Monday, September 26, 2016

Antisocial Personality Disorder: From Surgeons to Serial Killers

Now that we’ve discussed Narcissistic Personality Disorder and Borderline Personality Disorder, we’re ready to see what’s behind Personality Disorder Door Number Three…It’s Antisocial Personality Disorder (ASPD)!
While people with ASPD have the propensity for extreme violence, and some of the most violent people in our society have or have had it, I am not going to spend a lot of time on the crimes they have committed.  This article does contain one mention of a violent act, but not a detailed description.
This is a really interesting one.  The word “antisocial” leads a lot of people to misunderstand what the disorder really is.  It’s not about not socializing.  Some people with ASPD are some of the most charming, smooth, sociable characters you’ll ever meet.  Think of the “social” part of the word as “society.”  Anti-society.  These folks are not playing by the same rules as the rest of us.  
A person with ASPD has no regard for right and wrong.  They will ignore the rights and feelings of other people.  They may be harsh, callous, and indifferent toward someone.  They will do so without guilt or remorse.  
Here’s an example from when I was working inpatient forensic mental health: 
In order to restrain someone or force medication, the patient had to be currently violent and threatening.  Keep that in mind.  On this particular day, a patient with BPSD walked into another patient’s room who owed him money.  He beat the man so badly, the victim’s jaw was broken.  Afterward, the assailant walked back to his own room, and laid calmly on his bed until staff came running.  Our hands were tied.  He had just violently assaulted someone, but no longer posed a threat.  He was talking to us as calmly as if he were asking about the weather.  We were able to place him in secluded observation for 30 minutes.  But the whole time he was in the locked room, he sat on the bed and was completely quiet.  I don’t think he was even breathing hard.  When the 30 minutes were up, we had no choice but to release him back onto the ward.  
Creeped out?  So was I.  
So let’s talk about the diagnostic criteria.  The DSM 5 states that a person with ASPD will have:
 A.  A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years, as indicated by three (or more) of the following:
1 Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are grounds for arrest.
2 deceitfulness, as indicated by repeated  lying, use of aliases, or conning others for personal profit or pleasure.
3 Impulsivity or failure to plan ahead. 
4 Irritability and aggressiveness, as indicated by repeated physical fights or assaults.
5 Reckless disregard for safety of self and others.
6 Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.
7 Lack of remorse, as indicated by being in different to or rationalizing having hurt, mistreated, or stolen from another.
B.  The individual is at least age 18 years.
C. There is evidence of conduct disorder with onset before age 15 years.
D. The occurrence of antisocial behavior is not exclusively during the course of schizophrenia or bipolar disorder.
(American Psychiatric Association, 2013).”
I am not going to get into Conduct Disorder in this article.  It’s a whole other topic which deserves its own article, and I figure ASPD is a lot to digest on its own.  What I would like you to take from this is that it’s a lifelong pattern.  Other personality disorders don’t really start showing until early adulthood, late teens at the earliest.  ASPD, on the other hand, starts showing up earlier.  
What I find really interesting about ASPD is that it can also make a person highly effective in certain situations.  I like to think of it as using their powers for good instead of evil.  Think of careers where a person would need to make decisions without letting emotions interfere in judgement:  I am absolutely serious when I tell you that people with ASPD make great attorneys.  A surgeon, to give another example, has to make split-second decisions based on what’s right in front of them, as opposed to feelings they may have about what may happen.  It’s also not hard to find examples of this disorder whenever you look at people in management level positions.  I’m not trying to be insulting.  It’s just that the characteristics of ASPD make for someone who makes shrewd business decisions without letting feelings get in the way.  A person has to have at least some of the traits in order to succeed in politics.  
This is the last article in the series on Personality Disorders.  I am looking forward to your thoughts, questions, and comments.  I wanted to end with this one because it tends to be interesting information that not many people know.  Antisocial Personality Disorder is something we see around us at a greater frequency than we really think about.  This article isn’t so much about techniques for dealing with someone with ASPD, but is intended to be more informative.  Just know that as with any personality disorder, you’re not going to change the person.  This is who they are.  But also remember that you are not the cause either.  
Be well.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.


  1. Thanks for the information on personality disorders. very interesting.

  2. Really interesting article on Antisocial Personality Disorder. I think I always assumed it had more to do with being an introvert than it is. Thanks for another fascinating look into the human brain and how it can affects people in every day life.

    1. That makes sense. I also think the media plays into that stereotype. "He was a loner." "He was a nice guy, but always kept to himself." Then we have the Unibomber who was quite literally shacked up in a cabin in the woods. Your comments always add great perspective to these discussions. Thanks Lori! Be well.

  3. Thats an intense read about Anti Social Personality Disorder. Interesting but intense always good to know more about whats out there.

    1. ASPD certainly is intense! That's one of my main goals for IOI is to get the information out there. It decreases our fear, since we tend to fear the unknown the most. Thank you for you comment, Kelly. Be well!

  4. ASPD is a scary one! I'm fairly certain my ex-fiance had it! Haha! But really! I found his sense of apathy and lack of remorse really fascinating at times. Probably the same reason I stay up late watching serial killer docs now! Very interesting story about the gent in the ward.

    1. Wow! I'm sorry you went through that. It must have been really hard at the time. I am glad you are safe now. Be well, Lillian!

  5. I'm geeking out because I love reading information on humanity from a outside point of view. The way you describe Antisocial Personality Disorder factually, while also stigmatizing it by pointing out aspects of it that can be very helpful for our society as a whole, is truly amazing! I love your blog!

    1. Thank you so much, Parker! I thoroughly enjoy writing IOI, and it always means a lot to hear others are benefiting from my blog. Be well, Parker!

  6. That is such a wild story to share! Thank you for detailing out this medical information and sharing some unbiased pointers on the subject. Looking forward to future posts!!

  7. Jennifer, you were right. That story was creepy but effective in showing some of the issues with Antisocial Personality Disorder.

    It's interesting to think how this disorder can be used for good or bad in determining a person's behavior. I'd love to see a follow-up on someone using this disorder to their advantage.

    Great read. Thanks for the unique look into something I wouldn't have checked out otherwise.

  8. That was a fantastic read, a unique look int a subject I was not familiar with