Understanding Antisocial Behaviour and Psychopathy

Written by Patricia Lockwood, Ph.D., and Ruth Pauli, Ph.D., with edits from Jo Cutler, Ph.D.

Antisocial behaviours include rule-breaking or criminal behaviour, lying, stealing, destruction of property, and aggression toward others. They are highly prevalent around the world and lead to significant personal, social, and economic costs.

Research estimates that around 10 percent of children and 2-3 percent of adults would qualify for diagnosis with an antisocial behaviour disorder. When considered globally, this affects millions of people. However, antisocial behaviour disorders have always been viewed as controversial diagnoses both clinically and in society.

Unlike other clinical disorders, such as anxiety and depression, it is less widely accepted that antisocial behaviour is a "real" mental disorder rather than an extreme personality. So, what is antisocial behaviour, how does it relate to psychopathy, and is it really a disorder?

Antisocial behaviours include aggression, lying, stealing, and destroying property

Source: engin akyurt/Unsplash

Different Types of Antisocial Behaviour Disorder

The most common and classically antisocial disorder in childhood is known as conduct disorder. The diagnostic criteria for conduct disorder include all the antisocial behaviours already mentioned, as well as age-sensitive criteria such as truanting from school. Not all these behaviours have to be present, but a qualifying number of them do to receive a diagnosis.

Recently, a "limited prosocial emotions" subtype of conduct disorder was recognised. This was added following decades of research showing that children and adolescents who displayed what was termed in research studies as "callous-unemotional traits" had a particularly problematic type of conduct disorder.

Limited prosocial emotions include traits we might recognise in adults with psychopathy, such as a lack of empathy, lack of remorse, and lack of concern about performance in important life activities. Conduct disorder with limited prosocial emotions is associated with different risk factors, poorer treatment outcomes, and a greater risk for continued antisocial behaviour and psychopathy in adulthood.

In addition to conduct disorder, other childhood disorders, such as oppositional defiant disorder, also contain some antisocial symptoms that overlap with conduct disorder. The criteria for oppositional defiant disorder include spiteful and vindictive behaviour, defiance, irritability and anger, and refusal to take responsibility for mistakes or misbehaviour.

Finally, when severe and persistent antisocial behaviour persists into adulthood, antisocial personality disorder might be diagnosed. The clinical criteria for antisocial personality disorder include criminal behaviour, lying and manipulation, aggression, impulsive behaviour, irresponsibility, and remorselessness.

Although antisocial personality disorder is only diagnosed in adults, the symptoms must have been shown before the age of 15 years to qualify for a diagnosis. Evidently, the diagnostic criteria overlap heavily with conduct disorder, but there are also notable differences, such as impulsivity only being part of antisocial personality disorder and not conduct disorder.

Controversies in the Definition and Diagnosis of Antisocial Behaviour Symptoms and Disorders

As mentioned above, there has been considerable controversy in the definition and study of antisocial behaviour within psychiatry. Conduct disorder is a leading cause of referrals for child and adolescent mental health services. Yet paradoxically, it is one of the least widely recognized or studied psychiatric disorders, and funding for research lags far behind many other childhood disorders.

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There are many portrayals in the popular media of children with a lack of empathy and guilt. These include the award-winning film and book We Need to Talk About Kevin, in which the callous and manipulative title character goes on a killing rampage at his high school. However, labeling a child as having limited prosocial emotions may seem extreme and even condemning, particularly when personalities are still developing.

Interestingly, one study showed that having the diagnosis of conduct disorder with limited prosocial emotions, compared to conduct disorder without limited prosocial emotions, did not increase negative perceptions of individuals with conduct disorder by a jury. In fact, those diagnosed with the limited prosocial emotions subtype were recommended less restrictive sentences in juvenile court proceedings in the U.S.

In adulthood, by contrast, there are no clinically accepted criteria for psychopathic traits or limited prosocial emotions according to the DSM-5, the diagnostic manual of mental disorders. Historically, psychopathy was often considered synonymous with antisocial personality disorder, but this conflation is no longer considered appropriate because the criteria for an antisocial personality disorder are too behaviourally focused to capture the specific emotional deficits seen in psychopathy. Currently, lack of remorse is the only criterion for antisocial personality disorder that captures any element of psychopathy.

A Computational Psychiatry Approach to Understanding Antisocial Behaviour and Psychopathy

One approach that is receiving considerable attention in research studies is known as "computational psychiatry," and we recently applied it to understanding antisocial behaviour and psychopathy too. Computational psychiatry aims to understand mental disorders through both theory-driven and data-driven approaches.

Theory-driven approaches use mathematical models to test explicit hypotheses about the core symptoms that underlie different disorders. The idea is that these core symptoms might not be unique to one disorder but could help explain a particular symptom across disorders.

By freeing ourselves from conventional distinctions between closely related disorders, such as conduct disorder and antisocial personality disorder, we might be able to learn more about the mechanisms underlying the symptoms themselves. For example, a failure to learn from punishment for wrongdoing is a common feature across several antisocial behaviour disorders.

This can be captured by a mathematical model that captures how future behaviour changes in response to past punishment. By breaking each feature of a disorder down into its constituent parts in this way, we might be able to discover hidden mechanisms that partially explain several related disorders at the same time.

The second aspect of computational psychiatry is the data-driven approach. This approach uses large datasets to identify features of disorders that have not traditionally been considered as symptoms but that could prove useful for predicting the onset of mental disorders or recognising them more accurately when they occur. For example, machine learning classifiers have used neuroimaging data, lab-based measures of behaviour, and demographic risk factors to identify different disorders with a high level of accuracy.

While this approach does rely on a conventional understanding of mental disorders as distinct categories, the major advantage is that algorithms can detect important patterns in the data without a researcher needing to know in advance what these patterns might be.

Ultimately, the aim is to bring these two approaches together to reveal new insights into disorders and symptoms of antisocial behaviour, which have such profound effects on individuals, their social relationships, and society as a whole.