Antisocial (or Dissocial) Personality Disorder is a relatively recent term for a condition that was previously referred to as "psychopathy," "sociopathy," or "dissocial personality disorder."

The core feature of this disorder is a long-standing pattern of disregarding and violating the rights of others. This is expressed through irresponsible, guiltless behavior, a disregard for laws and engagement in illegal activities, an inability to maintain steady employment, exploitation and manipulation of others for personal gain, deceitfulness, and an inability to sustain long-term relationships.

Individuals with this disorder usually do not seek treatment on their own and are more likely to be found in prisons or court systems. When they do appear in psychiatric settings, it is often against their will or to avoid legal consequences.

People with this disorder typically begin displaying antisocial behaviors before the age of 15, showing symptoms of Conduct Disorder. These include aggression toward people and animals, property destruction, deceitfulness or theft, and serious rule violations.

In adolescence, these individuals often engage in early sexual activity, which can be unusually aggressive or violent. They frequently abuse alcohol and drugs and start having legal problems. As they transition into adulthood, these behaviors continue, with added difficulties such as inability to hold a job, maintain relationships, or fulfill parental responsibilities. They disregard their own and others' safety (e.g., frequently driving drunk and having multiple accidents), and progressively, alcoholism, vagrancy, social isolation, and criminal activity dominate their lives.

A key characteristic is the absence of guilt. These individuals are often charming and manipulative, easily deceiving others. In psychiatric interviews, they may appear entirely normal, which makes it harder to diagnose them. Therefore, the diagnosis often relies on gathering information from family, social circles, or even law enforcement and legal authorities. A lack of responsibility, failure to learn from experiences, and inability to learn from mistakes also define this disorder.

Diagnostic Criteria (According to DSM-IV)

There is a pervasive pattern of disregard for and violation of the rights of others since age 15, as indicated by three (or more) of the following:

1. Failure to conform to social norms with respect to lawful behavior, as evidenced by repeated acts that are grounds for arrest.
2. Deceitfulness, indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure.
3. Impulsivity or failure to plan ahead.
4. Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5. Reckless disregard for the safety of oneself or others.
6. Consistent irresponsibility, as indicated by repeated failure to sustain steady work or honor financial obligations.
7. Lack of remorse, as indicated by being indifferent to or rationalizing having hurt, mistreated, or stolen from another.

Treatment

Treating individuals with this disorder is extremely challenging. They are often not motivated for therapy, do not learn from their experiences, and struggle to set boundaries for their behavior.

Long-term, behaviorally-oriented programs in hospitals or prisons aim to control antisocial behavior, help individuals establish boundaries, and restore their functionality. In these highly structured environments, people with this disorder may begin to show signs of anxiety and, later, depression. At this point, their deeper struggles with forming close relationships and their fear of criticism and rejection become evident. Individual and group psychotherapy, with a high level of support, can then be beneficial.

Support groups that include former patients in therapeutic roles can also contribute to the treatment of individuals with this disorder.

Finally, medications such as lithium, carbamazepine, or propranolol may sometimes help control violent or impulsive behavior.

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Scientific Editor: Dr. Yanni Malliaris

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