Living With Antisocial Personality Disorder 101: The Sociopath
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
- Typical traits of an antisocial person
- Treatment options
- Recommendations for healthcare professionals
- Recommendations for family and friends
Traits of Antisocial Personality Disorder
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.
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.
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
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.
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
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.
Sedation, decrease aggression
Decrease aggression, mood stabilization
Decrease aggression, mood stabilization
Sedation, decrease aggression
Decrease aggression, mood stabilization
Decrease aggression, mood stabilization
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."
Maintain safety of the staff and any other people in the area.
In the previous example, the nurse is engaged in a confrontation with a patient. Any time the nurse is confronting an antisocial patient about an unacceptable behavior, it is important to be aware of the potential for aggression. Let other staff know what is going on before confronting the patient. Make sure you are not alone with the patient or in an enclosed space where you cannot escape if the patient becomes aggressive. If other patients are nearby, keep them clear of the area.
Be aware of the use of manipulation and charm.
Rather than becoming aggressive, Jacob may try to manipulate you into letting him get away with the behavior. He may say, "I didn't know I wasn't allowed to do that," or, "Josh said I could go in his room and borrow his stuff anytime," or, "Hey, what's the big deal? Why are you getting your panties in a wad?" These are manipulative statements with a goal of not having logical consequences for unacceptable behaviors.
As long as you know the patient is aware of what is and is not acceptable, do not allow any deviation from the logical consequences. However, if Jacob is new to your unit and truly was not aware of the rules, for some reason, explain the rules at this time and in the future, enforce consequences when the rules are broken.
Note: On admission, all patients should be properly oriented to the rules and logical consequences of any unit.
Be aware of counter-transference.
Counter-transference refers to the transference of the healthcare provider's personal feelings towards someone in his/her life onto the patient. For example, if the healthcare provider's father frequently lied and manipulated him/her, the healthcare provider may feel hostility toward an antisocial patient who frequently deceives and manipulates others.
If the healthcare provider feels hostile toward Jacob, Jacob may sense this and react more defensively. The healthcare provider may unknowingly assume an aggressive stance or display other nonverbal cues (e.g. scowling, grimacing, etc.). Objective self-evaluation is essential when working with patients with personality disorders.
Monitor your own communications—verbal and nonverbal.
Be neutral in your interactions with the antisocial person. Assume open body language: arms relaxed, feet distanced from each other, stand at a slight angle to the patient, don't stand directly in front of a seated person, etc. Also, be aware of facial expressions. Practice neutral body language in a mirror, while recording yourself, or with another professional.
Teach the antisocial patient how to recognize emotions in themselves and others.
The patient needs to learn how to interact appropriately in a variety of settings. To do this, he/she must learn to properly recognize emotions. A trained healthcare professional can engage in role play activities with the antisocial person and have the patient identify body language, triggers for anger and aggression, and more. This is an integral aspect of recovery from a personality disorder.
Have the antisocial person evaluate actions and reactions.
Similar to debriefing (described above), the antisocial person needs to become more objective in their evaluation of their actions and reactions. Ask them to describe or journal about significant events, and go over their journal entries with them. Give feedback about their reactions and offer a menu of suggestions. Ask the antisocial person to list three ways they can react in a healthier manner the next time. Then, have them practice those behaviors.
Teach impulse control.
Impulse control can be very difficult for the person with antisocial personality disorder. Some simple suggestions include having the person count backward from 10 before responding to anything that causes an emotional reaction. To prevent agitation, have them brainstorm ways to respond to various scenarios ahead of time and practice those techniques in a safe setting.
Teach the antisocial person to use non-blaming statements. For example, when talking to his wife, Jacob might typically say, "You won't do what I say, and you dress like that on purpose to make me mad!" But, communication that is more likely to result in a conversation rather than an argument is to say, "I want you to wear more conservative clothing, but you seem to prefer shirts that are low-cut. How can we compromise?" This type of communication takes a lot of practice to learn.
Help the person identify goals and ways to reach them.
Without a clearly defined plan, the antisocial person may feel confused about the point of treatment. Ask the antisocial person what they would like to achieve from their treatment. This allows the healthcare provider to tailor a treatment plan that incorporates the patient's goals. Jacob might say he wants to have more money so he can buy a motorcycle, but perhaps he has not been able to hold down a job because of his violent outbursts at work. You can use his goal of wanting money to help him see why controlling his temper can help him.
Teach positive coping skills.
All people have coping skills. Some are adaptive, and some are maladaptive. The antisocial person may use aggression, manipulation, and deceit to cope. Until they learn more adaptive coping skills, they will continue to rely on the old standbys.
Suggestions for adaptive coping for aggressive behaviors can include:
- Exercise (running or kickboxing are good ways to work out aggression)
- Journaling (this helps to identify emotions and triggers)
- Relaxation techniques (progressive muscle relaxation helps to reduce muscle tension and make one aware of physiological changes that occur during stress)
Recommendations for Loving the Antisocial Person
You can use some of the recommendations for healthcare professionals list above as well, but here are some tips specifically for family and friends:
- Know yourself—what you are willing to tolerate and what you refuse to tolerate. Once you know your own boundaries, explain those boundaries to the antisocial person. Explain what actions you will take if and when those boundaries are violated.
- Follow through with your plan each and every time.
- Expect deception, manipulation, and betrayal.
- Keep your finances separate. Do not loan money that you expect to be repaid.
- If in a romantic relationship, do not trust the antisocial person to be alone with your friends and family, as cheating is highly likely, and a betrayal of this type is often very damaging.
- Have backup plans for child-care, dates, etc. as the antisocial person is not likely to be dependable.
- Maintain personal safety at all times. Keep a cell phone charged and on your person, keep enough gas in the car to get away, and, if necessary, inform a friend that you may need to stay with him/her sometimes. Know where shelters are in your area. Call 9-1-1 if the person becomes violent.
It is not recommended to have a romantic relationship with a person with antisocial personality disorder due to the emotional and/or physical damages that may be inflicted. However, if, for some reason, you feel you cannot end the relationship, keep yourself safe at all times.
© 2012 Leah Wells-Marshburn