Antisocial personality disorder is thought of as an uncommon and untreatable disorder, if it’s thought of at all. Not many researchers study the disorder because little funding is available. Practitioners aren’t particularly interested in working with these individuals either, because they’re difficult and some can be dangerous. Many also believe that studying antisocials is futile, because they’ll never improve.
“A lot of doctors and other mental health professionals just throw up their arms, and say, ‘What’s the point of even identifying antisocial personality disorder? What are we going to do with these people?’” said Donald W. Black, M.D., a professor of psychiatry at the University of Iowa Roy J. and Lucille A. Carver College of Medicine in Iowa City.
Dr. Black, also a consultant to the Iowa Department of Corrections, has been studying antisocial personality disorder (or ASP) for over 20 years. You might be more familiar with the term “sociopath,” which is used more often in the media. “Antisocial” isn’t the best word to describe the disorder, according to Black, because it’s often associated with being shy. “The term arose because the disorder is anti-society. It’s behavior that’s directed against society.”
Black believes it’s vital to study ASP. Not only is ASP costly to our society – economically, socially and emotionally – but you might be surprised to learn that it’s actually quite common. ASP is as common as attention deficit hyperactivity disorder, panic disorder and obsessive-compulsive disorder.
In fact, it might be even more common, because antisocials deny or lie about their symptoms. Black said ASP likely could be traced to “just about any bad thing” in our society, from domestic violence to murder.
Yet, ASP remains highly misunderstood. Below, you’ll learn more about antisocial personality disorder along with its myths and facts.
What Is Antisocial Personality Disorder?
In his new book Bad Boys, Bad Men: Confronting Antisocial Personality Disorder (Sociopathy), Revised and Updated, Black describes ASP as “a recurrent and serial pattern of misbehavior that involves all significant facets of life and is marked by violation of social norms and regulations that occur over time, ranging from repeated lies and petty theft to violence – and even murder, in the most serious cases.”
The major symptoms seem to strike individuals in their early teens and 20s. This is especially problematic, because this time is critical for completing education, starting a career and establishing a family life, Black said. “Antisocials never catch up with their peers.” (This is where early identification and intervention can help.)
Like other disorders, ASP lies on a continuum of severity, Black said. At one end of the spectrum are serial killers. At the other end are mildly affected individuals who commit bad acts from time to time that influence their and others’ lives, he said.
Also, like other disorders, ASP is a complex combination of genetic, biological and environmental causes. It runs in families. Identical twins are more likely to have the disorder than fraternal twins, he said. “Antisocials often come from very dysfunctional families, suffer childhood abuse, have head injuries as children, and their moms are more likely to smoke during pregnancy.” They’re also more likely to have antisocial friends, which only encourages, validates and reinforces bad behavior, he said.
Interestingly, people with antisocial personality disorder tend to gradually improve over time. According to Black, “if you follow them long enough, a certain percentage won’t meet criteria for antisocial personality disorder.” No one knows why they improve, but many other disorders, such as schizophrenia, also may improve over time.
Myths About Antisocial Personality Disorder
There are many myths about ASP. These are some of the most common misconceptions.
1. Myth: Antisocial personality disorder is untreatable.
Fact: Only one randomized controlled trial has been conducted. It tested the efficacy of cognitive-behavioral therapy (CBT) for treating ASP. The treatment didn’t work. However, Black said to contrast that with schizophrenia or bipolar disorder, where researchers have conducted literally hundreds – or thousands – of studies looking at the effectiveness of certain medications and psychotherapies, he said. “It is wrong to conclude that antisocial personality disorder is not treatable. We just don’t know.”
In other words, more research is needed. For instance, some medications have been shown to reduce aggressive tendencies, Black said. “Those may be helpful for antisocial persons in whom aggression is an important symptom.” For instance, atypical antipsychotics, which target mood and irritability, could help these individuals.
Smaller studies have suggested that CBT might hold promise for individuals on the milder end of the spectrum, he said.
2. Myth: Studying antisocial personality disorder coddles criminals and gives them an excuse.
Fact: “[Many worry] ASP is just an excuse for bad behavior, and courts will use it to excuse criminals from criminal responsibility,” Black said. However, he noted that ASP has never been used successfully in court.
According to Black, “An ASP diagnosis is not a license for patients to behave as they like, but instead is a lens through which to view their misbehavior, which is unusual by any standard.”
In another section of his book, he explains, “Although some antisocials – and their attorneys – may attempt to use ASP as an excuse, psychiatrists see the disorder differently. Antisocial personality disorder describes a pattern of behaviors, choices and feelings, but it does not mean that people with the disorder are unable to chart their own paths through life. Unlike some other mental disorders, ASP does not entail a break with reality. Antisocials know full well what is going on around them. They know the difference between right and wrong but may simply be unconcerned with it. Their actions are deliberate and focused on their self-centered goals. They are responsible for their own behavior and should be held accountable.”
3. Myth: You can’t prevent antisocial personality disorder.
Fact: About 40 percent of boys and 25 percent of girls with conduct disorder – the childhood precursor to ASP – are at a high risk for developing ASP as adults, Black said. However some research has shown that if you identify these kids early and work with their families to help them recognize and correct their child’s misbehavior, and steer them away from bad peers, it’s possible to stave off this trajectory, he said.
“Other data suggest that early adjudication may help. Placing a child before a judge and court and providing some kind of sentence has a preventive effect.” In other words, these kids are less likely to become antisocial adults. Adjudication teaches them that bad behavior has negative consequences, and they’re responsible for their actions, even as kids. (Excusing their behavior deprives kids of this vital lesson.)
Again, Black stressed the importance of researching antisocial personality disorder. As he writes, “ASP may be at the root of a substantial amount of the troubles that plague society, and … learning more about the disorder might help us fight crime, violence, and other social ills.”