People with ASPD often exhibit behavior that conflicts with social norms, leading to issues with interpersonal relationships, employment, and legal matters.
Individuals with severe ASPD symptoms may have difficulty forming stable relationships, maintaining employment, and avoiding criminal behavior, resulting in higher rates of divorce, unemployment, homelessness, and incarceration.
However, certain psychiatric medications, including antipsychotics, antidepressants, and mood stabilizers, may help manage symptoms like aggression and impulsivity in some cases, or treat co-occurring disorders.
Early diagnostic manuals, such as the DSM-I in 1952, described “sociopathic personality disturbance” as involving a range of antisocial behaviors linked to societal and environmental factors.
[9][10][11] Individuals with ASPD are at a higher risk of illegal drug usage,[12][13] blood-borne diseases, HIV,[14] shorter periods of abstinence, misuse of oral administrations, and compulsive gambling[15][16][17] as a consequence of their tendency towards addiction.
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.
[66][67] Individuals with antisocial personality disorder may deliberately show irresponsibility, have difficulty acknowledging their faults and/or attempt to redirect attention away from harmful behaviors.
[75] 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.
[91] 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.
[92][67] Some studies have found a relationship between monoamine oxidase A and antisocial behavior, including conduct disorder and symptoms of adult ASPD, in maltreated children.
[96] 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.
[103][104][105] 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.
[89] 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.
Poor parental bonding due to abuse or neglect puts children at greater risk for developing antisocial personality disorder.
[120]: 136 While the rise reported may be in part a byproduct of the widening use (and abuse) of diagnostic techniques,[121] 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[122] – it has been suggested that the erosion of collective standards may serve to release the individual with latent ASPD from their previously prosocial behavior.
[123] Controversial clinical psychiatrist Pierre-Édouard Carbonneau suggested that the problem with legal forced admittance is the rate of failure when diagnosing ASPD.
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".
[133] 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.
[136] In addition to the new criteria, the individual must be at least 18 years old, the traits must cause dysfunction or distress, and should not be better explained by another mental disorder, the pathophysiological effects of a substance, or a person's cultural or social background.
[140][141][142][143] Psychopathic traits are assessed using various measurement tools, including Canadian researcher Robert D. Hare's Psychopathy Checklist, Revised (PCL-R).
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".
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)".
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.
[160] 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.
[169] Therapists working with individuals with ASPD may have considerable negative feelings toward patients with extensive histories of aggressive, exploitative,[170] and abusive behaviors.
[156][171] 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.
[181][182] 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.
[196] 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.
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 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".