The main feature of ASPD (previously known as ‘psychopathy’ or ‘sociopathy’) is a pattern of complete disregard for the rights of others. Deceit and manipulation are central features of this disorder. ASPD begins in childhood or early adulthood and continues into adulthood. For a diagnosis of ASPD to be made, the individual must be at least 18 years old, and have had a history of some symptoms of ‘conduct disorder’ before age 15. The behaviours characteristic of conduct disorder fall into the following characteristics: aggression to people and animals, destruction of property, deceitfulness or theft, and serious violation of rules. This pattern of antisocial behaviour then continues into adulthood.
The main characteristics of ASPD are:
- Failure to conform to social norms with respect to lawful behaviour. Individuals with ASPD may repeatedly be involved in actions that are grounds for arrest (e.g., destroying property, harassing others, stealing, or pursuing illegal occupations). They tend to have disregard for the wishes, rights, and feelings of others.
- Being deceptive and manipulative in order to gain personal profit or pleasure (e.g., to obtain money, sex, or power). Individuals with ASPD may repeatedly lie or con others.
- Reckless disregard for their own or other’s safety (e.g., recurrent speeding, driving while intoxicated, multiple accidents, or high-risk sex).
- A tendency for impulsive behaviour due to a failure to plan ahead. Decisions may be made on the spur of the moment, without forethought, and without consideration of the consequences for themselves or others. This may lead to sudden changes of jobs, residences, or relationships.
- Irritability and aggression; repeated involvement in physical fights or assaults.
- Consistent and extreme irresponsibility. Behaviour that is indicative of this may include irresponsible work behaviour; for example, long periods of unemployment despite several job opportunities, abandonment of jobs without a plan for getting another, or repeated unexplained absences from work. Financial irresponsibility may include acts such as defaulting on debts and failing to provide child support.
- The absence of remorse for the consequences of their actions. Individuals with ASPD tend to provide superficial excuses for having hurt, mistreated, or stolen from someone. They may blame the victims of their actions for being foolish, helpless, or deserving their fate. They generally fail to correct their wrongdoings, or to apologise or show remorse for their behaviour.
A case study example of how comorbid ASPD and AOD use disorder may present is illustrated in Box 9.