Dr. Cindy Taylor

Clinical Psychologist

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Home About ADD Differential Diagnosis Differential Diagnosis Articles ADHD and Antisocial Personality Disorder

ADHD and Antisocial Personality Disorder

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ADHD and Antisocial Personality Disorder

The diagnosis of Antisocial Personality Disorder is only made in individuals 18 years of age or older.  It is characterized by a pervasive pattern of disregard for and violation of the rights of others. Some symptoms of Antisocial Personality Disorder are: failure to conform to social norms, repeatedly performing  acts that are considered unlawful, deceitfulness (lying, use of aliases, or conning others for personal profit or pleasure); impulsivity or failure to plan ahead; irritability and aggressiveness; reckless disregard for safety of self or others; consistent irresponsibility, as indicated by repeated inability to hold a job and pay bills; lack of remorse, as indicated by being indifferent to or rationalizing having hurt, or mistreated another (taken from DSM-IV).  It’s diagnosis requires evidence of Conduct Disorder prior to age 15.

Antisocial Personality Disorder is one of the most researched disorders in connection with ADHD and is the adult version of Conduct disorder.  Cantwell (1988) discusses the relationship of ADHD to conduct, affective disorders and later substance abuse disorders.  Dykman (1993) found that children with ADHD who were also hyperactive and aggressive were at increased risk to have oppositional and conduct disorders.  Lilienfeld, (1990) reviewed the literature on ADHD and antisocial behavior.  Findings from longitudinal, family and adoption, neuropsychological, psychophysiological, and other laboratory studies reviewed indicate that childhood ADHD is associated with adult disorders characterized by antisocial behavior.  The relationship between ADHD and Conduct Disorderis also recognized, however, and  there is still a question of whether  this finding simply represents the continuation of conduct problems from childhood to adulthood.  Manuzza's study of 91 adults diagnosed with ADHD as children found hyperactive subjects more than seven times more likely to have an antisocial personality disorder or a drug abuse problem than controls (1993).  The previously mentioned work by Loney and colleagues (1991), however, indicates that aggressiveness rather than ADHD is the better predictor of antisocial behaviors in adulthood. 

Antisocial Personality Disorder most closely resembles the hyperactive-impulsive type of ADHD.  A couple of the symptoms I am frequently asked about are “lying” and “irresponsibility”.  Is lying a  symptom of ADHD?  No, “forgetting” is a symptom of ADHD which can look like lying if you said you were going to do something and didn’t follow through because you either got sidetracked or just plain forgot.  Both ADHD and Antisocial personality have difficulties with impulse control.  There is a risk taking, thrillseeker component to both, but the individual with Antisocial Personality disorder will typically have less regard for their own safety and the safety of others than the person with ADHD.  I believe the most distinguishing feature is the lack of empathy found in persons with Antisocial Personality.  There is a disregard for the feelings of others and a lack of appropriate guilt over their own inappropriate or hurtful  behavior.  The person with Antisocial Personality will seek treatment, but typically only when in trouble and can get out of it by seeming to seek help.  Usually when the situation that caused the person to seek treatment clears up, he/she discontinues therapy.  In contrast, the adult with ADHD is often times overly sensitive to the reactions and feelings of others and may feel remorseful to the point of becoming depressed over his/her impulsive actions. 

Unlike some of the other disorders we have been discussing in the differential diagnosis section, Antisocial Personality disorder is not easily and quickly treated.  The personality disorders in general are long standing patterns of behavior and personality that have developed over a life time.  Individuals with personality disorders are so familiar with the symptoms and behaviors that they are not distressed by them.  Many times it is a significant other who will request that the personality disordered individual seek treatment, or in the case of Antisocial Personality, it is often times due to legal difficulties.  Relatively long term therapy can alter the patterns of behavior, and if the individual has ADHD and Antisocial Personality disorder, medications may help control the level of impulsive behavior. 

Last Updated on Tuesday, 26 August 2014 00:05  

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