Antisocial vs borderline personality disorder

Personality disorders are a group of mental health conditions that cause symptoms such as emotional dysregulation, harmful behaviors, and unstable relationships. Antisocial and borderline personality disorders are two Cluster B personality disorders that share some similarities in causes, symptoms, and treatment options.

What is antisocial personality disorder?

Antisocial personality disorder (ASPD) is a condition that often causes aggressive and criminal behaviors, impairments in relationships, and a lack of concern for others. It is more common among males than females and often emerges in adolescence, although it can affect people of any age or gender ^[1].

Typically, people with ASPD are diagnosed with conduct disorder in childhood, which is associated with disruptive, delinquent, violent, or criminal behaviors. ASPD can vary in severity, so while some with the condition commit violent crimes, this is not the case for all. Many professionals believe that psychopathy is at one end of this spectrum, characterized by the most severe presentation of ASPD symptoms ^[2][3].

What is borderline personality disorder?

Borderline personality disorder (BPD) is a condition that is characterized by emotional instability, intense and unstable relationships, and frequent self-harming behaviors. It is more common among females than males, and symptoms tend to emerge in adolescence, although it can affect any age or gender ^[4].

BPD can also occur on a spectrum, as some individuals with the condition have minimal impairment in social and professional functioning, while others experience severe difficulties. It is common for people with BPD to engage in self-harming and self-destructive behaviors, although they may also display verbal or physical aggression toward others ^[5].

ASPD vs. BPD: Symptoms

ASPD and BPD are both Cluster B personality disorders, along with narcissistic and histrionic personality disorders. This group of conditions is characterized by emotional dysregulation, impulsivity, and relationship difficulties. As such, there are many similarities between the symptoms of ASPD and BPD, although they are two distinct conditions ^[6].

Similarities between the symptoms of ASPD and BPD include ^[1][4][7][8]:

• Symptoms typically emerge in childhood and adolescence, although a diagnosis is not made until the age of 18.
• Both ASPD and BPD involve impulsive and irresponsible behaviors with potentially dangerous outcomes.
• Both ASPD and BPD involve emotional instability and issues with anger control.
• People with ASPD and BPD commonly experience a reduction in symptom severity as they age. Some individuals no longer meet diagnostic criteria by later adulthood, although they may continue to experience social and professional impairments.
• Individuals with both ASPD and BPD tend to become easily bored or rapidly change their views on people, hobbies, or employment.
• People with these conditions commonly experience comorbid conditions, such as depression, anxiety disorders, post-traumatic stress disorder (PTSD), and substance or alcohol use disorders.

Other signs and symptoms of ASPD include ^[1][7]:

• Regularly deceiving, controlling, or manipulating others for personal gain.
• Being verbally or physically aggressive toward others.
• Lacking empathy, guilt, or remorse.
• Having no concern for the well-being, needs, or emotions of others.
• Being incapable of forming or maintaining genuine relationships and attachments.
• Often engaging in illegal activities.
• Having no regard for social norms or acceptable behavior.
• Difficulties maintaining employment.
• Being irresponsible with finances or failing to plan for the future.
• Blaming others when problems arise.
• Presence of conduct disorder in childhood.

Other signs and symptoms of BPD include ^[5][7]:

• Emotional lability, regularly experiencing mood swings with extreme emotions.
• Intense outbursts of emotions, such as anger.
• Having an extreme fear of abandonment and making frequent attempts to prevent people from leaving.
• Intense and unstable relationships that may begin and end quickly.
• Black-and-white thinking, such as believing that something is only good or bad. This can apply to people or situations, changing from intense love or adoration to extreme hatred.
• Low self-esteem and distorted sense of self.
• Feelings of emptiness and loneliness.
• Feeling disconnected from reality or self, known as dissociation.
• Repeated self-harming behaviors, such as cutting.
• Regular thoughts, threats, or attempts at suicide.

ASPD vs. BPD: Causes

ASPD and BPD share many similarities in the causes and risk factors contributing to their development.

Childhood adversity

The development of both ASPD and BPD is thought to be significantly influenced by exposure to trauma and adversity in childhood.

Many people with these personality disorders have childhood experiences of sexual, physical, or emotional abuse, neglect, or parents with substance and alcohol use disorders. These experiences can result in maladaptive responses, believed to contribute to the attachment issues, emotional dysregulation, and relationship difficulties commonly seen in those with personality disorders ^[9][10].

Genetics

Genetics are believed to contribute to the development of these conditions. Individuals with a family history of ASPD, BPD, and other Cluster B personality disorder traits are found to be at a higher risk of going on to develop these disorders ^[2][11].

Environment

Along with genetic factors, it is also possible that children of parents with ASPD or BPD develop the same traits and conditions through exposure to their parent’s symptoms. As such, a genetic predisposition likely contributes to these conditions concurrently with environmental factors, such as witnessing and learning certain attitudes and behaviors during childhood ^[6][11].

Neurobiology

Studies have shown that individuals with ASPD and BPD may have differences in brain structure and functioning compared to those without these conditions.

For example, neurotransmitter levels and activity are shown to be different in individuals with ASPD and BPD, particularly serotonin. Serotonin impacts emotion, behavior, aggression, and impulse control, so it is believed to influence the development of these conditions ^[11][12].

Additionally, studies have found abnormalities in the volume and activity of specific brain areas in those with ASPD and BPD, such as the hippocampus, amygdala, and prefrontal cortex. These areas are responsible for the regulation of emotions, self-control, planning, and behavior ^[8][12].

Early experiences significantly impact brain development and functioning, so it is likely to be influenced by childhood adversity commonly seen in those with these conditions ^[8].

Gender

Research shows that ASPD is more common in males, while BPD is more common in females, even when individuals are exposed to similar experiences and adversities in childhood. This suggests that gender could influence how certain personality traits are developed and the emotional and behavioral responses to traumatic experiences ^[6][10].

ASPD vs. BPD: Treatment

Challenges and barriers to treatment

Generally, people with ASPD avoid seeking professional intervention, believing they don’t require mental health support. In many cases, people with ASPD only seek treatment when the court orders it or to treat other physical and mental health symptoms. In contrast, individuals with BPD are more likely to seek treatment for their BPD symptoms, co-existing conditions, or self-harm injuries ^[9].

People with these conditions are often subjected to stigma and discrimination from the public and medical professionals. They may be seen as challenging to treat, dangerous, or attention-seeking, causing barriers to diagnosis and treatment ^[4].

Additionally, misdiagnosis can be common, particularly if treatment is only sought for co-occurring symptoms and conditions. Individuals with these conditions may also struggle with treatment compliance due to the nature of their conditions, such as attachment or trust issues and impulsive or self-destructive behaviors ^[1][4].

Early intervention

For both ASPD and BPD, early intervention and prevention strategies are believed to be important in reducing the impact or development of these conditions. As these personality disorders often emerge in response to childhood adversity, providing early family, social, and psychological support can help prevent the formation of maladaptive and harmful patterns and improve outcomes ^[4][13].

Therapy

For both ASPD and BPD, psychotherapy can help reduce or manage symptoms. This could include cognitive behavioral therapy (CBT) or mentalization-based therapy ^[1][5].

These types of therapy can help individuals identify thought and behavior patterns that may harm themselves or others. Individuals can learn ways to challenge and adapt these thoughts and the associated behaviors to develop more positive attitudes and behaviors ^[1][8].

These techniques may be more self-focused for individuals with BPD, such as managing emotional distress and urges to self-harm. In contrast, therapy for individuals with ASPD may focus more on how outward expressions are affected by and affect others ^[14].

Another therapeutic approach, dialectical behavior therapy (DBT), was initially designed to treat BPD and can be very effective for this purpose. DBT teaches individuals to be more aware of their thoughts and emotions. DBT provides individuals with skills to help manage emotional distress, reduce self-harming behaviors, and improve interpersonal relationships ^[5][8].

Medication

There are no FDA-approved medications to treat ASPD or BPD. However, symptoms of these conditions and common comorbid conditions can potentially be managed with medication. For example, antidepressants, antipsychotics, and mood stabilizers can help reduce agitation, anxiety, low mood, aggression, and impulsivity ^[2][5].

Can you have BPD and ASPD at the same time?

People with personality disorders often experience comorbid conditions, including depression, anxiety disorders, and other personality disorders. It is not unusual for individuals with a cluster B personality disorder to also have traits or meet the criteria of another condition in this group. As such, ASPD and BPD can occur at the same time ^[2][12].

A higher prevalence of individuals with comorbid ASPD and BPD has been found among offenders of violent crimes than the general population. Research suggests that when these two conditions occur together, the symptoms of each disorder are likely to be more severe than when either condition occurs alone. This increases treatment challenges and the risk of violent and criminal behavior ^[15][16].