Antisocial personality disorder is diagnosed based on meeting criteria described in the Diagnostic and Statistical Manual on Mental Disorders, the book that mental health professionals use to assess patients. Although the fifth edition (DSM-5) was published in 2012, some clinicians continue to use the fourth edition (DSM-IV) in making diagnoses.
To assess a person for antisocial personality disorder, a mental health professional will ask the person a series of questions about their symptoms to determine if they meet the criteria. They will ask how severe the symptoms are, how frequently they occur, and how long they have existed. They may also give the person questionnaires to fill out to see whether the person meets the criteria for other mental, behavioral, personality, or developmental disorders. (1)
No physical test, such as a blood test or imaging, can be used to diagnose antisocial personality disorder. Some researchers have used brain scans to find ways that the brains of people with a diagnosis of antisocial personality disorder differ from people without any mental or personality disorders, but there is presently no way to use a scan of a person’s brain to determine whether they have the condition.
A diagnosis of antisocial personality disorder also requires a clinician to rule out other conditions which may show overlapping symptoms, including bipolar disorder, attention deficit hyperactivity disorder (ADHD), and schizophrenia-related disorders. Like many conditions, antisocial personality disorder occurs along a spectrum. It is not “present” or “absent,” but a person can have more or less severe symptoms.
The American Psychiatric Association, which publishes the DSM, does not use the word “sociopath” to describe people with antisocial personality disorder, although the traits associated with antisocial personality disorder overlap with the popular concept of what a sociopath is.
Diagnosis Based on DSM-IV Criteria
To receive a diagnosis of antisocial personality disorder according to the DSM-IV, a person must meet four criteria:
Showing “a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years”
Age 18 or older
Showing evidence of conduct disorder before age 15
Displaying antisocial behavior that is is not directly related to schizophrenia or bipolar disorder
The pattern of disregarding others’ rights is met by fulfilling at least three of the following seven behaviors:
Failure to conform to social norms with respect to lawful behaviors as indicated by repeatedly performing acts that are grounds for arrest
Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
Impulsivity or failure to plan ahead
Irritability and aggressiveness, as indicated by repeated physical fights or assaults
Reckless disregard for safety of self or others
Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
Lack of remorse, as indicated by being indifferent to or rationalizing
The second and third criteria, regarding age, go hand in hand: A person who shows characteristics of antisocial personality disorder before age 18 should be diagnosed with conduct disorder. A child or adolescent with conduct disorder has emotional and behavioral problems, including defiant and impulsive behavior and a willingness to break rules and laws. (2)
A clinician may diagnose a person with antisocial personality disorder even if they did not receive an official diagnosis of conduct disorder, as long as their behavior before age 15 met the criteria for conduct disorder.
Mental health professionals must also be sure that conduct disorder is not a misdiagnosis of another mental health or developmental condition. A child with ADHD, for example, may be misdiagnosed as having conduct disorder. The same symptoms that lead to a conduct disorder diagnosis may also be early symptoms of bipolar disorder, schizophrenia, or major depressive disorder. (2)
A recent study, published in January 2017 in the Journal of Clinical Psychiatry, found that up to 20 percent of Americans show strong characteristics of antisocial behavior in adulthood but without having a diagnosis of conduct disorder before age 15. (3)
Diagnosis Based on DSM-5 Criteria
The criteria for antisocial personality disorder in the DSM-5, the most recent edition, is more complex and nuanced. It also removes the requirement for evidence of conduct disorder before age 15. The DSM-5 defines a person with antisocial personality disorder as someone at least 18 years old who meets five other criteria:
1. Poor Individual and Interpersonal Functioning
The person must have problems with how they function as an individual and with how they interact with other people.
To show poor functioning as an individual, they may be egocentric and base their self-esteem on personal gain, power, or pleasure. Or they set goals based on how good it will make them feel without regarding its impact on others. They do not have an internal motivation to follow social rules, laws, or cultural ethics.
A person meets the criteria for poor interpersonal functioning by showing a lack of empathy or lack of intimacy with others. They demonstrate a lack of empathy by showing no concern for others’ feelings, needs, or suffering, and they lack remorse after hurting someone else.
Or their intimacy deficit makes them incapable of developing intimate relationships with others. Instead, they manipulate, exploit, or control others for personal gain by lying, intimidating others, and forcing others to do what they want.
2. Antagonism and Disinhibition
To meet the second criteria, a person must have two specific personality traits: antagonism and disinhibition.
They demonstrate antagonism by being manipulative, deceitful, callous, and hostile toward others. Their manipulativeness may involve using their charm or wit to seduce or control others to meet some goal for themselves.
Deceitfulness shows up in frequent lying to others or exaggeration about themselves. They may make things up when telling a supposedly true story, for example.
Callousness refers to showing no concern about others’ feelings or problems and not feeling guilt or remorse if their actions harm someone else. They may be aggressive or even sadistic, taking pleasure in other people’s pain.
Hostility refers to being frequently angry or irritable and seeking revenge for even minor insults or accidental harm from others.
A person with antisocial personality disorder demonstrates disinhibition through irresponsibility, impulsivity, and risk-taking. They may break promises or fail to meet financial, employment, personal, or social obligations, and they do not feel remorse for these actions.
They act spontaneously without thinking or caring about the possible consequences of their actions or without a plan to deal with those consequences.
They engage in dangerous activities that may harm themselves or others but without concern about the possible consequences. They may do so out of boredom, to prove that they are capable of doing something especially risky, or because they are in denial about their limitations.
In addition to the two criteria above, a person must meet all three of the following criteria to receive a diagnosis of antisocial personality disorder:
3. Consistent Behavior Across Time and Situations
Their problems with personal and interpersonal functioning described above have occurred throughout their life in all situations. Their problems do not go away for certain periods or in certain situations.
4. No Other Psychological, Social, or Cultural Explanation
Their personality problems and difficulties in interpersonal relationships are not otherwise explained by their stage of psychological development or by their social or cultural environment. If it would be normal for them to display these problems or characteristics based on their mental development or the social or cultural situation they live in, they would not meet this requirement.
5. Behavior Not Caused by Substance Abuse or Medical Disorder
Their problems are not a result of physical effects from drugs, alcohol, or another substance, and they are not a result of another medical condition, such as head trauma or another mental disorder.
By Tara Haelle Medically Reviewed by Allison Young, MD
A Clinical Psychologist Dallas, Texas. He graduated with honors in 1989 and has more than 29 years of diverse experiences. Also a family therapist and group counselor in Dallas TX.