Anti-Social Personality Disorder

Quick Reference
Overview: Characterised by childhood conduct disorder and impulsivity, irresponsibility, remorselessness and frequent rule breaking in adulthood. A very broad category which includes high numbers of offenders along a continuum of severity.

Link to Offending: Associated with an increased likelihood of general, violent and to a lesser extent sexual offending (although much more common in rapists than in child sexual offenders).

Tips: Important to identify the more psychopathic sub-group and seek specialist support. Target normal criminogenic variables (particularly substance misuse), be wary of attempts to manipulate and deceive, do not rely on empathy and rapport, and focus on external controls.

View of Self View of Others Main Beliefs Main Strategy
LonerAutonomousStrong VulnerableExploitative “I’m entitled to break rules”“Others are wimps”“I’m better than others” Attack, rob, deceive, manipulate

Profile of the Antisocial Personality

Individuals with ASPD may rigidly view the world as a hostile, ‘dog eat dog’ place, where survival is only possible through exploiting others. They may struggle to hold others’ points of view, be dismissive of close attachments and view relationships along a continuum of dominance and submission. At one end of the antisocial spectrum are highly psychopathic offenders who are likely to present a very high risk of harm to others. Such individuals may show conduct disorder from an early age, be highly callous or even sadistic, view others with contempt, have a strong need for dominance and a low tolerance for frustration. They may use both instrumental and explosive aggression, feel entitled to exploit others for their personal gain and be highly treatment resistant. At the other end of the continuum are prolific – but low harm – offenders whose problematic behaviour may begin in adolescence and not persist past early middle age (antisocial burnout). There is more likelihood of treatability at this end of the continuum, including a response to accredited programmes.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) identifies common features:

  1. Conduct disorder with onset prior to age 15 years
  2. Since age 15 years, three or more of the following must be present:
    • Failure to conform to social norms with respect to lawful behaviours
    • Deceitfulness (repeated lying, use of aliases, or conning others for personal profit or pleasure)
    • Lack of remorse
    • Impulsivity or failure to plan ahead
    • Irritability or aggressiveness as indicated by repeated physical fights or assaults
    • Reckless disregard for the safety of self or others
    • Consistent irresponsibility.
  3. Age at least 18 years

Relationship to offending

  • Almost 50% of UK prisoners may meet the criteria for ASPD. It is associated with an increased likelihood of general recidivism, violence and, to a lesser extent, sexual offending. Among sexual offenders it is far more common among rapists than child sexual offenders.
  • ASPD may be linked to offending in a number of ways:
    • Sufferers may have failed to internalise a social conscience, which might otherwise inhibit antisocial behaviour.
    • They may have a tendency towards acting out aggressively when faced with inner conflict (such as feelings of frustration, anxiety or helplessness).
    • They may experience others as threatening and therefore possess a strong need for dominance.
    • They may be highly impulsive, this is likely to get them in to trouble.
    • It often occurs in combination with other PD diagnoses. These traits (such as a paranoid thinking style, problems controlling emotions and a sense of superiority over others) may therefore also contribute to an increased likelihood to offend.
    • Substance misuse is common and when combined with antisocial traits, risk of harm (self and others) increases considerably.

Tips for working with ASPD

Tips for one-to-one working:

Monitor your own emotional reactions:
It is easy to become too punitive or submissive when working with highly antisocial individuals.

Limit excessive expectations of improvement (particularly in the short term):
The evidence regarding treatability is mixed and motivation is a problem. Most antisocial offenders desist by their late 20s as being antisocial is exhausting, and maturation sets in. Be positive, transparent, respectful, but not overly invested in the outcome.

Be firm and persistent:
Take a behavioural approach to problematic behaviours; give clear feedback, provide consistent responses, never make a threat you are not prepared to carry out.

Use ‘enlightened self-interest’:
Identify shared goals – perhaps money for lifestyle, or keeping out of prison – and encourage the offender to explore the costs and benefits associated with offending or a problem behaviour.

Be mindful of attempts to deceive or manipulate:
Do not be too trusting as it will make ASPD individuals suspicious. If anxious, they will manipulate or deceive you to restore the ‘status quo’. Try not to feel personally humiliated or defensive if you are caught out.

Tips for general offender management:

Address criminogenic need in the usual way:
For most individuals, general offender management targeting criminogenic variables with standard interventions is appropriate. Specialist assessment or intervention is likely to be needed with certain high risk, high harm, or high psychological dysfunction cases only.

Consider co-morbidity:
There are also sufferers of ASPD with more complex presentations. These individuals may present with mood disorders, may be highly psychopathic, or also meet the criteria for other personality disorders (e.g. borderline, narcissistic, paranoid). Signs which might suggest the need for further specialist assessment or support would include very early onset conduct problems, a history of serious childhood trauma, a diverse offending history, sadism, high levels of instrumental violence, very difficult or volatile interpersonal behaviour during supervision, attacks on staff, suicide/self harm, or a history of engagement with mental health services.

Target substance misuse:
This is a priority, due to the strong association with antisocial traits, substance misuse and risk of violence.

Prioritise external controls but NOT rules:
ASPD offenders are rule breakers, so do not create long lists of conditions which they will inevitably break! Prioritise.

Sanctions:
Think about these in advance, as you will need them! Anti-authoritarian rule-breakers with chaotic lives, miss sessions, drop out of programmes, and re-offend before completing orders. Make sure the offender knows and understands the consequences in specific, not general, terms.