Empathy is the ability to understand and share the feelings and perspectives of others. A lack of empathy is a common trait seen in some personality disorders, especially those in the cluster B category like narcissistic personality disorder and antisocial personality disorder. Individuals with these disorders often display a diminished capacity for empathy and an inability to recognize or respond appropriately to the needs and sufferings of others. In this article, we will explore the personality disorder most characterized by a lack of empathy – antisocial personality disorder.
What is Antisocial Personality Disorder?
Antisocial personality disorder (ASPD) is a mental health condition characterized by a pervasive pattern of disregard for and violation of the rights of others. According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), the key diagnostic criteria for ASPD include:
- Failure to conform to social norms with respect to lawful behaviors
- Deceitfulness and manipulativeness
- Impulsivity and irresponsibility
- Aggressive and irritable behavior
- Lack of remorse and indifference to having hurt, mistreated, or stolen from others
Individuals with ASPD often engage in behaviors that are grounds for arrest like theft, deception, violence, or violating the rights of others. They frequently lie, act impulsively, and lack regard for their own safety or the safety of others. They tend to be consistently irresponsible and often fail to hold down a steady job or pay debts. Interpersonal relationships are generally superficial and exist for self-serving purposes. Overall, those with ASPD display a blatant disregard for right and wrong.
It is estimated ASPD affects between 1-4% of the general population. The disorder is diagnosed more frequently in males than females at a ratio of about 3 to 1. ASPD often develops in childhood or the early teen years and persists into adulthood. While the exact causes are unknown, research suggests both genetic and environmental factors play a role. Childhood abuse, neglect, poor supervision, substance abuse, and modeling of antisocial behavior in the family can increase risk.
Lack of Empathy in Antisocial Personality Disorder
One of the hallmark traits of ASPD is a pronounced lack of empathy and lack of remorse for harming others. Those with the disorder are unable to experience empathy or choose not to empathize with others. This allows them to engage in exploitative behaviors without guilt or concern for potential victims.
Several reasons have been proposed as to why those with ASPD lack empathy:
- They may have an impaired ability to mentally represent the emotional states of others. This makes it hard to understand and share the feelings of others.
- The brains of those with ASPD may have structural and functional differences in regions linked to empathy compared to neurotypical individuals.
- They may have deficits in emotional processing and emotion regulation. This makes it hard to connect with and respond appropriately to emotions.
- Environmental factors like childhood trauma may hinder the development of empathy and compassion for others.
Whatever the causes, lack of remorse and limited empathy leads those with ASPD to act in their own self-interest, even when it causes harm to others. They do not feel guilt or concern for the pain they inflict. Hurting others essentially has no emotional consequence for them.
Examples of Low Empathy
Some examples of the low empathy seen in those with ASPD include:
- Exploiting others for personal gain without guilt
- Lying, cheating, and manipulating with no remorse
- Engaging in criminal behavior like theft or violence without concern for victims
- Taking dangerous risks without concern for personal safety or the safety of others
- Being indifferent to hurting others emotionally or physically
- Neglecting the needs of dependents like children or pets
- Blaming others for one’s problems or misdeeds
Their lack of empathy and remorse allows them to engage in these behaviors without hesitation or second thought. Hurting others brings them no moral quandary.
Contrast with Other Personality Disorders
While ASPD is the personality disorder most notably characterized by limited empathy, other cluster B disorders can also display impaired empathy. However, there are some differences:
Narcissistic Personality Disorder
Those with narcissistic personality disorder have an exaggerated sense of self-importance and often lack empathy. However, the lack of empathy stems from being excessively absorbed with the self. Their empathy is impaired by their extreme self-focus. They may be able to experience cognitive empathy by understanding emotions but have low emotional empathy. In contrast, those with ASPD have a more pervasive lack of both cognitive and emotional empathy.
Borderline Personality Disorder
People with borderline personality disorder often have unstable, intense personal relationships characterized by alternating idealization and devaluation. While they struggle to manage their emotions, most do not completely lack empathy or remorse. Their emotional instability can make it hard to regulate empathy. However, unlike ASPD, hurting others typically causes them emotional pain and remorse.
Histrionic Personality Disorder
Those with histrionic personality disorder have excessive emotionality and attention-seeking behavior. They may struggle to listen to or tolerate the emotions of others as it diverts attention back to themselves. However, they do not display the across the board lack of empathy seen in ASPD. They retain the capacity for empathy, even if drowned out at times by their need for attention.
Assessment of Empathy
Since lack of empathy is a key trait of ASPD, mental health professionals utilize a number of techniques to assess empathy impairment:
Clinical Interviews
Talking directly with the client allows a clinician to evaluate empathy by listening for any expressions of remorse, guilt, concern for others or emotional connectedness when discussing past exploits or relationships. Lack of empathy becomes evident when the person seems indifferent to the harm caused.
Review of Records
Looking at criminal, court, medical and psychological records can reveal a long-standing pattern of deceitful and criminal behavior with no evidence of remorse for victims. This helps confirm lack of empathy.
Psychological Testing
Formal psychological tests help quantify empathy impairment. For example, the Basic Empathy Scale measures both cognitive and emotional empathy. Those with ASPD typically score low in both domains. The Psychopathic Personality Inventory also assesses remorselessness and lack of empathy.
Observation of Behavior
Clinicians also watch for behaviors demonstrating lack of empathy like hostility, aggression, manipulation, or emotional coldness. The person may also lack emotional expressiveness and seem indifferent to the emotions of others.
Getting information from multiple sources is key, as those with ASPD are often deceitful and can attempt to manipulate clinicians. However, their low empathy inevitably reveals itself through consistent callous, irresponsible and antisocial behavior.
Treatment for Antisocial Personality Disorder
Treating ASPD can be challenging given the characteristic lack of empathy, disregard for others, and resistance to following social norms. Those with the disorder generally lack motivation to change. The main treatment approaches include:
Psychotherapy
Talk therapy aims to teach coping skills, change problematic thinking patterns, and improve interpersonal functioning. Cognitive behavioral therapy helps patients recognize the harm their behaviors cause others. Dialectical behavior therapy and schema therapy also show some efficacy. However, progress can be slow due to lack of patient motivation and high treatment dropout rates.
Medications
While no medications treat ASPD directly, certain drugs may help reduce related symptoms like aggression and impulsivity. Antipsychotics, mood stabilizers, and SSRIs show some promise. Medication is often given in conjunction with psychotherapy.
Group Therapy
Group therapy provides peer feedback about the negative consequences of antisocial behaviors. This modality has only shown limited effectiveness for those with ASPD.
Family Therapy
Including family members helps educate loved ones about ASPD and teaches skills to set healthy boundaries around manipulative behaviors. Family support helps encourage treatment compliance.
Correctional Rehabilitation
For incarcerated individuals, programs focused on improving social skills, self-control, and moral reasoning can potentially reduce future criminal behaviors after release. However, effects tend to be short-term without accompanying psychotherapy.
Overall, treating ASPD remains difficult with limited outcomes. The characteristic lack of conscience, guilt, empathy, and behavioral control make those with ASPD resistant to change. Life-long management of symptoms is often the goal.
Conclusion
Empathy allows us to understand the emotions of others, feel compassion for their suffering, and restrain our behavior to avoid harming them. In antisocial personality disorder, deficits in empathy and remorse enable exploitation, manipulation, and harm towards others without concern. While other cluster B personality disorders may also struggle with empathy, ASPD stands out for its cold-hearted, predatory violation of social norms. Their lack of humanity spares no one, whether strangers, friends or family. They leave heartbreak and destruction in their wake. While difficult to treat, professionals must seek to limit the damage inflicted by their chronic lack of empathy. With minds devoid of conscience, those with ASPD earn the moniker of society’s true psychopaths.