Specific Personality Disorders: Antisocial Personality Disorder

People with features of an antisocial personality disorder show longstanding disregard for the rules of society and the rights of others. The main features are aggression; property loss and damage; deceitfulness and theft, and the serious violation of societal rules. People with an antisocial personality disorder may present to psychiatric or forensic services and there may be significant levels of risk to staff and peers. In addition to aggression and criminal behaviours, people with antisocial personality disorder can also be impulsive with little regard for the safety of themselves or others. They may take no responsibility for their actions and appear incapable of genuine remorse. Clinicians may be reluctant to diagnose such a disorder in a person with intellectual disability and may attribute these features to developmental delay and intellectual disability. However,  learning disability, Attention Deficit Hyperactivity Disorder and challenging behaviour are seen as risk factors for antisocial personality disorder in the general population. All of these are more common in people with intellectual disability. Specific syndromes leading to intellectual disability are also associated with antisocial behaviour and these include foetal alcohol syndrome and acquired brain injury. Abuse, neglect, inadequate education, poor social skills and maladaptive coping behaviours occurring in someone with a low threshold to frustration and limited impulse control will all also contribute to a risk of developing an antisocial personality. An undiagnosed pervasive developmental disorder can also present with features of antisocial personality disorder. In people with both intellectual disability and antisocial personality disorder, assessment may reveal a disrupted school experience, inappropriate sexual behaviour, criminal charges and behaviours, drug and alcohol problems, poor self-care and homelessness. The person may present to disability services through the forensic system or be referred to behaviour intervention teams due to anger, aggression, property damage, sexual offending, demanding behaviour with an inflated sense of entitlement, substance use, deceitfulness, manipulation of others and malingering. There can be significant risks to the person themselves, support staff and to vulnerable peers.