Antisocial Personality Disorder
Cluster B. Dramatic / Emotional / Erratic · Table 3.2 [1]
Pervasive disregard for and violation of the rights of others; deceitful, impulsive, and lacking remorse.
Characteristics (Table 3.2) [1]
| Triggering Event(s) | Social standards and rules |
|---|---|
| Behavioral Style |
|
| Interpersonal Style |
|
| Cognitive Style |
|
| Affective Style |
|
| Temperament | Ill-tempered infantile pattern and an aggressive, impulsive adult pattern |
| Attachment Style | Fearful and dismissing |
| Parental Injunction | Absorbed the lesson that reaching the goal matters more than how it is reached. |
| Self-View | Views the self as shrewd and rightfully owed whatever it desires. |
| World-View | Regards the world as treacherous and hostile and rules as obstacles to getting needs met, so bends or breaks them freely. Putting personal needs first and resisting any attempt to control or belittle. |
| Maladaptive Schemas |
|
| Optimal Diagnostic Criterion | A pattern of unlawful, aggressive, impulsive, and irresponsible conduct. |
DSM diagnostic criteria
A far-reaching disregard for and trampling of others' rights dating to age 15, in a person at least 18 who showed conduct disorder before age 15.
- Repeatedly breaches social norms around lawful conduct, committing acts that are grounds for arrest.
- A pattern of dishonesty. Habitual lying, adopting false identities, and conning others for gain or amusement.
- Acts on impulse and neglects to plan for what lies ahead.
- Short-tempered and combative, with recurrent physical fights or assaults.
- Heedless of the safety of themselves and of other people.
- Chronic unreliability in meeting work and financial responsibilities.
- Little remorse, shrugging off or justifying the harm they cause others.
- Narcissistic PD (exploitation without the criminality/aggression and conduct-disorder history)
- Borderline PD (impulsivity tied to abandonment fear and affect dysregulation)
- Substance use disorders (antisocial acts only when using)
- Adult antisocial behavior without the full pervasive pattern
Treatment
- Increase impulse control and reduce harmful/illegal behavior
- Build pro-social problem-solving and consequential thinking
- Establish realistic, enforceable limits
Maintain a clear, consistent, limit-setting frame with explicit consequences; avoid being conned and avoid moralizing. Appeal to enlightened self-interest rather than empathy. Treatment is most viable when externally structured (e.g., court-mandated, residential) and when comorbid substance use is addressed concurrently.
- Structured cognitive-behavioral / contingency-management programs
- Substance-use treatment
- Mentalization-based approaches in forensic settings
- Explicit behavioral contracts with predictable consequences.
- Skills training in delaying gratification and problem-solving.
- Address comorbid substance use directly.
- Therapist self-monitoring for manipulation and countertransference.
- Low motivation; treatment usually externally imposed
- Manipulation of the therapist and the frame
- Limited empathy and remorse reduce internal leverage for change
Generally guarded; antisocial behavior often attenuates with age. Best outcomes occur with structure, leverage, and treatment of comorbidities.
Practise this presentation
For training only. Diagnostic criteria are summarised, consult the full sources [1,2] for the complete text; see References. Not a substitute for supervised clinical assessment.