Antisocial Personality Disorder (ASPD) is a psychiatric disorder that is diagnosed in those older than 15 years and who have a pattern of behavior that is characterized by criminal acts, a lack of empathy, a resistance to working, attempts to manipulate others, and an intense resistance to authority. These individuals are also more likely to have a substance abuse problem than others. According to the National Institute of Mental Health (NIMH), individuals who have antisocial personality disorder have a 15.5 percent greater risk than those without psychiatric disorders for having a drug abuse problem. They are also more likely to abuse alcohol than those who do not have the disorder.

According to a study of a large population reported in the Journal of Clinical Psychiatry in 2004, an estimated 7.6 million individuals in the United States have antisocial personality disorder.

Many individuals who have antisocial personality disorder (ASPD) are eventually imprisoned for criminal acts, and an estimated 50-60 percent of all prison inmates have this disorder. However, some high-functioning individuals who have ASPD are able to succeed in society.

Some studies have shown that men who have alcoholism are four to eight times more likely to have ASPD than others. In addition, the prevalence of ASPD among alcoholic women is even greater than among alcoholic men: Alcoholic women have ASPD 12-17 times more than nonalcoholic women. (This is a striking finding, because in the general population, men are about three times more likely to have ASPD than women.) An estimated 15-20 percent of alcoholic males and 10 percent of alcoholic females have ASPD.

By definition, individuals who have antisocial personality disorder exhibited problem behavior as children or adolescents, such as stealing items and frequently being in trouble. Such behavior is called Conduct Disorder when it occurs in a child or adolescent. However, some children who have problem behavior may have been diagnosed with oppositional defiant disorder, primarily because of their refusal to follow the rules that are set by others, including their parents.

In adulthood, the behavior continues or escalates, and the individual is usually arrested and incarcerated in jail or prison. The adult who has ASPD may tend to get many traffic tickets for offenses such as speeding. He or she may refuse to pay traffic fines and continue to drive, even after the driver's license is suspended for failure to pay fines, and ultimately the individual may be jailed for driving with a suspended driver's license.

Some individuals who have ASPD are very effective at manipulating others. They usually lack empathy, however, and although they understand how other people think, they have considerable contempt for them, particularly for those who willingly follow the laws, rules, and regulations of society.

The prognosis for ASPD is poor, and many individuals who have this disorder will be imprisoned, often for years, because of their criminal acts and their repeated refusal to follow the laws of society. The peak of antisocial behavior often occurs in the late teens and early 20s. Some research indicates that the behavior of males who have ASPD may improve when they are in their 40s. It is unknown whether this finding also applies to women who have ASPD.

Most individuals who have antisocial personality disorder do not acknowledge that they have a problem and will not seek treatment unless they are compelled, such as with a court order. Even when individuals who have ASPD accept treatment, it is difficult for most clinicians to treat the disorder. However, psychiatrists may treat concurrent disorders that are common among individuals with ASPD, such as substance abuse and depression. There are no known medications or reliably effective psychotherapies as of this writing to treat antisocial personality disorder.

Studies have indicated that males have a three times greater risk of having antisocial personality disorder than females. A study on personality disorders in the United States based on a very large population of over 43,000 respondents and reported in the Journal of Clinical Psychiatry in 2004 found that 5.5 percent of the males met the criteria for antisocial personality disorder, as did 1.9 percent of the females.

They also found that the risks of this disorder were highest among Native Americans and lowest among Asians. Those ages 18-29 years had the greatest proportion of antisocial personality disorder in comparison to individuals of other ages. In terms of income, the risks were greatest among individuals earning less than $35,000. Individuals who had never married had a higher risk than those who had been (or were) married. Individuals living in the West had a significantly greater risk of having antisocial personality disorder than individuals in other parts of the country.

References:

1)         Compton III, William M., M.D, et al. "The Role of Psychiatric Disorders in Predicting Drug Dependence Treatment Outcomes." American Journal of Psychiatry 160, no. 5 (May 2003): 890-895.

2)         Grant, Bridget, F., et al. "Prevalence, Correlates and Disability of Personality Disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions." Journal of Clinical Psychiatry 65 (2004): 948-958.

3)         Shivani, Ramesh, M.D., R. Jeffrey Goldsmith, M.D., and Robert M. Anthenelli, M.D. "Alcoholism and Psychiatric Disorders: Diagnostic Challenges." Alcohol, Research & Health 26, no. 2 (2002): 90-98.

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