Diagnosis

People with antisocial personality disorder are unlikely to believe they need help. However, they may seek help from their health care provider because of other symptoms such as depression, anxiety or angry outbursts or for treatment of substance abuse.

People with antisocial personality disorder may not provide an accurate account of signs and symptoms. A key factor in diagnosis is how the affected person relates to others. With permission, family and friends may be able to provide helpful information.

After a medical evaluation to help rule out other medical conditions, the health care provider may make a referral to a mental health professional for further evaluation.

Diagnosis of antisocial personality disorder is typically based on:

  • A psychological evaluation that explores thoughts, feelings, relationships, behavior patterns and family history
  • Personal and medical history
  • Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association

Though typically antisocial personality disorder isn't diagnosed before age 18, some signs and symptoms may occur in childhood or the early teen years. Usually there is evidence of conduct disorder symptoms before age 15.

Identifying antisocial personality disorder early may help improve long-term outcomes.

Treatment

Though antisocial personality disorder is difficult to treat, for some people, treatment and close follow-up over the long term may be beneficial. Look for medical and mental health professionals with experience in treating antisocial personality disorder.

Treatment depends on each person's particular situation, their willingness to participate in treatment and the severity of symptoms.

Psychotherapy

Psychotherapy, also called talk therapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for substance abuse, and treatment for other mental health conditions.

But psychotherapy is not always effective, especially if symptoms are severe and the person can't admit that he or she contributes to serious problems.

Medications

There are no medications specifically approved by the Food and Drug Administration to treat antisocial personality disorder. Doctors may prescribe medications for conditions sometimes associated with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression. Drugs are usually prescribed cautiously because some have the potential for misuse.

Coping and support

Skills for family members

People with antisocial personality disorder often act out and make other people miserable — with no feeling of remorse. If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself.

A mental health professional can teach you skills to learn how to set boundaries and help protect yourself from the aggression, violence and anger common to antisocial personality disorder. They can also recommend strategies for coping.

Seek a mental health professional who has training and experience in managing antisocial personality disorder. Ask your loved one's treatment team for a referral. They may also be able to recommend support groups for families and friends affected by antisocial personality disorder.

Preparing for your appointment

If a medical evaluation rules out physical causes for your behavior, your primary care doctor may make a referral to a psychiatrist.

Take a family member or friend along to your appointment, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with the doctor that you don't think to bring up.

What you can do

Before your appointment, make a list of:

  • Any symptoms you or your family noticed, and for how long
  • Key personal and medical information, including current physical or mental health conditions, personal or family history of mental illness, traumatic experiences or major stressors
  • All medications you take, including the names and doses of any medications, herbs, vitamins or other supplements
  • Questions you want to ask your doctor to make the most of your appointment

Some basic questions to ask your doctor include:

  • What is likely causing my symptoms?
  • What are other possible causes?
  • What treatments are most likely to be effective for me?
  • How much can I expect my symptoms to improve with treatment?
  • How often will I need treatment, and for how long?
  • Are there medications that can help? Is so, what are the possible side effects?
  • Is there a generic alternative to the medication you're prescribing?
  • Are there any printed materials I can have? What websites do you recommend?

Don't hesitate to ask any other questions during your appointment.

What to expect from your doctor

Your doctor is likely to ask you a number of questions, such as:

  • What are your symptoms?
  • When did you or your family first notice these symptoms?
  • How are your symptoms affecting your life?
  • Have relatives or friends expressed concern about your behavior?
  • Do you have any close relationships?
  • If you're not satisfied with work, school or relationships, what do you think is causing your problems?
  • Have you ever thought about harming yourself or others? Have you ever actually done so?
  • Have any of your close relatives been diagnosed or treated for mental illness?

Be ready to answer these questions to reserve time to go over points you want to spend more time on.

Aug. 04, 2017
References
  1. Antisocial personality disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American Psychiatric Association; 2013. http://www.psychiatryonline.org. Accessed March 21, 2016.
  2. Meloy JR, et al. Antisocial personality disorder. In: Gabbard's Treatment of Psychiatric Disorders. 5th ed. Arlington, Va.: American Psychiatric Association; 2014. http://psychiatryonline.org/doi/full/10.5555/appi.books.9781585625048.gg00pre. Accessed March 21, 2016.
  3. Antisocial personality disorder: Prevention and management. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/cg77. Accessed March 21, 2016.
  4. Black DW. The natural history of antisocial personality disorder. Canadian Journal of Psychiatry. 2015;60:309.
  5. Black DW. Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis. http://www.uptodate.com/home. Accessed March 21, 2016.
  6. Black DW. Treatment of antisocial personality disorder. http://www.uptodate.com/home. Accessed March 21, 2016.
  7. Werner KB, et al. Epidemiology, comorbidity, and behavioral genetics of antisocial personality disorder and psychopathy. Psychiatric Annals. 2015;45:195.
  8. Velotti P, et al. Mindfulness moderates the relationship between aggression and antisocial personality disorder traits: Preliminary investigation with an offender sample. Comprehensive Psychiatry. 2016;64:38.
  9. Palmer BA (expert opinion). Mayo Clinic, Rochester, Minn. March 24, 2016.

Antisocial personality disorder