Antisocial vs. Borderline Personality Disorder: What Are the Differences?

Antisocial personality disorder (ASPD) and borderline personality disorder (BPD) share some common traits (they're both personality disorders, after all). While there are some symptoms that overlap, it's essential to remember that these are distinct conditions with some key differences.

The causes of these conditions and how they manifest can be strikingly different.

Symptoms of ASPD vs. BPD

Both ASPD and BPD are Cluster B personality disorders in the DSM-5. Cluster B disorders are characterized by overly emotional, dramatic, and unpredictable thinking and behavior. Both conditions are marked by disinhibition, hostility, and impulsivity. ASPD and BDP are also characterized by an increased suicide rate of between 5% and 9%.

However, the two conditions differ in important ways. Antisocial personality disorder is characterized by few emotions and affects more men than women. In contrast, borderline personality disorder consists of extreme emotions and affects both men and women equally. 

ASPD Personality Traits

According to the DSM-5, people with antisocial personality disorder may exhibit the following behavioral characteristics:

• Antagonism: Antagonism in ASPD is displayed through manipulation, such as using charming behavior to influence someone. People with ASPD often engage in vengeful behaviors over minor slights and may even resort to aggression, violence, and cruelty.
• Disinhibition: Disinhibition in ASPD is characterized by a disregard for social conventions and reckless, risk-taking behaviors at the expense of others' safety or feelings. It is not uncommon for people with ASPD to break promises, miss appointments, or drop activities out of boredom or spite.
• Emotional detachment: People with ASPD exhibit greater egocentric behaviors, making it difficult to establish balanced and supportive relationships. This emotional detachment can complicate psychotherapy, the practice of which relies heavily on open interaction.

BPD Personality Traits

People with BPD may have the following personality traits:

• Negative affectivity: Negative affectivity is characterized by unstable and unpredictable mood changes that are more dramatic than a situation warrants. This includes intense anxiety over social situations, persistent fear of rejection, or sudden swings into a deep depression, shame, or guilt. Suicidal thoughts are not uncommon.
• Disinhibition: People with BPD may engage in impulsive, risky behaviors, often due to frantic efforts to avoid real or anticipated abandonment or to change intolerable emotional states. These actions are often turned inward, resulting in self-harm or self-destructiveness. Appointments, promises, and activities will be readily dropped more out of a sense of hopelessness or anger than out of boredom.
• Antagonism: People with BPD are easily spurred to anger but are less likely to shut others out. Rather, they will seek out relationships that can alternate between extremes of idealization and devaluation.
  

What Causes ASPD and BDP?

The exact causes of ASPD and BPD are not clear, but the two conditions share some risk factors in common. The following are known to increase the risk of a person developing a Cluster B personality disorder:

• Brain differences: Imaging studies suggest that people with ASPD and BPD have structural differences in areas of the brain that regulate emotions and impulse control.
• Family history: Having a family member who has a Cluster B personality disorder increases the risk that a person will also develop ASPD or BPD.
• Experiences: Stressful and traumatic life events such as attachment problems, neglect, and abuse increase the risk of developing these conditions.

According to some evidence, these conditions are influenced by a combination of genetic and environmental factors.

How are ASPD and BPD Diagnosed?

Because the two conditions share similarities, it is important to look for the key differences that differentiate them.  Both conditions involve severe problems with self-functioning and interpersonal functioning, but the way these symptoms manifest is somewhat different between ASPD and BPD.

Antisocial Personality Disorder

According to the "Diagnostic and Statistical Manual of Mental Disorders", 5th Edition, text revision (DSM-5-TR), a person with antisocial personality disorder must be at least 18 years old and have severe problems functioning in these two specific areas:

• Self-functioning: ASPD is broadly defined as behaviors in which people think only of themselves and/or focus on personal goals and gratification without considering what is culturally acceptable or ethical. By definition, people with ASPD gain a sense of self-esteem from pursuing pleasure, power, or getting what they want.
• Interpersonal functioning: People with ASPD cannot display concern or empathy for other people's feelings or needs. They have difficulty forming any true sense of intimacy and instead use power to exert dominance in a relationship.

Borderline Personality Disorder

To be diagnosed with borderline personality disorder, a person must have severe problems functioning in both of these areas:

• Self-functioning: People with BPD typically struggle with identity and are prone to feelings of emptiness, self-loathing, and worthlessness. Because of this, they have difficulty establishing goals or pursuing long-term interests, often undermining themselves at every turn.
• Interpersonal functioning: Feelings of low self-esteem typically manifest in hypersensitivity to anything construed as criticism or rejection. People with BPD tend to lash out irrationally at even minor slights (like interruptions in conversation). Unable to see beyond their own feelings, people with BPD tend to lack empathy and find themselves in unstable relationships prone to conflict.

Treatments for ASPD and BPD

Antisocial personality disorder and borderline personality disorder are both treated with therapy and medications, but they differ in terms of prognosis and outcomes. BPD can respond well to treatment, but ASPD can present more significant challenges.

Therapy for BPD and ASPD

Certain forms of cognitive-behavioral therapy (CBT), such as dialectical behavior therapy (DBT) and mentalization-based therapy (MBT), have been extremely effective in treating BPD.

People with the condition rarely seek treatment independently and may only come into contact with treatment due to arrest and incarceration. Some evidence suggests that long-term therapy with CBT may help people gain insight and improve their behavior.

Medications for BPD and ASPD

Medications such as antidepressants, antipsychotics, anxiolytics, and mood stabilizers can also help manage symptoms associated with BPD or ASPD, such as depression, aggression, or co-occurring disorders.

Can You Prevent ASPD or BPD?

There is no way to prevent antisocial personality disorder or borderline personality disorder. If you know that you have a family history of BPD, watching for signs and getting an early diagnosis and treatment may help improve outcomes.

ASPD is sometimes preceded by conduct disorder during childhood. Getting an accurate diagnosis and appropriate treatment of conduct disorder during childhood may help minimize the risk of developing ASPD during adulthood.

Takeaways

Antisocial personality disorder and borderline personality disorder are two distinct conditions, although they do have some overlapping features. It's possible to have both since many people have more than one personality disorder. If you think you might have a personality disorder or you're concerned about your mood and behavior, talk to your doctor. Only a trained mental health professional can diagnose you.