Help! My Antisocial Personality Diagnosis Terrifies Me

Dear GoodTherapy.org,

I started going to therapy a couple months ago as part of a court order after I was arrested (again) for shoplifting. I also have trauma-related depression and some social anxiety (among other things). It was going okay and my therapist is fine, but at my last session he told me in addition to my depression diagnosis he was also assessing me for antisocial personality. I wasn’t really familiar with the term and he only partially explained it as something like “difficulty relating to other people” and “having impulsive tendencies”—especially connected to the thefts and a history of what you might call mild arson. It still seemed kind of vague, so I looked it up when I got home. And now I’m horrified.

From the small amount of research I’ve done, it seems like people with antisocial personality are literal serial killers. What the hell? Like, I’m somewhat reclusive and I’ve stolen some clothes or occasionally lit a trash can on fire. But I don’t straight-up MURDER people and animals. Maybe you can explain the difference better.

I don’t know what to do, or whether to go back for our next appointment. It feels like my therapist is saying I’m actually going to go out and kill someone, or that I’m capable of doing something similar. It was already scary enough living in my own head because of all the other things I’m dealing with, and now I’m worried I have so little control over my own thoughts and actions that I might actually hurt people. Please help me understand why he might have said this. If someone’s going to label my issues, can’t I just be introverted and reckless? Or something? —Don’t Get Me Wrong

Dear DGMW,

Thanks for writing in. Your excellent question highlights one reason I am wary of diagnostic labels. They tend to be more helpful to mental health professionals than to the general public. In our field, you’ll often hear a psychologist make casual reference to a person in therapy who is “narcissistic” or “borderline.” Usually, this simply means the psychologist isn’t sure how to work with the person.

This cold, clinical jargon, shaming and wounding to many on the receiving end—i.e., those outside the profession and in a vulnerable position—reduces a person to a caricature and is dehumanizing. It is also, in terms of the depth and nuance of the understanding we need to really help people (in my experience, at least), pretty useless.

I suppose some might say it’s easy to say for someone like me, a psychotherapist/analyst in private practice. I did have to use those labels in an agency setting, which is one reason I couldn’t do it anymore. You are now at the mercy of a system which uses “antisocial” to describe just about anyone who cannot or will not “play by the rules.”

Why do I dislike labels? For starters, just about every person I know (including myself) has some traits, rather than defining features, of some of the so-called “personality disorders”; in fact, I remember in graduate school, while studying the Diagnostic and Statistical Manual (DSM), I began to worry I was narcissistic, then avoidant, or borderline, etc. We all sometimes act or think in certain ways that may bother others, being the highly imperfect beings we are. These labels were designed by looking from the “outside in,” rather than an “inside out” understanding of a person’s trauma or congenital social struggles, which is usually what leads to so-called “disorders.”

Such labels take a person out of context. In the treatment center where I used to work, any stubborn person was often labeled borderline or narcissistic, meaning we had failed to understand their problem in any substantial way or, in some cases, would prefer they went elsewhere. This was our problem, however, not theirs.

Occasionally, some types of labels or diagnoses are useful to people in therapy. For instance: anxiety or depression, where there may be relief in knowing that suffering has an actual “name” and an established course of treatment. Certainly, the term addiction is charged with all manner of meanings. Some prefer to use it; others find it useless.

The other thing to keep in mind is that official diagnoses, even within mainstream “evidence-based” psychology, are always changing: those on the various research committees of the DSM, for instance, often disagree. For instance, should a behavioral or “process” compulsivity (such as viewing pornography or, yes, shoplifting) be defined as an addiction or impulse or mania or …?

Which brings us, finally, to your question. The label of “antisocial personality” has its own particular negative valence. Some people tend to think Ted Bundy or Hannibal Lecter, right? I somehow doubt you are similar to either of these two infamous figures, and your own expressed self-awareness and concern speaks to that contrast.

Were we to meet in person, I can imagine I would try to investigate and assess in collaboration what, exactly, is going on here. What do you make of them? Why do you do it? What are the benefits? The perceived risks?

I would also want to know more about “mild arson,” in terms of your own safety and others’, since this could inadvertently lead to more damage or harm than intended. But I have certainly worked with many who have struggled with “impulse issues”; over time, we came to understand this behavior in a deeper way, and people who stuck with therapy eventually lost the desire or compulsion to keep doing it.

My guess is you didn’t come to these behaviors overnight; there is a story and broader context here. So many people I have worked with, who struggle with a variety of hard-to-control impulses, have long suffered painful isolation, hurt, and (eventually) behavioral compulsion, all in an attempt to express what is going on inside, to gain some semblance of control over such emotion.

The justice system, alas, has you caught in its machinations. Those machinations are definitely looking “outside in”—to contain and stop rather than understand. Unlike a private therapist, the system is for better or for worse looking to protect the public and possibly yourself. Such a system uses jargon like labels, crude and ill-fitting as it may be.

My hunch is you struggle with strong and possibly difficult feelings and impulses. Such emotions are “speaking” via action rather than language/feeling; these actions become a charged way of communicating—perhaps temporarily sating—such powerful feelings. They may even provide a rush, though the downside is you then miss the opportunity to see through and around them to help you understand what’s underneath, to make different choices; after a while, the compulsion may be controlling you rather than the other way around.

Again, the authorities are seeing only the behavior, not the struggles going on within you. Thus, you become, to the system you are forced to comply with, a kind of walking diagnosis.

I’m sure it’s unsettling to have a label thrust upon you that may not fit, but let’s suppose you and I are powerless to change the justice system. Hopefully this system will, over time, become more nuanced in terms of human understanding, as is very slowly happening in terms of addiction as a malady rather than “crime.”

In the meantime, here is some food for thought: My guess is you didn’t come to these behaviors overnight; there is a story and broader context here. So many people I have worked with, who struggle with a variety of hard-to-control impulses, have long suffered painful isolation, hurt, and (eventually) behavioral compulsion, all in an attempt to express what is going on inside, to gain some semblance of control over such emotion.

Whatever “heated” passion, hurt, or anger you are feeling inside may eventually find its expression in the behavior of starting a fire, for example. A rather simplistic way of describing it is: by doing this, you manage to place fiery emotion “outside” rather than inside yourself. Meanwhile, the actual emotional root of the issue remains opaque. It’s also possible the behavior has taken on a life of its own, in that it is now hard or impossible to not act on those urges. This is where the danger lies; it’s of course more preferable to have options than to feel compelled to act.

Why do I doubt you are like the “literal serial killers” you read about? Most seriously hardened people with sociopathy tend to think everyone else is the problem; their painfully low self-esteem remains hidden from them, too painful to contemplate. The fact you are writing indicates you are curious and searching for more substantial meaning. With only the information you provided to go on, the fire, to me, suggests anger, rage, or deep hurt (or all of these) seeking expression. Perhaps you are saying, in some indirect way, “I’ve been burned.”

Therapy, counseling, spirituality/religion, or creativity (or some other reflective outlet for strong emotion) is probably a safer and more fruitful long-term option to understand and express in a protected environment whatever you are carrying; the justice system is more interested in keeping order than helping someone unpack or demystify their painful existential challenges.

I sense you have a story to tell, besides a somewhat arbitrary label imposed on you by a system. You strike me—and, again, I am only going on what I read—as a well-intentioned person. Why not find your own labels and language to describe yourself—before a large and powerful system imposes one on you that could stick for a long time?

Hope this helps!

Darren

Darren Haber

Darren Haber, PsyD, MFT is a psychotherapist specializing in treating alcoholism and drug addiction as well as co-occurring issues such as anxiety, depression, relationship concerns, secondary addictions (especially sex addiction), and trauma (both single-incident and repetitive). He works in a variety of modalities, primarily cognitive behavioral, spiritual/recovery-based, and psychodynamic. He is certified in eye movement desensitization and reprocessing (EMDR) therapy, and continues to receive psychodynamic training in treating relational trauma, including emotional abuse/neglect and physical and sexual abuse.