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Teenagers, who are by nature in a difficult social and physical stage of development anyway, often suffer from low self-esteem in normal circumstances. Low self-esteem reinforces and deepens an anti-social personality disorder because it tends to lead a teen to isolate themselves further from society and personal relationships.
The isolation, which in itself can cause an anti-social tendency to develop, impedes normal socialization further and leaves a teen with only their anxieties and (most likely skewed) perceptions of reality to shape how they view and react other people. Furthermore, the isolation tendency is simply the path of least resistance, the easiest and seemingly safest decision for the teen to make. This makes it very common that low self esteem and this particular personality disorder coexist in the same patient.
Since anti-social personality disorder is also marked by a lack of conscience and a contempt for other members of society, it is also possible a teen with low self-esteem may compensate for it by taking an even more aggressive stance towards others, or behaving with an even greater degree of callous disregard for the feelings of others.
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