1. Running head: ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 1
Antisocial Personality Disorder: a Meta-Analysis
Jonathan McCormick
Messiah College

2. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 2
Antisocial Personality Disorder: a Meta-Analysis
Antisocial Personality Disorder (ASPD) is a personality disorder related to a person's
behavior. ASPD is often directly related to psychopathy, and those with ASPD often demonstrate
behaviors such as "emotional shallowness and lack of guilt", and aggression which are parkers of
psychopathy (Blair, 2001). It is, however, important to note that psychopathy and ASPD are not
synonymous. Research suggests that roughly 9% of people in the U.S. have a personality
disorder as classified by the DSM-IV with roughly 0.6% of the total population having ASPD
(National Institute of Mental Health, 2007). ASPD is part of cluster B in the DSM-V and
previous versions, and is therefore similar in nature to disorders such as Borderline Personality
Disorder, but it is different in key ways.1
Key symptoms of ASPD include persistent exploitation of others through the use of lies
and/or manipulations, disregard for right vs. wrong—particularly as it pertains to the rights of
others—, impulsive actions, unnecessary risk-taking, disregard for own or others safety, and
failure to learn from punishment (Mayo Clinic Staff, 2013; Merrill, 2012; Psych Central Staff,
2014). People with ASPD may exibhit exceptional wit and charm, flattery and manipulations of
others, complete lack of empathy or remorse, inflated sense of self, and callousness and cynicism
towards others emotions (Merrill, 2012; Psych Central Staff, 2014). ASPD is found more in men
than it is found in women (Straussner & Nemenzik, 2007).
Brain Dysfunction
Research suggests that ASPD may be partially caused by a dysfunction in the brain.
People with damage to the prefrontal cortex seem to have an increased risk of developing
reactive aggression (Blair, 2001; Gregory, et al., 2012). Furthermore, the more threatened the
person with high reactive aggression feels in a given situation, the more likely they are to be
1 This paragraph was inspired by Poole, A. (2013).

3. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 3
aggressive, particularly if their hypothalamus and periaqueductal grey areas are not functioning
properly. Blair (2001) asserts that another possibility is that persons with psychopathy may have
a disruption to their violence inhibition mechanism which works to inhibit violence in certain
situations. The area of the brain this relates to is the amygdala.
A study by Gregory, et al. (2012) revealed that gray matter volumes in men with ASPD
and psychopathic traits was significantly less than in men without psychotic traits, and those
without ASPD entirely. The study states that gray matter volume in areas involved in
"…empathic processing, moral reasoning, and processing of prosocial emotion such as guilt and
embarrassment may contribute to the profound abnormalities of social behavior observed in
psychopathy" (Gregory, et al., 2012). Finally, Gregory, et al. (2012) reports that men with ASPD
with psychopathic traits have significantly less gray matter in several regions of the brain when
compared to men without psychopathic traits, and those without ASPD.
Conduct Disorder
Conduct Disorder is a childhood disorder that manifests itself in the behavior of the child
with relation to socially unacceptable behavioral and emotional problems (American Academy
of Child & Adolescent Psychiatry, 2013). These children are considered delinquent or "bad" by
others. They manifest aggressive tendencies towards people and animals, deliberate destruction
of other's property, dishonesty, and serious violations of rules or laws.
In order to be diagnosed with ASPD, a person must have been diagnosed with Conduct
Disorder (CD) prior to age 15 (American Psychiatric Association, 2000; Straussner & Nemenzik,
2007). CD is essentially the same diagnosis as ASPD, only for children. In order to be diagnosed
with CD, one must "…show at least three different forms of antisocial behavior for at least 6
months…" (Blair, 2001), as well as be under the age of 15. Furthermore, Conduct Disorder in

4. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 4
children can often be a predictor of ASPD in adulthood (Lahey, Loeber, Burke, & Applegate,
2005). It was found that 82% of adults with sociopathy had been previously diagnosed with CD.
Aggression and Criminality
Aggression
One of the more well-known traits of ASPD is aggressive behavior. The two major kinds
of aggression are proactive aggression and reactive aggression (Ross & Babcock, 2009;
Lobbestael, Cima, & Arntz, 2013). Proactive aggression is motivated by a need for control, and
reactive aggression is motivated by emotion.
Reactive aggression is impulsive and unplanned (Ross & Babcock, 2009). It is enacted in
a moment of high arousal and intense anger. People with ASPD who engage in reactive
aggression are usually reacting to a perceived insult or threat. This type of aggression is
congruent with the impulsive actions and disregard for the safety of others symptoms of ASPD.
Furthermore, it shows the person's lack of empathy and inflated sense of self.
In contrast, proactive aggression tends to be planned, committed without provocation,
and without anger (Ross & Babcock, 2009; Lobbestael, Cima, & Arntz, 2013). In this case the
violence is a means to an end, which is congruent with these people's manipulation of others to
serve their own purpose, their lack of remorse and empathy, and their callousness towards others
emotions. Often, in marriages or partnerships the violence is used as a way for the person with
ASPD to control their partner and resolve conflicts.
Oftentimes both of these types of aggression can be found in the same person (Ross &
Babcock, 2009; Lobbestael, Cima, & Arntz, 2013). While reactive aggression will often be found
without proactive aggression, it is rarer that proactive aggression be found in someone with no
history of reactive aggression. This suggests that aggression is better represented by a two-factor

5. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 5
model (both proactive and reactive aggression) rather than by a single-factor (one or the other,
but not both). Furthermore, callous and unemotional traits have been linked with severe
aggression in a study done by Stickle and Kirkpatrick (2009).
Criminality
Due to the necessity of violating other's rights for the diagnosis of ASPD, it is
intrinsically linked with criminal behavior. According to a study by Black, Gunter, Loveless,
Allen, and Sieleni (2010) roughly 35% of newly incarcerated offenders meet criteria for ASPD.
Research suggests that people with ASPD who are released from incarceration will offend again
(Howard, McArthy, Husband, & Duggan, 2013). In the study by Howard et al. (2013) it was
found that about 53% of released patients were re-convicted within 5 years. However, research
also shows that person's with ASPD who have high intelligence tend to commit less criminal acts
compared to those with lower intelligence scores (Wall, Sellbom, & Goodwin, 2013).
Related Disorders
Apart from Conduct Disorder, Borderline Personality Disorder (BPD) is the disorder in
the DSM-V most closely associated with ASPD. It is characterized by "unstable moods, behavior,
and relationships" (National Institute of Mental Health, 2014). Common symptoms include
extreme reactions to real or perceived abandonment, intense relationships, distorted and unstable
sense of self, impulsive behaviors, intense and unpredictable moods, intense and inappropriate
anger, and chronic feelings of emptiness. These people will often have symptoms triggered over
seemingly ordinary things—such as a friend canceling plans due to unforeseen circumstances.
BPD is more common in women than it is in men (Straussner & Nemenzik, 2007).
The symptom that BPD and ASPD have most in common is impulsive behavior. Both
disorders are marked by impulsivity and dangerous behaviors. However, there are factors that

6. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 6
differentiate the two. A study by Kurtz and DeShong (2013) found that BPD uniquely contained
negative urgency and lack of perseverance, while ASPD uniquely contained sensation seeking
and lack of premeditation.
Comorbidity
ASPD is often comorbid with Borderline Personality Disorder, and with substance use
disorders (DeShong & Kurtz, 2013; Howard, McArthy, Husband, & Duggan, 2013; Straussner &
Nemenzik, 2007). DeShong and Kurtz (2013) state that ASPD and BPD comorbidity is a
problem that complicates diagnosis. They also state that the two are "highly comorbid", and that
this might be partially due to the shared impulsivity criterion (DeShong & Kurtz, 2013).
Straussner and Nemenzik (2007) state that personality disorders and substance use
disorders are "…among the most commonly co-occuring mental health diagnoses" (p. 6). They
further state that those personality disorders in cluster B—which containes BPD and ASPD—are
the most commonly comorbid with substance use disorders. They found that roughly 24 – 43%
of opiod users also have ASPD.
This comorbidity is even more likely in prisons. Furthermore, Howard et al. (2013)
discovered that prediction of criminal recidivism was impacted heavily with ASPD/BPD
comorbid with Conduct Disorder and drug and alcohol abuse. They found that criminals with
ASPD or BPD were likely to reoffend faster if they had some form of comorbidity with
substance abuse.
Conclusion
Antisocial Personality Disorder (ASPD) is a personality disorder in cluster B of the
DSM-V that is characterized primarily by criminal disregard for the rights of others,
manipulation of others for personal gain, impulsive and dangerous behavior, lack of empathy or

7. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 7
remorse, and callousness towards other's emotions. There is some research that suggests a
possible cause for ASPD in some cases may be a dysfunction in the brain, particularly due to
damage in the preftrontal cortex. Conduct disorder (CD) is a childhood form of ASPD, and is a
prerequisit disorder for ASPD. Many people with ASPD exhibit aggressive behavior in the form
of reactive aggression, proactive aggression, or both. Due to criminal disregard for other's rights
being a requirement of ASPD many people with this disorder are convicted criminals. ASPD is
closely related to Borderline Personality Disorder (BPD) in that both show signs of impulsivity,
but they differ in the way the impulsive behaviors manifest themselves. Finally, ASPD is often
comorbid with BPD and substance use or abuse disorders, and this impacts how fast they will
reoffend after being released from incarceration.

8. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 8
References
American Academy of Child & Adolescent Psychiatry. (2013, August). Conduct Disorder.
Retrieved from American Academy of Child & Adolescent Psychiatry.
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental
Disorders, Fourth Edition, Text Revision.
Black, D. W., Gunter, T., Loveless, P., Allen, J., & Sieleni, B. (2010). Antisocial Personality
Disorder in Incarcerated Offenders: Psychiatric Comorbidity and Quality of Life. Annals
of Clinical Psychiatry, 113-120.
Blair, J. (2001). Neurocognitive Models of Aggression, the Antisocial Personality Disorders, and
Psychopathy. Journal of Neurology, Neurosurgery & Psychiatry, 727-731.
DeShong, H. L., & Kurtz, J. E. (2013). Four Factors of Impulsivity Differentiate Antsocial and
Borderline Personality Disorders. Journal of Personality Disorders, 144-156.
Gregory, P. S., Ffytche, MD, MRCPsych, D., Simmons, PhD, S., Kumari, PhD, V., Howard,
PhD, M., Hodgins, PhD, S., & Blackwood, MA, MD, MRCPsych, N. (2012). The
Antisocial Brain: Psychopathy Matters A Srtuctural MRI Investigation of Antisocial
Male Violent Offenders. JAMA Psychiatry.
Howard, R., McArthy, L., Husband, N., & Duggan, C. (2013). Re-offending in Forensic Patients
Released from Secure Care: The Role of Antisocial/Borderline Personality Disorder Co-
morbidity, Substance Dependence and Severe Childhood Conduct Disorder. Criminal
Behavior and Mental Health, 191-202.
Lahey, B. B., Loeber, R., Burke, J. D., & Applegate, B. (2005). Predicting Future Antisocial
Personality Disorder in Males From a Clinical Assessment in Childhood. Journal of
Consulting and Clinical Psychology, 389-399.

9. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 9
Lobbestael, J., Cima, M., & Arntz, A. (2013). The Relationship Between Adult Reactive and
Proactive Aggression, Hostile Interpretation Bias, and Antisocial Personality Disorder.
Journal of Personality Disorders, 53-66.
Mayo Clinic Staff. (2013, April 12). Antisocial Personality Disorder. Retrieved from Mayo
Clinic.
Merrill, M. D. (2012, November 10). Antisocial Personality Disorder. Retrieved from
MedlinePlus.
National Institute of Mental Health. (2007, October 18). National Survey Tracks Prevalence of
Personality Disorders in U.S. Population. Retrieved from National Institute of Mental
Health.
National Institute of Mental Health. (2014). Borderline Personality Disorder. Retrieved from
National Institute of Mental Health.
Psych Central Staff. (2014, May 4). Antisocial Personality Disorder Symptoms. Retrieved from
PsychCentral.
Ross, J. M., & Babcock, J. C. (2009). Proactive and Reactive Violence Among Intimate Partner
Violent Men Diagnosed with Antisocial and Borderline Personality Disorder. Journal of
Family Violence, 607-617.
Steadham, J. A., & Rogers, R. (2013). Predictors of Reactive and Instrumental Aggression in Jail
Detainees: An Initial Examination. Journal of Forensic Psychology Practice, 411-428.
Stickle, T. R., & Kirkpatrick, N. M. (2009). Callous-Unemotional Traits and Social Information
Processing: Multiple Risk-Factor Models for Understanding Aggressive Behavior in
Antisocial Youth. Law & Human Behavior, 515-529.

10. ANTISOCIAL PERSONALITY DISORDER: A META-ANALYSIS 10
Straussner, S. L., & Nemenzik, J. M. (2007). Co-Occuring Substance Use and Personality
Disorders: Current Thinking on Etiology, Diagnosis, and Treatment. Journal of Social
Work Practice in the Addictions, 5-23.
Wall, T. D., Sellbom, M., & Goodwin, B. E. (2013). Examination of Intelligence as a
Compensatory Factor in Non-Criminal Psychopathy in a Non-Incarcerated Sample.
Journal of Psychopathology & Behavioral Assessment, 450-459.