Antisocial Personality Disorder Treatment

What Is Antisocial Personality Disorder?

Antisocial personality disorder, informally known as sociopathy is a personality disorder that involves a pervasive pattern of disregard for and violation of other people’s rights.¹ Those with ASPD don’t understand the difference between right and wrong, and don’t feel uncomfortable with their behavior.

Given that associated thoughts, feelings, and behaviors have been established at a young age (generally before age 15), people with ASPD believe that antisocial behavior is OK. Unfortunately, personality characteristics of hostility, irritability, aggression, or violence commonly result in others simply backing off—allowing the behavior to continue—as engaging often leads to unwanted problems.⁴

How Is ASPD Diagnosed?

ASPD diagnosis can take time due to the nature of the symptoms overlapping with other disorders such as OCD, NPD, and mood disorders. Diagnosis comes from a psychiatrist who will likely consider childhood diagnoses and conduct as well as adult conduct to determine if their behavioral history matches the criteria for ASPD.

According to the DSM 5, a diagnosis of ASPD may be given if:³

• Three or more of the following occurred 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 the 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 disorder

Antisocial Personality Disorder Treatment Options

There is no set treatment for antisocial personality disorder in adults.² Rather, treatment aims to work with particular symptoms to help keep the condition under control. Ongoing therapy provides the best chance for people to improve symptoms and maintain progress. Again, while sociopathy cannot be cured, treatment of ASPD will need to be intentional, consistent, and ongoing throughout the duration of one’s life.⁵

Therapies for Antisocial Personality Disorder

There are a handful of ASPD therapy options to consider and some may work better than others. Some of the therapies include behavior therapies and working with specialists.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a form of psychotherapy that explores one’s thoughts, feelings, and emotions with 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

In behavior therapy for antisocial personality disorder, the client and clinician work collaboratively toward adjusting maladaptive beliefs that impact the person’s actions. 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.

Mentalization-Based Treatment (MBT)

MBT focuses on the way someone thinks, and asks them to consider the influence of their thought process on their behavior.

Democratic Therapeutic Community (DTC)

DTC is an approach which aims to understand how someone with ASPD can become more self aware of their destructive behaviors and the needs these behaviors are meeting. DTC gives those with ASPD a tool to understand their impact and educate themselves on how to meet their needs in socially acceptable ways.

Dialectical Behavioral Therapy (DBT)

DBT is a type of CBT which aims to help people with ASPD accept their circumstances and learn how to regulate their emotions so their thought processes are based in reality. It helps to increase tolerance for distressing feelings and manage them more effectively.

Contingency Management (CM)

Depending on the other issues someone with ASPD is dealing with, such as substance use disorder, CM is a great way to improve behavior through positive reinforcements.

Schema Therapy

Schema therapy helps people with ASPD address their maladaptive thought patterns that trigger their poor behaviors. This therapy challenges people to learn the root cause of why they behave in the way they do, and how to change their coping methods so their behaviors are more healthy and appropriate.

Family Therapy

Family therapy is an approach which helps everyone in the family unit have a voice on how they are feeling and the impact of their behaviors on the other members of the family. A family member with ASPD will also be able to share and participate as much as every other member. The goal is to help everyone understand what is happening and feel seen, heard, and safe in ensuring their individual needs are met.

Impulsive Lifestyle Counseling

This approach is a psychoeducational-behavioral approach aimed to help those with ASPD become more self aware and identify their impulsive thoughts to learn how to change them.

Medications for Antisocial Personality Disorder

There is no specific medication for ASPD, but 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.

Medications for ASPD may include:

• Antidepressants: Antidepressants can help regulate serotonin levels in the brain.² This balances out neurotransmitters to minimize or eradicate extreme feelings of sadness, depression, and suicidal ideation.
• Antipsychotics: Antipsychotics help to reduce violent behavior or aggression.² These work by blocking D2 dopamine receptors and serotonin receptor antagonist action.⁶
• Mood stabilizers: Mood stabilizers help to 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).

Hospitalization for ASPD

ASPD can often be managed in an outpatient setting. However, ASPD may need to be treated in a hospital if the individual has co-occuring medical issues, substance abuse issues, or is experiencing suicidal ideation.

Does Treatment for Antisocial Personality Disorder Work?

Antisocial personality disorder, like other personality disorders, often stems from trauma and other disruptions during childhood (especially in the household). Given that people shape their personalities in childhood and adolescence, which become increasingly difficult to adjust as they age, treatment for ASPD that notes and addresses antisocial behavior ingrained in one’s personality can and does help.

Seeking early intervention is especially beneficial when treating antisocial personality disorder. Though this research is fairly limited, the best means of preventing ASPD is by intervening as soon as possible.⁷ This may involve parents/guardians working toward establishing and maintaining a healthy and functional household, authoritative parenting styles, networking with prosocial peers, and early engagement in therapy.

How to Support a Loved One With ASPD in Treatment

It’s a common experience for friends, loved ones, and others to feel as though they are misperceiving, overthinking, or exaggerating their concerns for a loved one with ASPD. Sadly, this is one of the many harmful effects of interactions with these individuals.

If you are supporting someone during their treatment for ASPD, it is important to remember that allowing their influence or problematic behavior to continue without intervening is problematic for both of you. Further, your top priority should be your own safety and well-being. To ensure you stay healthy while helping a loved one in their treatment, be sure to remain mindful of your own needs, limitations, and boundaries.

Below are ways to support a loved one with ASPD in treatment:

• Prioritize self-care: Self care is time you can give back to yourself to make sure you are feeling your best and not internalizing the issues of the person with ASPD.
• Join a support group: It can be hard to cope with ASPD in a loved one, and having a support group to learn how to cope and find community can be affirming.
• Develop coping skills: Finding out ways to cope that are fun and healthy is a good way to manage the challenges you’re dealing with. You could try yoga, meditation, relaxation techniques, breathwork, and more.
• Set and maintain boundaries: Maintain firm boundaries with the person with ASPD and do not allow for their poor behavior to be excused.
• Recognize when it’s time to leave: If you have given yourself and your loved one time and you’re feeling stuck in a cycle of bad behavior and manipulation, it may be time to consider leaving. Talking with a therapist is a good way to learn how to manage that transition and do it safely.

Final Thoughts

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.