Symptoms and Signs of Antisocial Personality Disorder

Our mental health encompasses our psychological, emotional and social well-being. This means it impacts how we feel, think and behave each day. Our mental health also contributes to our decision making process, how we cope with stress and how we relate to others in our lives. 

If you know someone who lies, steals, starts fights, and refuses to conform to social norms, chances are you know someone with antisocial personality disorder.

Most people consider a lack of empathy the defining feature of antisocial personality disorder (ASPD), along with a disregard for other people’s rights. But there is disagreement over whether these and other characteristics of antisocial personality disorder are a result of a person’s genetics or whether they develop as a result of a person’s environment in childhood. What is considered most likely is that in most cases, it is a combination of these factors.r.

For example, researchers have seen abnormalities in the gray and white matter volumes in the parts of their brains related to attention, self-regulation, self-control, and resolving conflicts.  Brain scans have also revealed poor connections among certain brain areas and abnormal organization of the brain’s network in the brains of individuals with antisocial personality disorder. But to date, it is not known what leads to these differences.

While individuals with antisocial personality disorder are often referred to as sociopaths in popular culture, the American Psychiatric Association does not use that term to describe them.

Characteristics of People With Antisocial Personality Disorder

People with antisocial personality disorder are very manipulative and often successful at misleading others. They may be witty, clever, funny, and charming, and they may frequently give compliments to others. They may use this flattery to manipulate others’ emotions. 

People with antisocial personality disorder may also show arrogance and an inflated sense of self-confidence. They ignore the safety of others and may disregard safety for themselves as well. In addition to lying, a person with antisocial personality disorder may frequently steal and start fights. They may even derive pleasure from seeing other people experience harm or pain. They may have substance use problems as well.

Men are much more likely to be diagnosed with antisocial personality disorder than women, but the reasons for this are not understood. Two studies estimated that approximately 4.5 or 6.8 percent of men have antisocial personality disorder, and both estimated that percent of women have it.  European studies have found lower estimates, of approximately 1 to 1.3 percent in men and up to 0.2 percent in women. 

Symptoms of antisocial personality disorder may decrease as a person ages, particularly around their forties. But this decrease does not necessarily mean the condition goes away. It may simply look different in older adults, or people who have it may learn to hide their symptoms better from others as they grow older. They may also experience a decline in mental, emotional, or physical health because of the energy spent over their lifetime opposing social norms and potentially engaging in self-destructive behavior.

Antisocial personality disorder is much, much more common among people in prison. Among the worldwide prison population, one study estimated that nearly half of men (47 percent) and 1 in 5 women (21 percent) have antisocial personality disorder. 

Risk Factors for Antisocial Personality Disorder

Although the cause of antisocial personality disorder is not known, researchers have identified factors that make a person more likely to have it. People may be at a higher risk if they have the following risk factors:

• A history of child abuse
• A parent with a drug or alcohol dependence disorder
• A parent with antisocial personality disorder
• Family conflict
• Genetic mutations
• Poverty 
• Childhood neglect 
• Long periods of childhood spent in orphanages or other forms of institutionalization

Early Signs of Antisocial Personality Disorder

Symptoms of antisocial personality disorder that show up before age 18 usually result in a diagnosis of conduct disorder. But even if a person does not receive a diagnosis of conduct disorder, many behaviors in childhood or adolescence are associated with a later diagnosis of antisocial personality disorder.

A person with antisocial personality disorder may have shown the following behaviors before age 18:

• Animal cruelty
• Intentionally setting fires 
• Drug or alcohol dependence or excessive use
• Frequently breaking the law or school rules for no obvious reason
• Cruel or aggressive behavior toward other people
• Engaging in bullying or fighting
• Forcing others to engage in sexual activity
• Stealing
• Using weapons
• Skipping school before age 
• Lying for personal gain
• Running away from home
• Vandalism and property destruction
• Mood swings
• Being bullied by others
• Difficulty making friends or maintaining close relationships 
• Poor performance in school 

Are There Different Symptoms Between Being Antisocial and Having ASPD?

The word "antisocial" may get thrown around in casual conversation — to refer to someone who doesn't enjoy socializing, say — but that's not what it means in a psychiatric context.

A condition called adult antisocial behavior syndrome is diagnosed when a person meets all of the criteria for an ASPD diagnosis, as defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM), but wasn't diagnosed with conduct disorder before they were 15 years old.  

A person should not be assumed to have antisocial personality disorder unless they have received the diagnosis from a mental health professional. Still, it is possible to identify someone as having a higher likelihood of having the disorder if they frequently act to intentionally harm others and show no evidence of guilt or remorse for the harm they cause.

The following are common or possible behaviors of people with antisocial personality disorder, but showing one or more of these behaviors does not mean a person definitely has the disorder:

• Frequently lying or otherwise tricking or deceiving others
• Acting impulsively
• Engaging in risky behavior that may harm themselves or others, such as frequent speeding and reckless driving
• Flattering others to gain something
• Intentionally inflicting physical or psychological harm on others
• Frequently causing or getting into fights
• Refusing to meet financial, family, or job responsibilities
• Violating rules in public or private establishments or other social norms
• Breaking the law, possibly to gain something they want or for the fun of it
• Making a decision without considering whether it will harm others
• Committing physical or sexual assault
• Manipulating, gaslighting, or otherwise trying to control others
• Regularly exaggerating stories, especially to make themselves look better
• Seeking revenge for perceived wrongs against them, whether the insult is real or imagined
• Excessively using alcohol, illegal drugs, or other substances
• Expressing pleasure in another person’s suffering
• Refusing to accept reasonable personal limitations