What are the characteristics of a client with antisocial personality disorder?
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Most people consider a lack of empathy the defining feature of antisocial personality disorder (ASPD), along with a disregard for other people’s rights. Show
But there is disagreement over whether these and other characteristics of antisocial personality disorder are a result of a person’s genetics or whether they develop as a result of a person’s environment in childhood. What is considered most likely is that in most cases, it is a combination of these factors. Functional magnetic resonance imaging brain scans of people with antisocial personality disorder have shown differences in their brains from what is typically seen in people without a personality disorder. (1,2,3) For example, researchers have seen abnormalities in the gray and white matter volumes in the parts of the brain related to attention, self-regulation, self-control, and resolving conflicts. (1,2) Brain scans have also revealed decreased connections among certain brain areas and abnormal organization of the brain’s network in the brains of individuals with antisocial personality disorder. (3) But to date, it is not known what leads to these differences. While individuals with antisocial personality disorder are often referred to as sociopaths in popular culture, the American Psychiatric Association does not use that term to describe them.
People with antisocial personality disorder are very manipulative and often successful at misleading others. They may be witty, clever, funny, and charming, and they may frequently give compliments to others. They may use this flattery to manipulate others’ emotions. (4) People with antisocial personality disorder may also show arrogance and an inflated sense of self-confidence. They ignore the safety of others and may disregard safety for themselves as well. In addition to lying, a person with antisocial personality disorder may frequently steal and start fights. They may even derive pleasure from seeing other people experience harm or pain. They may have substance use problems as well. (4) Men are much more likely to be diagnosed with antisocial personality disorder than women, but the reasons for this are not understood. (4) Two studies estimated that approximately 4.5 or 6.8 percent of men have antisocial personality disorder, and both estimated that 0.8 percent of women have it. (5) European studies have found lower estimates, of approximately 1 to 1.3 percent in men and up to 0.2 percent in women. (5)  Symptoms of antisocial personality disorder may decrease as a person ages, particularly around their forties. (4) But this decrease does not necessarily mean the condition goes away. It may simply look different in older adults, or people who have it may learn to hide their symptoms better from others as they grow older. They may also experience a decline in mental, emotional, or physical health because of the energy spent over their lifetime opposing social norms and potentially engaging in self-destructive behavior. (6) Antisocial personality disorder (ASPD) isn’t diagnosed under age 18, but children exhibiting severely antisocial behavior may have its close cousin: conduct... Forensic AOD clients often display antisocial traits and behaviours (e.g. Regier et al, 1990) which can present specific challenges in working with this client group. Common Antisocial TraitsIn your work with antisocial clients there are a range of traits – including thoughts, feelings and behaviours – which contribute to the challenges of working with these individuals, and which can have a significant impact on the clinician working with them. Some common characteristics which you may observe in these clients include:
Antisocial Personality DisorderA personality disorder exists where personality patterns differ markedly from cultural norms and are long-standing, inflexible and pervasive. Where a person displays many of the above antisocial characteristics, they may meet the criteria for Antisocial Personality Disorder (APD), which is broadly characterised by:
Rates of APD in forensic clients are much greater than in the general population. As such, it is highly likely that you will regularly treat clients who meet the criteria for APD. Be aware however that there is some disagreement in the literature about what factors constitute a personality disorder, and whether “personality disorders” should be conceived as a continuum of trait severity rather than a categorical classification, and that they may not remain stable over time. As such be cautious about using this term with clients, and if they do say they have a Personality Disorder, encourage them to be flexible in their thinking about it, to avoid a labelling mindset. If you are concerned that a client’s antisocial tendencies may constitute a personality disorder, you may consider referring them to a forensic psychologist to conduct a thorough personality assessment. Antisocial Personality Disorder and Substance Use DisorderWhere a client has been diagnosed with both APD and Substance Use Disorder, the following complications are generally present:
Challenges of working with antisocial clientsCommon features that make antisocial clients difficult to treat include:
Additionally, antisocial clients sometimes manipulate in order to get their needs/wants met. This can be particularly problematic during assessment if it is not recognised. Manipulation may occur by:
Finally, antisocial clients also may be more adept at breaching boundaries than clinicians may be at managing them. Some clients may take pleasure in placing clinicians in vulnerable or uncomfortable situations, or in forcing clinicians to violate their own rules. Tips for working with antisocial clientsAntisocial clients, more than most, will invite us to respond in a way that doesn’t feel authentic to us, to respond more harshly or more passively than we might normally. It requires effort to maintain our “normal” stance but doing so provides the client an experience of consistency and boundaries, which can assist in client containment. Working with an approach that is too firm may invite a power struggle, disrespectful treatment, and is not likely to work. Often this approach leads antisocial clients to feel they need to reassert their autonomy. They may perceive your firmness as hostile, and in turn escalate. Being too permissive with antisocial clients increases the risk of violated boundaries. It is vital to set firm boundaries with someone whose own boundaries are poor. It increases the risk of colluding, being seduced into meeting client’s non-therapeutic agenda, ‘rescuing’, and being taken advantage of. Furthermore, this approach makes it less likely to earn client’s respect, does not provide the structured environment necessary for treatment, reinforces entitlement and victim mentality, and does not allow use of consequences as a motivator for change. Some helpful tips for working with this client group include:
Many of the above strategies are probably common to your work with all clients – but they are particularly important with antisocial presentations. References:Regier, D. A., Farmer, M. E., Rae, D. S., Locke, B. Z., Keith, S. J., Judd, L. L., & Goodwin, F. K. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: results from the Epidemiologic Catchment Area (ECA) study. Jama, 264(19), 2511-2518. Which characteristics of clients with antisocial personality?The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) criteria for ASPD include criminality, aggressiveness, deceitfulness, impulsivity, irritability, disregard for safety, irresponsibility, and lack of remorse (APA, 2013).
Which of the following characteristics would you expect to assess in a patient with antisocial personality disorder?Lack of internal motivation to follow social rules, lack of empathy, and manipulative, deceitful, or hostile behavior toward others are just a few of the characteristics mental health professionals look for in diagnosing antisocial personality disorder.
What are antisocial behaviors examples?Examples of antisocial behaviour. noisy neighbours.. graffiti.. drinking or drug use which leads to people being rowdy and causing trouble.. large groups hanging about in the street (if they are causing, or likely to cause, alarm and distress). litter problems.. racism.. What are the characteristics of personality disorder?Some general signs of people with a personality disorder include: Their behavior is inconsistent, frustrating and confusing to loved ones and other people they interact with. They may have issues understanding realistic and acceptable ways to treat others and behave around them.
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