Today we move on to the Cluster B disorders, which are known as the “dramatic” or “erratic” disorders. The first of these is Antisocial Personality Disorder (ASPD).

The stereotypical understanding of ASPD is of a criminal with little-to-no empathy or regard for others; someone who will break things and break people “just because they can”. While elements of that are true for some people with ASPD, this stereotype is more influenced by sensationalism and crime-based media than reality.

In the DSM-5, ASPD is considered to be a long-term pattern of disregard for and violation of other people’s rights, which has occurred since the age of 15. To be diagnosed with ASPD, someone must meet at least three of these criteria:

• They do not conform to social norms and laws, and repeatedly perform criminal acts
• They repeatedly lie, use aliases, or con others for personal profit or pleasure
• They are impulsive and fail to plan ahead.
• They are irritable and aggressive; they frequently get in fights or commit assaults.
• They do not care about their own or other’s safety
• They are consistently irresponsible and fail to keep steady work or honor financial commitments.
• They lack remorse and do not care if they have hurt or mistreated others.

PD diagnoses are generally given only to adults, although under-18s can be diagnosed in special circumstances if there is overwhelming evidence that their symptoms are stable over time and not caused by anything else. ASPD is the exception; it cannot ever be applied to someone under 18.

People with ASPD are often unsure of why other people are governed by their emotions, or why people try to flatter or fit in with others. Unlike people with other conditions that affect social understanding such as SzPD and autism spectrum conditions, many people with ASPD see bypassing these inefficient and mostly meaningless social conventions as a badge of honour. They may believe that seeing through these irrational social conventions is a mark of their rationality and superiority over “mindless” typical people.

ASPD can be characterised by ruthlessness and by using task-focused logic over people-focused logic. People usually see a “good” action as one which helps people and a “bad” action as one which harms people, while someone with ASPD will see a “good” action as one which helps their progress and a “bad” action as one which hinders their progress. However, some people with ASPD are superficially charming and affectionate, either to gain people’s trust or to strategically blend in.

Another element of ASPD is boredom and stimulation. People with ASPD can describe themselves as being permanently bored, finding nothing fun unless it is extreme. They may obtain continual stimulation through impulsive and reckless behaviours, such as reckless driving, extreme sports, or substance abuse. Stimulation can also be achieved through premeditated manipulation. Some people with ASPD gain enjoyment from their ability to “push people’s buttons” and manipulate or provoke them.

One media character who fits the typical violent and remorseless portrayal of ASPD is Patrick Bateman from American Psycho. Bateman has no feelings for or attachment to anyone else, but uses his superficial charm to distract and coerce them. His entire goal is inspiring jealousy in others through his exterior image, before using them as tools for sex, drugs, or (possibly) murder.

However, an interesting character who illustrates ASPD traits yet remains sympathetic is Barney Stinson from How I Met Your Mother. Barney does not follow typical moral rules. Instead, he resolutely sticks to his personal “Bro Code”. He is impulsive and reckless; he has a gambling problem, which is common in ASPD, while his focus on making everything “legendary” shows a need for higher-than-typical stimulation. He can also be superficially charming, such as by talking his way out of speeding tickets. Although loyal and caring to his friends, Barney began the show as a serial womaniser who manipulated social situations to pick up women he did not care about. However, he can also use his knowledge of human behaviour for good, manipulating situations to help out his friends.

The character of Barney is not written to portray any particular mental health condition. However, he can be seen as an example of someone with ASPD traits who develops a way to express them while remaining socially successful.

In fact, ASPD traits can be advantageous in some situations – Jon Ronson’s book The Psychopath Test explains how ASPD traits can help CEOs, who must ruthlessly focus on tasks rather than people to reach the peak of business. However, it is hard to study how people can adapt and benefit from ASPD traits. The tools used to study ASPD group symptoms in terms of observed negative behaviours and traits, without any information on how people may work around those traits or limit their severity. This is because most studies on ASPD take place within prisons or secure units, which are two of the least adaptive situations a person can be in. Studies like those in The Psychopath Test suggest that there could be two results of ASPD traits rather than one. Maybe some people with ASPD traits have enough protective factors that they learn to channel their traits into a socially rewarded form and succeed in intense careers like business.

Psychological Criticisms of ASPD

As with some other conditions, people with ASPD will not be distressed by their symptoms – many will consider themselves to be superior in contrast to weak and over-emotional “typical” people. (Legal authorities will disagree).

ASPD is often used interchangeably with the term psychopath, even in research, an equivalence which makes talking about ASPD complicated. (Psychopath should not be confused with the word psychopathology, which just means “the study of mental ill health of suffering”.) The term psychopath has multiple meanings within psychiatry, and these meanings disagree with and even contradict each other. Current research suggests that while most people defined as psychopaths would be diagnosed with ASPD, only a small percentage of people diagnosed with ASPD would fit the description of a psychopath.

P.S. I’ll finish with a philosophical tangent. Philosophically speaking, the outlook and traits of someone with ASPD would not always be seen as negative. Some proposed views of ideal humans, such as Friedrich Nietzsche’s Ubermensch, or Soren Kierkegaard’s Knight of Faith, have parallels with ASPD. In a world with a different ruling philosophy, people with ASPD would be examples of powerful self-reliance while typical people would be seen as disordered.