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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 to help determine a diagnosis. These evaluations generally include:
- Physical exam. This is done to help rule out other problems that could be causing symptoms and to check for any related complications.
- Lab tests. These may include, for example, a complete blood count (CBC), a thyroid function check, and screening for alcohol and drugs to determine if there are other causes for symptoms.
- Psychological evaluation. A doctor or mental health provider explores thoughts, feelings, relationships, behavior patterns and family history, which may include psychological tests about personality. 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. The doctor also asks about thoughts of suicide, self-injury or harming others.
A person with antisocial personality disorder is unlikely to provide an accurate account of his or her signs and symptoms. Family and friends may be able to provide helpful information.
Pinpointing the type of personality disorder
It's sometimes difficult to determine if symptoms point to antisocial personality disorder or another personality disorder because some symptoms overlap more than one disorder. A key factor in diagnosis is how the affected person relates to others. Someone with antisocial personality disorder is likely to have an accurate — sometimes superior — understanding of others' thinking with little awareness or regard for their feelings. This leads the person to act out and make other people miserable — with no feeling of remorse.
Diagnostic criteria
To be diagnosed with antisocial personality disorder, a person must meet the symptom criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM). This manual, published by the American Psychiatric Association, 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 self or others
- Acting impulsively and not planning ahead
- Being irresponsible and repeatedly failing to honor work or financial obligations
- 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 March 1, 2013.
- Paris J, et al. Antisocial and borderline personality disorders revisited. Comprehensive Psychiatry. In press. Accessed March 1, 2013.
- Black DW. Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis. http://www.uptodate.com/home. Accessed March 1, 2013.
- Black DW. Treatment of antisocial personality disorder. http://www.uptodate.com/home. Accessed March 1, 2013.
- Shi Z, et al. Childhood maltreatment and prospectively observed quality of early care as predictors of antisocial personality disorder features. Infant Mental Health Journal. 2012;33:55.
- Kendall T, et al. Borderline and antisocial personality disorders: Summary of NICE guidance. British Medical Journal. 2009;338:293.
- Alarcon RD (expert opinion). Mayo Clinic, Rochester, Minn. March 21, 1013.
- Palmer BA (expert opinion). Mayo Clinic, Rochester, Minn. April 1, 2013.
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