Antisocial personality disorder (ASPD) is diagnosed based on meeting criteria described in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the book that mental health professionals use to assess patients.
In assessing a person for antisocial personality disorder, a mental health professional will do a full psychiatric examination. This means that the mental health professional will ask the person a series of questions about their symptoms and behavior. They will ask how severe the behaviors and symptoms are, how frequently they occur, and how long they have existed. They may also give the person questionnaires to fill out, to see whether the person meets the criteria for other mental, behavioral, personality, or developmental disorders, notes MedlinePlus.
No physical test, such as a blood test or imaging, can be used to diagnose antisocial personality disorder. Some researchers have used brain scans to find ways that the brains of people with a diagnosis of antisocial personality disorder differ, on average, from those of people without any mental or personality disorders, but there is presently no way to use a scan of a person’s brain to determine whether they have the condition.
A diagnosis of antisocial personality disorder may be included in a so-called “differential diagnosis,” in that it also requires a clinician to rule out other conditions that may show overlapping symptoms, including bipolar disorder, attention deficit hyperactivity disorder (ADHD), and schizophrenia-related disorders. Like many conditions, antisocial personality disorder occurs along a spectrum. It is not “present” or “absent,” but a person can have more or less severe symptoms.
The American Psychiatric Association, which publishes the DSM, does not use the word “sociopath” to describe people with antisocial personality disorder, although the traits associated with antisocial personality disorder overlap with the popular concept of what a sociopath is.
Is There an ASPD Test?
You may see online ASPD tests, which include a series of questions about your personality. These are based on DSM criteria that mental health professionals use to help diagnose ASPD. These tests, however, typically come with the caveat that they’re for “educational” purposes only. They’re not meant to take the place of a professional diagnosis.
Diagnosis Based on DSM-5 Criteria
The criteria for antisocial personality disorder most used today comes from the fifth edition of the DSM (DSM-5), which was published in 2013. It should be noted that some clinicians continue to use the fourth edition (published in 1994) in making ASPD diagnoses, but that edition is less nuanced, and for ASPD, it stipulated that there must be evidence of conduct disorder before age 15.
The DSM-5 defines a person with antisocial personality disorder as someone at least 18 years old who meets the criteria below:
1. Poor Individual and Interpersonal Functioning
The person must have problems with how they function as an individual and with how they interact with other people.
To show poor functioning as an individual, they may be egocentric and base their self-esteem on personal gain, power, or pleasure. Or they set goals based on how good it will make them feel without regard for the impact on others. They do not have an internal motivation to follow social rules, laws, or cultural ethics.
A person meets the criteria for poor interpersonal functioning by showing a lack of empathy or lack of intimacy with others. They demonstrate a lack of empathy by showing no concern for others’ feelings, needs, or suffering, and they lack remorse after hurting someone else.
Their intimacy deficit may also make them incapable of developing intimate relationships with others. Instead, they manipulate, exploit, or control others for personal gain by lying, intimidating others, and forcing others to do what they want.
2. Antagonism and Disinhibition
To meet the second criterion, a person must have two specific personality traits: antagonism and disinhibition.
They demonstrate antagonism by being manipulative, deceitful, callous, and hostile toward others. Their manipulativeness may involve using their charm or wit to seduce or control others to meet some goal for themselves.
Deceitfulness shows up in frequent lying to others or exaggeration about themselves. They may make things up when telling a supposedly true story, for example.
Callousness refers to showing no concern about others’ feelings or problems and not feeling guilt or remorse if their actions harm someone else. They may be aggressive or even sadistic, taking pleasure in other people’s pain.
Hostility refers to being frequently angry or irritable and seeking revenge for even minor insults or accidental harm from others.
A person with antisocial personality disorder demonstrates disinhibition through irresponsibility, impulsivity, and risk-taking. They may break promises or fail to meet financial, employment, personal, or social obligations, and they do not feel remorse for these actions.
They act spontaneously without thinking or caring about the possible consequences of their actions or without a plan to deal with those consequences.
They engage in dangerous activities that may harm themselves or others but without concern about the possible consequences. They may do so out of boredom, to prove that they are capable of doing something especially risky, or because they are in denial about their limitations.
In addition to the two criteria above, a person must meet all three of the following criteria to receive a diagnosis of antisocial personality disorder:
3. Consistent Behavior Across Time and Situations
Their problems with personal and interpersonal functioning described above have occurred throughout their life in all situations. Their problems do not go away for certain periods or in certain situations.
4. No Other Psychological, Social, or Cultural Explanation
Their personality problems and difficulties in interpersonal relationships are not otherwise explained by their stage of psychological development or by their social or cultural environment. If it would be normal for them to display these problems or characteristics based on their mental development or the social or cultural situation they live in, they would not meet this requirement.
5. Behavior Not Caused by Substance Abuse or Medical Disorder
Their problems are not a result of physical effects from drugs, alcohol, or another substance, and they are not a result of another medical condition, such as head trauma or another mental disorder.