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Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis

Donald W Black, MD
Section Editor
Andrew Skodol, MD
Deputy Editor
Richard Hermann, MD


Antisocial personality disorder (ASPD) is defined as a pattern of socially irresponsible, exploitative, and guiltless behavior that begins in childhood or early adolescence and is manifested by disturbances in many areas of life [1]. It is usually a lifelong disorder that begins in childhood and is fully manifest by the late 20s or early 30s [2].

Typical behaviors include criminality and failure to conform to the law, failure to sustain consistent employment, manipulation of others for personal gain, and failure to develop stable interpersonal relationships. Other features of ASPD include lacking empathy for others, rarely experiencing remorse, and failing to learn from the negative results of one’s experiences [3,4].

This topic describes the epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of antisocial personality disorder. Treatment of antisocial personality disorder is discussed separately. (See "Treatment of antisocial personality disorder".)


Antisocial personality disorder — Antisocial personality disorder (ASPD) is characterized by behaviors constituting a pervasive pattern of disregard for and violation of the rights of others that begins in childhood or early adolescence and is manifested by disturbances in many areas of life, including family relations, schooling, work, military service, and marriage. Sociopathy is a lay term that is essentially synonymous with antisocial personality disorder, and has been used less over time.

Psychopathy — Psychopathy has been described as a clinical construct distinct from ASPD, defined by a constellation of antisocial behaviors and psychological symptoms, such as lack of emotional connection with others and an incapacity for guilt or remorse [5,6]. In contrast, except for “lacking remorse,” the DSM-5 criteria for ASPD are mainly focused on observable behavioral manifestations. Psychopathy indicates a particularly malignant form of ASPD and appears to fall at the severe end of the antisocial behavior spectrum [7]. Most psychopaths meet criteria for ASPD, but not all ASPD patients are psychopathic.

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Literature review current through: Nov 2017. | This topic last updated: Sep 15, 2017.
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  1. North C, Yutzy S. Goodwin & Guze’s Psychiatric Diagnosis, 6th ed, Oxford University Press, New York 2010.
  2. Robins LN, Price RK. Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project. Psychiatry 1991; 54:116.
  3. Black DW. Bad Boys, Bad Men – Confronting Antisocial Personality Disorder, Oxford University Press, New York 1999.
  4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  5. Hare RD. Twenty years of experience with the Cleckley psychopath. In: Unmasking the Psychopath: Antisocial personality and related syndromes, Reid WJ. Dorr D, Walker JI, Bonner JW (Eds), WW Norton, New York 1986. p.3.
  6. Hare RD. Without conscience: The disturbing world of psychopaths among us, Pocket Books, New York 1993.
  7. Coid J, Ullrich S. Antisocial personality disorder is on a continuum with psychopathy. Compr Psychiatry 2010; 51:426.
  8. Robins LN. The epidemiology of antisocial personality disorder. In: Psychiatry, Michels RO, Cavenar JO (Eds), JB Lippincott, Philadelphia 1987. Vol 3.
  9. Grant BF, Hasin DS, Stinson FS, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2004; 65:948.
  10. Robins LN, Helzer JE, Weissman MM, et al. Lifetime prevalence of specific psychiatric disorders in three sites. Arch Gen Psychiatry 1984; 41:949.
  11. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 1994; 51:8.
  12. Compton WM, Conway KP, Stinson FS, et al. Prevalence, correlates, and comorbidity of DSM-IV antisocial personality syndromes and alcohol and specific drug use disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry 2005; 66:677.
  13. Ullrich S, Coid J. Antisocial personality disorder: Co-morbid Axis I mental disorders and health served use among a national household population. Personality Ment Health 2009; 3:151.
  14. Guze S. Criminality and psychiatric disorders, Oxford University Press, New York 1976.
  15. Black DW, Gunter T, Loveless P, et al. Antisocial personality disorder in incarcerated offenders: Psychiatric comorbidity and quality of life. Ann Clin Psychiatry 2010; 22:113.
  16. Hesselbrock V, Meyer R, Hesselbrock M. Psychopathology and addictive disorders: The Specific case of antisocial personality disorder. In: Addictive States, O’Brien CP, Jaffe JH (Eds), Raven Press, New York 1992.
  17. Tsai J. Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Public Health (Oxf) 2017; :1.
  18. North CS, Smith EM, Spitznagel EL. Is antisocial personality a valid diagnosis among the homeless? Am J Psychiatry 1993; 150:578.
  19. Robins LN, Murphy GE, Woodruff RA Jr, King LJ. Adult psychiatric status of black schoolboys. Arch Gen Psychiatry 1971; 24:338.
  20. Robins L. Deviant Children Grown Up, Williams and Wilkins, Baltimore, MD 1966.
  21. Black DW, Baumgard CH, Bell SE. A 16- to 45-year follow-up of 71 men with antisocial personality disorder. Compr Psychiatry 1995; 36:130.
  22. Grant BF, Stinson FS, Dawson DA, et al. Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Arch Gen Psychiatry 2004; 61:361.
  23. Regier DA, Farmer ME, Rae DS, et al. Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study. JAMA 1990; 264:2511.
  24. Dinwiddie SH, Reich T. Attribution of antisocial symptoms in coexistent antisocial personality disorder and substance abuse. Compr Psychiatry 1993; 34:235.
  25. Zimmerman M, Coryell W. DSM-III personality disorder diagnoses in a nonpatient sample. Demographic correlates and comorbidity. Arch Gen Psychiatry 1989; 46:682.
  26. Mannuzza S, Klein RG, Bessler A, et al. Adult psychiatric status of hyperactive boys grown up. Am J Psychiatry 1998; 155:493.
  27. Guze SB, Wolfgram ED, McKinney JK, Cantwell DP. Psychiatric illness in the families of convicted criminals: a study of 519 first-degree relatives. Dis Nerv Syst 1967; 28:651.
  28. Crowe RR. An adoption study of antisocial personality. Arch Gen Psychiatry 1974; 31:785.
  29. Brennan PA, Mednick SA. Genetic perspectives on crime. Acta Psychiatr Scand Suppl 1993; 370:19.
  30. Slutske WS. The genetics of antisocial behavior. Curr Psychiatry Rep 2001; 3:158.
  31. Cadoret RJ, O'Gorman TW, Troughton E, Heywood E. Alcoholism and antisocial personality. Interrelationships, genetic and environmental factors. Arch Gen Psychiatry 1985; 42:161.
  32. Krueger RF, Hicks BM, Patrick CJ, et al. Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. J Abnorm Psychol 2002; 111:411.
  33. Rosenström T, Ystrom E, Torvik FA, et al. Genetic and Environmental Structure of DSM-IV Criteria for Antisocial Personality Disorder: A Twin Study. Behav Genet 2017; 47:265.
  34. Slutske WS, Eisen S, Xian H, et al. A twin study of the association between pathological gambling and antisocial personality disorder. J Abnorm Psychol 2001; 110:297.
  35. Caspi A, McClay J, Moffitt TE, et al. Role of genotype in the cycle of violence in maltreated children. Science 2002; 297:851.
  36. Foley DL, Eaves LJ, Wormley B, et al. Childhood adversity, monoamine oxidase a genotype, and risk for conduct disorder. Arch Gen Psychiatry 2004; 61:738.
  37. Scarpa A, Raine A. Psychophysiology of anger and violent behavior. Psychiatr Clin North Am 1997; 20:375.
  38. Raine A, Venables PH, Williams M. Relationships between central and autonomic measures of arousal at age 15 years and criminality at age 24 years. Arch Gen Psychiatry 1990; 47:1003.
  39. Dolan M. Psychopathy--a neurobiological perspective. Br J Psychiatry 1994; 165:151.
  40. Moffitt TE, Lynam D Jr. The neuropsychology of conduct disorder and delinquency: implications for understanding antisocial behavior. Prog Exp Pers Psychopathol Res 1994; :233.
  41. Wakschlag LS, Lahey BB, Loeber R, et al. Maternal smoking during pregnancy and the risk of conduct disorder in boys. Arch Gen Psychiatry 1997; 54:670.
  42. Neugebauer R, Hoek HW, Susser E. Prenatal exposure to wartime famine and development of antisocial personality disorder in early adulthood. JAMA 1999; 282:455.
  43. Nielsen DA, Goldman D, Virkkunen M, et al. Suicidality and 5-hydroxyindoleacetic acid concentration associated with a tryptophan hydroxylase polymorphism. Arch Gen Psychiatry 1994; 51:34.
  44. Yang Y, Glenn AL, Raine A. Brain abnormalities in antisocial individuals: implications for the law. Behav Sci Law 2008; 26:65.
  45. Goyer PF, Andreason PJ, Semple WE, et al. Positron-emission tomography and personality disorders. Neuropsychopharmacology 1994; 10:21.
  46. Raine A, Lencz T, Bihrle S, et al. Reduced prefrontal gray matter volume and reduced autonomic activity in antisocial personality disorder. Arch Gen Psychiatry 2000; 57:119.
  47. Dolan MC. What imaging tells us about violence in anti-social men. Crim Behav Ment Health 2010; 20:199.
  48. Glueck S, Glueck E. Unraveling Juvenile Delinquency, Harvard University Press, Cambridge, MA 1950.
  49. Hesse M. What should be done with antisocial personality disorder in the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V)? BMC Med 2010; 8:66.
  50. Hart SD, Kropp PR, Hare RD. Performance of male psychopaths following conditional release from prison. J Consult Clin Psychol 1988; 56:227.
  51. Hare RD. Psychopathy as a risk factor for violence. Psychiatr Q 1999; 70:181.
  52. Kiehl KA, Smith AM, Hare RD, et al. Limbic abnormalities in affective processing by criminal psychopaths as revealed by functional magnetic resonance imaging. Biol Psychiatry 2001; 50:677.
  53. Reti IM, Samuels JF, Eaton WW, et al. Adult antisocial personality traits are associated with experiences of low parental care and maternal overprotection. Acta Psychiatr Scand 2002; 106:126.
  54. Luntz BK, Widom CS. Antisocial personality disorder in abused and neglected children grown up. Am J Psychiatry 1994; 151:670.
  55. Egami Y, Ford DE, Greenfield SF, Crum RM. Psychiatric profile and sociodemographic characteristics of adults who report physically abusing or neglecting children. Am J Psychiatry 1996; 153:921.
  56. Loeber R. Development and risk factors of juvenile antisocial behavior in delinquency. Clin Psychol Rev 1990; 10:1.
  57. Juvonen J, Ho AY. Social motives underlying antisocial behavior across middle school grades. J Youth Adolesc 2008; 37:747.
  58. Ferguson CJ, Rueda SM, Cruz AM, et al. Violent video games and aggression: causal relationship or byproduct of family violence and intrinsic violence motivation? Crim Justice Behav 2008; 35:311.
  59. Black DW, Baumgard CH, Bell SE. The long-term outcome of antisocial personality disorder compared with depression, schizophrenia, and surgical conditions. Bull Am Acad Psychiatry Law 1995; 23:43.
  60. Fiedler ER, Oltmanns TF, Turkheimer E. Traits associated with personality disorders and adjustment to military life: predictive validity of self and peer reports. Mil Med 2004; 169:207.
  61. Black DW. The Natural History of Antisocial Personality Disorder. Can J Psychiatry 2015; 60:309.
  62. Epstein LJ, Mills C, Simon A. Antisocial behavior of the elderly. Compr Psychiatry 1970; 11:36.
  63. Moffitt TE. Adolescence-limited and life-course-persistent antisocial behavior: a developmental taxonomy. Psychol Rev 1993; 100:674.
  64. Robins L. Deviant Children Grown Up, Williams and Wilkins, Baltimore 1966. p.236.
  65. Black DW, Baumgard CH, Bell SE, Kao C. Death rates in 71 men with antisocial personality disorder. A comparison with general population mortality. Psychosomatics 1996; 37:131.
  66. Hyde LW, Burt SA, Shaw DS, et al. Early starting, aggressive, and/or callous-unemotional? Examining the overlap and predictive utility of antisocial behavior subtypes. J Abnorm Psychol 2015; 124:329.
  67. Black DW, Monahan P, Baumgard CH, Bell SE. Predictors of long-term outcome in 45 men with antisocial personality disorder. Ann Clin Psychiatry 1997; 9:211.
  68. Burt SA, Donnellan MB, Humbad MN, et al. Does marriage inhibit antisocial behavior?: An examination of selection vs causation via a longitudinal twin design. Arch Gen Psychiatry 2010; 67:1309.
  69. JENKINS RL, GLICKMAN S. Common syndromes in child psychiatry. Am J Orthopsychiatry 1946; 16:244.
  70. Henn FA, Bardwell R, Jenkins RL. Juvenile delinquents revisited. Adult criminal activity. Arch Gen Psychiatry 1980; 37:1160.
  71. Andreasen NC, Rice J, Endicott J, et al. The family history approach to diagnosis. How useful is it? Arch Gen Psychiatry 1986; 43:421.
  72. Dinwiddie SH, Cottler L, Compton W, Abdallah AB. Psychopathology and HIV risk behaviors among injection drug users in and out of treatment. Drug Alcohol Depend 1996; 43:1.
  73. Goldstein RB, Dawson DA, Chou SP, et al. Antisocial behavioral syndromes and past-year physical health among adults in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry 2008; 69:368.
  74. Ellis D, Collis I, King M. Personality disorder and sexual risk taking among homosexually active and heterosexually active men attending a genito-urinary medicine clinic. J Psychosom Res 1995; 39:901.
  75. Garvey MJ, Spoden F. Suicide attempts in antisocial personality disorder. Compr Psychiatry 1980; 21:146.
  76. Dahlstrom WG, Welsh GS, Dahlstrom LE. An MMPI handbook, University of Minnesota Press, Minneapolis 1972.
  77. Brooner RK, Greenfield L, Schmidt CW, Bigelow GE. Antisocial personality disorder and HIV infection among intravenous drug abusers. Am J Psychiatry 1993; 150:53.
  78. Woodruff RA Jr, Guze SB, Clayton PJ. The medical and psychiatric implications of antisocial personality (sociopathy). Dis Nerv Syst 1971; 32:712.
  79. Cardasis W, Huth-Bocks A, Silk KR. Tattoos and antisocial personality disorder. Personal Ment Health 2008; 2:171.
  80. Black DW. Antisocial personality disorder: The forgotten patients of psychiatry. Prim Psychiatry 2001; 8:1.
  81. Anderson SW, Bechara A, Damasio H, et al. Impairment of social and moral behavior related to early damage in human prefrontal cortex. Nat Neurosci 1999; 2:1032.