Antisocial Personality Disorder

What Causes Antisocial Personality Disorder?

The exact cause of ASPD has not yet been discovered. Several factors, however, seem to put an individual at increased risk of ASPD.

• Family history and genetics. People with ASPD often have a family history of the same disorder. Therefore, scientists suspect a genetic component to ASPD, but no definite association with any gene or group of genes has yet been discovered.
• Childhood experiences. Children at risk for ASPD may be even more at risk if they experience abuse or neglect during childhood.
• Brain chemistry. People with ASPD often have a lower than usual level of the neurotransmitter chemical serotonin.
• Drug or alcohol abuse may increase the risk of ASPD.

Is Antisocial Personality Disorder Hereditary?

Scientists have not yet been able to identify a specific genetic component that increases the risk of ASPD. Inherited genes may increase an individual’s susceptibility to ASPD, but the disorder’s actual development may result from external triggering circumstances.

How Is Antisocial Personality Disorder Detected?

In many cases, ASPD is preceded by a childhood condition called conduct disorder. Children with conduct disorder have a similar disregard for right and wrong as adults with ASPD. However, ASPD can’t be diagnosed until a person reaches the age of 18, so childhood symptoms fall under a diagnosis of conduct disorder.

Symptoms of conduct disorder include:

• Getting in fights or bullying
• Cruel, manipulative, coercive, or intimidating behavior
• Cruelty to animals
• Sexual assault or harassment
• Lying
• Stealing
• Vandalism or arson
• Running away or skipping school

 Conduct disorder is often mistaken for other conditions, such as attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder, or depression.

How Is Antisocial Personality Disorder Diagnosed?

Diagnosis of ASPD begins with determining that the patient has a cluster of symptoms that meet the diagnostic criteria for the disorder. A doctor will start with a physical exam to rule out biological problems that may be causing symptoms. After these exams, if the doctor suspects that ASPD or another mental disorder is the cause of the symptoms, they may recommend a psychological or psychiatric assessment to solidify the diagnosis further.

Diagnostic steps may include:

• A physical exam. This exam rules out physical conditions that could be causing the symptoms.
• Psychological assessments. These assessments may take the form of questionnaires or talk sessions with a mental health professional to assess the patient’s mood, mental state, and mental health history. Family members or caregivers may also be asked to participate in these assessments.

The results of the psychological assessments will be compared to the diagnostic criteria for ASPD in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM criteria for ASPD include:

• Persistent disregard for others.
• At least three symptoms are present.
• The symptoms begin by the age of 15.

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Antisocial Personality Disorder Treated?

People with ASPD typically do not acknowledge that they have a problem and rarely seek treatment on their own. Research has not shown that any treatment options are consistently effective, but sometimes psychotherapy or medications may achieve some short-term improvements.

Therapies

Cognitive-behavioral therapy may help some people with ASPD to control some of their symptoms. This type of therapy teaches the patient to recognize problematic behavior patterns and develop strategies to control the behavior before it occurs.

Contingency management is a type of treatment that withholds rewards from the patient to motivate them to change their behavior. This approach may be effective in some cases.

Medications

Medicines may be used to treat specific symptoms that co-exist with ASPD. The drugs used to treat these symptoms include selective serotonin reuptake inhibitors (SSRIs), mood stabilizers such as lithium, or antipsychotics such as aripiprazole or risperidone.

How Does Antisocial Personality Disorder Progress?

People with ASPD are at high risk of physical, social, financial, and legal consequences stemming from their behavior. In addition, the people around them are at risk of harm as well, making identification and treatment of the disorder essential.

Long-term adverse effects of ASPD can include:

• Domestic violence
• Child abuse
• Sexual abuse
• Unemployment
• Homelessness
• Alcohol or substance abuse
• Homicide
• Incarceration
• Depression
• Anxiety
• Injury or death as a result of violent or impulsive behavior
• Suicide

How Is Antisocial Personality Disorder Prevented?

There is no sure way to prevent ASPD, but early intervention when a child exhibits symptoms of conduct disorder may improve the long-term outlook.

Antisocial Personality Disorder Caregiver Tips

Many people with antisocial personality disorder also suffer from other brain and mental health-related issues, a condition called co-morbidity. Here are a few of the disorders commonly associated with ASPD and conduct disorder:

• More than half of people with ASPD also have an anxiety disorder at some point in their lives.
• People with both ASPD and anxiety disorder are more likely to suffer from depression, alcoholism, substance abuse, or suicide attempts.
• ASPD and post-traumatic stress disorder (PTSD) are often comorbid.

Antisocial Personality Disorder Brain Science

Researchers have tried to identify the underlying neurological causes of ASPD by examining brain function and structure in people with the disorder. Studies have found some structural differences in the brains of people with ASPD, including:

• A smaller than average amount of brain tissue (called gray matter) in the prefrontal cortex. This is the part of the brain responsible for planning, decision-making, and impulse control.
• A larger than normal corpus callosum, a structure that connects the left and right hemispheres of the brain. This abnormality could be an indicator of disrupted brain development during childhood.

Some scientists believe that these structural abnormalities in the brains of people with ASPD may result from traumatic experiences, such as abuse or neglect, during critical periods of brain development in childhood.

Antisocial Personality Disorder Research

Title: Adapting Dialectical Behavior Therapy for the Treatment of Criminal Offenders With Antisocial Personality Disorder (DBT-ASPD)

Stage: Not Yet Recruiting

Principal investigator: Barry Rosenfeld, PhD

Fordham University

Bronx, NY 

Antisocial personality disorder (ASPD) is among the most damaging and costly mental disorders, yet little research has sought to address the root causes of this disorder. Indeed, many clinicians consider ASPD to be “untreatable” and have primarily relegated the management of this challenging disorder to the criminal justice system, effectively relinquishing responsibility for understanding and treating ASPD. Although the criminal justice system utilizes a number of interventions, these interventions have typically focused on specific problem behaviors, such as anger management and substance abuse. In addition, these interventions, along with the more broad-based approaches occasionally studied (e.g., criminal cognitions), focus primarily on cognitive processing, effectively ignoring core elements of ASPD such as impulsivity and emotion dysregulation. Recently, however, growing interest has centered on Dialectical Behavior Therapy as a potential intervention approach, particularly given the emphasis on tangible behaviors and the acquisition of skills to address the core elements of APSD. The proposed study builds upon an innovative rehabilitative program developed by the U.S. District Court in New York. Beginning in 2020, the Fordham Community Mental Health Clinic has provided a DBT-based intervention to participants in this rehabilitation program. This population comprises repeat criminal offenders deemed at high risk for reoffending by the Probation Department, the vast majority of whom meet diagnostic criteria for ASPD. This intervention, which builds on the researcher team’s past work treating offenders with a history of stalking and intimate partner violence, has the potential to advance the utility of DBT for the treatment of this challenging population. The present application proposes to advance this goal by adapting DBT to target core symptoms of ASPD, including impulsivity, difficulties in emotional processing, and problem-solving deficits. By adapting traditional DBT, this intervention hopes to demonstrate increased success in retaining and engaging this challenging population in treatment, decreasing the extent of problematic behaviors, and reducing the rates of violent and criminal re-offense. 

Most importantly, this application takes an experimental therapeutics approach by identifying potential mediators of successful change in ASPD and quantifying the extent to which DBT impacts these traits and behaviors. Although DBT is not expected to “cure” ASPD, even modest improvements in the treatability of this challenging population would translate into substantial benefits given the high social, economic, and health care costs associated with this disorder. Given these goals, the present application seeks to a) demonstrate the feasibility and acceptability of this intervention, b) reduce problematic character traits and behaviors (e.g., decreased impulsivity, increased emotion recognition), and c) reduce the rates of reoffending.

Title: Multisystemic Therapy-Emerging Adults (MST-EA) for Substance Abuse

Stage: Recruiting

Contact: Amanda Jacobs, LPC

North American Family Institute

Hamden, CT 

Prevalence of alcohol and other drug (AOD) abuse and criminal activity is highest during emerging adulthood compared to any other developmental period and causes extraordinary costs to society. Emerging Adults (EAs; ages 17-26) with AOD abuse have greater incarceration rates than EAs without AOD abuse. AOD-abusing offenders have significantly more recidivism, severe offending, and incarceration than other offenders. Such serious behavior interferes with successful transition into adulthood in areas such as school completion, employment, and housing. Thus, there is a strong public health need for effective treatment to reduce AOD abuse and justice involvement in EAs. Surprisingly, no interventions have established efficacy to reduce criminal activity among EAs, with or without AOD abuse. Among younger adolescents, the comprehensive causes of antisocial behavior are addressed by effective interventions (e.g., Multisystemic Therapy [MST]; Treatment Foster Care Oregon [TFCO]).  The present investigative team has developed and evaluated a well-defined age-tailored intervention for EAs with criminal behavior. The developed intervention is an adaptation of MST and integrates a skills coaching component from TFCO, both well-established effective juvenile justice interventions. Initial MST-EA research focused on justice-involved young adults who had mental health problems, a high-risk subpopulation of offenders, but AOD abuse quickly became a primary problem the MST-EA team treated. As a single-source intervention, MST-EA targets the EA correlates of criminal activity and AOD abuse, including gainful EA activities (positive relationships, school, work, and housing) and reduced AOD abuse-in part by targeting the proximal mechanism of poor self-regulation. In a successfully completed community-based open trial, the intervention’s safety, feasibility, and preliminary efficacy were established.

The proposed study will evaluate the effectiveness of MST-EA for reducing justice involvement and AOD abuse. EAs (n = 240) with AOD abuse and justice involvement (recent arrests or release from justice facilities) will be randomized to receive MST-EA or Enhanced Treatment as Usual (E-TAU). Assessments will be completed at months 0, 2, 4, 6, 8, 12, and 16, with confirmation of outcome data using official records. Aims will be to evaluate the effect over time of MST-EA for reducing AOD abuse and criminal activity and evaluate the effect of MST-EA on the key proximal target of treatment (self-regulation) and intermediate outcomes of treatment (gainful activities). A final aim will be to investigate if the direct effect of treatment on criminal activity is mediated by its effect on self-regulation, AOD abuse, and gainful activities. There is a complete absence of AOD abuse and recidivism reduction treatments with demonstrated effectiveness in this specific age group. The ultimate effect of the proposed research is decreased AOD abuse and justice involvement in a high-risk population and improved outcomes that have a significant societal impact (e.g., reduced homelessness and unemployment).

Title: The Effect of Repeated Prefrontal Cortex Stimulation on Antisocial and Aggressive Behavior

Stage: Recruiting

Principal Investigator: Adrian Raine, DPhil

University of Pennsylvania

Philadelphia, PA 

This study investigates the relationship between prefrontal cortex activity and antisocial and aggressive behavior and risk factors for such behavior. In the double-blind, randomized controlled trial, participants will undergo three sessions of anodal transcranial direct current stimulation of the dorsolateral prefrontal cortex or sham stimulation and complete survey and laboratory measures assessing antisocial behavior and risk factors. Heart rate and skin conductance will also be measured.