Antisocial personality disorder is a psychological disorder involving lifelong patterns of manipulation, exploitation, or the violation of the rights of other people. This disorder is also known as sociopathic personality disorder, or sociopathy. Criminal behavior is common among people with this personality disorder, as well as increased risk-taking and disregard for rules or expectations.
This disorder can only be diagnosed in adults. A similar childhood disorder, conduct disorder, is a common precursor to antisocial personality disorder. While not all children with conduct disorder go on to develop antisocial personality disorder; an adult is required to have had the childhood disorder in order to be diagnosed with antisocial personality disorder.
Personality disorders are psychological disorders that are pervasive, lifelong, and affect all areas of an individual’s life. These disorders involve patterns of thought or behavior that deviate from accepted societal norms, are constant across all areas of life, begin in childhood or early adulthood, and significantly impair the individual’s functioning. Personality disorders can only be diagnosed in adulthood, because it is believed that personality during childhood is still in a state of development.
According to the National Institute of Mental Health (NIMH), people with antisocial personality disorder often lie, act in self-serving ways, place others at risk in order to benefit themselves, and show a lack of remorse for their actions. Approximately 1 percent of the US adult population has this disorder. Mayo Clinic reports that people with antisocial personality disorder display increased impulsivity and disregard for commonly accepted rules of right and wrong, which can lead to drug and alcohol abuse. Harsh treatment of others and indifference for others’ wellbeing can make it difficult for people with this disorder to function within society.
Symptoms of Antisocial Personality Disorder
People with antisocial personality disorder can often act in charming and likable ways. They may be very skilled at manipulating situations and appear very believable and trustworthy. However, they also tend to be irresponsible, impulsive, and appear to have no understanding of empathy or remorse. Mayo Clinic lists the following common symptoms of antisocial personality disorder:
- Disregard for rules and laws
- Frequent lying
- Manipulating others for personal gain or pleasure
- Egocentrism and a sense of superiority
- Frequent violations of the rights of others
- Hostile, aggressive, or violent behavior
- Impulsivity, risk-taking, or dangerous behavior
- Lack of empathy for others and lack of remorse for harmful behavior
- Unhealthy or abusive relationships
The symptoms of this disorder usually manifest at an early age and are most evident during a person’s 20s and 30s. While this disorder is lifelong, the most severe symptoms may decrease with age.
Causes of Antisocial Personality Disorder
The causes of antisocial personality disorder are not well understood. It is believed that a combination of genetics and environmental factors work together to create this disorder. The U.S. National Library of Medicine reports that factors like child abuse, and having a parent with this disorder or a parent with alcoholism, can contribute to the formation of antisocial personality disorder. Certain childhood behaviors, including cruelty to animals and setting fires, are often seen in people with this disorder. It is more common among men than women and often seen in prison populations.
Addiction and Co-occurring Disorders
The co-occurrence of addiction among people with antisocial personality disorder is common. NIDA estimates that 40-50 percent of people who enter treatment for addiction or substance abuse have antisocial personality disorder, compared to only 1 percent of the general population. People with antisocial personality disorder often seek treatment for substance abuse or alcoholism rather than their personality disorder.
The Graduate Journal of Counseling Psychology reports that as much as 90 percent of people with antisocial personality disorder have a co-occurring substance use disorder. A study published by the Journal of Substance Abuse Treatment reported that court mandates greatly increase treatment retention among people with this disorder who abuse addictive substances; otherwise, treatment retention among this population tends to be very low. This population is also more prone to relapse into substance use and return to criminal behavior.
Alcoholism is one of the most common forms of addiction found in those with antisocial personality disorder. Aggressive or violent behavior can be more common among people with this addiction. Those with antisocial personality disorder are more likely to become violent under the influence of alcohol than others suffering from alcoholism, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA).
A study published by Drug & Alcohol Dependence found that people with antisocial personality disorder who abuse intravenous drugs are not only more likely to drop out of treatment, but also tend to engage in more risky behaviors, increasing the likelihood of contracting communicable diseases like HIV. A similar study found that people with antisocial personality disorder are more likely to share needles, and share with more people, than people without this disorder, which contributes to the high occurrence of HIV among this population.
Disorders like pathological gambling are also much more common among people with antisocial personality disorder, according to a study published in Addiction. People with this disorder who gamble compulsively tend to have more severe gambling problems than those without the disorder. These people also tend to start gambling earlier in life.
Effects of Addiction
People with antisocial personality disorder who also suffer from addiction are more likely to drop out of treatment, are at an increased risk for relapse, and frequently engage in risky behaviors that can compromise their health. Because people with this disorder typically show lowered impulse control, they are more likely to abuse drugs or alcohol on a long-term basis. Negative effects of addictive substances increase over time and with higher rates of use, putting people with antisocial personality disorder at higher risk for effects like permanent brain damage and chronic health problems.
NIDA reports that long-term addiction or drug abuse can have extensive negative impacts on mental functioning, physical health, and psychological wellbeing. Depression, paranoia, and anxiety are common among people suffering from long-term substance use. The kidneys and liver can sustain permanent damage from extensive alcohol or drug use. The lungs also suffer serious damage from smoking or snorting substances. Heart disease and heart failure are common causes of death among those suffering from addiction. Risk of overdose also increases over time, as the addicted individual builds up a tolerance to the substance.
While the impacts of drug or alcohol addiction can be extensive and long-lasting, treatment is effective, and physical and mental health can improve. With treatment, many of these effects can be at least partially reversed.
Talking to a loved one about substance use and addiction can seem scary and difficult, but bringing attention to the problem in a supportive and honest way can be an important first step in that person receiving needed treatment. Because people with antisocial personality disorder tend to have an aggrandized sense of self, they may be unaware that their drug or alcohol use has reached the level of addiction.
There are many resources available to those seeking treatment for addiction. The best way to find treatment for a loved one suffering from addiction is to encourage that person to see a doctor who is comfortable diagnosing and treating substance use disorders. The American Academy of Addiction Psychiatry offers a database of physicians who specialize in addiction. The American Society of Addiction Medicine also maintains a member search function, which allows users to locate a local professional who can help find the appropriate treatment.
Despite the prevalence of substance use disorders among people with antisocial personality disorder, this combination of issues can be very difficult to treat. A recent study states that personality disorders are commonly viewed as being resistant to treatment, and the complications presented by co-occurring addiction can exclude this population from certain treatment programs. Many programs are not designed to treat both antisocial personality disorder and addiction, so this population can have difficulty finding an appropriate treatment source.
The best treatment approach will depend on the individual’s needs and circumstances. Treatment must be tailored to the specific person in need of help in order to be successful. NIDA has found that certain principles of treatment tend to be the most helpful and show the highest rates of effectiveness, including the following:
- Treatment should address all the needs of the individual, not just the addiction.
- The individual must remain in treatment for an adequate length of time.
- Individual and group therapy are commonly employed in effective programs.
- Medications can be very helpful for some individuals suffering from addiction.
- Involuntary treatment for addiction can still be effective.
- Relapse may occur, but the individual can still recover and continue to improve.
Personality disorders and substance use disorders are both most commonly treated with behavioral therapy. Research has shown that Cognitive Behavioral Therapy and Contingency Management are the most effective modes of therapy in the treatment of addiction among people with antisocial personality disorder. While improvement in substance use disorders among this population can be achieved, improvement of the personality disorder itself is more difficult. Long-term inpatient therapy, followed by continued outpatient therapy, tends to be the most effective in reducing the symptoms of antisocial personality disorder. Because this disorder is lifelong, continued treatment is typically necessary.
Cognitive Behavioral Therapy has shown some effectiveness in treating both addiction and personality disorders. This therapy focuses on patterns of behavior and thought that contribute to the problems experienced by the individual. Increased awareness of these destructive patterns can help the individual better understand the disorders. New patterns are established so the person in treatment can make healthier choices when faced with stressful circumstances and triggers.
Contingency Management is commonly used in the treatment of addiction and has been shown to be effective for people with antisocial personality disorder. This model of treatment uses positive reinforcement to encourage healthy behavior. Rewards are given when behaviors like participating in treatment or abstaining from drug use are achieved. This encourages the individual to continue healthy behavior in the future.
The efficacy of behavioral therapy for the treatment of antisocial personality disorder may depend on the individual’s ability to form a relationship with the therapist. People with this disorder commonly have difficulty maintaining relationships, which can make progress in therapy less likely. An ability to form and maintain a working relationship with a therapist was a strong predictor of success in treatment in a study published by the American Journal of Psychology.
Certain medications can assist in recovery from drug or alcohol addiction. Some medications help manage the symptoms of withdrawal, while others reduce cravings to prevent relapse. Medications are currently available to treat opioid addiction, alcoholism, and tobacco addiction.
In the treatment of addiction to opioids, methadone, buprenorphine, and naltrexone are commonly used. Methadone has been used for decades to treat addiction, and it works by mimicking the effects of opioids to reduce symptoms of withdrawal and manage cravings. Buprenorphine treats many of the same symptoms but carries less risk of abuse, so it is available more widely. Naltrexone works by blocking the effects of opioid drugs within the brain, so the individual has less motivation to relapse into drug use.
The FDA has approved three medications for the treatment of alcohol dependence. Naltrexone is used in the treatment of both opioid dependence and alcoholism. Acamprosate lessens symptoms of withdrawal like insomnia, anxiety, restlessness, and dysphoria. Disulfiram triggers nausea and other unpleasant effects when combined with alcohol, which discourages the individual from relapsing. Topiramate is another drug that is sometimes used in the treatment of alcohol dependence, but it is not yet FDA-approved for this purpose.
The co-occurrence of antisocial personality disorder and addiction is a common problem. Impulsivity and lack of remorse can make treatment difficult among this group, but improvement in both the personality disorder and substance use disorders is possible with treatment. Behavioral therapy and medication may be needed to effectively treat people suffering from these co-occurring disorders. Loved ones can support those who need help by locating resources and encouraging individuals to see doctors who can diagnose these disorders.