Antisocial personality disorder
Antisocial personality disorder is a pervasive, adult pattern of disregard for and violation of others' rights, with deceitfulness, impulsivity, and lack of remorse, diagnosable only at age 18 or older and only with documented conduct disorder before age 15. Management leads with consistent limit-setting; psychotherapy has limited proven benefit, and pharmacotherapy targets comorbid depression, impulsivity, or substance use disorder rather than the personality disorder itself.
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What this article covers
- Overview
A pervasive, adult pattern of disregard for and violation of others' rights: a lifelong pattern, not an isolated act, that includes criminality, deceitfulness, impulsivity, hostility, manipulation…
- Epidemiology
No antisocial-specific prevalence figure is established: personality disorders as a group affect an estimated 10% to 15% of the United States population, with substantial comorbid psychiatric illness.
- Risk factors
Documented conduct disorder before age 15: not merely associated but a required antecedent for the adult diagnosis.
- Pathophysiology
A developmental continuum from conduct disorder to antisocial personality disorder: the same repetitive, pervasive pattern of violating societal norms and the basic rights of others (aggression…
- Clinical features
The diagnosis requires disregard for and violation of the rights of others, plus at least 3 of the following 7 features: failure to conform to legal norms, deceitfulness or manipulating others…
- Differential diagnosis
Conduct disorder: the identical behavioral pattern but the patient is younger than 18; antisocial personality disorder cannot be diagnosed until that threshold is crossed.
- Diagnosis
Antisocial personality disorder is a clinical diagnosis: confirmed by disregard for and violation of the rights of others plus at least 3 of the 7 features above, together with both required gates…
- Management
First, establish clear behavioral boundaries and consistent limits from the outset of care: hold limits where necessary, avoid overidentifying with the patient, and clarify the purpose and structure…
- Complications
Recurrent legal and occupational problems: irresponsibility, inconsistent work behavior, and repeated conflict with the law are intrinsic to the disorder.
- Prognosis
Guarded, since the core pattern responds poorly to available treatment: psychotherapy is described as generally ineffective for the disorder itself, and no medication treats the underlying personality pattern.
- Prevention
Treat conduct disorder before age 18 to interrupt the developmental continuum: individual CBT and/or family therapy for conduct disorder is the described management, and treating it early, before…
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