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Born or made? Understanding antisocial personality disorder

Posted on: December 19, 2023

Antisocial personality disorder (ASPD) is a complex – and often misunderstood – mental health condition, and one that can significantly impact the lives of those affected, as well as their family members and loved ones.

While the question of whether someone is born with ASPD, or whether it’s a product of their environment, remains a topic of ongoing research and debate, what we do know is that understanding the common traits and potential causes of ASPD is crucial in addressing the disorder effectively.

What is antisocial personality disorder?

Antisocial personality disorder affects an individual’s thoughts, behaviours, and emotions. It is characterised by a pattern of pervasive disregard for the rights of others. People with ASPD typically display traits such as impulsivity, deceitfulness, and a lack of empathy or remorse for their actions. They may also have a propensity for engaging in aggressive or even criminal behaviour, and according to the NHS, the signs will typically start in childhood:

“A person with antisocial personality disorder will have a history of conduct disorder during childhood, such as truancy (not going to school), delinquency (for example, committing crimes or substance misuse), and other disruptive and aggressive behaviours.”

ASPD is a mental health condition recognised by the World Health Organization’s International Classification of Diseases (ICD) – which is used in the UK – and listed in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

Common misconceptions: sociopaths, psychopaths, and antisocial personality disorder

There are a lot of misunderstood or misused words with roots in psychology – narcissism, schizophrenia, mental illness, bipolar disorder, ‘psycho’ – even serial killer. And this is no less true with ASPD.

When speaking about someone with the characteristics of antisocial personality disorder, many people use the words “sociopath” or “psychopath” – and often interchangeably. However, it’s worth noting that the formal classification for both sociopathy and psychopathy is ASPD.

That said, there are distinctions between sociopathic traits and psychopathic traits within ASPD: 

  • So-called sociopaths are more likely to demonstrate a lack of self-control or other volatile behaviours. Sociopathy is often associated with environmental factors, such as childhood trauma or adverse life experiences. 
  • So-called psychopaths tend to be more calculating and manipulative, with a reduced capacity for forming emotional attachments. Psychopathy is more likely to have a genetic component, rather than an environmental cause, and it may be assessed using what’s commonly called the psychopathy checklist, or PCL-R, which was developed by psychologist Robert Hare in the 1970s.

Common traits of antisocial personality disorder

While individuals with ASPD may exhibit a wide range of behaviors, several key personality traits are often present:

  • Lack of empathy. People with ASPD commonly struggle with understanding and relating to the emotions, rights, and feelings of others. 
  • Impulsivity. Impulse control is a significant challenge for people with ASPD, and they will often act irresponsibly without considering the consequences of their actions.
  • Deceitfulness. A tendency to lie, manipulate, and engage in deceitful behaviours for personal gain is a common trait of ASPD. 
  • Lack of remorse. People with ASPD may feel little to no remorse or guilt for their harmful actions, and they are often indifferent to the suffering they cause others.

Other signs of ASPD noted by the NHS include:

  • Having difficulty with social norms or sustaining long-term relationships.
  • An inability to control their anger.
  • Blaming others for problems in their lives.
  • Repeatedly breaking the law.

There are also overlaps between ASPD and other personality disorders, such as narcissistic personality disorder.

Causes of antisocial personality disorder

Current research and consensus suggests that the development of antisocial personality disorder is likely influenced by a combination of genetic and environmental factors. 

While the exact causes are still not fully understood, researchers have identified a few contributing factors:

  • Genetic predisposition. Studies suggest that there is a genetic component to ASPD, so people who have a family history of the disorder may be at a higher risk of developing it themselves.
  • Childhood trauma and other environmental factors. Traumatic childhood experiences, such as abuse, neglect, or witnessing violence, can contribute to the development of ASPD. Wider environmental factors, such as growing up in a chaotic or unstable environment, or lacking positive role models or social support, can also increase the risk of developing ASPD.
  • Brain abnormalities. Some research points to brain abnormalities, impairments, or injuries to certain parts of the brain as potential contributors to ASPD. 

Can someone be born with antisocial personality disorder?

The question of whether people can be born with ASPD or if it is solely a product of their environment is a complex one, and does not have a conclusive answer. However, it is widely accepted that both genetic and environmental risk factors commonly play a role in the development of the disorder.

The links between antisocial personality disorder and crime

Antisocial personality disorder is often associated with criminal behaviour:

  • The impulsivity commonly associated with ASPD means that people with the disorder may act on their desires without considering the legal consequences.
  • The deceitfulness and lack of empathy common in ASPD means that some individuals may find it easy to commit fraud, theft, or other illegal activities without concern for the impact of their crime on others. Plus, if the individual finds it easy to manipulate or lie, this can help them to commit crimes or even avoid legal consequences.
  • People with ASPD are at an increased risk of reoffending – known as recidivism – as they may continue to engage in criminal behaviour even after prior legal repercussions.

However, it’s important to understand that not everyone with ASPD becomes involved in criminal activities.

Treatments for antisocial personality disorder

Treating antisocial personality disorder can be challenging – in fact, the NHS says it’s the most difficult personality disorder to treat. However, there are several treatments and interventions available:

  • Psychotherapy. Psychotherapy, particularly cognitive-behavioral therapy (CBT), has shown effectiveness in treating people with ASPD. CBT aims to help patients develop better impulse control, recognise and modify harmful thought patterns, and improve their social and interpersonal skills. The NHS has also started using mentalisation-based therapy (MBT), which is another form of talking therapy and encourages people to consider the way they think, and how their mental state affects their behaviour.
  • Social therapy. A social therapy known as democratic therapeutic communities (DTC) is a community-based programme that evidence suggests can be effective for the long-term treatment of ASPD. According to the NHS, it is increasingly popular in prisons, and aims to address a person’s “risk of offending, as well as their emotional and psychological needs.” 
  • Medication. There is no specific medicine that’s used for treating ASPD, however, the NHS notes that “certain antipsychotic and antidepressant medicines may be helpful in some instances.” For example, carbamazepine and lithium may help control symptoms such as aggression and impulsive behaviour, while selective serotonin reuptake inhibitor (SSRI) antidepressants may help to improve anger issues and general personality disorder symptoms.

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