• ignoring social norms and laws, breaking rules at school or work, overstepping social boundaries, stealing, stalking and harassing others, or destroying property
• dishonesty and deceit, including using false identities and manipulating others for personal gain
• difficulty controlling impulses and planning for the future, or acting without considering the consequences
• aggressive or aggravated behavior, including frequent fights or physical conflict with others
• disregard for personal safety, or the safety of others
• difficulty managing responsibilities, including showing up at work, handling tasks, or paying rent and bills
• little to no guilt or remorse, or a tendency to justify actions that negatively affect others

People with ASPD generally show little emotion or interest in the lives of others. They might:

• come across as arrogant or superior, with firmly fixed opinions
• use humor, intelligence, and charisma to manipulate
• seem charming at first until their self-interest becomes clear

People with ASPD generally find it challenging to maintain friendships, relationships, and other mutually fulfilling connections. This difficulty may stem from traits, like:

• low empathy and emotional intelligence
• difficulty learning from mistakes
• lack of concern for the safety of others
• a tendency to intimidate and threaten in order to maintain control

Many experts consider sociopathy more of an environmental construct than a genetic one.

Yes, brain chemistry and inherited genes play a part, but parenting styles and upbringing, along with other environmental factors, carry the most weight. Psychopathy, on the other hand, appears linked to more innate biological factors.

Children who don’t receive nurturing attention from caregivers tend to grow up learning they have to take care of themselves because no one else will. Some children who experience abuse, violence, and manipulation from an early age may come to model this behavior as they navigate their own conflicts.

Research also suggests it’s possible to “acquire” sociopathy. Head trauma or damage to the frontal lobes of the brain, which can happen as a result of a head injury or progressive conditions like dementia, can lead to some antisocial behaviors.

Again, keep in mind that the DSM-5-TR makes no distinction between sociopathy and psychopathy or any separate subtypes of ASPD.

Mental health professionals use DSM-established criteria to diagnose ASPD. This diagnosis can apply to someone whose behavior aligns with the accepted definition of either sociopathy or psychopathy.

A diagnosis of ASPD requires at least three of the seven signs listed above, plus a few additional criteria:

• These behaviors appear across multiple areas of life.
• The person is at least 18 years old.
• They had some symptoms of conduct disorder before the age of 15. This helps distinguish ASPD from lawbreaking behavior that begins in adulthood.
• Antisocial traits and behaviors don’t relate to schizophrenia or bipolar disorder.

To make a diagnosis, a therapist or psychologist might:

• ask questions about a person’s feelings, thoughts, behavior, and personal relationships
• ask (with permission) family members and romantic partners about their behaviors
• evaluate their medical history for signs of other conditions

Keep in mind that personality disorders, including APSD, involve traits that are beyond the person’s control. These characteristics go beyond a desire for personal gain and tend to remain fixed over time, causing distress.

Could it be a different condition?

Other mental health conditions can involve symptoms similar to ASPD:

• Intermittent explosive disorder (IED) involves extreme and repeated verbal or physical outbursts. These outbursts, driven by impulse or anger, can be directed toward people, property, or animals. IED commonly begins in adolescence and usually before the age of 40. On its own, it doesn’t involve low empathy or lack of remorse.
• Conduct disorder involves antisocial behavior that typically begins by the age of 16. Experts consider this condition a major risk factor for ASPD. Adults must show signs of conduct disorder in childhood to be diagnosed with ASPD. Someone who doesn’t meet full ASPD criteria might be diagnosed with conduct disorder.
• Schizophrenia often involves trouble recognizing facial emotions, a trait also associated with ASPD. The condition may involve aggressive or antisocial behavior — but not always. It also involves psychosis, while ASPD does not. Experts won’t diagnose ASPD before treating schizophrenia.
• Bipolar I disorder. Episodes of mania can involve impulsivity, aggression, irritability, and increased thoughts of suicide — symptoms also linked to ASPD. Experts won’t diagnose ASPD during an episode of mania.

People living with personality disorders don’t always recognize any issues with their behavior, so they often don’t consider getting professional support.

They might choose to work with a therapist if prompted by a court order or someone in their personal or professional life.

Work supervisors, family members, and romantic partners might notice traits, like impulsivity and a tendency toward aggressive outbursts, for example, and they may recommend professional support.

Some people also try therapy to address other challenges or mental health concerns, including:

• depression
• difficulty coping with boredom or stress
• substance use disorders

However, since many people living with ASPD never choose to go to therapy, little research on helpful treatment approaches exists. That doesn’t mean treatment can’t help. But therapy and other approaches generally only work when someone willingly puts in the effort.

Possible treatments for ASPD include the following.

Psychotherapy

Therapy involves talking with a therapist about thoughts and feelings that can prompt harmful or aggressive behavior. It might also include anger management tactics or treatment for substance use.

Potentially beneficial approaches include:

• Cognitive behavioral therapy (CBT). CBT can help people learn to consider their responses to people and situations, which may lead to more productive behaviors. Therapy can, for example, help someone recognize the benefits of using negotiation rather than violence to solve conflicts or disagreements. CBT also involves psychoeducation, which can teach people more about ASPD.
• Mentalization-based therapy (MBT). This approach aims to help people learn to better identify and understand mental and emotional mindsets — both their own and those of others. A small 2016 studyTrusted Source suggests MBT helped reduce hostility and anger, paranoia, self-harm, and interpersonal difficulties in people living with both ASPD and borderline personality disorder, along with leading to an improved mood overall.
• Democratic therapeutic communities. This approach, often used in prisons, involves therapy groups of various sizes that help participants make collaborative decisions as part of a group and work together on problems affecting the community. It can help boost community-minded and prosocial thinking in people living with ASPD.
• Contingency management. This approach offers rewards to encourage treatment progress. Older researchTrusted Source suggests it can help people living with ASPD limit their intake of alcohol and other substances.

Medication

The Food and Drug Administration (FDA) hasn’t approved any medications to treat symptoms of ASPD.

A doctor or psychiatrist may recommend medication for symptoms associated with the condition, such as:

• antipsychotics, like risperidone (Risperdal), as a first-line treatment for aggression
• SSRI antidepressants, like fluoxetine (Prozac), or mood stabilizers, like lithium, to help treat aggression
• anticonvulsants, like carbamazepine (Tegretol), to help reduce impulsivity

According to a small 2014 studyTrusted Source, the antipsychotic medication clozapine (Clozaril) shows some promise as a treatment for men with ASPD. After taking the medication for several weeks, all seven participants experienced improvement in ASPD symptoms, including anger, impulsivity, and violence or aggression.

If you’d like to work on maintaining your relationship with someone who has ASPD, it may help to:

• recognize they may never fully understand your emotions
• explain specific ways their behavior affects others
• establish clear boundaries to protect your emotional and physical space
• encourage them to get professional support

Marriage or family counseling can also help you develop a more positive relationship with a loved one living with ASPD.

Ultimately, they may choose not to respect your boundaries and continue to cause emotional distress or physical harm. In that case, ending the relationship, or at least creating space from it, may be your safest option.

Working with a therapist yourself can also help you:

• explore productive communication
• build coping skills
• identify signs of abuse
• work on a plan to safely leave a relationship if needed

A therapist can also offer more specific guidance on handling problematic behaviors, including manipulation and control tactics or outbursts of anger.

Personality researchers and experts continue to explore the nuances of sociopathy and psychopathy. Still, they have yet to establish unique criteria to diagnose either, and ASPD remains the closest diagnosis to what people typically think of as psychopathy.

There’s no cure for ASPD. Some research suggests, though, that antisocial behavior often decreases over time. By middle age, people are less likely to behave in violent or aggressive ways.

Therapy approaches that help people learn to replace problematic behaviors with more constructive ones can also make a difference for ASPD symptoms.

In short, it’s absolutely possible for people with ASPD to build stable and fulfilling relationships with others, though it does take work.

Contrary to media portrayals, people who show signs of sociopathy don’t choose to be “evil.”

In many cases, they’re likely living with ASPD, a condition that develops from a combination of genetic and environmental factors, including childhood abuse and neglect.