Limited Empathy Or Remorse
People with ASPD may experience a limited capacity for empathy and can be more interested in benefiting themselves regardless of the expense it has on others. They may have no regard for morals, social norms, and the rights and feelings of others. People with Antisocial personality disorder may have difficulties in sustaining and maintaining relationships, and some have difficulty entering them. Interpersonal relationships often revolve around the exploitation and abuse of others. People with ASPD may display arrogance, think lowly and negatively of others, and have limited remorse for their harmful actions and have a callous attitude towards those they have harmed. Although behaviors vary in degree, individuals with this personality disorder will typically have limited compunction in exploiting others in harmful ways for their own gain or pleasure, and frequently manipulate and deceive other people. While some do so through a faÃ§ade of superficial charm, others do so through intimidation and violence. It is possible that people with ASPD may have intact cognitive empathy, but with a deficient theory of mind. Studies have found that people with ASPD have difficulty understanding other’s emotions and mental states. It also may be possible that people with ASPD do not lack empathy but are less inclined to use it.
Quality Of The Evidence
We identified 11 studies that met the criteria for inclusion in this review, involving a total of 411 participants with AsPD. Of these, only five provided usable data, involving 276 participants with AsPD. We judged the overall quality of the evidence from these trials to be relatively poor for the following reasons:
- The review relies on data from only five of the 11 included studies, despite attempts to contact the trial investigators for information on the AsPD subgroups.
- The study samples were heterogeneous they encompassed, for example, both prisoners and outpatients. In addition, AsPD was diagnosed under three similar but not identical rubrics .
- Where the completion rate was reported, it was high . This may be misleading because of the custodial element of some interventions. For example, Woodall 2007 had a 100% completion rate which might be expected given that one component of the intervention was incarceration.
- There was inconsistency in the way primary and secondary outcomes were measured and reported.
The authors consider that the body of evidence summarised in this review is insufficient to allow any conclusion to be drawn about the use of psychological interventions in the treatment of antisocial personality disorder.
Psychological Treatments For People With Antisocial Personality Disorder
Antisocial personality disorder is a condition that leads to persistent rule-breaking, criminality, and drug or alcohol misuse. It causes a great deal of hardship for the person concerned, as well as for the persons immediate family and society in general. This review systematically examines the evidence for the effectiveness of psychological treatments used to help people with antisocial personality disorder.
We considered 11 studies, but were unable to draw any firm conclusions from the evidence available. Although several studies looked at treatments to reduce drug or alcohol misuse in people with antisocial personality disorder, few studies focused on treating the disorder itself. Only three studies reported outcome measures that were originally defined in the review protocol as being of particular importance in this disorder . Nonetheless, there was some evidence that a type of treatment known as contingency management could help people with antisocial personality disorder to reduce their misuse of drugs or alcohol.
Further research is urgently needed to clarify which psychological treatments are effective for people with this disorder. This research is best carried out using carefully designed clinical trials. Such trials should focus on the key features of antisocial personality disorder. To be informative, they need to be carried out with samples of participants of sufficient size.
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At What Age Does Antisocial Personality Disorder Develop
Traits of ASPD usually develop during late childhood or the early teen years. Before age 18, the condition gets diagnosed as conduct disorder. Children with conduct disorder may lie, steal, ignore rules or bully other children.
Sometimes parents or healthcare providers miss the signs of conduct disorder. The signs may overlap with other conditions like attention-deficit/hyperactivity disorder , depression or oppositional defiant disorder.
When children get diagnosed and treated early, the condition may not continue into adulthood. If the behavior does continue, the diagnosis becomes antisocial personality disorder at age 18.
Types Of Therapy Used In The Treatment Of Antisocial Personality Disorder
Personality disorders develop out of ingrained patterns of thinking and behavior with highly charged emotional components. According to Brynmawr College, the complex interplay of emotion, perceptions and behavior make personality disorders in general very difficult to treat.
Antisocial disorder exists as the most common personality type with anywhere from 2.3 to 3.3 percent of the population meeting the criteria for the disorder. People suffering from antisocial personality disorder are driven by purely self-motivated intentions and they will stop at nothing to get what they want.
Therapies used to treat antisocial personality disorder attempt to help those affected identify abnormal behaviors and thought patterns using one or more treatment approaches.
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Psychotherapy For Individuals With Psychopathy/antisocial Personality Disorder
Internet Editors Note: Drs. Chakhssi, de Ruiter, and Bernstein recently published an article, along with their co-author Dr. Truus Kersten, titled Treating the untreatable: A single case study of a psychopathic inpatient treated with schema therapy in Psychotherapy.
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Cognitive Behavioral Theory Of Antisocial Personality Disorder
Although Young schema questionnaire scores are generally found to be higher in clients with personality disorders, there is still insufficient evidence to identify specific schemas for specific disorders. In the study that was conducted by Jovev and Jackson, it was aimed to examine which of the schema domains are specific in three personality disorders. For borderline personality disorder, high scores on dependence/incompetence, defectiveness/shame, and abandonment schema domains were detected while elevations on unrelenting standards and emotional inhibition schema domains were associated with obsessive-compulsive personality disorder and avoidant personality disorder, respectively . While Nordahl et al. found that vulnerability to harm, emotional inhibition, and insufficient self-control were associated with narcissistic personality disorder , in their nonclinical sample, Reeves and Taylor found that men endorsed more symptoms of ASPD and higher levels of the core beliefs of emotional deprivation, social isolation, defectiveness/shame, and emotional inhibition .
According to Millon and Everly, antisocial individuals tend to be interpersonally aggressive, abusive, and cruel. They have learned to rely on themselves and to distrust others because they have a fear of being exploited and humiliated by others. They are secured only when they are in control of the situation and are independent of the will of others who may threaten their security .
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Deterrence And Patient Education
- Antisocial personality disorder is one of the best-documented disorders in all of literature pertaining to psychiatry, including etiology, epidemiology, pathophysiology, neuroanatomy, heritability, and interventional treatment. However, an established treatment algorithm and specialized psychopharmacology currently fail to exist.
- Better preventative measures are necessary as many of those with ASPD may only have an evaluation upon incarceration after inflicting harm. One is not apt to seek help for ASPD symptomatology. Many only seek assistance for co-occurring mental disorders or only present for court-mandated assessments.
- Even with the remission rates in advanced ages, antisocial personality disorder causes much turmoil to the patient and the patientâs surrounding community. The lives of those with ASPD remain negatively impacted even after remission.
How The Intervention Might Work
Psychoanalytic therapies aim to help the patient understand and reflect on his inner mental processes and make links between his past and his current difficulties. To our knowledge, no randomised trials have been published assessing the efficacy of dynamic psychotherapies specifically for AsPD but there are a small number of trials which examined the effectiveness of psychoanalytic therapies for personality disorder in general. Limited evidence for the efficacy of psychodynamic psychotherapy comes from Bateman 2001, Chiesa 2003, Piper 1993 and Winston 1994.
Cognitive behavioural therapy based treatments place emphasis on encouraging the patient to challenge their core beliefs and to gain insight into how their thoughts and feeling affect their behaviour. A review of the evidence for this form of intervention concluded that the overall evidence in favour of cognitive behavioural therapy in the treatment of personality disorder is therefore relatively slim, with much of the evidence coming from one research group, but it has involved more patients than any other form of treatment .
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Aspd Sociopathy & Psychopathy
ASPD is often synonymous with non-diagnostic terms, such as sociopathy and psychopathy. There are differing perspectives on the usage of terminology, but neither is a DSM-5 disorder, and hence are not used diagnostically.2 Some believe they are similar disorders, others believe psychopathy is a more severe form of ASPD.
Psychopathy is most commonly measured using the Psychopathy Checklist Revised . It separates biological or innate characteristics such as low empathy, callousness from more social ones such as difficulty with employment, unstable housing. This dimensional measure of psychopathy is used in legal, clinical and research settings. It is often used as an actuarial risk assessment tool in measuring recidivism.
Not all people meeting criteria for ASPD will score high enough on the PCL-5 to be classified as having psychopathyhowever, those with psychopathy will likely always meet criteria for ASPD.3
Prevalence rates using DSM criteria are between 0.2 and 3.3% but these rates vary depending on the population and research methodology. Populations with the highest prevalence are men with substance abuse disorder, are incarcerated or in forensic settings, or that experience lower socioeconomic background or adverse sociocultural factors.1
Description Of The Condition
Antisocial personality disorder is one of the ten personality disorder categories in the current edition of the Diagnostic and Statistical Manual of Mental Disorders . DSM-IV defines personality disorder as: an enduring pattern of inner experience and behaviour that deviates markedly from the expectations of the persons culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment. General criteria for personality disorder according to DSM-IV are given in Table 1 below.
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Can Antisocial Personality Disorder Be Prevented
There is no known means of preventing antisocial personality disorder. In fact, the American Psychiatric Association wont allow a diagnosis to be made until the patient is at least 18 years old, though that diagnosis depends, in part, on evidence of antisocial behavior at a younger age. The best one can hope for is the early recognition of warning signs, with appropriate steps taken to counteract them.
Cognitive Therapy For Antisocial Personality Disorder
Cognitive therapy was initially established to help individuals suffering from depression, though the method has been applied to ASPD patients in modern treatments. Those with antisocial personality disorder usually lack the motivation to improve because they do not see themselves as others do, especially in a negative light. However, cognitive therapy can benefit the individual by helping them understand how they create their own problems through a distorted sense of self-perception.
For an individual with antisocial personality disorder to benefit from cognitive behavior therapy, they will need to attend sessions regularly and actively participate in any outside work or assignments that the therapist suggests.
Therapists must remain cautious of their own feelings to prevent their emotional bias toward their patients arrogance and unlikableness from disrupting the therapy process. The best option for cognitive behavior therapy must include a professional who is experienced in ASPD, anticipates the patients emotions and presents an attitude of acceptance without criticizing.
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Criteria For Considering Studies For This Review
Types of studies
Controlled trials in which participants have been randomly allocated to an experimental group and a control group, where the control condition is either treatment as usual, waiting list or no treatment. We included all relevant randomised controlled trials, with or without blinding of the assessors, and published in any language.
Types of participants
Men or women 18 years or over with a diagnosis of antisocial personality disorder defined by any operational criteria such as DSM-IV, or dissocial personality disorder as defined by operational criteria such as ICD-10. We included studies of people diagnosed with comorbid personality disorders or other mental health problems other than the major functional mental illnesses . The decision to exclude persons with co-morbid major functional illness is based on the rationale that the presence of such disorders might obscure whatever other psychopathology might be present and make it more difficult to evaluate the potential effect of any intervention. We placed no restrictions on setting and included studies with participants living in the community as well as those incarcerated in prison or detained in hospital.
Types of interventions
We included studies of psychological interventions, both group and individual-based. This included, but was not limited to, interventions such as:
Types of outcome measures
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 .
AsPD, like other personality disorders, often stems from trauma and other disruptions during childhood . 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 ones 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.
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Who Develops Antisocial Personality Disorder
Antisocial personality disorder affects more men than women.
It’s not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences, such as child abuse or neglect, are thought to play a role.
A person with antisocial personality disorder will have often grown up in difficult family circumstances.
One or both parents may misuse alcohol, and parental conflict and harsh, inconsistent parenting are common.
As a result of these problems, social services may become involved with the child’s care.
These types of difficulties in childhood will often lead to behavioural problems during adolescence and adulthood.
Search Methods For Identification Of Studies
The following electronic databases were searched to September 2009:
- the Cochrane Central Register of Controlled Trials
- Cochrane Schizophrenia Groups register of trials related to forensic mental health
- National Criminal Justice Reference Service Abstracts
- UK Clinical Trials Gateway*
- Kings College London *
- ISRCTN Register*
- NHS Trusts Clinical Trials Register*
- NHS R & D Health Technology Assessment Programme Register * and
- NHS R & D Regional Programmes Register*.
*Searched using the meta Register of Controlled Trials .
Searching other resources
We searched the reference lists of included and excluded studies for additional relevant trials. We examined bibliographies of systematic review articles published in the last five years to identify relevant studies. We contacted authors of relevant studies to enquire about other sources of information and the first author of each included study for information regarding unpublished data.
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Will Antisocial Personality Disorder Go Away
There is no cure for antisocial personality disorder. People generally manage the condition throughout their lives. But medication and therapy can help you cope with certain aspects of the disorder. The right treatment may help you adjust your behavior and reduce harm to those around you. Maintaining healthy relationships and a support system are key factors in managing ASPD long term.
Symptoms Of Antisocial Personality Disorder
Whereas signs of ASPD are often what people see and perceive in the person with the disorder, symptoms are the subjective experience of the person with ASPD. Symptoms of this ASPD often co-occur with other disorders which can complicate clinical presentation.
However, common features of ASPD symptoms include:
- Lack of empathy and inability to view situations from other perspectives.
- Hostility, anger, and fits of rage
- Feeling impulsive, high need for stimulation which can lead to substance abuse, promiscuity, and reckless behaviors
- Desire for control, lying, and manipulation of others
- Inability to feel remorse
- Difficulty feeling emotions, ability to mimic them
- Low autonomic nervous system arousal1,2,7
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Overall Completeness And Applicability Of Evidence
The evidence obtained from the included studies is relevant to the review question, but is incomplete for the following reasons:
- Although 11 different psychological interventions were compared, none of the studies evaluated psychodynamic psychotherapy, therapeutic community treatment, dialectical behaviour therapy, cognitive analytic therapy, mentalisation-based therapy or nidotherapy.
- The majority of studies did not primarily focus on the treatment of antisocial personality disorder, and in only two recruited samples did all participants have this diagnosis.
- Eight studies focused on participants with substance misuse difficulties. Although drug/alcohol misuse is often relevant to people with AsPD, having a substance abuse problem is not part of the diagnostic criteria for AsPD.
- The findings in two studies may not fully generalise to the population of interest: the sample in Woodall 2007 was drawn mainly from a Native American community found that women were significantly over-represented in their sample, and that individuals with more severe drug problems and less severe criminal histories were significantly more likely to have participated.