While popular culture often refers to people with antisocial personality disorder as “sociopaths,” mental health professionals do not use that term in diagnosing or discussing the disorder. Research has shown an increased risk for several mental health conditions in people with antisocial personality disorder. According to a 2017 study, these conditions include:
AnxietyBipolar disorderPost-traumatic stress disorderAttention deficit hyperactivity disorderBorderline personality disorderSchizotypal personality disorder (1)
Fortunately, most of these conditions can be treated with medication or cognitive behavioral therapy. Still, the individual must be willing to seek and receive treatment for their conditions, and people with ASPD are less likely to seek treatment than people with other disorders.
Depression and ASPD
There is also an association between ASPD and depression. (1) Depression can be treated with therapy and medication like selective serotonin reuptake inhibitors (SSRIs). Research suggests that SSRIs may decrease symptoms of aggression and impulsivity in people with ASPD. (2)
Smoking, Drugs, and Alcohol
People with antisocial personality disorder are much more likely to smoke, use illegal drugs, and become dependent on alcohol than people without a personality disorder. In one study, more than one-half of people with antisocial personality disorder were smokers, compared with only 12 percent of the general population. More than one-half also had a drug use disorder, compared with less than 5 percent of the general population. (3)
ASPD and Physical Health
The reason people with antisocial personality disorder have a higher risk of physical health problems is not entirely understood. At least some of those problems likely relate to taking bigger risks in their behavior and making choices with less regard for their personal safety. (4) Some could also be due to coexisting mental health problems. Depression, for example, is a risk factor for coronary artery disease. According to a very large, long-term U.S. study, people with antisocial personality disorder have a higher risk of the following physical conditions:
Five times greater risk of coronary artery diseaseThree times greater risk of liver diseaseFive times greater risk of gastrointestinal diseaseTwice the risk of arthritis in men, and 1.4 times greater risk for arthritis in womenSix times more likely to be hospitalizedNearly twice as likely to be hospitalized for at least three daysTwice as likely to visit the emergency department at least two times in a yearTwice as likely to have at least two injuries during the past year (4)
In addition, a higher percentage of people with antisocial personality disorder rely on government disability income or government food assistance programs than people with no personality disorder. (4) A long-term study found that people with antisocial personality disorder are less likely to seek, talk to, or feel close to relatives outside their immediate family, and less likely to have close friends compared with people with no antisocial symptoms. (3) People with antisocial personality disorder also have a higher risk of early death than the average person. One study of 500 people found that they had a highly increased mortality rate, about 8.5 times that of people with other psychiatric conditions over a follow-up period of seven years. (5) Other research has found that the causes of this high risk of early death include suicide, drug use, and reckless behavior, such as getting into fights. In one study, caregivers of people with antisocial personality disorder experienced more grief and a greater burden of care than caregivers for people with other mental illnesses. (6) These caregivers reported symptoms of depression, anxiety, and post-traumatic stress disorder and experienced a decline in their well-being. Caregivers of people with antisocial personality disorder should consider seeking support and possibly treatment for any symptoms they experience. If you or someone you know has talked about suicidal thoughts or shows symptoms of suicidal behavior, you may want to contact one of the following suicide hotlines:
The National Suicide Lifeline: 988The Crisis Text Line (text messaging): Text HOME to 741741The National Suicide Prevention Lifeline for people who are deaf or hard of hearing: For TTY users, dial 711 then 988The National Suicide Prevention Lifeline en Español: 888-628-9454The Trevor Project: For LGBTQ youth and young adults at risk of suicide; 866-488-7386Trans Lifeline: A transgender suicide hotline staffed only by transgender people; 877-565-8860 in the United States and 877-330-6366 in Canada
Studies on prison populations in specific countries or states have found varying numbers, but the percentages are always high. A study of prisoners in the United Kingdom, for example, found that 6 out of 10 male prisoners and 3 in 10 female prisoners have antisocial personality disorder. (5) A study of newly incarcerated prisoners in Iowa found that slightly over 35 percent of both male and female inmates have antisocial personality disorder. (8) It is difficult to calculate the monetary cost of antisocial personality disorder to society, but experts agree it is substantial. (5) The financial burden contributes to the costs of law enforcement, security, prisons, and the criminal justice system in general. Healthcare costs include those associated with the health of the individuals with antisocial personality disorder themselves, as well as the cost of treating the mental and physical health of victims of their crimes.
title: “Complications And Life Consequences Of Antisocial Personality Disorder” ShowToc: true date: “2022-12-25” author: “Michelle Clark”
According to the National Institute of Mental Health, diagnosing BPD generally involves a mental health professional interviewing the patient to talk through the symptoms he or she is experiencing, as well as reviewing family medical histories. (1) Marra Ackerman, MD, a clinical associate professor of psychiatry at NYU Langone Health in New York City, says symptoms of BPD can include interpersonal difficulties, intense and inappropriate anger, suicidal ideation, and fear of abandonment.
Difficulties Diagnosing Borderline Personality Disorder
Despite this list of specific symptoms, BPD can be tough to diagnose, just like other personality disorders, says David Ryan Hooper, PhD, a clinical psychologist in private practice and an assistant clinical professor of psychology at the University of Illinois at Chicago. He says that’s partly due to a lack of understanding. Personality disorders just aren’t talked about often, and they can be confusing to some people, which leaves many people suffering from BPD without ever realizing they have it. Other times, a patient exhibiting the symptoms tied to BPD might be embarrassed to admit there’s something going on. “This is an illness that’s really been stigmatized because it’s a personality disorder,” Dr. Ackerman says. One problem is in the name. “When you call it a personality disorder, it makes people assume it’s not biologically driven,” Ackerman continues. On the contrary: Ackerman says there are biological underpinnings. Genetics, brain structure, and a history of traumatic events all play a role in putting someone at risk of BPD. (1) Finally, BPD is often misdiagnosed, usually as bipolar disorder since there’s some overlap of symptoms — primarily unstable moods, according to a 2010 study. (3) Dr. Hooper says it can take as many as five interactions with the mental health system before BPD is identified as the root of the problem. He estimates that about three-quarters of the BPD patients he’s worked with have taken medication. Normally, medication is used to treat a co-occurring disorder. For instance, an antidepressant might be prescribed to treat the depression that can go along with BPD. (4) Psychotherapy, which is the first-line treatment for BPD, can help address the other symptoms. Over the past 10 years, dialectical behavior therapy (DBT), a cognitive behavioral treatment developed by Marsha Linehan, PhD, has become the gold standard in treating BPD, Hooper says. (5) But it won’t necessarily be easy. DBT can involve up to a year or more of intense therapy, which usually includes 2.5 hours of group therapy each week plus one-on-one therapy sessions, as well as case management if needed. This type of therapy is primarily skills-based. Those in treatment will learn how to handle different situations that come up by practicing mindfulness, tolerating distress, regulating emotions, and engaging with others effectively. (5) If DBT isn’t successful for you, know that you have other psychotherapy options available. Other people may do well with good psychiatric management, while some may see success in transference-focused psychotherapy or mentalization-based therapy. (6)
Relationship Troubles
People with BPD have a black-and-white view of the world: Things (and people) are either good or bad, and how someone with BPD is feeling can change almost instantly. (1) Relationships in particular can be problematic. Hooper says people with BPD commonly have a love-hate approach to others. One day, a person with BPD might view their partner, friend, or family member as the best person in the world. The next day, he or she might do a 180 and decide that that “best person in the world” is now the worst. Some of this can be traced back to the fact that people with BPD tend to fear abandonment. For instance, they might cut off communication with a loved one if they feel they’re at risk of being left behind. (1) This, of course, can lead to lots of interpersonal conflict and chronic difficulties with relationships, Ackerman says. Hence relationship turmoil, divorce, and trouble maintaining positive relationships with family and friends can be common among people suffering from BPD. (2)
Job Loss
These interpersonal conflicts can also affect someone’s ability to maintain a steady job, especially if they take that love-hate approach with their boss or coworkers. (2) “Their life is in disarray,” Hooper says. The symptoms of BPD can be severe and debilitating, to the point where being unable to regulate emotions can “almost certainly wreck their life,” Hooper says. “What you begin to see is a life described as instability.” But that doesn’t mean everyone with BPD will fall into this camp. “There are some people with BPD who function quite well,” Ackerman says. “I wouldn’t say the diagnosis alone means someone might not be able to hold a job or get married if they wanted to.” (For example, Dr. Linehan, mentioned above for her pioneering work in treatment of BPD, has acknowledged having BPD herself.) But should the relationship problems be severe, job loss could be the ultimate result.
Hospitalizations Due to Self-Harm
Many people with BPD harm themselves, such as by cutting, to try to deal with their overwhelming feelings. (1) Some may even attempt to take their own lives. Suicide attempts are so common among people with BPD that they are considered a symptom of the disorder. Up to 10 percent of the people who qualify for having BPD die by suicide, which is 50 times the rate of the population as a whole. (7) Generally, this self-destructive behavior starts up when a person’s mood is down. “That’s where the self-mutilation comes in, the really impulsive behavior comes in,” Hooper says. Suicidal thoughts that become overwhelming may lead a person with BPD to seek help through hospitalization or by entering an inpatient treatment center, according to a study. (8) Often, this kind of behavior serves as a wake-up call for the person suffering. “For a lot of clients, the suicide attempt scares them, and it wakes them up to how threatening this is to their life,” Hooper says. As a result of engaging in these dangerous activities, the person with BPD will have to face the health and physical repercussions, Ackerman says. For instance, binge eating can lead to serious health issues, such as heart disease and blood sugar spikes, while sexually transmitted diseases or unplanned pregnancies can result from engaging in unsafe sex. (1)
A General Feeling of Unsteadiness
Hooper says living with BPD without treatment is like trying to walk on ice. “That’s how a person with BPD feels almost at all times, like they can just never get their footing,” he says. For instance, people with BPD can be preoccupied with the fear of abandonment (whether real or imagined) mentioned earlier. They may also have a skewed view of reality and feel like they’re cut off from themselves and viewing their body from the outside. (1)
Other Illnesses
According to the National Institute of Mental Health, people with BPD who decline treatment are at risk of other medical issues and psychiatric diagnoses. (1) About 10 percent of people with BPD, for example, also have bipolar 1 disorder, and another 10 percent have bipolar 2 disorder, according to a 2013 study. (9) It may seem strange that having one condition means you’ll likely have another, but this is common across personality disorders. People with personality disorders are at an increased risk of having other anxiety, mood, and impulse control disorders, as well as issues with substance abuse. Still, Ackerman says it’s entirely possible for a person to have BPD as their primary diagnosis. There’s also a chance that BPD symptoms will improve with time. “Research shows that almost all mental health gets better,” Hooper says. In fact, according to a 2011 study, 85 percent of the study’s 175 BPD patients were able to enter remission by the 10-year mark. Only about 11 percent of the study participants relapsed, though some of the social functioning issues remained. (10) Why might this happen? “Emotional dysregulation just changes with time,” Hooper says. “As you get older — into your thirties, forties, fifties — hormones change, and some of that dysregulation sort of subsides.”
