1.     Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.

2.     Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.

3.     Impulsivity or failure to plan ahead.

4.     Irritability and aggressiveness, as indicated by repeated physical fights or assaults.

5.     Reckless disregard for safety of self or others.

6.     Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

7.     Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

B.    The individual is at least age 18 years.

C.    There is evidence of conduct disorder with onset before age 15 years.

D.    The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.

Antisocial personality disorder (ASPD) is characterised by a pervasive pattern of disregard for the rights of others and violation of those rights [1]. People with ASPD have a tendency to antagonise, manipulate or deceive others. They lack remorse for their callous actions towards others [8]. Moreover, they are often aggressive, impulsive, arrogant, hostile, irritable. As a result, they are often unable to keep a stable job or form relationships [4]. Just like any other personality disorder, ASPD is on a spectrum [9].

This pattern of behaviour begins in late childhood or early adolescence and prevails until adulthood. Before the age of 15, people with ASPD display symptoms of conduct disorder [1]. These include aggression to people or animals; destruction of property; deceitfulness; theft; or serious violation of rules. If conduct disorder is diagnosed early, it can be managed and it might be possible to prevent development of ASPD in adulthood [2].

ASPD is more prevalent among men than women [9]. It is a chronic condition that can however become less evident by the time the person reaches their 40s [1]. The estimated lifetime prevalence is between 1-4% [4].

There is an ongoing debate regarding the relationship between ASPD, psychopathy and sociopathy. Firstly, it is important to keep in mind that out of these three, only ASPD is an official clinical diagnosis in DSM-5. Otherwise, it is still quite unclear how exactly these three terms relate. Some researchers argue that psychopathy is an extreme form of ASPD [3, 9]. Others argue that psychopathy is a distinct diagnosis that, however, significantly overlaps with ASPD [4] as it includes many of the features of ASPD with the addition of other interpersonal and affective characteristics [6]. As for sociopathy, many use the terms sociopathy and ASPD interchangeably, although some suggest that sociopathy is a subcategory of ASPD [2, 8, 10].

Etiology

The exact cause is unknown. However, it seems that both genetics and environmental factors play a role. Studies found that heritability ranges from 38-69%, meaning that ASPD is more common among people who have a first-degree relative with ASPD compared to the general population [1]. There is no one gene that is responsible for ASPD [2], but certain genetic makeup can make a person more vulnerable to developing it. Moreover, some studies provide evidence for people with ASPD that may have disrupted levels of the neurotransmitter serotonin which is responsible for regulation of mood [2].

Among the possible environmental risk factors are adverse childhood experiences, such as neglect or abuse [2]. Research also found that the variation in the oxytocin receptor gene can contribute to a range of behaviours displayed by people with ASPD, due to its interaction with environmental factors, namely peer affiliation [4].

Is ASPD related to crime?

Criminal behaviour is closely related to ASPD, and indeed research shows that ASPD appears to be the personality disorder most strongly related to crime [7]. However, no causal relationship has been established yet. This relationship differs depending on gender and comorbidity with other disorders.

People with ASPD often violate the law, either by behaving violently or by abusing drugs [8]. Research shows that a considerable number of prisoners suffer from ASPD. Studies estimated that around 47% of male and 21% of female inmates have been diagnosed [10]. Moreover, a study by Fridell and colleagues [5] investigated the link between ASPD and crime in a sample of substance abusers; they found that subjects with ASPD were 2.16 times more likely to be charged with theft and 2.44 times more likely to be charged with committing multiple types of crimes, compared to subjects without ASPD. 90% of ASPD subjects committed a property crime compared to 76% of non-ASPD; violent crimes were committed by 57% of ASPD and 43% non-ASPD; drug offences were registered in 83% of ASPD and 61% of non-ASPD subjects.

Can ASPD be treated?

There is no specific course of treatment for ASPD. However, it can be managed with psychotherapy [2] such as cognitive-behavioural therapy (CBT). CBT can help people with ASPD realise how their actions affect others. In some cases, medication can help manage some of the behaviours. For example, antidepressants can help regulate serotonin levels, antipsychotics may help with aggressive behaviour and mood stabilisers can regulate mood and behavioural swings [2].

Extra resources:

1. YouTube video – At war with the world: Antisocial personality disorder

https://www.youtube.com/watch?v=-oGPF0ekINI

2. YouTube video – 10 antisocial behaviours and the thoughts that cause them

https://www.youtube.com/watch?v=7E_kDo90HRw

References

1. American Psychiatric Association. (2013). Diagnostic criteria and codes. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA.

2. Cleveland Clinic. (May 2021) Antisocial Personality Disorder (ASPD). Retrieved on September 4, 2021 from https://my.clevelandclinic.org/health/diseases/9657-antisocial-personality-disorder

3. Coid, J., & Ullrich, S. (2010). Antisocial personality disorder is on a continuum with psychopathy. Comprehensive psychiatry, 51(4), 426-433. https://doi.org/10.1016/j.comppsych.2009.09.006

4. Fisher, K. A., & Hany, M. (2019). Antisocial Personality Disorder.

5. Fridell, M., Hesse, M., Jæger, M. M., & Kühlhorn, E. (2008). Antisocial personality disorder as a predictor of criminal behaviour in a longitudinal study of a cohort of abusers of several classes of drugs: relation to type of substance and type of crime. Addictive behaviors, 33(6), 799-811. https://doi.org/10.1016/j.addbeh.2008.01.001

6. Glenn, A. L., Johnson, A. K., & Raine, A. (2013). Antisocial personality disorder: a current review. Current psychiatry reports, 15(12), 427.

7. Howard, R. (2015). Personality disorders and violence: what is the link?. Borderline Personality Disorder and Emotion Dysregulation, 2(1), 1-11.

8. Mayo Clinic. Antisocial Personality Disorder. Retrieved on September 4, 2021 from https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/symptoms-causes/syc-20353928

9. NHS. (May 2018). Antisocial Personality Disorder. Retrieved on September 4, 2021 from https://www.nhs.uk/mental-health/conditions/antisocial-personality-disorder/