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Antisocial personality disorder

Antisocial personality disorder is a type of chronic mental condition in which a person's ways of thinking, perceiving situations and relating to others are dysfunctional — and destructive. People with antisocial personality disorder typically have no regard for right and wrong and often disregard the rights, wishes and feelings of others.

Those with antisocial personality disorder tend to antagonize, manipulate or treat others either harshly or with callous indifference. They may often violate the law, landing in frequent trouble, yet they show no guilt or remorse. They may lie, behave violently or impulsively, and have problems with drug and alcohol use. These characteristics typically make people with antisocial personality disorder unable to fulfill responsibilities related to family, work or school.

Symptoms Causes Risk factors Complications Prevention

Antisocial personality disorder signs and symptoms may include:

  • Disregard for right and wrong
  • Persistent lying or deceit to exploit others
  • Using charm or wit to manipulate others for personal gain or for sheer personal pleasure
  • Intense egocentrism, sense of superiority and exhibitionism
  • Recurring difficulties with the law
  • Repeatedly violating the rights of others by the use of intimidation, dishonesty and misrepresentation
  • Child abuse or neglect
  • Hostility, significant irritability, agitation, impulsiveness, aggression or violence
  • Lack of empathy for others and lack of remorse about harming others
  • Unnecessary risk-taking or dangerous behaviors
  • Poor or abusive relationships
  • Irresponsible work behavior
  • Failure to learn from the negative consequences of behavior

Antisocial personality disorder symptoms may begin in childhood and are fully evident for most people during their 20s and 30s. In children, cruelty to animals, bullying behavior, impulsivity or explosions of anger, social isolation, and poor school performance may be, in some cases, early signs of the disorder.

Although considered a lifelong disorder, some symptoms — particularly destructive and criminal behavior and the use of alcohol or drugs — may decrease over time, but it's not clear whether this decrease is a result of aging or an increased awareness of the consequences of antisocial behavior.

Personality is the combination of thoughts, emotions and behaviors that makes everyone unique. It's the way people view, understand and relate to the outside world, as well as how they see themselves. Personality forms during childhood, shaped through an interaction of these factors:

  • Genetics. These inherited tendencies are aspects of a person's personality passed on by parents, such as shyness or having a positive outlook. This is sometimes called temperament.
  • Environment. This means the surroundings a person grows up in, events that occurred, and relationships with family members and others. It includes such life situations as the type of parenting a person experienced, whether loving or abusive.

Personality disorders are thought to be caused by a combination of these genetic and environmental influences. Some people may have genes that make them vulnerable to developing antisocial personality disorder — and life situations may trigger its development.

There may be a link between an early lack of empathy — understanding the perspectives and problems of others, including other children — and later onset of antisocial personality disorder. Identifying these personality problems early may help improve long-term outcomes.

Although the precise cause of antisocial personality disorder isn't known, certain factors seem to increase the risk of developing or triggering it, including:

  • Diagnosis of childhood conduct disorder
  • Family history of antisocial personality disorder or other personality disorders or mental illness
  • Being subjected to verbal, physical or sexual abuse during childhood
  • Unstable or chaotic family life during childhood
  • Loss of parents through traumatic divorce during childhood
  • History of substance abuse in parents or other family members

Men are at greater risk of having antisocial personality disorder than women are.

Complications, consequences and problems of antisocial personality disorder include:

  • Aggressiveness leading to verbal or physical violence
  • Gang participation
  • Reckless behavior
  • Risky sexual behavior
  • Child abuse
  • Alcohol or substance abuse
  • Gambling problems
  • Being in jail or prison
  • Homicidal or suicidal behaviors
  • Relationship difficulties
  • Occasional periods of depression or anxiety
  • School and work problems
  • Strained relationships with health care providers
  • Low social and economic status, and homelessness
  • Premature death, usually as a result of violence

There's no sure way to prevent antisocial personality disorder from developing in those at risk. Trying to identify those most at risk, such as children living with neglect or abuse, and offering early intervention may help. Getting appropriate treatment early, and sticking with it for the long term, may prevent symptoms from worsening.

Because antisocial behavior is thought to have its roots in childhood, parents, teachers and pediatricians may be able to spot early warning signs. While diagnosis of antisocial personality disorder generally isn't done before age 18, children at risk may have symptoms of conduct disorder, especially behavior that involves violence or aggression toward others, such as:

  • Bullying
  • Conflict with peers, family members and authority figures
  • Stealing
  • Cruelty to people and animals
  • Fire starting and vandalism
  • Use of weapons
  • Sexual assault
  • Repeated lying
  • Problem behaviors in school and poor academic performance
  • Gang involvement
  • Running away from home

Early, effective and appropriate discipline, lessons in behavioral skills, family therapy, and psychotherapy may help reduce the chance that at-risk children go on to become adults with antisocial personality disorder.

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