Treatment For Antisocial Personality Disorder

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.

Aspd Vs Bipolar Disorder

The symptom presentation of ASPD must be consistently present, and not only during active manic or depressive phases of Bipolar Disorder. Both disorders share symptoms of impulsivity, increased likelihood of criminal offending, substance abuse disorder and suicidal ideation.

Symptoms of ASPD and Bipolar Disorder often present as more severe when in combination. This is particularly true of people with an early onset of Bipolar and with a primarily manic presentation.19

How To Get Help For Antisocial Personality Disorder

If you or someone you care about is struggling with antisocial behaviors, and possibly ASPD, there are resources in the medical, mental health and school counseling fields. Treatment for ASPD is typically covered by insurance. Finding a specialty treatment provider for ASPD may prove difficult, but utilizing the directories provided by insurance companies may be a useful starting point.7

Getting treatment for a disorder that a person does not know or cannot admit that they have is nearly impossible. This is why many people who seek treatment for ASPD have been mandated by adjudication processes, or at the insistence of friends and family.

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Severity As A Potential Moderator Of Effect In Group

Does the pre-treatment level of the severity of disorder/problem have an impact on the outcome of group-based cognitive and behavioural interventions for offending behaviour? A meta-analysis of individual participant data should be conducted to determine whether the level of severity assessed at the beginning of the intervention moderates the effect of the intervention. The study could inform the design of a large-scale RCT to test the impact of severity on the outcome of cognitive and behavioural interventions.

Why this is important

Research has established the efficacy of cognitive and behavioural interventions in reducing reoffending. However, the effects of these interventions in a range of offending populations are modest. The impact of severity on the outcome of these interventions has not been systematically investigated, and post hoc analyses and meta-regression of risk as a moderating factor have been inconclusive. Expert opinion suggests that severe or high-risk individuals may not benefit from cognitive and behavioural interventions, but if they were to be of benefit then the cost savings could be considerable.

Emerging Of The Impulsive Lifestyle Counselling Program

The treatment workbook for Impulsive Lifestyle Counselling is based on a number of research projects in which Birgitte Thylstrup and Morten Hesse have explored the relationship between personality disorders and substance abuse. As a part of this work, they have tested and compared various treatment methods for people who are both suffering from mental health problems and receiving treatment for drug abuse.

Birgitte and Morten have also examined to what extend people felt helped by going through the Impulsive Lifestyle Counselling program with regard to their antisocial personality disorder.

On the right you find research articles from these research projects.

Birgitte Thylstrup and Morten Hesse have developed the Impulsive Lifestyle Counselling program. They are both psychologists, PhDs and associate professors at Centre for Alcohol and Drug Research and have researched and worked with people who have drug or alcohol problems and mental health issues through more than 15 years.

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The Use Of Medication To Treat People With Antisocial Personality Disorder

Background

People with antisocial personality disorder may behave in a way that is harmful to themselves or others, and is against the law. They can be dishonest and act aggressively without thinking. Many misuse drugs and alcohol. Certain types of medication may help people with AsPD. This review updates one published in 2010.

Review question

What are the beneficial and harmful effects of medication on aggression, reconviction , and people’s ability to function in society?

Study characteristics

We searched for relevant studies up to 5 September 2019 and found 11 randomised controlled trials a type of study in which people were allocated at random to have either a medication or a placebo .

The studies included 416 AsPD participants, mostly male , with an average age of 39.6 years. Most studies were carried out in North America in outpatient clinics . Two studies were conducted in mixed settings and one apiece in an inpatient hospital or prison. Studies lasted between six and 24 weeks, and had no follow-up period. Data were only available from four of the 11 included studies for 274 participants with AsPD.

No study set out to recruit participants on the basis of having AsPD. Many participants presented primarily with substance abuse problems. The studies used methods that increased the risk of data being biased or untrue and that did not allow independent statistics to be calculated for this review.

Main results

Phenytoin versus placebo

Desipramine versus placebo

Why Is Treatment Of Antisocial Personality Disorder So Difficult

Most people with ASPD are mandated to treatment. Sources of mandate include courts, probation, parole, and child and family services. These mandates serve as a condition to stay out of prison.

Many affected people will enter treatment to prevent more severe consequences for their actions. However, they often remain unmotivated to change. Their motivation is to get out of trouble, not to develop a healthier lifestyle.

There are some cases in which an affected person decides to try to make a change in their life. This could be for different reasons, like relationships or circumstances that motivate change. In these instances, there is a higher chance of seeing improvement.

Treatment must stay consistent. While there may be motivation for change, the process toward change is complicated. People with ASPD will need to reconstruct most of their lives. They will need to think, feel and behave differently. This takes time, patience, and consistency.

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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 .

Personality Disorders With Similar Traits

What can make a diagnosis of ASPD difficult are the overlapping symptoms it shares with other mental health disorders. Because there are other disorders that mimic ASPD, special care must be taken to properly evaluate the persons illness.

Similar personality disorders include:

• Psychopathic personality disorder. Psychopathic personality is very similar to ASPD. The main difference is that psychopaths can come across as charming when it will serve him or her. They also tend to be sexually promiscuous.
• Narcissistic personality disorder. A narcissistic personality is similar to an antisocial personality in that NPD has little regard for others and feels no guilt or remorse. NPD differs in that the narcissist generally lacks the criminal behaviors of ASPD.
• Borderline personality disorder. Borderline is similar to ASPD, as they both feature impulsive and reckless behaviors and have a higher risk of suicide. Borderline, though, features extreme mood swings, whereas ASPD doesnt.

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Organisation And Planning Of Services

There has been a considerable expansion of services for people with antisocial personality disorder in recent years involving a wider range of agencies in the health and social care sector, the non-statutory sector and the criminal justice system. If the full benefit of these additional services is to be realised, effective care pathways and specialist networks need to be developed.

1.6.1. Multi-agency care

1.6.2. Inpatient services

1.6.2.1.

Healthcare professionals should normally only consider admitting people with antisocial personality disorder to inpatient services for crisis management or for the treatment of comorbid disorders. Admission should be brief, where possible set out in a previously agreed crisis plan and have a defined purpose and end point.

1.6.2.2.

Admission to inpatient services solely for the treatment of antisocial personality disorder or its associated risks is likely to be a lengthy process and should:

• be under the care of forensic/specialist personality disorder services
• not usually be under a hospital order under a section of the Mental Health Act .

1.6.3. Staff training, supervision, support

Working in services for people with antisocial personality disorder presents a considerable challenge for staff. Effective training and support is crucial so that staff can adhere to the specified treatment programme and manage any emotional pressures arising from their work.

Staff competencies

Supervision and support

Are There Medications For Antisocial Personality Disorder

Medication generally only helps people with aggression, depression or erratic moods alongside ASPD. Your healthcare provider may recommend:

• Antidepressants, which can regulate serotonin levels in your brain. Examples include sertraline and fluoxetine.
• Antipsychotics, which can control violent behavior or aggression. Examples include risperidone and quetiapine.
• Mood stabilizers, which help manage severe changes in mood or behavior. Examples include lithium and carbamazepine.

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Antisocial Personality Disorder Prognosis

Antisocial personality disorder prognosis is poor although, symptoms tend to peak during the 20s, and, as mentioned, sometimes improve during middle age.

APA ReferenceGluck, S. . Antisocial Personality Disorder Treatment, HealthyPlace. Retrieved on 2022, September 24 from https://www.healthyplace.com/personality-disorders/antisocial-personality-disorder/antisocial-personality-disorder-treatment

Treating Other Medical Needs

Even if antisocial personality disorder itself cannot be treated, people with the condition can seek treatment for other mental health problems. Psychiatric conditions in general are much more common in this population than in the general population.

In one study, 90 percent of people with antisocial personality disorder had another mental illness. The most common coexisting diagnosis is a substance dependence disorder. Women with antisocial personality disorder are at higher risk for substance use disorders than men with the disorder.

Substance dependence may be treated with medication, depending on the specific addiction a person has. For example, a person with an opioid addiction may be prescribed Subutex , methadone, or extended-release naltrexone. Similarly, Vivitrol , acamprosate, and Antabuse can be used to treat alcohol dependence in a person with antisocial personality disorder.

People with an antisocial personality disorder diagnosis are also at higher risk for anxiety and depression. About half of all people with antisocial personality disorder have an anxiety disorder, and about one-quarter of them have depression. These conditions are treated similarly in those with and without antisocial personality disorder. But there is not much research on whether those treatments are as effective in people with antisocial personality disorder.

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Medication For Antisocial Personality Disorder

Another systematic review in 2010 examined the evidence on medication for antisocial personality disorder. But none of the eight studies the researchers found included only people with ASPD as participants, and most focused on treating substance dependence. One study found that the antidepressant drug Pamelor helped treat misuse of alcohol in people with antisocial personality disorder.

Researchers have also studied antiepileptic drugs for treating aggression in people with antisocial personality disorder. These drugs are typically used to control seizures in people with epilepsy as well as to treat mood disorders, such as bipolar disorder. They are additionally prescribed to treat aggression or impulsivity in certain psychiatric or neurological disorders.

The 2010 review included one study in which the anti-epileptic drug Dilantin helped reduce the intensity of impulsive aggressive acts in people with antisocial personality disorder. Another study also found that the anti-epileptic drugs Depacon or Depakote , Tegretol , and Trileptal , in addition to phenytoin, reduced aggression in this population. But in a different, third study, valproate, carbamazepine, and phenytoin had no effect on aggression.

Contradictory results of studies can be frustrating for families who want a person with this condition to get help. Unfortunately, scientists have not been able to find treatments that consistently work.

When Should I Call My Doctor About Aspd

If you or someone you know has any of the following symptoms, seek medical attention right away:

• Extreme changes in mood.
• Suicidal thoughts.
• Violent behavior.

You can call the National Suicide Prevention Lifeline at 800.273.8255. This hotline connects you to a network of local crisis centers that provide free and confidential emotional support. The centers support people in suicidal crisis or emotional distress 24 hours a day, 7 days a week. In an emergency, call 911.

A note from Cleveland Clinic

ASPD causes people to act without thinking how they’re affecting others. Someone with ASPD may break rules or laws. They often show no remorse and take no responsibility. Psychotherapy and certain medications may help people with ASPD. With treatment, they may be able to control their thoughts and behavior. Healthcare providers, such as psychiatrists and psychologists, do thorough assessments to diagnose ASPD. They can recommend the right treatment plan.

Last reviewed by a Cleveland Clinic medical professional on 05/12/2021.

References

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Impulsive Lifestyle Counselling Found Most Effective

The psychoeducation program, Impulsive Lifestyle Counselling , has been proved to be the more effective treatment of antisocial personality disorder in relation to addiction treatment compared to treatment as usual. ILC is based on the American psychologist, Matthew D. Geyers guide, ‘Criminal Lifestyle Curriculum.

What Is Antisocial Personality Disorder

Antisocial personality disorder is a mental health condition. People with ASPD show a lack of respect toward others. They dont follow socially accepted norms or rules. People with ASPD may break the law or cause physical or emotional harm to the people around them. They may disregard consequences or refuse to take responsibility for their actions.

ASPD is one of many personality disorders. Personality disorders affect the way someone thinks or behaves.

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Psychopathy And Dangerous And Severe Personality Disorder

People with psychopathy and people who meet criteria for dangerous and severe personality disorder represent a small proportion of people with antisocial personality disorder. However, they present a very high risk of harm to others and consume a significant proportion of the services for people with antisocial personality disorder. In the absence of any high-quality evidence for the treatment of DSPD, the Guideline Development Group drew on the evidence for the treatment of antisocial personality disorder to arrive at their recommendations. Interventions will often need to be adapted for DSPD . People with DSPD can be seen as having a lifelong disability that requires continued input and support over many years.

1.5.1. Adapting interventions for people who meet criteria for psychopathy or DSPD

1.5.2. Intensive staff support

1.5.2.1.

Staff providing interventions for people who meet criteria for psychopathy or DSPD should receive high levels of support and close supervision, due to increased risk of harm. This may be provided by staff outside the unit.

Treatment In Antisocial Personality Disorder

When a therapist works with a client with antisocial personality disorder many challenges would be there from the beginning. First of all, most of the professionals believed that antisocial personality disorder is an untreatable condition. Thats why they are reluctant to treat patients with ASPD. On the other side of the relationship antisocial patients that are coming for therapy are also very reluctant .

It is not common that an individual with ASPD goes to the therapists office for getting help for the problems that are already considered so by the environment. They usually come to therapy when their conventional strategies have stopped working and have not been able to get what they wanted or the law or unofficial authority has threatened them. In these conditions, subjects of the admission are usually mood problems, behavioral problems, and alcohol and substance use problems. Another issue while working with ASPD is motivation. From the stages of change perspective, individuals with ASPD are usually at precontemplation or contemplation stages. This suggests that these people believe the source of the problem is from the outside they are not the responsible one or there is some kind of problem but they cannot do anything to solve it.

Cognitive interventions include introduction of conditional and unconditional beliefs first cognitive restructuring of the intermediate beliefs in terms of rationality and functionality positive schema log and behavioral experiments.

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Effective Forms Of Treatment For Antisocial Personality Disorder

It is difficult to recover from ASPD. Even though it is difficult, there are effective forms of therapy. These forms of therapy will only work for those who are motivated to change.

Such forms of therapy include:

Cognitive therapy. Cognitive therapy is effective for treating ASPD. It helps the affected person understand how their thoughts affect their behavior.

Cognitive therapy also slows down impulsive behaviors that can cause them trouble. By modifying thoughts, emotional reactions and behavior will change.

Family therapy. Many people with ASPD find their motivation for change from relationships. They want their relationships with partners, family, and friends to improve.

It is sometimes helpful to have family involved with therapy. This can provide consistency outside of therapy. It can also provide understanding and patience to all parties involved.

Anger management. Antisocial personality disorder is associated with anger, rage, and poor consequential thinking. Anger management teaches techniques to manage the snap reactions triggered by anger.

Addiction programs. Many people with ASPD also have issues with substance use and addiction. When a person in treatment for ASPD also has a history of substance use, they may be referred to a substance use treatment center for assessment.