Antisocial personality disorder: symptoms, causes and treatment

Key points

• Antisocial personality disorder is a diagnosis given for a long-standing pattern of disregarding and violating other people’s rights [5].
• Sociopath is not a clinical term, and psychopathy is a separate research idea measured with tools such as the PCL-R, not a diagnosis [2].
• DSM-5-TR requires evidence of conduct disorder before age 15, so the diagnosis is not given to an adult with no earlier history [5].
• It is over-represented in prisons, and also held by many people who have never offended [2][4].
• NICE says to consider group-based cognitive and behavioural interventions, and that medication should not be used routinely for the disorder itself [1].

What antisocial personality disorder is

Antisocial personality disorder is a mental health diagnosis given for a lasting pattern of disregarding and violating other people’s rights, shown through deceit, impulsivity, aggression, recklessness, irresponsibility and little remorse [5]. It is diagnosed only from age 18, and only where the pattern has been present since around age 15 [5]. Around 2.0% of adults in England screened positive on a survey questionnaire in 2023/4, 2.9% of men and 1.2% of women [4].

If you need help now. Samaritans: call 116 123, free, 24/7. Shout: text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.

Three words are often treated as the same thing:

• Antisocial personality disorder is the diagnosis in DSM-5-TR, the American diagnostic manual [5].
• Psychopathy is a research idea, not an NHS diagnosis, measured with rating tools such as the Psychopathy Checklist-Revised, or PCL-R [2]. Only about 10% of people with antisocial personality disorder reach its threshold [2].
• Sociopath is not a diagnosis in either manual, and has no criteria and no measure of its own.

ICD-11, the World Health Organization’s current classification, does not name the disorder. NHS England still codes with ICD-10, in which dissocial personality disorder remains a named category. A person is diagnosed with mild, moderate or severe personality disorder plus trait qualifiers, the nearest being dissociality: callousness, exploiting others, entitlement and lack of empathy [3][6][10].

Symptoms

The DSM-5-TR pattern requires at least three of seven features, across different situations [5].

Towards other people:

• repeated lying, aliases, or conning people for gain [5]
• irritability and aggression, including repeated fights or assaults [5]
• lack of remorse, or indifference to having hurt or robbed someone [5]

Towards rules and their own safety:

• repeatedly acting in ways that are grounds for arrest [5]
• reckless disregard for their own or others’ safety [5]
• impulsivity and failure to plan ahead [5]
• consistent irresponsibility with work or debts [5]

Alcohol and drug problems, anxiety and depression are all common alongside it, anxiety in around half of people with the diagnosis [2].

It is commonly confused with borderline and narcissistic personality disorder, attention deficit hyperactivity disorder, and with behaviour driven by ongoing drug or alcohol use [2][5].

Types

There are no recognised subtypes in DSM-5-TR. Severity bands and presentations are used instead.

• Mild, moderate and severe personality disorder. ICD-11 grades severity rather than naming types, adding trait qualifiers such as dissociality [3][6].
• With prominent psychopathic features. A minority also meet PCL-R criteria for psychopathy, which forensic services assess separately [1][2].
• With and without an offending history. NICE suggests offence-focused group programmes only where there is a history of offending [1].

Causes and risk factors

There is no single cause. The NHS describes personality disorders as arising from a mix of inherited genes and early environment, including childhood abuse or neglect [9].

• Childhood conduct problems. Lying, aggression or rule-breaking before age 15 is both a risk factor and a diagnostic requirement [5].
• Substance misuse. Men with the diagnosis are three times more likely to misuse alcohol and five times more likely to misuse illicit drugs [2].

The diagnosis is given far more often to men than to women [2][4]. It is not the same as psychopathy, and it is not criminality renamed: many people who offend do not meet the criteria, and many who do have never been convicted [2].

How it is diagnosed

In the UK a psychiatrist or clinical psychologist makes the diagnosis, in a community mental health team or a forensic or prison service, usually after a GP referral [1][9].

NICE says assessment should cover antisocial behaviours, personality functioning, other conditions including depression, anxiety and substance misuse, social and work needs, and domestic violence [1]. Forensic services should use the PCL-R or its short form, the PCL-SV [1].

Two points surprise people: evidence of conduct disorder before age 15 is required, so the diagnosis cannot appear in adulthood from nowhere, and a person must be at least 18 [5].

No reliable national figure exists for waiting times, which vary by area. A diagnosis names a pattern and opens access to the interventions researched for it.

Treatment

NICE clinical guideline CG77, published in 2009 and last updated in 2013, is the current NHS guidance. A 2018 review decided against updating it while the effects of ICD-11 were unclear [1][3].

• Group-based cognitive and behavioural interventions. Considered for impulsivity, difficulty with other people and antisocial behaviour [1].
• Offence-focused group programmes. Considered where there is a history of offending, aimed at reducing reoffending [1].
• Treating other conditions. Depression, anxiety and substance misuse are treated in line with the relevant NICE guideline, whether or not the personality disorder is [1].
• Medication. NICE says medication should not be used routinely for the disorder or for associated aggression, anger and impulsivity [1]. It may still be prescribed for a separate condition [1].

The evidence is thin. A 2020 Cochrane review of psychological interventions found too little good quality evidence to recommend or reject any of them, with certainty rated low or very low [7], and a parallel review of 11 medication trials found the evidence insufficient to draw any conclusion [8].

The older view that the disorder is untreatable is neither fully supported nor fully contradicted. Psychiatry described therapeutic gloom about it in the 1970s, and reviews in the 1990s found the evidence base poor [2]. English policy moved against exclusion from services in 2003 [2], so access has changed more than proof of benefit. NICE notes that positive approaches engage people better than punitive ones [1].

Living with antisocial personality disorder

You are entitled to NHS care for this diagnosis and for anything alongside it, and services should not turn you away because of it [1][2].

Alcohol and drugs make everything harder, and treating them is one of the few areas where the evidence is stronger than for the disorder itself [1][2]. Ask your GP about local drug and alcohol services.

If you are offered a group programme, finishing it matters, and NICE tells services to help people attend [1].

You decide what to tell an employer or university, and you need not give a diagnosis to ask for adjustments.

Impulsive behaviour often lessens with age, while difficulty in relationships tends to continue [2].

If someone close to you has this diagnosis and their behaviour frightens you, your safety comes first, and domestic abuse support exists separately from their care [1].

When to speak to a professional

Speak to your GP if impulsive, aggressive or reckless behaviour has been present since your teens and is damaging your work, housing or relationships [1][9]. Ask about referral to the community mental health team, and say if you had conduct problems before age 15 [5].

Contact your GP or care team sooner if you are drinking or using drugs more, have become depressed or very anxious, or have been arrested [1][2].

Get urgent help the same day if you are thinking about ending your life, cannot keep yourself safe, or think you may seriously hurt someone. Samaritans: 116 123. Shout: text SHOUT to 85258. NHS 111, then the mental health option. Call 999 if anyone is in immediate danger.

Common questions

Is antisocial personality disorder the same as being a psychopath or a sociopath?

No to both. Psychopathy is a research idea measured with tools such as the PCL-R, not an NHS diagnosis, and only about 10% of people with antisocial personality disorder reach its threshold [2]. Sociopath is not a diagnosis in either manual. DSM-5-TR mentions sociopathy only as an older informal label for the same pattern, and it has no criteria and no measure of its own.

Are people with antisocial personality disorder dangerous?

Some are, and most are not. The diagnosis is heavily over-represented in prisons: a UK survey found it in 63% of male remand prisoners, 49% of sentenced men and 31% of women in prison [2]. It is also held by many people who have never offended: around 950,000 adults screened positive in a household survey in England [4].

Can antisocial personality disorder be treated?

There are interventions, and the evidence for all of them is weak. NICE suggests considering group-based cognitive and behavioural interventions, and says medication should not be used routinely for the disorder [1]. Cochrane reviews in 2020 found the evidence insufficient to recommend or reject either [7][8].

Clinical review pending

References

1. National Institute for Health and Care Excellence. Antisocial personality disorder: prevention and management. NICE clinical guideline CG77, published 28 January 2009, last updated 27 March 2013. https://www.nice.org.uk/guidance/cg77/resources/antisocial-personality-disorder-prevention-and-management-pdf-975633461701
2. National Collaborating Centre for Mental Health. Antisocial Personality Disorder: Treatment, Management and Prevention. NICE Clinical Guidelines No. 77. British Psychological Society, 2010. https://www.ncbi.nlm.nih.gov/books/NBK55345/
3. National Institute for Health and Care Excellence. 2018 surveillance of personality disorders (NICE guidelines CG77 and CG78). NICE, 2018. https://www.ncbi.nlm.nih.gov/books/NBK550289/
4. NHS England Digital. Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2023/4. Personality disorder chapter, published 27 November 2025. https://digital.nhs.uk/data-and-information/publications/statistical/adult-psychiatric-morbidity-survey/survey-of-mental-health-and-wellbeing-england-2023-24/personality-disorder
5. StatPearls Publishing. Antisocial Personality Disorder. StatPearls, updated 29 February 2024. https://www.ncbi.nlm.nih.gov/books/NBK546673/
6. Bach B, First MB. Application of the ICD-11 classification of personality disorders. BMC Psychiatry, 2018, article 351. https://bmcpsychiatry.biomedcentral.com/articles/10.1186/s12888-018-1908-3
7. Gibbon S, Khalifa NR, Cheung NH-Y, Voellm BA, McCarthy L. Psychological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews, 2020. https://www.cochrane.org/CD007668/BEHAV_psychological-interventions-antisocial-personality-disorder
8. Khalifa NR, Gibbon S, Voellm BA, Cheung NH-Y, McCarthy L. Pharmacological interventions for antisocial personality disorder. Cochrane Database of Systematic Reviews, 2020. https://www.cochrane.org/CD007667/BEHAV_pharmacological-interventions-antisocial-personality-disorder
9. NHS. Personality disorders. nhs.uk. https://www.nhs.uk/mental-health/conditions/personality-disorder/
10. Mind. Types of personality disorder. mind.org.uk. https://www.mind.org.uk/information-support/types-of-mental-health-problems/personality-disorders/types-of-personality-disorder/