It is possible that the development of APD begins in childhood, although it is not diagnosed as such until after eighteen years of age. In childhood, Conduct Disorder carries almost identical symptoms to APD. Patterns of blatant disregard for rules and authority, aggression, habitual lying, a tendency toward stealing and destruction of property that occur early in

A. There is a pervasive pattern of disregard for and violation of the rights of others occurring since age 15 years, as indicated by three (or more) of the following:

7) lack of remorse, as indicated by being indifferent to or rationalizing

In classic APD form, he lied extensively about the details of his life, abused alcohol and dabbled in drugs, could not hold a job for a long period, dropped in and out of college many times (lying his way in) and exhibited kleptomaniac behavior, stealing anything and everything from anywhere. He could not maintain an intimate, long lasting relationship with a woman. In fact, he says that he did not understand intimacy - what it was or how to achieve it. Even after his conviction, he rationalized that he knew so many details about the murders because he had been at the center of the investigation for so long as a suspect. In interviews, he spoke as a third person, observing and analyzing the killing as though someone else had done it.

Many other disorders are associated with and often confused with APD. Substance Abuse Disorder is one of the often confused disorders because the influence of drugs or alcohol can be a temporary cause of antisocial behavior. Conversely, substance abuse can be a symptom of APD. Therefore, in treating substance abuse, a determination of earlier antisocial behavior or Conduct Disorder in childhood must be made before a diagnosis of APD can be rendered. Also, Schizophrenic or Manic episodes that include that include some antisocial behavior cannot be declared APD unless the symptoms are present at other times. Narcissistic, Histrionic, Borderline and Paranoid Personality Disorders also closely resemble APD, however each seems to lack the aggression factor that APD carries (again this can include things such as con games and does not necessarily mean violence).

When treatment is sought though, emotions - the lack of and learning to connect to - should be the main focus of therapy. Ways of reinforcing appropriate behavior should be used in relation to the patient connecting with some sort of human feeling. The trust built with a therapist can be a learning tool in and of itself since most of those with APD have never had a solid, trusting relationship. Group or family therapy can be helpful by putting the patient at ease in a group of similar people, but the group setting can become more of a bragging ground for criminal exploits. Family therapy can also be used as a platform to educate family members about the persons illness and how to deal with it.

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