Most human beings live in accordance with a moral compass, a sense of right and wrong. Most individuals learn at a very young age that there are certain things that should not be done. We learn that we should not lie or cheat. We are taught that it is wrong to take things that do not belong to us, and that it is wrong to exploit others for personal gain. We also learn the importance of living up to our responsibilities, of doing what we say we will do. People with antisocial personality disorder, however, do not seem to have a moral compass. These individuals act as though they neither have a sense of nor care about right or wrong. Not surprisingly, these people represent a serious problem for others and for society in general. According to the DSM-5, the individual with antisocial personality disorder shows no regard at all for other people’s rights or feelings. This lack of regard is exhibited a number of ways and can include repeatedly performing illegal acts, lying to or conning others, impulsivity and recklessness, irritability and aggressiveness toward others, and failure to act in a responsible way (e.g., leaving debts unpaid) (APA, 2013). People with this disorder have no remorse over their misdeeds; these people will hurt, manipulate, exploit, and abuse others and not feel any guilt. Signs of this disorder can emerge early in life; however, a person must be at least 18 years old to be diagnosed with antisocial personality disorder. People with antisocial personality disorder seem to view the world as self-serving and unkind. They seem to think that they should use whatever means necessary to get by in life. They tend to view others not as living, thinking, feeling beings, but rather as pawns to be used or abused for a specific purpose. They often have an over-inflated sense of themselves and can appear extremely arrogant. They frequently display superficial charm; for example, without really meaning it they might say exactly what they think another person wants to hear. They lack empathy: they are incapable of understanding the emotional point-of-view of others. People with this disorder may become involved in illegal enterprises, show cruelty toward others, leave their jobs with no plans to obtain another job, have multiple sexual partners, repeatedly get into fights with others, and show reckless disregard for themselves and others (e.g., repeated arrests for driving while intoxicated) (APA, 2013). The DSM-5 has included an alternative model for conceptualizing personality disorders based on the traits identified in the Five Factor Model of personality. This model addresses the level of personality functioning such as impairments in self (identity or self-direction) and interpersonal (empathy or intimacy) functioning. In the case of antisocial personality disorder, the DSM-5 identifies the predominant traits of antagonism (such as disregard for others’ needs, manipulative or deceitful behavior) and disinhibition (characterized by impulsivity, irresponsibility, and risk-taking) (Harwood, Schade, Krueger, Wright, & Markon, 2012). A psychopathology specifier is also included that emphasizes traits such as attention seeking and low anxiousness (lack of concern about negative consequences for risky or harmful behavior) (Crego & Widiger, 2014). Risk Factors for Antisocial Personality Disorder Antisocial personality disorder is observed in about 3.6% of the population; the disorder is much more common among men, with a 3 to 1 ratio of men to women, and it is more likely to occur in men who are younger, widowed, separated, divorced, of lower socioeconomic status, who live in urban areas, and who live in the western United States (Compton, Conway, Stinson, Colliver, & Grant, 2005). Compared to men with antisocial personality disorder, women with the disorder are more likely to have experienced emotional neglect and sexual abuse during childhood, and they are more likely to have had parents who abused substances and who engaged in antisocial behaviors themselves (Alegria et al., 2013). Table 15.3 shows some of the differences in the specific types of antisocial behaviors that men and women with antisocial personality disorder exhibit (Alegria et al., 2013). Men with antisocial personality disorder are more likely than women with antisocial personality disorder to Women with antisocial personality disorder are more likely than men with antisocial personality to do things that could easily hurt themselves or others receive three or more traffic tickets for reckless driving have their driver’s license suspended destroy others’ property start a fire on purpose make money illegally do anything that could lead to arrest hit someone hard enough to injure them hurt an animal on purpose run away from home overnight frequently miss school or work lie frequently forge someone’s signature get into a fight that comes to blows with an intimate partner live with others besides the family for at least one month harass, threaten, or blackmail someone Table 15.3 Gender Differences in Antisocial Personality Disorder Family, twin, and adoption studies suggest that both genetic and environmental factors influence the development of antisocial personality disorder, as well as general antisocial behavior (criminality, violence, aggressiveness) (Baker, Bezdjian, & Raine, 2006). Personality and temperament dimensions that are related to this disorder, including fearlessness, impulsive antisociality, and callousness, have a substantial genetic influence (Livesley & Jang, 2008). Adoption studies clearly demonstrate that the development of antisocial behavior is determined by the interaction of genetic factors and adverse environmental circumstances (Rhee & Waldman, 2002). For example, one investigation found that adoptees of biological parents with antisocial personality disorder were more likely to exhibit adolescent and adult antisocial behaviors if they were raised in adverse adoptive family environments (e.g., adoptive parents had marital problems, were divorced, used drugs, and had legal problems) than if they were raised in a more normal adoptive environment (Cadoret, Yates, Ed, Woodworth, & Stewart, 1995). Researchers who are interested in the importance of environment in the development of antisocial personality disorder have directed their attention to such factors as the community, the structure and functioning of the family, and peer groups. Each of these factors influences the likelihood of antisocial behavior. One longitudinal investigation of more than 800 Seattle-area youth measured risk factors for violence at 10, 14, 16, and 18 years of age (Herrenkohl et al., 2000). The risk factors examined included those involving the family, peers, and community. A portion of the findings from this study are provided in Figure 15.20. Figure 15.20 Longitudinal studies have helped to identify risk factors for predicting violent behavior. Those with antisocial tendencies do not seem to experience emotions the way most other people do. These individuals fail to show fear in response to environment cues that signal punishment, pain, or noxious stimulation. For instance, they show less skin conductance (sweatiness on hands) in anticipation of electric shock than do people without antisocial tendencies (Hare, 1965). Skin conductance is controlled by the sympathetic nervous system and is used to assess autonomic nervous system functioning. When the sympathetic nervous system is active, people become aroused and anxious, and sweat gland activity increases. Thus, increased sweat gland activity, as assessed through skin conductance, is taken as a sign of arousal or anxiety. For those with antisocial personality disorder, a lack of skin conductance may indicate the presence of characteristics such as emotional deficits and impulsivity that underlie the propensity for antisocial behavior and negative social relationships (Fung et al., 2005). Another example showing that those with antisocial personality disorder fail to respond to environmental cues comes from a recent study by Stuppy-Sullivan and Baskin-Sommers (2019). The researchers studied cognitive and reward factors associated with antisocial personality disorder dysfunction in 119 incarcerated males. Each subject was administered three tasks targeting different aspects of cognition and reward. High-magnitude rewards tended to impair perception in those with antisocial personality disorder, worsened executive function when they were consciously aware of the high rewards, and worsened inhibition when the tasks placed high demand on working memory.