Diagnostic overview

ASPD (DSM‑5) requires a history of Conduct Disorder symptoms before age 15 and a pervasive pattern of disregard for others from age 18, including deceitfulness, impulsivity, irritability/aggressiveness, reckless disregard for safety, consistent irresponsibility and lack of remorse. Severity and functional impact should be documented.

Core features

• Violation of social norms and repeated unlawful behaviour.
• Deceitfulness, manipulativeness and chronic lying.
• Impulsivity and failure to plan ahead.
• Irritability and aggressiveness — assaults and fights.
• Irresponsibility in work and financial obligations.
• Lack of remorse or rationalisation of harming others.

Associated features & comorbidity

• High rates of substance use disorders, mood disorders, anxiety disorders and other personality disorders (notably Borderline and Narcissistic PD).
• Elevated risk of legal problems, incarceration and interpersonal violence.
• Functional impairment in relationships and employment; poor adherence to treatment.

Assessment checklist

1. Obtain developmental history focusing on conduct problems before age 15 (truancy, theft, fire setting, cruelty to animals).
2. Document adult behavioural pattern since age 18 and rule out substance‑induced or neurocognitive causes.
3. Assess risk: violence, impulsive self‑harm, suicide risk, weapon access and victim vulnerability.
4. Evaluate comorbid psychiatric disorders and substance use; use collateral sources (family, criminal records) where possible.
5. Consider structured instruments: SCID‑II / SCID‑5‑PD, PCL‑R for forensic risk assessment if trained and appropriate.

Treatment principles

• ASPD is challenging to treat; focus on risk reduction, improving functioning, managing comorbidity and engagement rather than personality ‘cure’.
• Prioritise interventions that reduce harm: substance use treatment, anger management, vocational support, and social skill training.
• Psychosocial interventions with evidence: structured CBT adapted for offenders, mentalisation‑based approaches (MBT) for some overlapping traits, and schema‑focused strategies in longer‑term settings.
• Dialectical Behaviour Therapy (DBT) modules can help with emotion regulation and impulsivity when comorbid Borderline traits exist.
• Pharmacotherapy targets comorbid conditions (antidepressants for depression, mood stabilisers/antipsychotics for impulsive aggression) — there is no medication approved specifically for ASPD.

Risk management & forensic considerations

• Conduct thorough risk assessments and document management plans (behavioural contracts, supervision levels, contingency plans).
• Coordinate with probation, legal services, and community agencies to ensure monitoring and social supports.
• Where violence risk is high, consider multidisciplinary case review, specialist forensic services, and secure settings if necessary.

Engagement strategies

• Use brief, concrete goals and emphasise pragmatic benefits (employment, reduced legal trouble) to increase motivation.
• Set clear boundaries, consistent consequences and structured appointments; avoid punitive therapeutic styles that erode trust.
• Provide assertive outreach and integrate practical support (housing, job training) which improve treatment retention.

Key takeaways

• ASPD requires childhood conduct history and persistent adult pattern of antisocial behaviour; diagnosis should be made carefully with collateral.
• Treatment focuses on risk reduction, managing comorbidity, psychosocial rehabilitation and improving practical functioning.
• Close collaboration with legal and social services and clear risk management plans are essential.