Naveed Saleh:
People with antisocial personality disorder (ASPD) may not follow social norms and may act disrespectfully towards others. They can cause emotional and physical harm, with disregard for consequences. Their actions can run afoul of the law and result in incarceration. It’s common for those with ASPD to break the law earlier in life and to exhibit high rates for recidivism. In fact, 47% of incarcerated people exhibit ASPD, according to research.
In addition to the risk of self-harm, those with antisocial personality disorder (ASPD) can represent a threat to others. In the United States, between 2% and 3% of people have it. It is more common in men than women, but ASPD presents similarly in both genders and is rooted in similar familial and non-familial factors.
Although more research needs to be done, here are 10 things to know about ASPD based on the evidence.
ASPD is hard to diagnose because it overlaps with other mental conditions, such as psychopathy, with which it often co-occurs.
One emerging strategy in helping to identify ASPD is the use of EEG as a biomarker. Researchers have shown strong brain activity at the level of the frontal lobe in those with ASPD.
ASPD is marked by impulsivity, co-occurring substance misuse, and psychopathic traits. In a study published in PLOS ONE, researchers found that in 96 male, Portuguese inmates with ASPD, the prevalence of impulsive aggression was 71.9% and that of premeditated aggression was 28.1%. Those with greater sociopathic traits were more likely to demonstrate premeditated aggression, whereas high impulsivity or frequency of substance misuse was not related to aggression type.
Criteria underlying a diagnosis of ASPD have a heritability of between 38% to 69%, according to research cited in an article presented at 24th Pacific Asia Conference on Information Systems. In addition to genetics, family background and parental conflicts, as well as harsh or inconsistent parenting, are also common contributors.
According to the results of a Cochrane review, psychotherapy is of limited efficacy in treating ASPD. Interventions that could be considered include cognitive behavioral therapy plus treatment-as-usual therapy, schema therapy, and dialectical behavior therapy. “In the absence of good-quality trial data, the use of psychological interventions to treat people with AsPD in clinical practice remains a matter for the clinician, who will wish to weigh the limited evidence of effectiveness against any risk of possible harm; it should ideally be based on consultation with the patient, their family and carers (subject to their consent) and the multidisciplinary team involved in the individual’s care,” wrote the authors.
There are no drugs approved by the FDA to treat ASPD, although physicians may prescribe psychotropics to treat comorbid depression and anxiety.
A predilection for ASPD can start very early in life, according to research published in Development and Psychopathology. In this longitudinal study following 956 participants, disregard for others in children aged exhibited at between 14 and 36 months predicted adult ASPD. These results suggest that diagnosis of this condition can be made earlier in life, thus aiding with management.
In a study published in the Journal of Clinical Neuroscience, researchers found that in 20 ASPD patients, the volumes of the amygdala and the hippocampus were decreased versus those of controls. Of note, the amygdala processes fears/threats, and the hippocampus is involved in learning and memory.
The prevalence of ASPD peaks in younger adults, with 3.91% affected. Only 0.78% of adults aged 65 years or older harbor these conditions, according to the results of a population-based study published in Aging and Mental Health. Older adults with ASPD are more likely to be diagnosed with a substance use disorder, mania, major depression, and anxiety.
In the United States, the lifetime prevalence of cruelty to animals is 1.8%. Among various other risk factors, the authors of a study published in the Journal of Psychiatric Research cited young age, poverty, family history of antisocial behavior, and ASPD as contributory.
(Naveed Saleh, M.D., M.S., attained a medical degree from Wayne State University School of Medicine and a master’s degree in science journalism from Texas A&M).
