Therapy For Antisocial Personality Disorder: Exploring Mental Health Treatment For ASPD
Antisocial personality disorder (ASPD) is a mental health condition characterized by a pattern of disregard for the rights and feelings of others.
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 treatment for co-occurring disorders such as substance use disorders (SUDs).
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.
Signs you may see in individuals with antisocial personality disorder (ASPD)
- 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.
Diagnosis of ASPD and underlying mental health disorders
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.”
Effective treatment strategies
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 and be diagnosed with ASPD. However, 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.
Efficacy of online therapy
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.
Takeaway
Read more below for answers to questions asked about therapy for antisocial personality disorder.
How do you help the mental health of someone with antisocial personality disorder?
Community-based programs and psychological therapies can help improve the mental health condition of people with ASPD or antisocial personality disorder. It is often important to seek treatment for both antisocial personality disorder and any other mental health conditions. Sometimes, the person may have a substance use disorder or past adverse childhood experiences that need attention, too.
Working with healthcare providers helps create a care plan that can reduce impulsive behaviors and violent behavior. A closer look at a person’s medical history and family history with mental health can also guide the treatment.
Psychological interventions like therapy help address harmful behaviors and improve social skills. In some cases, group psychotherapy can help people work through issues with others who face similar challenges. Understanding and following the norms is a big part of improving their interactions with others.
What type of treatment is the therapy for antisocial personality disorder?
The main therapy for antisocial personality disorder is cognitive behavioral therapy (CBT), which helps change unhealthy thoughts and behaviors. Psychotherapy can help with managing impulsive behaviors and harmful behaviors. If someone has both antisocial personality disorder and a substance use disorder, therapy might include support for that, too.
Sometimes, people use FDA-approved medications to help with mood swings or other symptoms. Mood stabilizers may be used to help manage emotional highs and lows. It’s also important to consider the person’s family history and how it might affect their behavior. Group therapy is intended to help patients practice social skills and learn from others. Psychological interventions work best when they’re tailored to each person’s needs.
What therapy is best for a personality disorder?
There are several types of therapy that can be used to treat personality disorders, such as cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal therapy (IPT), or family-focused therapy.
Group psychotherapy is another option that works for many people, especially if they live with antisocial personality disorder. Psychotherapy can help people with impulsive behaviors learn to manage their reactions.
Behavior patterns that contribute to harmful behaviors may also be improved through different types of therapy. In some cases, therapy might include both individual and family-focused sessions. For people who also have a drug use disorder, a treatment that focuses on addiction might be added to the plan. The goal is usually to help the individual build healthier relationships and more stable emotions.
What is schema therapy for antisocial personality disorder?
Schema therapy, developed by psychologist Jeffrey Young, Ph.D., is an integrative approach derived mainly from cognitive behavioral theory. This also includes elements of the object relations theory and attachment theory.
Schema therapy is a type of therapy that recognizes underlying patterns of thought and behavior, particularly in individuals with antisocial personality disorder. It may resolve impulsive behavior and emotional suffering by exploring the impact of past experiences, including negative childhood experiences, on present behavior. This therapy seeks to alter harmful behaviors and improve relationships. It also helps people better understand psychopathic traits and learn to manage their emotions.
Psychotherapy can be part of schema therapy, making it easier to address the core issues that affect the person’s relationships and emotional state. Mood stabilizers or other medications might also be used to help control extreme mood swings. A key part of this therapy is learning to identify and change behavior patterns that may hold someone back from forming healthy relationships.
How do you manage antisocial behavior?
Managing antisocial behavior often involves using therapy to help individuals change their actions and improve their social skills. Psychotherapy is often the first step in helping someone learn to manage impulsive behaviors. Group therapy can be especially useful for people who want to learn from others who face similar struggles. Sometimes, mood stabilizers are used to help with extreme mood changes that may trigger harmful or violent behavior.
Working with healthcare providers helps the patient get the right treatment for both antisocial personality disorder and any other related conditions. Psychological interventions can address deeper emotional issues that lead to harmful behaviors. A close look at the person’s medical and family history can help inform treatment.
Sometimes, substance use disorder is diagnosed alongside antisocial personality disorder. In these cases, addiction treatment may help, too. Learning and following the norms is another important part of managing these behaviors.
How do you help someone with a personality disorder?
Helping people with personality disorders involves understanding their problems and offering support. It’s important to coordinate with healthcare providers who can provide treatment for the mental health conditions the patient may have. Therapy can help address symptoms and reduce emotional distress.
It’s often essential to look at a person’s family members and any other risk factors that may be affecting their behavior. Sometimes, the individual might have a history of alcohol use disorder or other mental health conditions that need attention as well. Impulsive behaviors can often be a part of the diagnosis, so helping the person learn impulse control may be key. Including the individual in their treatment plan and focusing on the person’s situation can also improve outcomes. Therapy may focus on managing anger and helping the patient navigate relationships and responsibilities.
Why is it difficult to treat antisocial personality disorder?
Treating antisocial personality disorders is difficult because individuals with ASPD often struggle with impulse control, making their actions unpredictable. Symptoms like violent behavior or disregard for social norms can complicate treatment efforts. Anger, common in individuals with ASPD, can often lead to aggressive behavior and difficulties in maintaining relationships. The diagnostic criteria for antisocial personality disorders also vary, making them harder to identify. Some individuals may also have a history of childhood psychopathology that contributes to their behaviors. Alcohol use disorder or other substance issues can interfere with treatment as well.
People with this disorder may not recognize the need for help, making it challenging for healthcare providers to implement a treatment plan. Risk factors like adverse childhood experiences may need to be addressed for better long-term success. Since many people with antisocial personality disorder lack empathy, it can also be hard to form trusting therapeutic relationships.
What is the hardest mental illness to live with?
The hardest mental illness to live with can vary depending on the person, but personality disorders like antisocial personality disorder can be particularly challenging. Individuals with antisocial personality disorder often have impulsive behaviors and struggle to form lasting relationships. Symptoms like anger or violent behavior can make everyday life difficult. People with this condition may also have other mental health conditions, such as depression or alcohol use issues, which make their situation more complicated.
Suicidal thoughts may also occur in some individuals due to the emotional distress they experience. It can be hard to help someone who has been diagnosed with antisocial personality disorder because they may not seek treatment or acknowledge the need for help. Family members of individuals with this disorder often feel uncertain about how to provide support. Finding the right treatment, perhaps using a novel treatment approach, can sometimes help manage the condition.
How can you tell if someone has antisocial personality disorder?
To determine whether a person has antisocial personality disorder, look for signs of impulsive behaviors that often land them in trouble. These individuals may act in ways that hurt others and sometimes seek personal gain without caring about the consequences. You might notice symptoms like lying, aggression, or breaking the law.
People with antisocial personality disorder may also have a background in childhood psychopathology, which can explain some of their actions. Early childhood experiences, such as trauma or neglect, are likely to play a significant role in their behavior. When healthcare providers diagnose this disorder, they typically examine long-term patterns of behavior in the individual.
In some cases, individuals might also struggle with other mental health conditions, such as depression, which can add to the complexity of their symptoms. A careful differential diagnosis is crucial to make sure other issues aren't causing their behavior.
What do people with antisocial personality disorder lack?
Antisocial personality disorder affects a person in many ways, making it difficult for them to connect with others emotionally. The condition can affect how they interact with people, often leading to harmful behaviors and a disregard for social norms. The American Psychiatric Association outlines the diagnostic criteria to help professionals recognize this disorder. When someone is diagnosed with antisocial personality disorder, it’s important to consider the impact it can have on their relationships and decision-making skills. This disorder can affect their ability to feel empathy, making it challenging to form meaningful connections with others.
Individuals with antisocial personality disorder often lack empathy, or they don't care about other people's feelings. This prevents them from being able to create healthy, significant relationships. They may also lack impulse control, which may lead to dangerous or harmful behavior. This condition can affect their ability to follow social norms, and they may often disregard rules or laws for personal gain. The following symptoms can be common in these individuals:
- Deceit
- Aggression
- Breaking the law
They also might have difficulty experiencing emotional distress in the same way other people do. This lack of empathy and impulse control may lead to harmful behaviors.
Many people with antisocial personality disorder also struggle with medical conditions like depression or substance use problems, making it harder to manage their actions. These individuals may be recommended for medications or therapy to help manage their symptoms when diagnosed. Differential roles in therapy may be used to address these challenges and help improve their behavior.
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