Antisocial personality disorder, like other personality disorders, is a longstanding pattern of behavior and experience that impairs functioning and causes distress.

People with antisocial personality disorder don't follow society's norms, are deceitful and intimidating in relationships, and don't consider the rights of others. People with this type of personality sometimes have a history of criminal activity but are not sorry for their hurtful deeds. They can be impulsive, reckless and sometimes violent. This disorder is far more common and more apparent in men than women.

People with antisocial personality disorder may believe that only threats of punishment, rather than personal values, cause people to play by the rules. The belief leads to a tendency to exploit others, take advantage of their fairness or soft-heartedness, and feel indifferent toward or even contemptuous of their victims. A person with this disorder has little, if any, ability to be intimate with another person. Any lasting relationships involve abuse or neglect. Yet people with this disorder are sometimes charming and can be good actors who use lies and distortion to keep relationships going. Some with antisocial personality disorder have no goal beyond the pleasure of deceiving or harming others.

People with antisocial personality disorder appear to care for no one but themselves. They may be able to understand the emotions of others, but they don't suffer any shame or guilt about the pain they may be causing. Instead, they use their knowledge of others' weaknesses to gain favors or to manipulate. A person with this disorder usually does not take responsibility for any of his or her own suffering. He or she will blame others when things go badly. Many with this disorder are self-defeating and live lives without the many pleasures that come to people who are better able to have mutual and satisfying relationships.

People with this personality disorder can have related problems, such as chronic boredom or irritability, psychosomatic symptoms, pathological gambling, alcohol and substance abuse, and a variety of mood or anxiety disorders. They have a higher risk of suicide. A significant number have had behavior problems or attention deficit disorder as children.

Antisocial personality disorder is probably caused by a combination of factors.

• Influences from the environment. A chaotic family life with a lack of supervision may be involved in the development of this personality disorder. The disorder also may be more common where the community is unsupportive and provides little opportunity to be rewarded for positive behavior.



• Genetic (inherited) or biological factors. Researchers have found certain physiological responses that may be specific to people with antisocial personality disorder. For example, they have a comparatively flat response to stress � they seem to get less anxious than the average person. They seem to have a harder time maintaining daytime arousal. They also have a weak "startle reflex," the involuntary response to loud noises. This relative insensitivity may affect their ability to learn from reward and punishment.
  
  The frontal lobe, the area of the brain that governs judgment and planning, also appears to be different in people with antisocial personality disorder. Some researchers have found changes in the volume of brain structures that mediate violent behavior. They may thus have more difficulty restraining their impulses, which may account for the tendency toward more aggressive behavior.

A person with antisocial personality disorder tends to have few symptoms, but causes discomfort or distress to others through socially unacceptable behavior and by being:

• Deceitful
• Impulsive
• Aggressive or irritable
• Reckless
• Irresponsible
• Remorseless

The diagnosis is made on the basis of a person's history, usually by a mental health professional. There are no laboratory tests to assist in diagnosing this disorder. Other psychiatric disorders, such as a mood or anxiety disorder, attention deficit disorder, or substance abuse, may also be present.

All personality disorders are lifelong patterns.

There is no way to prevent this disorder. An improvement in a person's social environment may reduce the severity of the problem, especially if changes are made early in life.

Many types of psychotherapy techniques have been used to treat antisocial personality disorder. In younger people, family or group psychotherapy may help to change destructive patterns of behavior, teach new vocational and relationship skills, and reinforce a person's social support. Psychotherapy also may help a person with this disorder learn to be more sensitive to the feelings of others and encourage new, socially acceptable and productive ways of thinking about one's goals and aims. Cognitive therapy attempts to change sociopathic ways of thinking. Behavior therapy uses reward and punishment to promote good behavior.

In some cases, symptoms can be treated with medication. Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft), may decrease aggressiveness and irritability. They are useful if anxiety or depression is present, or if either is contributing to substance abuse.

There are many questions about how helpful any of these interventions can be. Treatment is more likely to be successful if it is started earlier in life, but long-entrenched patterns of thinking and behavior are difficult to change. Also, the longer a person lives with this personality style, the less he or she may be interested in taking responsibility for change. For some people, the tendency toward aggression and irritability decreases with age, but some personality characteristics may persist.

Often the only thing that can protect victims of antisocial behavior is the criminal justice system. In rare instances, corrections systems (jails and prisons) provide opportunities for treatment or rehabilitation, but often these environments, with their abundance of antisocial individuals, only promote antisocial behavior.

People with antisocial personality disorder generally do not acknowledge that they have a problem that requires treatment. When a pattern of antisocial behavior is noted, others can recommend or encourage treatment. Often treatment occurs only when it is imposed by a court.

The long-term outlook for antisocial personality disorder is highly variable. In one study, about half of people diagnosed with antisocial personality disorder were either improved or had no psychiatric symptoms many years later. However, change is not likely to be rapid when antisocial behavior is prominent and active. Any change that occurs may be measurable only after years or decades.

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