Antisocial personality disorder (AsPD) is a diagnosable condition in which someone continuously disregards or violates the rights and considerations of others without feeling any remorse for their actions.1 Like other diagnosable personality disorders, AsPD is considered a chronic disorder. Various symptoms of the condition may be treated using therapy and/or medication through the duration of someone’s life.2
What Is Antisocial Personality Disorder?
Antisocial personality disorder is a Cluster B personality disorder as defined by the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders.1 It involves a pervasive pattern of disregard for and violation of other people’s rights.
Here is diagnostic criteria for AsPD:
- Three or more of the following occurring since age 15:
- Failure to conform to social norms with respect to lawful behaviors, as indicated by repeatedly performing acts that are ground for arrest
- Deceitfulness, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure
- Impulsivity or failure to plan ahead
- Irritability and aggressiveness, as indicated by repeated physical fights or assaults
- Reckless disregard for safety of self or others
- Consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations
- Lack of remorse, as indicated by being indifferent, or rationalizing having hurt, mistreated or stolen from another
- The individual is at least 18
- Evidence of conduct disorder with onset before age 15 years
- Occurrence of antisocial behavior not exclusively during the course of schizophrenia or bipolar disorder3
Why Don’t People With Antisocial Personality Disorder Seek Treatment?
There are many reasons why individuals with AsPD don’t seek treatment. Among the most common is that they don’t feel wrong or uncomfortable with their behavior. Given that associated thoughts, feelings, and behaviors have been established at a young age (generally before age 15) and follow the individual throughout life, they believe that this is just who they are and that it’s OK.
Given the marked personality characteristics of “hostility, significant irritability, agitation, aggression, or violence;” it is common for others in one’s social environment to back off—allowing the behavior to continue, as engaging it oftentimes leads to unwanted problems.4
Aside from potential legal problems, which may be more or less telling to the individual, they believe their personalities to be normal—or even superior—to others. Accordingly, they believe there is no need to change and are unwilling to seek treatment on their own.
Given the diagnostic criteria for AsPD, individuals may find themselves continually engaging in unlawful behavior. Though some of the behavior may be less physically invasive, such as lying or stealing, some can become life-threatening to self and others. An unfortunate, common route to treatment for many with AsPD is getting into legal trouble, which may “force” them into court-mandated treatment.
Although there is always the option with court mandates to engage in treatment or face legal consequences, many choose to begrudgingly oblige. While mandated treatment is not necessarily the ideal toward getting one to engage, it may serve as the first step toward getting one’s life back on track—benefitting self and others.
“Personality disorders are ingrained ways of thinking and behaving that are tough to change, nor should we want to completely change them. The goal in treating people with personality disorders, ASPD specifically, is helping them better manage their personality characteristics. The term “personality disorder” itself is pretty harsh; so thinking of these symptoms as being related to a set of personality characteristics that cause a lot of problems can be more helpful. Clients with this disorder can learn to better notice how their personality characteristics manifest and make their lives more difficult. Often, when people with ASPD can relate how THEY suffer, they can begin to learn more adaptive methods of being in the world. A lot of this issue is related in their deeply ingrained beliefs, and changing those completely is difficult and often unnecessary. Shifting their beliefs or creating some cognitive flexibility however is doable.” – Ed Dunbar Jr, Assistant Professor at Montana State University
Antisocial Personality Disorder Treatments
Although AsPD is a fairly well-understood condition in mental health care, there is no set treatment for the condition itself.2 Rather, treatment aims to work with particular symptoms to help keep the condition under control. Ongoing therapy (contingency management) provides the best chance for individuals to improve symptoms and maintain progress. Again, without any known cure for the condition, treatment will need to be intentional, consistent, and ongoing throughout the duration of one’s life.5
Dunbar states, “The key thing to understand is that people with this disorder don’t seek treatment for this disorder; rather they seek treatment for conditions related to this disorder such as addiction or mood issues. Often they are court ordered to receive treatment so the method of treatment really varies based on the individual’s needs. Once you identify the presenting concern and identify features of ASPD you can tailor the treatment method to that individual. So, as with many disorders, there is not a BEST method; but once you can relate the presenting issue (addiction, mood, legal etc) to antisocial traits you can often help people develop cognitive, behavioral, and interpersonal methods of better managing distress. You can help them reduce the harm they cause in their own lives and the lives of others.”
Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that explores one’s thoughts, feelings, and emotions in respect to a given stimulus, such as a particular interaction with another. By understanding what triggers can lead to certain behavioral responses, the person with AsPD may take pause and consider a better reaction.5 Here, the client and clinician work collaboratively toward adjusting maladaptive beliefs and values that impact how the person behaves. For example, a maladaptive belief may be that one’s aggressive behavior in social settings is appropriate. By challenging this, one may come to realize that how one responds to others is undesirable and, at times, harmful or life-threatening.
Though CBT may be administered in residential (in-patient), intensive outpatient (IOP), outpatient, and/or support group settings, many individuals with AsPD attend consistent outpatient sessions, which typically occur weekly for an hour. This, of course, is adjusted depending on the severity of the condition and needs of the individual client.
It is important to work with a competent, licensed therapist where one may form a strong working alliance. Where empathic understanding, authenticity, and unconditional positive regard (UPR) are present, both the client and counselor may work through any challenges as they arise.
There is no specific medication that treats AsPD itself. Rather, medications such as antidepressants, antipsychotics, and mood stabilizers are prescribed to address associated symptoms. Also, even if medication is used, it is important to continue psychotherapy to continue monitoring symptoms.
Antidepressants can help regulate serotonin levels in the brain.2 This regulation balances out neurotransmitters to minimize or eradicate extreme feelings of sadness, depression, and suicidal ideation. These are most used with diagnoses along the continuum of major depressive disorder.
Antipsychotics such as risperidone and quetiapine help to reduce violent behavior or aggression.2 These work by “blocking D2 dopamine receptors as well as serotonin receptor antagonist action.”6 These are most used with conditions along the schizophrenia continuum and other psychotic disorders.
Finally, mood stabilizers such as lithium and carbamazepine manage emotional lability (instability).2 This class of medications act upon specific neurotransmitters that, when unbalanced, lead toward high highs (mania) and low lows (depression) that act upon one’s thoughts and behaviors. These are most used with diagnoses associated with bipolar disorder and similar conditions.
Are There Preventative Treatment Options?
The consensus is that there are no preventative treatment options for AsPD.2 One study concluded that early intervention with severely antisocial children “for whom treatment is indicated” may prevent the development of antisocial personality in adolescence and improve academic performance.7
Though this research is fairly limited, the best means of preventing AsPD is by intervening as soon as possible (before one is met with a diagnosis of conduct disorder in childhood and/or full-blown AsPD diagnosis in adulthood).
AsPD, like other personality disorders, often stems from trauma and other disruptions during childhood (especially in the household). Given that childhood and adolescence are when individuals shape their personalities, which become increasingly difficult to adjust as people age, noting and addressing antisocial tendencies before they become ingrained in one’s personality can and does help.
This may involve but is not limited to parents/guardians working toward establishing and maintaining a healthy/functional household, authoritative parenting styles, networking with prosocial peers, and early engagement in therapy.
How to Cope if You Were Harmed by Someone With ASPD
If you’ve been harmed by someone with AsPD, know that you’re not alone. It’s a common experience for friends, loved ones, and others to feel as though they are misperceiving, overthinking, or exaggerating their concern, which is one of the many harmful effects of interactions with a person who has AsPD.
Know that allowing their influence or problematic behavior to continue without intervening is problematic for both of you. Given the nature of the incurable condition, whatever has happened in the past or is currently happening is likely to further intensify. As such, therapy is an appropriate option. For treatment inquiries or assistance finding your own therapy, visit an online online therapist directory.
Although they don’t always seek antisocial personality disorder treatment, it’s possible for those with AsPD to be treated. The first step is acknowledging the problem and staying intrinsically motivated to work through it. Even if initiating treatment begins through a court mandate, full engagement may prove the beginning of a happier, healthier, more socially integrated life. Though there may be setbacks, there is hope.
For Further Reading
- SAMHSA Find Treatment
- SAMHSA’s National Helpline: (800) 662-HELP (4357)
- National Suicide Prevention Lifeline: (800) 273-TALK (8255)
- SAMHSA Early Serious Mental Illness Treatment Locato