Antisocial Personality Disorder

An inability to conform to the social norms that ordinarily govern adolescent/adult behaviour. Concurrent substance use disorder is common.

Epidemiology: prevalence ~2–3% in the general population, rising to as high as 80% in male prison populations (up to 60% in female inmates). More common in men. Onset is usually before age 15, with symptoms typically appearing before puberty (earlier in boys than girls). Strong familial tendency — around 5× more likely with an affected first-degree relative.

Clinical features

Patients may initially appear composed, credible, charming, and ingratiating — but a careful life history usually reveals a pattern of disordered functioning: theft, truancy, running away, fighting, illegal activity. They can be manipulative and demanding, and cannot be relied on to complete a task or adhere to a conventional standard of morality. Promiscuity, spousal or child abuse, and drink driving are common, typically with complete lack of remorse.

Management

Treatment is difficult. Self-help groups can help, since motivation often improves when the person feels among peers. Hospital admission is not generally beneficial or cost-effective for ASPD itself, and should be reserved for concurrent complications such as substance intoxication/withdrawal or acute suicidal behaviour, not used routinely as a way to increase psychotherapy engagement. Medication doesn’t treat the disorder itself, though it can help alleviate specific symptoms.