March 10, 2026 • 29 mins
In this episode of the Personality Couch Podcast, we (licensed clinical psychologists Doc Bok and Doc Fish) begin our much-awaited series on antisocial personality disorder! In the DSM, antisocial personality is the only diagnosis that includes law-breaking as a criterion. But surely all criminals can’t have the same personality, right? In this episode, we break down its stigmatized history while sharing our thoughts and opinions about the DSM’s limitations. We take a critical look at each of the DSM’s 7 criteria, while also discussing the overlap with other disorders like narcissism, psychopathy, and the sadistic personality.
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Chapters 00:00 Introduction & History of Antisocial Personality Disorder 05:21 DSM Criteria for Antisocial Personality Disorder 07:06: Criterion 1: Unlawful Behavior 09:32: Criterion 2: Deceitfulness & Manipulation 12:49 Criterion 3: Impulsivity 15:27 Criterion 4: Irritability & Aggression 16:21 Criterion 5: Disregard for Safety 17:44 Criterion 6: Irresponsibility 20:08 Criterion 7: Lack of Remorse 21:42 Antisocial Personality & Aging 25:05 Our Critiques & Thoughts
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(00:00):
Welcome to the Personality Couch podcast,where we discuss all things personality
and clinical practice. I'm your host, Doc Bok
and I'm here with my co host, DocFish. We are both licensed clinical
psychologists and private practice.And today we are
kicking off our series on antisocial personalitydisorder. This is not to be
(00:23):
confused with asocial, whichis a socially backwards
individual. Antisocial is a power hungry,norm busting individual who goes against
social norms in a way that cansometimes get them in
trouble with the law. In this episode, webreak down the disorder level DSM
criteria for antisocial, while alsosharing briefly about its
(00:46):
fascinating history. We have a lot to coveras usual. So let's dive on in. So
Millon's history on antisocial personalitywent all the way back to
Aristotle's student with the unscrupulous man.So this is basically a man who was a
con artist with everyday affairsand like didn't have any
empathy. So that's where we started. But thenjumping ahead to 1801, Philippe Pinel
(01:12):
proposed a character that wasimpulsive and self
destructive, even though theirreasoning abilities
were intact. And he called it insanitywithout delirium.
Oh, insanity without delirium. Okay, so they'reasking basically, is this criminal
behavior coming from being in realityor not? Which we actually have a
(01:34):
similar question today in the judicialor forensic system,
when people take the not guilty byreason of insanity plea.
That's true. Yeah. So then history veeredoff the psychological track and
antisocial concepts were interpretedthrough the lens of social
condemnation, very similar to like the waywe do with the word psychopath now.
(01:56):
So there was a focus on the forensic side ofthings, meaning those interfacing with
the legal system and like jails or prisons.But here the term actually became more
judgmental. Antisocials go against society.And so society goes against them. Like
we're not looking under the surface to tryto understand what's going on in the
(02:17):
psyche here. We're just namingit based on what
we see and based on the problematicbehaviors.
Yeah. And honestly, we did the same type ofthing with schizoid, right? Except they
don't break the rules. Like theyjust turtle and then we
judge them for it in history andespecially in the DSM.
So then around 1896, Kraepelin was one ofthe prominent figures who used the term
(02:40):
antisocial as like broader theory ofpsychopathic personalities.
And Kernberg also deserves an honorablemention here because in 1989 he coined
malignant narcissism. So antisocial personality,as we'll talk about more in the
series, has a lot of overlap withmalignant narcissism.
(03:00):
All right. So skipping ahead again, weend up with the DSM taking antisocial
personality disorder on theline of criminality.
And then also in the DSM, we took out the sadisticpersonality, which is also prone
to criminality. So in doing this, we ignorethe character that is antisocial or the
type who has adaptively found away to blend into society.
(03:24):
Like lawyers or police, politicians,etc. So they're
still like power hungry, but notnecessarily disorder level.
Right. Okay. Yeah. Yeah. And then this alsoreminds me like we have like the white
collar crime gurus who may notmake it into the criminal
system, but operate the same typeof illegal schemes, right?
(03:46):
They just have the money, power and connectionsto cover up their corruption. But I
mean, these types technically can still beantisocial, but I would argue they're
way less likely to receive a diagnosis ofantisocial personality disorder.
Sure. And there are some jobs where it'stotally acceptable to have power over
other people or like be more ruthless, lessempathetic, possibly more reckless.
(04:11):
Yeah. Yeah, exactly. Yeah. Like the power hungrypolitician or maybe the impossible
police officer who won't back down. Likeit is possible to have an antisocial
personality and sublimateit into society.
So what that means is basically to find away to make it adaptive and to work for
you, but not against societyin an overt way.
(04:33):
So multiple researchers have actually saidthat most antisocial personalities
aren't criminals, actually. Many are eitherhiding in shady but acceptable white
collar dealings or passively takingadvantage of people
in ways that maybe blend in orat a non disorder level.
Maybe they're just angsty and counter-
(04:54):
cultural, but not to a pointthat's problematic.
Right. But for today, we'll stick with theDSM antisocial, which obviously is that
disorder level. And I do think it is importantto note that for this personality
disorder, we don't love the DSMbecause it does focus
too much on over criminality, whichI think is a problem.
(05:17):
Absolutely. Yeah. All right. So here we are.Let's move on to the DSM. So as we
say, the DSM captures disorder level functioning.So in order to be a personality
disorder, it has to be persistentand enduring.
It's not someone's bad day,bad week, bad year.
You can often see the evidence of ongoing relationshipissues starting in youth and
(05:39):
worsening in adulthood. So these relationshipbreakdowns occur across contexts and
settings. So family and home work andco workers, and they're going to
significantly interfere with the
individual's ability to functionin our social world.
With this in mind, the DSM says this aboutantisocial personality disorder. So it
(06:02):
involves a persistent pattern of disregardfor and violations of the rights of
others that often involve deceit and manipulation.This personality disorder is
actually really unique in that it cannotbe diagnosed before age 18.
And there has to be evidence of a conductdisorder that started before age 15. So
(06:23):
conduct disorder involves patterns of violatingthe rights of others, social norms
or rules, such as aggression to people oranimals, destruction of property,
deceitfulness or theft or seriousviolation of rules.
Yeah, so this pattern has to show up in childhoodor the early teens and continues
(06:44):
into adulthood. So the DSM notes that thispattern has also been referred to as
psychopathy, sociopathy, or dissocial personalitydisorder. And we also have to
note that this is not part ofschizophrenia or bipolar.
Exactly. And there also has to be at leastthree of the following seven criteria.
(07:06):
Criterion one is failure to conform tosocial norms with respect to lawful
behaviors as indicated by repeatedly performingacts that are grounds for arrest.
Yeah, so whether or not they're actuallycaught or arrested, they repeatedly do
things that they could be arrested for, likestealing, harassment, destruction of
(07:28):
property, or just doing illegalthings at work.
Right. They disregard the wishes, rights orfeelings of others. There is a lack of
regard for others and how their actions mayaffect them. They often lack empathy
and take like an approach of each man for themselves.But antisocial individuals do
not just have to be men, theycan be women as well.
(07:51):
Absolutely. Yes. So while men are three timesas likely to be diagnosed as women,
women can absolutely still be antisocialas well. But they are likely to be
diagnosed as borderline personality instead,as clinicians may wrongly assume that
they're against-the-grainenergy comes from
(08:13):
emotional instability versus calculatedexploitation.
Yes, the way the DSM has categorized antisocialpersonality puts an emphasis on
aggressive behavior, which may notbe as overt for women.
Yeah, exactly. So women can break laws inmore subtle, manipulative ways that are
(08:35):
less overtly aggressive, like maybe notfollowing a custody agreement, conning
their spouse or business partner out of
money. Like women can be moresly and crafty.
Oh, definitely. Like there might be shoplifting,breaking and entering, credit card
fraud, DUIs, forgeries, etc.It's less overtly
(08:56):
violent and more manipulative orrelationally aggressive.
Absolutely. Yes. But with this criterionhere, we do start to see the antisocial
name at work, right? So doing things thatgo against social norms, laws, rules,
etc. Like again, this is not asocial orbeing socially backwards. We conflate
(09:19):
these two terms colloquially all the time.But an antisocial is someone who doesn't
really follow the social and legalrules of the land.
Exactly. They put their self-interest first.Yeah. All right. So the second
criterion is deceitfulness as indicatedby repeated lying, use of aliases or
(09:39):
conning others for personal profit or pleasure,like sex, power, money. So for
example, this might be someone who can'tgo a day without lying, like lying to
cover up their last events andthe one before that. And
then maybe it spins into theirown version of reality.
Yeah. So they might use alternate names, especiallyif they're running from the law
(09:59):
and don't want to get caught. So this actuallyreminds me of a recent news story
where a mother tragically killed her daughter.But in order to conceal her
identity, she used wigs on herself and herdaughter, frequently changing license
plates as she drove across state lines. Right.So I don't know what her full story
was. I don't know if shewas antisocial, but
(10:21):
that type of deceptive behavioris what the
criterion is talking about. Okay. So usingdisguises, different names or IDs to
gain power, money, maybe for sexual advantageor to run from law enforcement,
right? Like the possibilities are endless.Yeah. Oh, for sure. Yeah. And I do. I
(10:41):
will put this in here. I do watch some lawenforcement stuff on YouTube. So I see
these types popping up with others'IDs or like stealing
others' vehicles, maybe flirting withlaw enforcement to destroy
or distract from the drug paraphernalia thatthey're carrying, like those types of
things. And this is where it's interestingbecause some may even be superficially
(11:04):
charming and impress others with their verbalskills, but it's all to get what they
want or to distract from their law breaking.Right? Antisocials are manipulative
and conniving and might even malinger. Sowhat is malingering? It's like faking an
illness, maybe looking like a victim inorder to get out of responsibility.
(11:24):
It's like work, child support, criminal charges,even. Yeah. So malingering could
look like after being charged for crimes,taking the insanity plea and trying to
make yourself look like you're severelyincapacitated psychologically, which
interestingly, we have a test for that.There's several really. But forensic
psychologists use these instruments to helpsniff out when someone is faking bad
(11:49):
for secondary gain. And I have used it as
a testing psychologist,a handful of times
in outpatient practice, but it is pretty rare.So I'm curious, Doc Fish, have you
seen many antisocial in treatment? No, notin outpatient, like not the personality
disorder; antisocial behaviors? Yes,absolutely. But not true antisocial
(12:12):
personalities at a disorder level. Yeah, Ihaven't either. Like at least not as the
patient, maybe a relative or aclose associate that's
causing the patient grief, but typicallynot as the patient.
They're not the patient themselves for testingor therapy. And my hypothesis is
like, we don't really see a lot presentingto outpatient treatment at all, maybe
(12:34):
court order treatment. But generally, I don'tthink they're going to come to us for
help on their own volition, because we representthe social world and rules and
mores and how to act, which they circumventor avoid. Right, right. Okay. And then
we have the third criterion, which is impulsivityor failure to plan ahead.
(12:54):
So we're going to look at the second one, like, the first one is like, how do wemake decisions in the moment, like not considering the consequences or thinking
through what could happen, and this can leadto spontaneous changes in areas like
work, home life, social relationships,they may never have kept a monogamous
relationship instead having like a ton ofintimate partners, but not only that,
(13:15):
they can be exploitative and irresponsiblewith those partners. Yeah, this is
interesting because impulsivity is also a criterion
for multipleother disorders like borderline and
ADHD, to be specific, but they look very different.So I'll start with ADHD. ADHD
is a neurodevelopmental condition, which impactsour ability to wait our turn, not
(13:39):
blurt out answers, stay in our seat, right?It's an organic condition that affects
the prefrontal cortex, and our ability toinhibit behavior. So it's typically very
innocent, but it can be annoyingsometimes to others.
Then the impulsivity in borderline is moreemotionally driven or triggered by
abandonment fears, like impulsively hangingup on someone who slighted you or
(14:04):
impulsively drinking or eatingto soothe yourself when I
don't know your significant otherleaves after a fight.
Yeah, yeah, but in antisocial, it's impulsivitythat's tied to a disregard for
rules and laws, like impulsively quittinga job because I don't know, the Feds
showed up and asked you some questions,leading to running from the law and
abandoning your house, etc. Butit's the impulsivity to
(14:27):
cover up the bad choices and chancesof getting busted.
Or maybe just thinking that your boss isstupid and then you don't show up, you
just quit. Like it doesn't have to be a hugething that triggers the impulsivity.
Right, yeah, because rules are dumb anyway,like they don't apply to me. That's a
good point. It doesn't have to be an overthe top thing with antisocial. It can
(14:48):
just be bad decisions andimpulsivity related
to how they view the socialworld with contempt.
Yes, and the DSM notes that they may be arrogantand have an inflated ego, like
they might feel like they're too superiorfor ordinary work or maybe just be super
cocky, opinionated and self-assured. Theyalso tend to not have realistic concerns
(15:10):
about problems that could affect them,like either now or in the future.
Yeah, rules don't apply. I'm above them. Likework is for sissies. I don't know. I
slay for my money! I don'tknow. But you can see
like the huge overlap with narcissismhere, basically.
Okay, and then we have the fourth criterion,which is irritability and
(15:30):
aggressiveness as indicated by repeatedphysical fights or assaults. And
unfortunately, this does include beatinga child or a spouse.
Oh, yeah, or animal cruelty as well. Like anythingcan set them off. So it could be
displaced irritability onto others and justa meanness that is a consistent thread.
(15:51):
And with this, there's a real lack of regardfor other living things. And it's not
uncommon for them to take their angerout on people or animals.
I do think it's important to note that selfdefense or defending others in an
aggressive manner is not something that actuallyfits here. Oh, definitely. Yeah,
that's a very helpful thing to distinguish.Like here, there's a real superiority,
(16:15):
right? Everything is beneath them. And thenthey take out their anger accordingly.
Yes, which leads us to the fifth criterion,reckless disregard for the safety of
self or others. So speeding all the time,driving under the influence, lots of
accidents, it could be in sexual risk-takingor risky substance use. It may even be
(16:37):
putting a child in danger throughneglect or failure to care.
Yeah, they can actually be very reckless andirresponsible parents, like sometimes
evidenced by malnutrition, maybe illnessfrom lack of hygiene or not giving the
child their medication, maybe neighborsor community end up taking care of the
(16:58):
child like in regards to food or shelter.
They might leave the child without a caretakerwhen they're too young, or maybe
like not use the money for what it shouldbe used for, like for diapers or
whatever, but using it irresponsibly, likeon drugs or pleasures. There is a real
disregard for the social world, like orders,laws, rules, other people, and even
(17:23):
people that they're supposed to care for,even the innocents who aren't threats to
them. Yeah, yeah, I feel likegoing back to YouTube,
I've seen a lot of body cam footage onlinedepicting these types of characters as
parents and it's awful to see. Yeah, itis. Well, this leads us to the next
(17:43):
criterion. So criterion six is consistent irresponsibilityas indicated by repeated
failure to sustain consistent work behavioror honor financial obligations. Yeah,
back to that irresponsibility again, likethey can be unemployed for a long time.
Even though they could get a job or maybe justlike quit jobs without a plan to get
(18:06):
another. And maybe they even just like won'tshow up to work for a period of time
without any regard for the repercussions offellow workers or the family that they
may be supporting. And if they do own businesses,because they can, remember we said
the white collarpart of it... like they
can mistreat employees
(18:28):
and may mismanage
money, going bankrupt or cutting off paychecksrecklessly. Like you can have
antisocial in boardrooms just as much, butthey might have a thicker veneer that
makes them blend in with the social herd.
And regarding finances, they may fail to supportdependents or pay child support or
(18:49):
maybe default on debt, just irresponsibilitywith money stuff. And when it gets
really bad, they might failto even support
themselves. So maybe fall intopoverty or homelessness.
They maybe could become dishonorablydischarged if they
were in the military or end up in penalinstitutions for years.
Yeah, you know, what's interesting is thatantisocial can also have this like
(19:14):
superficial charm, but it'skind of a narcissistic
shiny part of them that can glistenif the conditions are right.
So I've heard of antisocial personalities,charming judges, bosses, lawyers and
other family members who don't see theircon man act for what it is. Like some
(19:34):
antisocial types are just really good con artists,like almost sociopathic in their
ability to blend in with the social herdand exploit people while doing it.
Oh, absolutely. But then we have to facethe question, like, are they actually
antisocial personality disorder if they
blend in? Like, some peopledon't get caught.
(19:56):
Oh, no, not this question. This questionis going to come up a lot in this
series. That is one thatI am wrestling with
because I don't know, Doc Fish.I don't know yet.
Oh, man. Okay. All right. So we have the lastcriterion, which is criterion seven,
a lack of remorse as indicated bybeing indifferent to or
rationalizing having hurt, mistreatedor stolen from another.
(20:19):
Yeah. So this often looks like blaming anyoneor anything other than themselves, or
just maybe like minimizing or ignoring theharm that they caused. Like, they don't
typically try to make up for their behavioror compensate in any way.
Like maybe like maybe a true narcissist wouldto kind of protect their image. Like
they antisocial is just they don't care. Ormaybe they'll spin an entire version of
(20:44):
reality to keep the blame offthemselves not to
protect the image, but to keepthe blame off the self.
But in that there is a real narcissistic
deflection that does happen inantisocial individuals.
They might think that life is unfair and thateverybody's out to help themselves.
And so you have to do what you got to doto survive and not be pushed around.
(21:05):
Yeah. So they tend to blame victims forbeing weak or helpless or stupid and
deserving of whatever bad thing happened. It'skind of like he had it coming anyway
or like losers deserve to lose mentality.
Mm. Yeah. So the DSM literally says theyfrequently lack empathy and tend to be
(21:26):
callous, cynical, and contemptuous of the feelings,rights and sufferings of others.
Like they really don't care about you or
about the rules. Rules don'tapply to them anyway.
So you can often see this extreme self focusemerge in these types. Now I do think
that in the DSM there's some interesting
(21:46):
honorable mentions that we shouldalso talk about.
So per the DSM, individuals with antisocialpersonality disorder are more likely
than individuals in the generalpopulation to
die prematurely from naturalcauses and suicide.
Oh, oh my goodness. This actually makes mewonder if that reckless impulsivity has
(22:11):
anything to do with it, likedriving too fast,
drinking too much, putting themselvesin dangerous situations.
And I also know that antisocial commonly co-occurswith substance use disorders. So
drug and alcohol abuse can accelerate aging.It can exacerbate underlying health
issues, maybe lead to health issues and maybeeven leading to other diseases that
(22:34):
are influenced by theirlifestyle choices.
Exactly.
This also reminds me though that antisocialpersonalities can age out of their
criminal behavior or at least it seems todecrease with age, even though it's a
lifelong condition. So research tells us thatafter 40, they tend to engage in less
(22:55):
criminal behavior and substanceuse per the research.
Ooh, this reminds me of some of the researchthat we did on psychopathy.
Ooh, so that true psychopathy doesn't ageout, like it's persistent over time in
terms of crime and extremesocial problems?
Yes. Okay. So this is one of like the favoritethings that I've ever read. So in
(23:17):
his paper about the spectrum of negativepersonalities, Michael Stone provided a
good example of somebody who had antisocialpersonality without psychopathy.
So this guy's name is Stanley Williams III. He had a childhood filled with
criminality. Then he became the leader ofa prominent gang after getting out of
(23:39):
juvey at age 19. His goal was to protect
locals from other gangs andpolice brutality.
And he was a youth counselor. However, hebecame addicted to angel dust and killed
people and stealing money to buy drugs. Sohe was ultimately sent to prison and
sentenced to death. But inprison, he wrote
(24:00):
books discouraging black youthto engage in gangs.
And he was actually nominated for the NobelPeace Prize, but was executed in 2005.
Oh man. Okay. What an interesting story.This brings up like a lot of emotions,
like conflicting emotions. Yeah. So he agedout of his antisocial behavior and
(24:22):
tried to encourage others not to do what hedid, which honestly, this reminds me a
little bit of the country singer Jelly Rolland his story, where he has a history
of a lot of criminal activity and drugswhen younger and he served time.
And now he's using his music and influenceto help others and encourage them not to
do that. So I'm not sure that he's an antisocial.I honestly haven't looked into it
(24:47):
at all, but it's just a similar storyline,right? Where this behavior can change.
That's really interesting. Yeah. Like hemight be, but remember, there are many
other personalities that canlook like antisocial on
the outside, but not the inside.Oh my goodness. Yes. Yes.
So this discussion actually reminds me ofan episode we did awhile back called
(25:08):
What's Worse than a Narcissist? And I'll
actually link that to the shownotes and on YouTube.
But we talked about the most dark characters,like many who actually didn't make it
into the DSM, which then it brings me tothe question, Doc Fish, why did
antisocial? Like if noneof the other pure
forensic diagnoses made itin, why did this one?
(25:30):
Like what's so special about it? If it's notcommonly an outpatient diagnosis. Oh
boy. I have a lot to say on this. Okay. Okay.So I do think that we need a forensic
related personality diagnosis in the DSMbecause we can see that sometimes.
Yeah. But if we do that, I think we shoulddo it correctly and include like all of
(25:52):
the socially inappropriate or like slash criminalpersonality stuff. I don't really
think it's fair to just cutit off somewhere.
Like antisocial makes it in the DSM, but psychopathyand sadistic doesn't. So we're
missing a whole part of the human continuumof personality. Wow. Now the DSM is a
book focused on pathology, not likenormal or healthy personality.
(26:15):
So that does also mean we miss a chunk ofthe antisocial that are able to work
towards health or adapt adequately or justblend into society. So the DSM is
technically focused on criminal behavior andantisocial behavior, but it lacks the
depth into the personality underneath.Totally agree. Yeah.
(26:36):
So as an example that highlights this, themajority of prisoners, so like 70 to 80%
meet full criteria for antisocial personalitydisorder, but only 15 to 25% meet the
appropriate score for psychopathy. Whydoes this matter? Okay. Yeah.
70 to 80% of prisoners cannot all have thesame kind of personality. That doesn't
(27:02):
make sense. But they are there because oflaw breaking antisocial behaviors.
Behavior does not equal personality.Right.
So that is my biggest criticism with antisocialpersonality disorder in the DSM is
that it's not capturing that personalityunderneath. This is such a great point.
(27:22):
Yeah. This reminds me of our criticismwith schizoid personality disorder.
And it's similar here with antisocial personality.We're not describing what's
underneath the exterior stuff. Like why arethey prone to rule breaking and law
breaking? What is causing the behaviorthat is inherent to
(27:46):
the psyche? Like what is going on thatleads to these decisions?
And in that answer, I do think that we wouldfind a spectrum of dark characters
that meet criteria for antisocial, but reallyhave an array of personality features
underneath, be it psychopathic, sadistic,narcissistic, paranoid, et cetera.
(28:07):
So I'll say it here. Antisocial almost feelslike a DSM catch all for criminal
behavior that we see while treating
patients, but there has to bemore. I, yes, exactly.
I think it would be fascinating to dive intothe differences among all of these
personalities, but we would have to look outsideof the DSM. Uh-huh. Which we are
(28:28):
prepared to do in upcoming episodes. So makesure you subscribe so you don't miss
any of those episodes upcoming inthis fascinating series.
So today we unpacked the DSM antisocial criteria,but we have so much more to say
about this dark personality type, like somuch. Yeah. So if you're interested in
(28:50):
learning more, we do have blogs,visuals, and references
that coincide with each episode atwww.personalitycouch.com.
And if you're a provider looking to consultabout a case or you're in need of
psychodynamic therapy or a deep dive psychologicalevaluation, that's not forensic
in nature, our private practice Quest Psychcan help with that. I'll provide a link
(29:10):
in the show notes. Be well, be kind. And
we'll see you next time on thepersonality couch.
(29:37):
This podcast is for informational purposes only and does not constitute a professional relationship. If you’re in need of professional help, please seek out appropriate resources in your area. Information about clinical trends or diagnoses are discussed in broad and universal terms and do not refer to any specific person or case.
Welcome to the Personality Couch podcast,where we discuss all things personality
and clinical practice. I'm your host, Doc Bok
and I'm here with my co host, DocFish. We are both licensed clinical
psychologists and private practice.And today we are
kicking off our series on antisocial personalitydisorder. This is not to be
(00:23):
confused with asocial, whichis a socially backwards
individual. Antisocial is a power hungry,norm busting individual who goes against
social norms in a way that cansometimes get them in
trouble with the law. In this episode, webreak down the disorder level DSM
criteria for antisocial, while alsosharing briefly about its
(00:46):
fascinating history. We have a lot to coveras usual. So let's dive on in. So
Millon's history on antisocial personalitywent all the way back to
Aristotle's student with the unscrupulous man.So this is basically a man who was a
con artist with everyday affairsand like didn't have any
empathy. So that's where we started. But thenjumping ahead to 1801, Philippe Pinel
(01:12):
proposed a character that wasimpulsive and self
destructive, even though theirreasoning abilities
were intact. And he called it insanitywithout delirium.
Oh, insanity without delirium. Okay, so they'reasking basically, is this criminal
behavior coming from being in realityor not? Which we actually have a
(01:34):
similar question today in the judicialor forensic system,
when people take the not guilty byreason of insanity plea.
That's true. Yeah. So then history veeredoff the psychological track and
antisocial concepts were interpretedthrough the lens of social
condemnation, very similar to like the waywe do with the word psychopath now.
(01:56):
So there was a focus on the forensic side ofthings, meaning those interfacing with
the legal system and like jails or prisons.But here the term actually became more
judgmental. Antisocials go against society.And so society goes against them. Like
we're not looking under the surface to tryto understand what's going on in the
(02:17):
psyche here. We're just namingit based on what
we see and based on the problematicbehaviors.
Yeah. And honestly, we did the same type ofthing with schizoid, right? Except they
don't break the rules. Like theyjust turtle and then we
judge them for it in history andespecially in the DSM.
So then around 1896, Kraepelin was one ofthe prominent figures who used the term
(02:40):
antisocial as like broader theory ofpsychopathic personalities.
And Kernberg also deserves an honorablemention here because in 1989 he coined
malignant narcissism. So antisocial personality,as we'll talk about more in the
series, has a lot of overlap withmalignant narcissism.
(03:00):
All right. So skipping ahead again, weend up with the DSM taking antisocial
personality disorder on theline of criminality.
And then also in the DSM, we took out the sadisticpersonality, which is also prone
to criminality. So in doing this, we ignorethe character that is antisocial or the
type who has adaptively found away to blend into society.
(03:24):
Like lawyers or police, politicians,etc. So they're
still like power hungry, but notnecessarily disorder level.
Right. Okay. Yeah. Yeah. And then this alsoreminds me like we have like the white
collar crime gurus who may notmake it into the criminal
system, but operate the same typeof illegal schemes, right?
(03:46):
They just have the money, power and connectionsto cover up their corruption. But I
mean, these types technically can still beantisocial, but I would argue they're
way less likely to receive a diagnosis ofantisocial personality disorder.
Sure. And there are some jobs where it'stotally acceptable to have power over
other people or like be more ruthless, lessempathetic, possibly more reckless.
(04:11):
Yeah. Yeah, exactly. Yeah. Like the power hungrypolitician or maybe the impossible
police officer who won't back down. Likeit is possible to have an antisocial
personality and sublimateit into society.
So what that means is basically to find away to make it adaptive and to work for
you, but not against societyin an overt way.
(04:33):
So multiple researchers have actually saidthat most antisocial personalities
aren't criminals, actually. Many are eitherhiding in shady but acceptable white
collar dealings or passively takingadvantage of people
in ways that maybe blend in orat a non disorder level.
Maybe they're just angsty and counter-
(04:54):
cultural, but not to a pointthat's problematic.
Right. But for today, we'll stick with theDSM antisocial, which obviously is that
disorder level. And I do think it is importantto note that for this personality
disorder, we don't love the DSMbecause it does focus
too much on over criminality, whichI think is a problem.
(05:17):
Absolutely. Yeah. All right. So here we are.Let's move on to the DSM. So as we
say, the DSM captures disorder level functioning.So in order to be a personality
disorder, it has to be persistentand enduring.
It's not someone's bad day,bad week, bad year.
You can often see the evidence of ongoing relationshipissues starting in youth and
(05:39):
worsening in adulthood. So these relationshipbreakdowns occur across contexts and
settings. So family and home work andco workers, and they're going to
significantly interfere with the
individual's ability to functionin our social world.
With this in mind, the DSM says this aboutantisocial personality disorder. So it
(06:02):
involves a persistent pattern of disregardfor and violations of the rights of
others that often involve deceit and manipulation.This personality disorder is
actually really unique in that it cannotbe diagnosed before age 18.
And there has to be evidence of a conductdisorder that started before age 15. So
(06:23):
conduct disorder involves patterns of violatingthe rights of others, social norms
or rules, such as aggression to people oranimals, destruction of property,
deceitfulness or theft or seriousviolation of rules.
Yeah, so this pattern has to show up in childhoodor the early teens and continues
(06:44):
into adulthood. So the DSM notes that thispattern has also been referred to as
psychopathy, sociopathy, or dissocial personalitydisorder. And we also have to
note that this is not part ofschizophrenia or bipolar.
Exactly. And there also has to be at leastthree of the following seven criteria.
(07:06):
Criterion one is failure to conform tosocial norms with respect to lawful
behaviors as indicated by repeatedly performingacts that are grounds for arrest.
Yeah, so whether or not they're actuallycaught or arrested, they repeatedly do
things that they could be arrested for, likestealing, harassment, destruction of
(07:28):
property, or just doing illegalthings at work.
Right. They disregard the wishes, rights orfeelings of others. There is a lack of
regard for others and how their actions mayaffect them. They often lack empathy
and take like an approach of each man for themselves.But antisocial individuals do
not just have to be men, theycan be women as well.
(07:51):
Absolutely. Yes. So while men are three timesas likely to be diagnosed as women,
women can absolutely still be antisocialas well. But they are likely to be
diagnosed as borderline personality instead,as clinicians may wrongly assume that
they're against-the-grainenergy comes from
(08:13):
emotional instability versus calculatedexploitation.
Yes, the way the DSM has categorized antisocialpersonality puts an emphasis on
aggressive behavior, which may notbe as overt for women.
Yeah, exactly. So women can break laws inmore subtle, manipulative ways that are
(08:35):
less overtly aggressive, like maybe notfollowing a custody agreement, conning
their spouse or business partner out of
money. Like women can be moresly and crafty.
Oh, definitely. Like there might be shoplifting,breaking and entering, credit card
fraud, DUIs, forgeries, etc.It's less overtly
(08:56):
violent and more manipulative orrelationally aggressive.
Absolutely. Yes. But with this criterionhere, we do start to see the antisocial
name at work, right? So doing things thatgo against social norms, laws, rules,
etc. Like again, this is not asocial orbeing socially backwards. We conflate
(09:19):
these two terms colloquially all the time.But an antisocial is someone who doesn't
really follow the social and legalrules of the land.
Exactly. They put their self-interest first.Yeah. All right. So the second
criterion is deceitfulness as indicatedby repeated lying, use of aliases or
(09:39):
conning others for personal profit or pleasure,like sex, power, money. So for
example, this might be someone who can'tgo a day without lying, like lying to
cover up their last events andthe one before that. And
then maybe it spins into theirown version of reality.
Yeah. So they might use alternate names, especiallyif they're running from the law
(09:59):
and don't want to get caught. So this actuallyreminds me of a recent news story
where a mother tragically killed her daughter.But in order to conceal her
identity, she used wigs on herself and herdaughter, frequently changing license
plates as she drove across state lines. Right.So I don't know what her full story
was. I don't know if shewas antisocial, but
(10:21):
that type of deceptive behavioris what the
criterion is talking about. Okay. So usingdisguises, different names or IDs to
gain power, money, maybe for sexual advantageor to run from law enforcement,
right? Like the possibilities are endless.Yeah. Oh, for sure. Yeah. And I do. I
(10:41):
will put this in here. I do watch some lawenforcement stuff on YouTube. So I see
these types popping up with others'IDs or like stealing
others' vehicles, maybe flirting withlaw enforcement to destroy
or distract from the drug paraphernalia thatthey're carrying, like those types of
things. And this is where it's interestingbecause some may even be superficially
(11:04):
charming and impress others with their verbalskills, but it's all to get what they
want or to distract from their law breaking.Right? Antisocials are manipulative
and conniving and might even malinger. Sowhat is malingering? It's like faking an
illness, maybe looking like a victim inorder to get out of responsibility.
(11:24):
It's like work, child support, criminal charges,even. Yeah. So malingering could
look like after being charged for crimes,taking the insanity plea and trying to
make yourself look like you're severelyincapacitated psychologically, which
interestingly, we have a test for that.There's several really. But forensic
psychologists use these instruments to helpsniff out when someone is faking bad
(11:49):
for secondary gain. And I have used it as
a testing psychologist,a handful of times
in outpatient practice, but it is pretty rare.So I'm curious, Doc Fish, have you
seen many antisocial in treatment? No, notin outpatient, like not the personality
disorder; antisocial behaviors? Yes,absolutely. But not true antisocial
(12:12):
personalities at a disorder level. Yeah, Ihaven't either. Like at least not as the
patient, maybe a relative or aclose associate that's
causing the patient grief, but typicallynot as the patient.
They're not the patient themselves for testingor therapy. And my hypothesis is
like, we don't really see a lot presentingto outpatient treatment at all, maybe
(12:34):
court order treatment. But generally, I don'tthink they're going to come to us for
help on their own volition, because we representthe social world and rules and
mores and how to act, which they circumventor avoid. Right, right. Okay. And then
we have the third criterion, which is impulsivityor failure to plan ahead.
(12:54):
So we're going to look at the second one, like, the first one is like, how do wemake decisions in the moment, like not considering the consequences or thinking
through what could happen, and this can leadto spontaneous changes in areas like
work, home life, social relationships,they may never have kept a monogamous
relationship instead having like a ton ofintimate partners, but not only that,
(13:15):
they can be exploitative and irresponsiblewith those partners. Yeah, this is
interesting because impulsivity is also a criterion
for multipleother disorders like borderline and
ADHD, to be specific, but they look very different.So I'll start with ADHD. ADHD
is a neurodevelopmental condition, which impactsour ability to wait our turn, not
(13:39):
blurt out answers, stay in our seat, right?It's an organic condition that affects
the prefrontal cortex, and our ability toinhibit behavior. So it's typically very
innocent, but it can be annoyingsometimes to others.
Then the impulsivity in borderline is moreemotionally driven or triggered by
abandonment fears, like impulsively hangingup on someone who slighted you or
(14:04):
impulsively drinking or eatingto soothe yourself when I
don't know your significant otherleaves after a fight.
Yeah, yeah, but in antisocial, it's impulsivitythat's tied to a disregard for
rules and laws, like impulsively quittinga job because I don't know, the Feds
showed up and asked you some questions,leading to running from the law and
abandoning your house, etc. Butit's the impulsivity to
(14:27):
cover up the bad choices and chancesof getting busted.
Or maybe just thinking that your boss isstupid and then you don't show up, you
just quit. Like it doesn't have to be a hugething that triggers the impulsivity.
Right, yeah, because rules are dumb anyway,like they don't apply to me. That's a
good point. It doesn't have to be an overthe top thing with antisocial. It can
(14:48):
just be bad decisions andimpulsivity related
to how they view the socialworld with contempt.
Yes, and the DSM notes that they may be arrogantand have an inflated ego, like
they might feel like they're too superiorfor ordinary work or maybe just be super
cocky, opinionated and self-assured. Theyalso tend to not have realistic concerns
(15:10):
about problems that could affect them,like either now or in the future.
Yeah, rules don't apply. I'm above them. Likework is for sissies. I don't know. I
slay for my money! I don'tknow. But you can see
like the huge overlap with narcissismhere, basically.
Okay, and then we have the fourth criterion,which is irritability and
(15:30):
aggressiveness as indicated by repeatedphysical fights or assaults. And
unfortunately, this does include beatinga child or a spouse.
Oh, yeah, or animal cruelty as well. Like anythingcan set them off. So it could be
displaced irritability onto others and justa meanness that is a consistent thread.
(15:51):
And with this, there's a real lack of regardfor other living things. And it's not
uncommon for them to take their angerout on people or animals.
I do think it's important to note that selfdefense or defending others in an
aggressive manner is not something that actuallyfits here. Oh, definitely. Yeah,
that's a very helpful thing to distinguish.Like here, there's a real superiority,
(16:15):
right? Everything is beneath them. And thenthey take out their anger accordingly.
Yes, which leads us to the fifth criterion,reckless disregard for the safety of
self or others. So speeding all the time,driving under the influence, lots of
accidents, it could be in sexual risk-takingor risky substance use. It may even be
(16:37):
putting a child in danger throughneglect or failure to care.
Yeah, they can actually be very reckless andirresponsible parents, like sometimes
evidenced by malnutrition, maybe illnessfrom lack of hygiene or not giving the
child their medication, maybe neighborsor community end up taking care of the
(16:58):
child like in regards to food or shelter.
They might leave the child without a caretakerwhen they're too young, or maybe
like not use the money for what it shouldbe used for, like for diapers or
whatever, but using it irresponsibly, likeon drugs or pleasures. There is a real
disregard for the social world, like orders,laws, rules, other people, and even
(17:23):
people that they're supposed to care for,even the innocents who aren't threats to
them. Yeah, yeah, I feel likegoing back to YouTube,
I've seen a lot of body cam footage onlinedepicting these types of characters as
parents and it's awful to see. Yeah, itis. Well, this leads us to the next
(17:43):
criterion. So criterion six is consistent irresponsibilityas indicated by repeated
failure to sustain consistent work behavioror honor financial obligations. Yeah,
back to that irresponsibility again, likethey can be unemployed for a long time.
Even though they could get a job or maybe justlike quit jobs without a plan to get
(18:06):
another. And maybe they even just like won'tshow up to work for a period of time
without any regard for the repercussions offellow workers or the family that they
may be supporting. And if they do own businesses,because they can, remember we said
the white collarpart of it... like they
can mistreat employees
(18:28):
and may mismanage
money, going bankrupt or cutting off paychecksrecklessly. Like you can have
antisocial in boardrooms just as much, butthey might have a thicker veneer that
makes them blend in with the social herd.
And regarding finances, they may fail to supportdependents or pay child support or
(18:49):
maybe default on debt, just irresponsibilitywith money stuff. And when it gets
really bad, they might failto even support
themselves. So maybe fall intopoverty or homelessness.
They maybe could become dishonorablydischarged if they
were in the military or end up in penalinstitutions for years.
Yeah, you know, what's interesting is thatantisocial can also have this like
(19:14):
superficial charm, but it'skind of a narcissistic
shiny part of them that can glistenif the conditions are right.
So I've heard of antisocial personalities,charming judges, bosses, lawyers and
other family members who don't see theircon man act for what it is. Like some
(19:34):
antisocial types are just really good con artists,like almost sociopathic in their
ability to blend in with the social herdand exploit people while doing it.
Oh, absolutely. But then we have to facethe question, like, are they actually
antisocial personality disorder if they
blend in? Like, some peopledon't get caught.
(19:56):
Oh, no, not this question. This questionis going to come up a lot in this
series. That is one thatI am wrestling with
because I don't know, Doc Fish.I don't know yet.
Oh, man. Okay. All right. So we have the lastcriterion, which is criterion seven,
a lack of remorse as indicated bybeing indifferent to or
rationalizing having hurt, mistreatedor stolen from another.
(20:19):
Yeah. So this often looks like blaming anyoneor anything other than themselves, or
just maybe like minimizing or ignoring theharm that they caused. Like, they don't
typically try to make up for their behavioror compensate in any way.
Like maybe like maybe a true narcissist wouldto kind of protect their image. Like
they antisocial is just they don't care. Ormaybe they'll spin an entire version of
(20:44):
reality to keep the blame offthemselves not to
protect the image, but to keepthe blame off the self.
But in that there is a real narcissistic
deflection that does happen inantisocial individuals.
They might think that life is unfair and thateverybody's out to help themselves.
And so you have to do what you got to doto survive and not be pushed around.
(21:05):
Yeah. So they tend to blame victims forbeing weak or helpless or stupid and
deserving of whatever bad thing happened. It'skind of like he had it coming anyway
or like losers deserve to lose mentality.
Mm. Yeah. So the DSM literally says theyfrequently lack empathy and tend to be
(21:26):
callous, cynical, and contemptuous of the feelings,rights and sufferings of others.
Like they really don't care about you or
about the rules. Rules don'tapply to them anyway.
So you can often see this extreme self focusemerge in these types. Now I do think
that in the DSM there's some interesting
(21:46):
honorable mentions that we shouldalso talk about.
So per the DSM, individuals with antisocialpersonality disorder are more likely
than individuals in the generalpopulation to
die prematurely from naturalcauses and suicide.
Oh, oh my goodness. This actually makes mewonder if that reckless impulsivity has
(22:11):
anything to do with it, likedriving too fast,
drinking too much, putting themselvesin dangerous situations.
And I also know that antisocial commonly co-occurswith substance use disorders. So
drug and alcohol abuse can accelerate aging.It can exacerbate underlying health
issues, maybe lead to health issues and maybeeven leading to other diseases that
(22:34):
are influenced by theirlifestyle choices.
Exactly.
This also reminds me though that antisocialpersonalities can age out of their
criminal behavior or at least it seems todecrease with age, even though it's a
lifelong condition. So research tells us thatafter 40, they tend to engage in less
(22:55):
criminal behavior and substanceuse per the research.
Ooh, this reminds me of some of the researchthat we did on psychopathy.
Ooh, so that true psychopathy doesn't ageout, like it's persistent over time in
terms of crime and extremesocial problems?
Yes. Okay. So this is one of like the favoritethings that I've ever read. So in
(23:17):
his paper about the spectrum of negativepersonalities, Michael Stone provided a
good example of somebody who had antisocialpersonality without psychopathy.
So this guy's name is Stanley Williams III. He had a childhood filled with
criminality. Then he became the leader ofa prominent gang after getting out of
(23:39):
juvey at age 19. His goal was to protect
locals from other gangs andpolice brutality.
And he was a youth counselor. However, hebecame addicted to angel dust and killed
people and stealing money to buy drugs. Sohe was ultimately sent to prison and
sentenced to death. But inprison, he wrote
(24:00):
books discouraging black youthto engage in gangs.
And he was actually nominated for the NobelPeace Prize, but was executed in 2005.
Oh man. Okay. What an interesting story.This brings up like a lot of emotions,
like conflicting emotions. Yeah. So he agedout of his antisocial behavior and
(24:22):
tried to encourage others not to do what hedid, which honestly, this reminds me a
little bit of the country singer Jelly Rolland his story, where he has a history
of a lot of criminal activity and drugswhen younger and he served time.
And now he's using his music and influenceto help others and encourage them not to
do that. So I'm not sure that he's an antisocial.I honestly haven't looked into it
(24:47):
at all, but it's just a similar storyline,right? Where this behavior can change.
That's really interesting. Yeah. Like hemight be, but remember, there are many
other personalities that canlook like antisocial on
the outside, but not the inside.Oh my goodness. Yes. Yes.
So this discussion actually reminds me ofan episode we did awhile back called
(25:08):
What's Worse than a Narcissist? And I'll
actually link that to the shownotes and on YouTube.
But we talked about the most dark characters,like many who actually didn't make it
into the DSM, which then it brings me tothe question, Doc Fish, why did
antisocial? Like if noneof the other pure
forensic diagnoses made itin, why did this one?
(25:30):
Like what's so special about it? If it's notcommonly an outpatient diagnosis. Oh
boy. I have a lot to say on this. Okay. Okay.So I do think that we need a forensic
related personality diagnosis in the DSMbecause we can see that sometimes.
Yeah. But if we do that, I think we shoulddo it correctly and include like all of
(25:52):
the socially inappropriate or like slash criminalpersonality stuff. I don't really
think it's fair to just cutit off somewhere.
Like antisocial makes it in the DSM, but psychopathyand sadistic doesn't. So we're
missing a whole part of the human continuumof personality. Wow. Now the DSM is a
book focused on pathology, not likenormal or healthy personality.
(26:15):
So that does also mean we miss a chunk ofthe antisocial that are able to work
towards health or adapt adequately or justblend into society. So the DSM is
technically focused on criminal behavior andantisocial behavior, but it lacks the
depth into the personality underneath.Totally agree. Yeah.
(26:36):
So as an example that highlights this, themajority of prisoners, so like 70 to 80%
meet full criteria for antisocial personalitydisorder, but only 15 to 25% meet the
appropriate score for psychopathy. Whydoes this matter? Okay. Yeah.
70 to 80% of prisoners cannot all have thesame kind of personality. That doesn't
(27:02):
make sense. But they are there because oflaw breaking antisocial behaviors.
Behavior does not equal personality.Right.
So that is my biggest criticism with antisocialpersonality disorder in the DSM is
that it's not capturing that personalityunderneath. This is such a great point.
(27:22):
Yeah. This reminds me of our criticismwith schizoid personality disorder.
And it's similar here with antisocial personality.We're not describing what's
underneath the exterior stuff. Like why arethey prone to rule breaking and law
breaking? What is causing the behaviorthat is inherent to
(27:46):
the psyche? Like what is going on thatleads to these decisions?
And in that answer, I do think that we wouldfind a spectrum of dark characters
that meet criteria for antisocial, but reallyhave an array of personality features
underneath, be it psychopathic, sadistic,narcissistic, paranoid, et cetera.
(28:07):
So I'll say it here. Antisocial almost feelslike a DSM catch all for criminal
behavior that we see while treating
patients, but there has to bemore. I, yes, exactly.
I think it would be fascinating to dive intothe differences among all of these
personalities, but we would have to look outsideof the DSM. Uh-huh. Which we are
(28:28):
prepared to do in upcoming episodes. So makesure you subscribe so you don't miss
any of those episodes upcoming inthis fascinating series.
So today we unpacked the DSM antisocial criteria,but we have so much more to say
about this dark personality type, like somuch. Yeah. So if you're interested in
(28:50):
learning more, we do have blogs,visuals, and references
that coincide with each episode atwww.personalitycouch.com.
And if you're a provider looking to consultabout a case or you're in need of
psychodynamic therapy or a deep dive psychologicalevaluation, that's not forensic
in nature, our private practice Quest Psychcan help with that. I'll provide a link
(29:10):
in the show notes. Be well, be kind. And
we'll see you next time on thepersonality couch.
(29:37):
This podcast is for informational purposes only and does not constitute a professional relationship. If you’re in need of professional help, please seek out appropriate resources in your area. Information about clinical trends or diagnoses are discussed in broad and universal terms and do not refer to any specific person or case.
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