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Living With Antisocial Personality Disorder 101: The Sociopath

I have been a registered nurse since 2004. I teach mental health nursing and have worked at an in-patient psychiatric healthcare facility.

The term antisocial is often mistaken as a synonym for asocial. In fact, these two terms are very different. Antisocial is better described as a rule-breaker; think anti-societal rules rather than anti-socialization. A person who suffers from antisocial personality disorder (ASD) has historically been described as a person without a conscience—a sociopath.

However, recent research suggests that the brains of people with antisocial personality disorder function differently than those of people without. Those with the disorder do not have emotional reactions to words like “puppies” or “babies,” and, likewise, they have no emotional reactions to words like “rape” or “murder.” In contrast, people without the disorder show significant activity in the temporal lobes of the brain, the areas associated with emotions.

This suggests that people with antisocial personality disorder are not able to empathize or understand emotions. Imagine if you had never felt love, either given or received. How would you know what “love” means? Also, when someone said he/she loved you, would you believe him/her? How could you believe in love if you had never experienced it?

The answer is simple: you couldn’t. For this reason, it is, at least, somewhat easier to comprehend the atrocities done by those who suffer from antisocial personality disorder. They cannot understand that other people feel love, anger, hurt, resentment, guilt, or any other emotion because they have never experienced those emotions themselves.

At this point, you may be saying, “But my antisocial boyfriend…” or “But my antisocial mother…” From what we understand of the disorder, those who suffer from it can learn to mimic emotions by watching other people. They can learn to cry on demand—to feign fear or hatred—but they do not actually feel those things. Their lives are much like a play, and they are the Tony Award winners. That is why it is so hard to match up what we see them saying or doing with what they actually do when no one is watching.

What You Will Find in This Article

  1. Typical traits of an antisocial person
  2. Treatment options
  3. Recommendations for healthcare professionals
  4. Recommendations for family and friends

Traits of Antisocial Personality Disorder

Frequent Lying

Often, they seem to deceive simply because they can. If you notice frequent lying early in a relationship, this should be a red flag.

Charismatic and Charming

Charisma and charm are manipulative tools of the antisocial person. The charming antisocial person knows they need friends and romantic partners, so charm is used to gain trust and relationships. Often, friends and loved ones will say they did not know the depth of the problem until they were already deeply involved.

Impulsivity

Impulsive behaviors can seem fun at first. Who doesn't want a friend or partner who is spontaneous and exciting? However, a lack of personal responsibility accompanies this aspect. The antisocial person will opt to do fun things rather than take care of obligations, like picking up the kids from daycare or taking you to a doctor's appointment. Instead, they will suddenly change plans to do what they want.

Manipulative

People with ASD are skilled manipulators. You see this often in abusive relationships. After the abuse, the antisocial person convinces the abused partner that the abuse will never happen again; they will get treatment; they will bring flowers and show outward signs of remorse. Yet, there is no actual, lasting behavior change.

Lack of Regard for Safety

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Lack of regard for the safety of themselves and those around them. They may drive too fast, even with children in the car, abuse drugs, have multiple sex partners without using protection, etc.

Does Not Pay Bills or Honor Debts

Beware of loaning money to an antisocial person. You likely will not be repaid. In fact, they may manipulate the situation to make you feel like they somehow earned or deserved the money you loaned them.

Lack of Loyalty in Romantic Relationships

They are often unfaithful and likely to cheat. Akin to the manipulation you see after episodes of abuse, they may seem very remorseful and make promises to change, or offer explanations—or even blame you for their cheating.

Easily Agitated and Can Be Aggressive

When they don't get their way through charm and manipulation, often, the behavior escalates to aggression. Imagine being on a date and a having the suitor try to charm you out of your pants, literally. When the charm fails, the antisocial person may become aggressive and sexually assault the victim.

Breaks Laws

As mentioned earlier, they are best described as rule-breakers. In the extreme, they may be serial rapists, murderers, money launderers, etc. Petty acts may involve stealing friends' clothes or taking money from your wallet without asking permission.

Lack of Remorse

Remorse is not just saying you're sorry. They may be very good at apologizing and have lots of practice at it. True remorse involves behavioral change so as not to cause hurt in the future. An antisocial person rarely has long-term behavior change without skilled treatment.

Keep in mind that personality disorders have a range of mild (e.g. lies, cheats, and manipulates) to severe (e.g. rapists, murderers), and one does not have to have all of the traits to be diagnosed with ASD.

Treatment Options for Antisocial Personality Disorder

Medications

Medication treatment for personality disorders is quite limited as there are no known medications to cure or reverse the actual disorder. However, mood stabilizers and antipsychotics may be given to help reduce the impulsivity, irritability, and aggression. If hospitalized, the patient may require sedatives to help control any violent behavior. The table below lists some of the medications that may be used to treat ASD.

As you can see, most drugs work to decrease mood instability and treat aggressive behaviors. However, the drugs cannot change the personality itself. Behavior change requires psychotherapy and behavioral therapy.

Brand NameGeneric NameClassIntended Effect

Ativan

lorazepam

Benzodiazapine

Sedation, decrease aggression

Haldol

haloperidol

Antipsychotic

Decrease aggression, mood stabilization

Thorazine

chlorpromazine

Antipsychotic

Decrease aggression, mood stabilization

Benadryl

diphenhydramine

Antihistamine

Sedation, decrease aggression

Zyprexa

olanzapine

Atypical antipsychotic

Decrease aggression, mood stabilization

Abilify

aripiprazole

Atypical antipsychotic

Decrease aggression, mood stabilization

Depakote

divalproex sodium

Anti-epileptic

Mood stabilization

Tegretol

carbamazepine

Anti-epileptic

Mood stabilization

Therapy

Cognitive-behavioral therapy (CBT) is highly recommended for the antisocial person. CBT can help the person recognize emotions, decrease impulsivity and aggression, and learn to identify with others. It is also recommended that those close to someone with ASD see a mental health professional when feeling a lack of control and/or emotional injury. Living with someone with ASD is very difficult and can cause a wide range of reactions.

Recommendations for Healthcare Professionals

It can be extremely difficult to have a professional relationship with a person with antisocial personality disorder. The following general recommendations are given using the example of a fictional patient named Jacob:

Set clear boundaries with enforceable limits and logical consequences for behavior.

"Jacob, aggressive behavior is not tolerated here. If you threaten staff or other patients, you will be placed in seclusion."

Enforce consequences immediately when boundaries are violated.

If Jacob does threaten staff or other patients, immediately escort him to seclusion. Do not offer multiple opportunities. If you offer multiple opportunities, the antisocial person will learn that they can sometimes get away with the behavior.

Debrief after consequences have been enforced and when the person is calm.

After Jacob has been secluded and calmed down, when he is released, a qualified healthcare professional should talk with him about the behavior that led to the seclusion. The discussion should include what was unacceptable and suggestions for preventing the behavior in the future. Jacob should be asked what types of ideas he has for changing the behavior as well. He should also be given opportunities to practice these behaviors in a safe environment.

Do not argue or engage in power struggles.

If you see Jacob taking another patient's clothes out of his room, address this. If he argues and says, "It's not any of your business what I was doing in his room!" you may be tempted to say something like, "Oh, yes, it is my business. I am the nurse on this unit." However, that statement is argumentative and will only serve to further escalate his agitation. A better response is, "Jacob, as I said, it is not okay to enter another patient's room or take their clothes. As we discussed before, the consequence of this behavior is a time-out. Take a 15-minute time-out in room 101 now."