What Is Therapy For Antisocial Personality Disorder?

People with ASPD may have difficulty forming or maintaining relationships, controlling their impulses, and may show aggressive or hostile behavior toward other people. While there is no cure, treating antisocial personality disorder may help individuals manage their symptoms and lead healthier lives. Therapy for antisocial personality disorder may include talk therapy interventions such as cognitive behavioral therapy, anger and violence management, and as a treatment for co-occurring disorders such as substance use disorders (SUD). 

If you believe you or someone close to you may be living with antisocial personality disorder, seeking professional help is important. A healthcare provider can help you understand what treatments are available and provide techniques to help those affected by this complex condition.

An introduction to antisocial personality disorder

Antisocial personality disorder (ASPD) is a type of personality disorder marked by a consistent pattern of disregard for the feelings and rights of others. People with ASPD can have difficulty forming or maintaining meaningful relationships and may have a history of struggles with violence, theft, or substance use. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), for a person to be diagnosed with ASPD, they must have exhibited symptoms of conduct disorder prior to turning 15. 

Individuals with ASPD may show signs such as: 

• Manipulation

• Deception

• Reckless behavior

• Aggression

• Lack of remorse or concern for others

• Inability to control anger

• Abnormal social behavior

Antisocial personality disorder can significantly impact an individual’s mental health, relationships, and ability to function. People with antisocial personality disorder are at high risk of engaging in criminal activity and can struggle to remain employed. 

Diagnosing antisocial personality disorder can be a complex process due to the common presence of co-occurring conditions. The symptoms of different mental health disorders can overlap or mask each other and lead to the need for a dual diagnosis by a mental health professional. For example, someone with ASPD can display signs of impulsivity, antisocial behavior, or aggression that may be attributed to the disorder alone but can actually be a result of underlying disorders such as depression, anxiety, or attention-deficit/hyperactivity disorder (ADHD). 

Symptoms of ASPD also overlap with those of other cluster B personality disorders. There are four cluster B disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, including antisocial personality disorder. The three other disorders are borderline personality disorder, narcissistic personality disorder, and histrionic personality disorder. These mental health conditions are characterized by erratic behavior, intense emotional responses, and fraught relationships. The similarities in the features and etiologies of these disorders can make it hard to distinguish between them or determine whether comorbidity exists. 

If you or someone you know might have an antisocial personality disorder, it may be helpful to seek a mental health practitioner who specializes in treating this disorder in order to find the right treatment plan. With proper treatment, individuals can learn skills to help manage their condition more effectively while improving their overall quality of life. 

Treating antisocial personality disorder

The treatment of antisocial personality disorder is usually centered around psychotherapeutic approaches, though medication may also be utilized. As stated in an article published in the Cochrane Database of Systematic Reviews, the goal of psychotherapy is to help people with ASPD “develop a better understanding of themselves, others and their difficulties”. 

It is important to note that there is no one treatment strategy that is known to be effective for people with ASPD. The exact cause of antisocial personality disorder is unknown, but it may result from various underlying factors unique to each individual. For example, the Diagnostic and Statistical Manual of Mental Disorders makes it clear that conduct disorder is a precursor to antisocial personality disorder. Because of this connection, children and adolescents with conduct disorder are more likely to develop ASPD. But there are several other genetic, biological, and environmental influences that can contribute to the development of antisocial personality disorder. Understanding these factors can lead to more personally tailored treatment strategies. 

In some cases, medications may be prescribed to help manage symptoms and conditions that occur alongside ASPD. These symptoms can be similar to those experienced with conditions like anxiety, bipolar disorder, and depression. In other cases, CBT or anger and violence management might be used to help individuals gain insight into their condition and learn strategies for managing it more effectively. 

Cognitive behavioral therapy (CBT)

Cognitive behavioral therapy (CBT) is an evidence-based therapy that focuses on changing unhealthy thought patterns and behaviors. CBT aims to help individuals become more aware of their thoughts and feelings while also teaching them how to make consistent positive changes in their behavior. Through CBT, individuals with ASPD may become able to better control their impulses and learn new skills such as adaptability, problem-solving, and communication. 

Some research suggests that CBT may help individuals with ASPD experience less problematic alcohol use, more positive beliefs about others, and better social functioning. A common goal of CBT is to teach patients how to examine their thoughts and behaviors and replace negative beliefs about themselves with self-compassion. Additionally, CBT may be useful for helping people learn how to interact appropriately with others and understand the consequences of their actions. With proper guidance from a trained mental health professional, individuals living with ASPD may be able to make improvements in social settings or other areas of life.

A relatively new modality that utilizes CBT principles (as well as techniques from other types of therapy) is mentalization-based therapy. Originally created to treat borderline personality disorder, this approach focuses on helping participants manage their emotions and develop a better understanding of the mental states of others. Research shows that mentalization-based therapy can help alleviate symptoms like aggression and paranoia in people with antisocial personality disorder and related conditions. 

Anger and violence management

Aggression, hostility, and indifference are prominent symptoms of ASPD listed in the Diagnostic and Statistical Manual of Mental Disorders. Because of these challenges, anger and violence management techniques are often recommended for individuals with antisocial personality disorder. This type of therapy is designed to help clients develop better ways to manage their emotions and aggressive behavior. During therapy sessions, individuals can learn how to recognize triggers of aggression and learn strategies to become more aware of the triggers of outbursts. They can also learn how to modify their beliefs to reduce anger, resentment, and mistrust while identifying the root causes of these belief patterns. 

Studies on anger management counseling for antisocial personality disorder found that a combined approach may be the most effective way to manage the negative aspects of anger arousal leading to aggression in individuals with ASPD. This combined approach includes “both the enhancement of social skills and the reduction of physiological arousal (relaxation therapies).”

Treatment for ASPD should always involve seeking professional help from a qualified mental health provider. It is important to note that managing antisocial personality disorder may require patience and dedication from both the individual receiving treatment and those supporting them. 

Help through online therapy

Online therapy may be able to provide individuals with ASPD with a safe and nurturing environment to seek help and explore their concerns without feeling judged or misunderstood. With online therapy, sessions can take place wherever you have internet—including the comfort of home—which may be helpful for those who are reluctant to seek help in person due to shame or fear about their disorder. 

Research has also demonstrated the effectiveness of online therapy and of online cognitive behavioral therapy (CBT), in particular, which may serve as an approach to treat ASPD. In one study, researchers reviewed the evidence for the effectiveness of internet-delivered CBT, including primarily randomized trials and meta-analyses of intervention studies. Based on their review, the researchers concluded that “strong evidence from randomized controlled trials indicates that Internet-delivered CBT can be used in clinical practice for many patients.” This illustrates that online CBT can be a useful, effective alternative to face-to-face therapy, which may be relevant for individuals with ASPD interested in this kind of treatment.