Antisocial personality disorder is a psychiatric diagnosis that encompasses the formerly separated diagnoses of Psychopathy and Sociopathy. The diagnosis is established in a patient who is over the age of 18, who exhibited conduct disorder before the age of 15, where the behavior cannot be traced to schizophrenia or a manic episode and the patient exhibits at least three of the following behaviors:
- Failure to conform to social norms, particularly engaging in repeated criminal behavior;
- Skilled in the arts of deception or lying, particularly when done to hurt others for pleasure, staying out of trouble, personal gain or profit;
- Skilled with charm;
- Impulsiveness and failure to plan ahead;
- Irritability or aggression, particularly getting into fights;
- Reckless disregard for the safety of themselves or others;
- Constant irresponsibility, particularly with respect to employment or financial obligations;
- Lack of remorse characterized by rationalization or indifference to the damage caused to others;
- Constant blaming of others;
- Sexual promiscuity.
The disorder has a combination of both genetic and environmental causes. It is about three times more likely to be observed in males than females.
Theodore Millon has broken down the types of behaviors exhibited by individuals with the order into five broad types: covetous, reputation-defending, risk-taking, nomadic and malevolent.
A psychiatrist attempting to make the diagnosis must go through a careful differential to rule out similar conditions. Anxiety, clinical depression, addiction, sleep disorders, borderline personality disorder, histrionic personality disorder and narcissism can all masquerade as antisocial personality disorder.
There is no effective treatment for antisocial personality disorder. Physicians and others merely attempt to control the behavior of the individual through diligence and exploiting the patient's behavior. Psychotherapy and other behavioral therapies are commonly used with mixed effectiveness.