There are physical findings among sociopathic individuals which suggest a biological difference between them and others. This imperviousness to anxiety may explain why they fail to learn, since much of our learning is based upon the need to avoid future anxiety for ourselves and others. There is some evidence that anti-social personalities begin to burn out in their 40 s with regard to impulsive aggression and crime. And for their doctors, they represent treatment dilemmas since the pain they inflict upon their victims and society as a whole makes it difficult to imagine wanting to help them. It is also clear that good outcome to treatment does not appear to be related to IQ, family history or imprisonment.
Bad outcome does appear to be related to alcohol and other substance abuse.
Whether tending toward the narcissistic or tending toward the sadistic, the antisocial personality represents a consistent legal and moral dilemma. Since these individuals will inflict rather than experience suffering, it is exceedingly rare that they seek treatment except to access prescription drugs. Clearly, early identification and attempts to contain their victimization of others and misuse of resources becomes the primary goal. Since true remorse does not occur, motivation for change is absent.