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. It is diagnosed only from age 18, and only where the pattern has been present since around age 15.
Key points
- Antisocial personality disorder is a diagnosis given for a long-standing pattern of disregarding and violating other people's rights.
- Sociopath is not a clinical term, and psychopathy is a separate research idea measured with tools such as the PCL-R, not a diagnosis.
- DSM-5-TR requires evidence of conduct disorder before age 15, so the diagnosis is not given to an adult with no earlier history.
- It is over-represented in prisons, and also held by many people who have never offended.
- NICE says to consider group-based cognitive and behavioural interventions, and that medication should not be used routinely for the disorder itself.
Symptoms
- Repeated lying, aliases, or conning people for gain; irritability and aggression, including repeated fights or assaults.
- Lack of remorse, or indifference to having hurt or robbed someone; reckless disregard for their own or others' safety.
- Impulsivity and failure to plan ahead; consistent irresponsibility with work or debts.
Causes and risk factors
- Childhood conduct problems (lying, aggression or rule-breaking before age 15) are both a risk factor and a diagnostic requirement.
- A mix of inherited genes and early environment, including childhood abuse or neglect; substance misuse is common alongside it.
Treatment
- Group-based cognitive and behavioural interventions, considered for impulsivity and antisocial behaviour.
- Offence-focused group programmes where there is a history of offending, aimed at reducing reoffending.
- Medication should not be used routinely for the disorder or for associated aggression; co-occurring conditions are treated in line with their own guidelines.
When to speak to a professional
- Impulsive, aggressive or reckless behaviour has been present since your teens and is damaging your work, housing or relationships.
- You are drinking or using drugs more, have become depressed or very anxious, or have been arrested.
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.