To be clear, I absolutely agree that NPD is/has a real pathology, and is a disability. Under the hood, it's most often a trauma-related disorder of self-security. Like Trump, I only don't meet NPD criteria myself bc it doesn't impair my life

I guess I'm mostly just surprised to see You taking ASPD at face value in the first place, unlike the critical way You approach NPD. I would expect that if one takes an anarcho-antirealist approach, the conclusion would be that the ASPD diagnosis doesn't serve the individual, but rather serves the state, and ought to be discarded. I worry that normalizing the ASPD label is likely to subvert the notion that smashing the state is good and that people should do so without remorse.

I imagine, however, this difference in perspective comes down to a macro lens vs a micro lens. For an individual stuck with the diagnosis on their medical documentation, leaning into it and wielding it might be in their best interest. As their provider, however, I would encourage them not to identify with that label, and to let me write a rule out diagnosis for their file, removing the label from their documentation. Of course, if they disagreed, I would just pivot to trying to further foster the empowerment of it.

If I met someone like You described, finding themself acting without thinking, regretting it, and wishing they could better mind social boundaries to improve their wellbeing, but without an existing ASPD diagnosis, I would likely explore other relevant diagnoses, like ADHD, ASD, BPD, etc.