Antisocial personality disorder

Diagnosis

People with antisocial personality disorder are not likely to believe they need help. But they may seek help from their primary health care provider because of other symptoms such as depression, anxiety or angry outbursts. Or they may seek treatment for problems with alcohol or drug use.

People with antisocial personality disorder may not give an accurate description of their symptoms. A key factor in diagnosis is how the person relates to others. With permission, family and friends may be able to give helpful information.

After a medical exam to help rule out other medical conditions, the health care provider may make a referral to a mental health provider with experience in diagnosing and treating antisocial personality disorder.

Diagnosis of antisocial personality disorder is usually based on:

• A mental health exam that includes talking about thoughts, feelings, relationships, behavior patterns and family history.
• Symptoms.
• Personal and medical history.

Antisocial personality disorder usually isn't diagnosed before age 18. But some symptoms may occur in childhood or the early teen years.

Identifying antisocial personality disorder early may help improve long-term outcomes.

Treatment

Antisocial personality disorder is challenging to treat, but for some people, treatment and close follow-up over the long term may help. Look for medical and mental health providers with experience in treating antisocial personality disorder.

Treatment depends on each person's situation, their willingness to participate in treatment and the severity of their symptoms.

Talk therapy

Talk therapy, also called psychotherapy, is sometimes used to treat antisocial personality disorder. Therapy may include, for example, anger and violence management, treatment for problems with alcohol or drugs, and treatment for other mental health conditions.

But talk therapy is not always effective, especially if symptoms are severe and the person can't admit that they contribute to serious problems.

Medications

There are no medicines specifically approved by the Food and Drug Administration (FDA) to treat antisocial personality disorder. Health care providers may prescribe medicines for conditions that sometimes occur along with antisocial personality disorder, such as anxiety or depression, or for symptoms of aggression.

Coping and support

Skills for family members

People with antisocial personality disorder often act out and cause others to suffer — with limited remorse. If you have a loved one with antisocial personality disorder, it's critical that you also get help for yourself.

A mental health provider can teach you skills to learn how to set boundaries and help protect yourself from the aggression, violence and anger common to antisocial personality disorder. The provider also can recommend strategies for coping.

Look for a mental health provider who has training and experience in managing antisocial personality disorder. Ask your loved one's health care provider for a referral. The provider may be able to recommend support groups for families and friends affected by antisocial personality disorder.

Preparing for your appointment

If a medical exam rules out physical causes for the behavior, the primary health care provider can make a referral to a mental health provider, such as a psychiatrist or psychologist.

Take a family member or friend along to your appointment, if possible. With your permission, someone who has known you for a long time may be able to answer questions or share information with the provider that you don't think to bring up.

What you can do

Before your appointment, make a list of:

• Any symptoms you or your family noticed, and for how long.
• Key personal and medical information, including current physical or mental health conditions, personal or family history of mental health conditions, traumatic experiences, or major stressors.
• All medicines, herbs, vitamins or other supplements you take, including the doses.
• Questions you want to ask your provider to make the most of your appointment.

Some basic questions to ask include:

• What is likely causing my symptoms?
• What are other possible causes?
• What treatments are most likely to work best for me?
• How much can I expect my symptoms to improve with treatment?
• How often will I need treatment, and for how long?
• Are there medicines that can help? If so, what are the possible side effects?
• Is there a generic option to the medicine you're recommending?
• Are there any printed materials I can have? What websites do you suggest?

Feel free to ask other questions during your appointment.

What to expect from your doctor

Your mental health provider is likely to ask you some questions, such as:

• What are your symptoms?
• When did you or your family first notice these symptoms?
• How are your symptoms affecting your life?
• Have relatives or friends expressed concern about your behavior?
• Do you have any close relationships?
• If you're not satisfied with work, school or relationships, what do you think is causing your problems?
• Have you ever thought about harming yourself or others? Have you ever actually done so?
• Have any of your blood relatives, such as a parent or sibling, been diagnosed with or treated for mental health conditions?

Be ready to answer questions so that you'll have time to talk about what's most important to you.