What We’ve Said

What we’ve said about Antisocial personality disorder

10 points from 6 episodes, newest first

Also searched as ASPD, sociopathy

In short

Antisocial personality disorder is a broad label that covers low-grade rule breaking as well as true psychopathy, which should be reserved for an innate lack of guilt and remorse. Most psychopaths are impulsive and low functioning, people who innately lack guilt need very different management, and the insanity defense does not apply.

How we diagnose it

  1. The antisocial personality disorder diagnosis is not psychopathy. It is purposefully broad, covering a low-grade tendency to break rules and a parasitic lifestyle as well as actual psychopaths.

    “The antisocial personality disorder diagnosis is not psychopathy. It's purposefully encompassing both low grade tendency to break rules, basically. And the parasitic lifestyle and the actual psychopaths, right”
    The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026

  2. Reserve the term psychopathy for people with a true innate impairment, not just a psychological problem, in feeling remorse, guilt and concern for others.

    “I'm saying that we should reserve the term psychopathy for people who have a true innate impairment, not just a psychological problem when it comes to feeling remorse, guilt and concern for others”
    28:24What Psychiatrists Get Wrong About Personality DisordersOct 2024

  3. Psychopathy is not a totally separate thing. It often has the same underlying structure with superego deficits on top: absolutely no guilt, and a desire to get over on, manipulate and use other people.

    “Psychopathy is not a totally separate thing. Psychopathy often has this structure and then often what we call like super ego deficits. So there's absolutely no guilt. There's often on top of this a desire to kind of get over on other people, to manipulate, to use other people”
    52:49The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026

  4. Even a psychopath can show apparent affection. It does not come from a strong moral core or from weighing other people's reactions; it comes from what seems easy, doable and pleasurable in the moment.

    “It's not because he has some kind of a strong moral core where he has deliberated and felt about other people's reactions. It's because it seems to be easy and doable and pleasurable in the moment that he does it”
    The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026

  5. Antisocial and borderline are the two personality disorders that are pretty robustly validated. Toward the end of his career Gunderson argued for separating them from the rest as the major personality syndromes, listing them on Axis I and letting trait psychologists dimensionalize everything else.

    “Within the personality disorders category, I think there are two personality disorders that are pretty robustly validated, and that's borderline personality disorder and antisocial personality disorder”
    41:02Diagnostic Hierarchy Explained: Why Patients Get 5 DiagnosesNov 2026Guest episode
    Also said in 1 more episode
    “John Gunderson, by the way, towards the end of his career, argued that we needed to separate borderline and antisocial from the rest of the personality disorders. Those were the major personality syndromes. List those on axis one and let the trait psychologists dimensionalize everything else”
    41:16Diagnostic Hierarchy Explained: Why Patients Get 5 DiagnosesNov 2026Guest episode

Pearls

  1. Most psychopaths are low functioning: very impulsive and probably incarcerated. High-functioning psychopaths exist, but they are the minority.

    “There are high functioning psychopaths and then there actually are mostly low functioning psychopaths. Most psychopaths are low functioning. They're probably incarcerated. They're very impulsive”
    50:39The Psychology of Elizabeth Holmes in You Can See Everything: Narcissism, Autism, or Manipulation?Oct 2026

  2. Personality and other disorders are not separate islands. Gambling disorder, for example, is not a little pathology isolated from the rest of the personality.

    “It's not like axis one and axis two are like these islands of like gambling disorder is this little pathology that exists in this part of the brain and that it's isolated from the rest of the personality”
    The Psychology of Seinfeld: What’s Really Wrong With George, Kramer, Jerry & Elaine?Aug 2026

  3. Antisocial patterns can wear down: you see the burnt-out antisocial, or the tired antisocial.

    “You can see this in what I would refer to as the burnt-out antisocial or the tired antisocial”
    29:11Bipolar Misunderstandings, Integrating Biology & Personality, & Broader ConceptualizationsSep 2024

Pitfalls and myths

  1. Do not assume everyone who chronically harms others or violates their rights had some awful experience that switched off their feelings. Many innately lack guilt and remorse, and people like that have to be managed very differently.

    “a lot of these people who chronically harm others or violate their rights, I think they are lacking innately in that sense of guilt and remorse. And then you have to manage people like that very differently”
    27:51What Psychiatrists Get Wrong About Personality DisordersOct 2024

  2. The insanity defense traditionally excludes antisocial personality disorder. Anyone trained appropriately, who understands why the defense exists and who it applies to, knows it cannot apply.

    “the insanity defense. traditionally excludes antisocial personality disorder. Everyone who has been trained appropriately and understands fundamentally why the insanity defense exists and who it applies to knows that it cannot apply to antisocial personality disorder”
    13:29Lessons from Forensic Psychiatry: Insanity Defense, Subtle Patients and CulpabilityApr 2025

From these episodes

Every point above is something said on the Psychofarm podcast, with the words as spoken and a link to the moment in the episode. It is education, not medical advice, and an episode reflects what we thought when we recorded it.

Educational content only. Everything here is what was said on the Psychofarm podcast, for clinicians. It is not medical advice and not a substitute for clinical judgment, current labeling or guidelines. An episode reflects what we thought when we recorded it, so check anything before you rely on it.