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Tests and diagnosis
By Mayo Clinic staffWhen doctors believe someone has antisocial personality disorder, they typically run a series of medical and psychological tests and exams. These can help rule out other problems that could be causing symptoms, pinpoint a diagnosis and also check for any related complications. These exams and tests generally include:
- Physical exam. This may include measuring height and weight; checking vital signs, such as heart rate, blood pressure and temperature; listening to the heart and lungs; and examining the abdomen.
- Laboratory tests. These may include a complete blood count (CBC), screening for alcohol and drugs, and a thyroid function check.
- Psychological evaluation. A doctor or mental health provider asks about thoughts, feelings, relationships and behavior patterns. He or she asks about symptoms, including when they started, how severe they are, how they affect daily life and whether similar episodes have occurred in the past. They will also ask about thoughts of suicide, self-injury or harming others.
Pinpointing the type of personality disorder
It sometimes can be difficult to determine if symptoms point to antisocial personality disorder or another personality disorder, since some symptoms overlap more than one disorder. A key factor in diagnosing antisocial personality disorder is how the affected person relates to others. Someone with this condition is likely to act out and make other people miserable — while they, themselves, feel no remorse.
Diagnostic criteria
To be diagnosed with antisocial personality disorder, a person must meet the symptom criteria for that disorder listed in the "Diagnostic and Statistical Manual of Mental Disorders" (DSM). This manual is published by the American Psychiatric Association and is used by mental health providers to diagnose mental illnesses and by insurance companies to reimburse for treatment.
Symptom criteria required for a diagnosis of antisocial personality disorder include:
- Being at least 18 years old
- Having had symptoms of conduct disorder before age 15, which may include such acts as stealing, vandalism, violence, cruelty to animals and bullying
- Repeatedly breaking the law
- Repeatedly conning or lying to others
- Being irritable and aggressive, repeatedly engaging in physical fights or assaults
- Feeling no remorse — or justifying behavior — after harming others
- Having no regard for the safety of yourself or others
- Acting impulsively and not planning ahead
A person with antisocial personality disorder is unlikely to provide an accurate account of these signs and symptoms. Instead, a doctor will gather evidence for the diagnosis by asking detailed questions about the affected person's interactions and daily life.
- Antisocial Personality Disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. 4th ed. Arlington, Va.: American Psychiatric Association; 2000. http://www.psychiatryonline.com. Accessed July 13, 2010.
- Antisocial Personality Disorder. In: Hales RE, et al., eds. The American Psychiatric Publishing Textbook of Psychiatry. 5th ed. Arlington, Va.: American Psychiatric Association; 2008. http://www.psychiatryonline.com. Accessed July 13, 2010.
- Blais MA, et al. Personality and personality disorders. In: Stern TA, et al. Massachusetts General Hospital Comprehensive Clinical Psychiatry. Philadelphia, Pa.: Mosby; 2008. http://www.mdconsult.com/das/book/body/208922830-3/1022719999/1657/387.html#4-u1.0-B978-0-323-04743-2..50041-X--cesec11_990. Accessed July 13, 2010.
- Silk KR. Personality disorders. http://www.uptodate.com/home/index.html. Accessed July 13, 2010.
- Cohen P. Child development and personality disorder. Psychiatric Clinics of North America. 2008;31:477.
- Staying well when you have a mental health condition. Mental Health America. http://www.nmha.org/go/mental-health-month/staying-well-when-you-have-a-mental-illness. Accessed July 13, 2010.
- Koegl CJ, et al. Clinician perceptions of childhood risk factors for future antisocial behavior. Journal of Clinical Child & Adolescent Psychology. 2009;38:564.
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. July 26, 2010.
- Bostwick MJ (expert opinion). Mayo Clinic, Rochester, Minn. Aug. 21, 2010.
- Kendall T, et al. Borderline and antisocial personality disorders: Summary of NICE guidance. British Medical Journal. 2009;338:293.
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