The key diagnostic criteria for Antisocial Personality Disorder (ASPD) according to the DSM-5 include a pervasive pattern of disregard for and violation of the rights of others since age 15 years. This pattern is demonstrated by behaviors such as repeated unlawful acts, deceitfulness, impulsivity, irritability and aggressiveness, reckless disregard for safety of self or others, consistent irresponsibility, and lack of remorse after harming others.
Additionally, the individual must be at least 18 years old, and there must be evidence of conduct disorder with onset before age 15 years. The antisocial behavior must not occur exclusively during the course of schizophrenia or bipolar disorder.
This diagnostic framework emphasizes behavioral criteria reflecting a long-term pattern of antisocial conduct and interpersonal difficulties, which aligns with the clinical understanding of ASPD as a disorder characterized by persistent antisocial and often criminal behavior, impaired empathy, and poor impulse control.
UK clinical guidelines for antisocial personality disorder reinforce this by highlighting the importance of a detailed history of violence, criminal justice contact, and comorbidities such as substance misuse when assessing and diagnosing ASPD. They also stress that diagnosis should be followed by discussions about treatment options and implications, recognizing the complexity and heterogeneity of the disorder.
Thus, the DSM-5 criteria provide the formal diagnostic framework, while UK guidelines contextualize diagnosis within a broader clinical and social care approach, emphasizing comprehensive assessment and engagement strategies.
References: NICE CG77 Skodol et al. 2011 Black 2024