What To Know About Antisocial Personality Disorder Treatment

According to a 2015 study published in Psychiatric Annals, approximately 1-4% of the general population meets the diagnostic criteria for Antisocial Personality Disorder (ASPD), which is also known as sociopathy.

It is essential to understand that Antisocial Personality Disorder does not simply refer to being unsociable or unfriendly, as explained by Susan Masterson, PhD, a psychologist based in Lexington, Kentucky. The term “antisocial” can be interpreted as being against society or people. Individuals with ASPD are primarily focused on their own needs, perceiving social norms and laws as mere obstacles or challenges rather than barriers.

Relationships are only considered in terms of how they can benefit the individual or reduce negative outcomes, and the impact of their behavior on others is only a concern if it poses a problem for themselves.

Susan Masterson further elaborates that individuals with ASPD view relationships solely in the context of personal gain or avoidance of negative consequences. Their behavior is driven by self-interest, and they prioritize their own goals above social norms and the well-being of others.

Diagnosis

To receive a diagnosis of ASPD, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), certain impairments in personality functioning must be observed. These impairments include:

• Identity issues: Individuals may have an egocentric or self-esteem derived from personal gain, power, or pleasure.
  
• Goal-setting and self-direction: Their goals and actions are primarily driven by personal gratification rather than considering broader societal norms.
  
• Lack of ethical behavior: They do not have internal standards that conform to lawful or culturally normative ethical behavior.
  
• Impaired interpersonal functioning: There is a lack of empathy or concern for the feelings, needs, or suffering of others.
  
• Lack of remorse: They do not experience remorse or guilt after hurting or mistreating others.
  
• Incapacity for intimate relationships: They struggle with forming and maintaining meaningful and intimate relationships.

Individuals with ASPD often display antagonistic and deceitful behavior, utilizing manipulation and deceit to control or influence others. They may appear callous and remorseless, displaying a lack of concern for others’ feelings or problems, and disregarding the potential impact of their actions on others. Additionally, they can exhibit aggressiveness, hostility, impulsivity, and irresponsibility, failing to consider or dismissing the consequences of their behavior.

Determining the precise cause of ASPD is challenging, as it is influenced by various factors. While there is evidence of it running in families, it remains unclear whether genetic predisposition or learned behaviors and environmental influences play a significant role. The development of ASPD is likely influenced by a combination of nature and nurture factors.

ASPD Treatment

Treating ASPD can be challenging. According to GinaMarie Guarino, a licensed mental health counselor based in New York, there is no definitive cure for the mental and behavioral issues associated with ASPD. Individuals with ASPD often lack motivation to change their behavior as they may not perceive a need for change. They may believe that their actions are acceptable and instead expect others to modify their behaviors and expectations. Furthermore, they may be inclined to shift responsibility or blame onto other authority figures rather than taking personal accountability for their actions. These factors make it difficult to engage individuals with ASPD in treatment and facilitate meaningful change.

Not a Chemical-based Issue

Personality disorders, including antisocial personality disorder (ASPD), are not primarily caused by chemical imbalances, which is why there is no specific medication to treat ASPD. However, healthcare providers may prescribe medication to address overlapping mood issues that can accompany ASPD.

As Susan Masterson noted, ASPD is a mindset that influences an individual’s impressions and decision-making, shaping their behavior in various situations. Treatment for ASPD focuses on managing the symptoms of the disorder, learning coping skills, and developing strategies to deal with triggers and modify behavior.

It is uncommon for individuals with ASPD to seek help voluntarily, unless they believe it can prevent or alleviate negative consequences such as legal consequences or significant material losses. ASPD is recognized as one of the most challenging personality disorders to treat, according to the National Library of Medicine’s MedlinePlus resource.

As a result, many cases of ASPD that come to public attention are often associated with individuals within the criminal justice system. Therapy is frequently a condition of probation or parole for individuals with ASPD, as noted by GinaMarie Guarino. The legal system often plays a role in mandating treatment for individuals with ASPD, as part of their rehabilitation process.

Cognitive Behavioral Therapy and Relaxation

For individuals with ASPD who seek help, cognitive-behavioral therapy (CBT) is one of the most common treatments employed. CBT aims to assist individuals in slowing down their reaction times, reducing impulsive behavior, and incorporating consequential thinking into their decision-making process, as explained by GinaMarie Guarino.

In addition to CBT, various forms of psychotherapy may be utilized. The focus of these therapies is to improve conduct and reduce negative consequences in the person’s life. This may involve modifying expectations to align more with reality or utilizing relaxation techniques to manage angry reactions that arise when a sense of entitlement conflicts with the desired outcome of a situation, as described by Susan Masterson.

Overall, psychotherapy approaches aim to help individuals with ASPD develop strategies for behavior modification, enhance their understanding of the impact of their actions, and provide them with skills to navigate challenging situations more effectively.

Internalized Desire for Change

Psychotherapy for ASPD can be effective, but it heavily relies on the affected person’s motivation to change, as highlighted by GinaMarie Guarino. Like with many mental health disorders, the desire for change must come from within the individual themselves. They need to have their own personal reasons and willingness to modify their behavior.

Treating individuals with ASPD can be particularly challenging because many of them do not perceive their behaviors as problematic. As a result, they may lack the desire to be “cured” or make significant changes to their behavior. This lack of insight and motivation can pose significant barriers to successful therapy outcomes.

Engaging individuals with ASPD in treatment often requires a careful approach to build rapport, establish trust, and help them recognize the potential benefits of change. Therapeutic interventions need to focus on addressing their specific concerns and goals, highlighting how behavioral modifications can lead to improved outcomes in their own lives.

While psychotherapy can be beneficial for ASPD, the motivation and readiness for change on the part of the affected individual play a crucial role in the success of the treatment.