Thus, antisocial patients’ automatic thoughts and reactions are frequently distorted by self-serving beliefs that emphasize immediate, personal satisfactions and minimize future consequences. The underlying belief that they are always right makes it unlikely that they will question their actions. Patients may vary in the degree of trust or mistrust they have in others, but they are unlikely to seek guidance or advice on any particular course of action. A person with ASPD who wants something will take it without either understanding the possible consequences or manifesting concern about possible consequences.

For example, the therapist noticed that magazines were disappearing from his waiting room, and he suspected Randy, his ASPD patient. He checked that the magazines were there prior to Randy’s session. Afterward they were gone. Asking Randy at the following session about the missing magazines, Randy at first vigorously denied the action. He then switched to the position that he must have inadvertently taken them. But, he reasoned, the magazines were there for the patients, and as a patient he was then justified in taking “his” magazine home to read. Thus, the behaviors of individuals with ASPD tend to elicit negative responses from others without awareness or concern that what he was doing was stealing from someone who was trying to help him.

Because the problems that they manifest are generally chronic and ego-syntonic, the patients themselves are often baffled by the responses of others and unable to see how present circumstances arose. For example, Randy was genuinely astounded that the therapist made such a “big deal” about a “stupid” magazine. Further, even after Randy offered to pay for the magazines, the therapist still saw a need for discussion of the behavior. Typically, the patient with ASPD will see the locus of the difficulties that they encounter in dealing with other people or tasks as external and independent of their behavior, viewing themselves as victims of unfair, prejudiced, or hostile systems.