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Living with Antisocial Personality Disorder 101: The Sociopath
Antisocial Personality Disorder Description
The term “antisocial” often is 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 historically has 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 antisocial personality disorder. Those with the disorder do not have emotional reactions to words like “puppies” or “babies,” but neither do they have reactions to words like “rape” or “murder.” 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 a 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 things themselves.
At this point, you may be saying, “But my antisocial boyfriend…” or “But my antisocial mother…” From what we understand of antisocial personality disorder, those who suffer from it 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 winner. 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.
Traits of Antisocial Personality Disorder
The traits of antisocial personality disorder are:
- Frequent lying
Often, the antisocial person seems to deceive just 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 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 very involved.
Impulsive behaviors can seem fun at first. Who doesn't want a friend or partner who is 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, he/she will suddenly change plans to do the more fun thing.
People with antisocial personality disorder 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; he/she will get treatment; they bring flowers and show outward signs of remorse; yet there is no actual behavior change over the long-term.
- Lack of regard for safety
Lack of regard for safety involves the antisocial person 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, the antisocial person 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
Antisocial people often cheat in romantic relationships. Akin to the manipulation you see after episodes of abuse, afterwards 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 the antisocial person does not get his 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
The antisocial person may break laws. In the extreme, they may be serial rapists and murderers, money launderers, etc.. Petty acts involve stealing a friend's clothes or CD collection or taking money from your wallet without asking permission.
- Shows a lack of remorse
Remorse is not just saying your sorry. The antisocial person may be very good at apologizing and have lots of practice at it. True remorse involves behavior 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 the PDs 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 antisocial PD.
Treatment Options for Antisocial Personality Disorder
Medication treatment for the personality disorders is quite limited, as there are no known medications to treat or cure the actual disorder. However, mood stabilizers and antipsychotics may be given to help fend off the impulsivity, irritability, and aggression. If hospitalized, the antisocial person may require sedatives to help control violent behavior. The chart (below) lists some of the medications that may be used to treat antisocial personality disorder.
Medications & Intended Effects
Medication (Brand Name)
Medication (generic name)
Class of Medication
Sedation, decrease aggression
Decrease aggression, mood stabilization
Decrease aggression, mood stabilization
Sedation, decrease aggression
Decrease aggression, mood stabilization
Decrease aggression, mood stabilization
Highly recommended is cognitive-behavioral therapy (CBT) for the antisocial person. CBT can help the person recognize emotions, decrease impulsivity and aggression and learn to identify with others. It also is recommended that those who love someone with antisocial personality disorder see a mental healthcare professional when feeling a lack of control and/or emotional injury. Living with someone with antisocial personality disorder 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 with examples of a fictional patient named "Jacob":
- Set clear boundaries with enforceable limits and logical consequences for behavior.
E.g. "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.
E.g. If "Jacob" does threaten staff or patients, immediately escort him to seclusion. Do not offer multiple opportunities. If you offer multiple opportunities, the antisocial person will learn they can get away with the behavior sometimes.
- Debrief after consequences have been enforced and when the person is calm.
E.g. After "Jacob" has been secluded and calmed down, when he is released a qualified healthcare professional should talk with Jacob 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. "Jacob" also should be given opportunities to practice these behaviors in a safe environment.
- Do not argue or engage in power struggles.
E.g. If you see "Jacob" taking another patient's clothes out of his room, address this. If "Jacob" 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 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 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 engaging 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.
E.g. 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 any time," 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 feelings from a significant other in his/her life onto the patient. For example, if the healthcare provider's father frequently lied and manipulated him, 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 other body language (e.g. scowling, grimacing, etc.). Objective self-evaluation is essential when working with patients with personality disorders.
- Monitor one’s own communications, including verbals and nonverbals.
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 person with antisocial personality disorder how to recognize emotions in themselves and others.
The person with antisocial personality disorder needs to learn how to interact appropriately in a variety of settings. To do this, he/she must learn to 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 the recovery from 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 then go over their journal entries with them. Give feedback about their reactions and offer a menu of suggestions. Ask the antisocial person to list 3 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 backwards from 10 before responding to anything that causes an emotional reaction. To prevent agitation, have the antisocial person brainstorm ways to respond to various situations 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 change.
- 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 "Jacob" has not been able to hold down a job because of his violent outbursts at work. You can use "Jacob's" 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 maladaptive and some are adaptive. The antisocial person may use aggression, manipulation, and deceit to cope. Until he learns more adaptive coping skills, he will continue to rely on the old standbys. Suggestions for adaptive coping for aggressive behaviors can include: exercise (e.g. running or kickboxing are good ways to work out aggression); journaling (helps to identify emotions and triggers); and relaxation techniques (e.g. progressive muscle relaxation helps to reduce muscle tension and make one aware of physiological changes that occur under stress).
Recommendations for Loving the Antisocial Person
- (See recommendations for healthcare professionals—above)
- 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 person with antisocial personality disorder.
- 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 often is more damaging.
- Have back-up plans for child-care, dates, etc. as the antisocial person is highly unlikely to be dependable.
- Maintain personal safety at all times (e.g. keep a cell phone charged and on your person; keep enough gas in the car to get away, if necessary; inform a friend that you may need to stay with him/her sometime; 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.
Stay tuned for further information on the specific personality disorders.
For further study, there are many resources available to help in the understanding of antisocial personality disorder, living with antisocial people, and the treatment options available.
Resources for Healthcare Professionals, Sufferers, and Loved Ones
© 2012 Leah Wells-Marshburn