From the Research
Antisocial personality disorder (ASPD) should be treated with mentalisation-based treatment (MBT-ASPD), as it has shown promise in reducing aggressive behaviors and improving social functioning, according to the most recent and highest quality study available 1.
Diagnosis of ASPD
ASPD is a mental health condition characterized by a persistent pattern of disregard for the rights of others, lack of empathy, and manipulative behaviors. Diagnosis is typically made through a comprehensive clinical evaluation, including a thorough medical and psychological history, and assessment of symptoms using standardized diagnostic criteria.
Treatment of ASPD
Treatment of ASPD is challenging and requires long-term commitment, often lasting years. While there are no FDA-approved medications specifically for ASPD, certain medications may help manage specific symptoms:
- Antipsychotics like risperidone (0.5-2mg daily) for aggression
- Mood stabilizers such as lithium (600-900mg daily) or valproate (750-1500mg daily) for impulsivity
- SSRIs like sertraline (50-200mg daily) for co-occurring depression or anxiety Therapy focuses on developing empathy, impulse control, and social skills. Early intervention, especially in adolescence when conduct disorder is present, offers better outcomes.
Key Components of MBT-ASPD
MBT-ASPD is a promising intervention that targets the mentalizing vulnerabilities and attachment patterns of patients with ASPD. Key components of MBT-ASPD include:
- A semi-structured group process focused on personal formulation
- Establishing group values to promote learning from other members and generating "we-ness"
- Emphasizing mentalizing in relationships
Importance of Comprehensive and Persistent Therapeutic Approaches
Individuals with ASPD often have altered brain structure and function in areas responsible for emotional processing and decision-making, which explains the difficulty in treatment and the importance of comprehensive, persistent therapeutic approaches. A treatment framework based on 'state of the art' methods and best practices, offering guidelines on the treatment of ASPD, is urgently needed 2.
Some key points to consider when treating ASPD include:
- The need for a long-term commitment to therapy
- The importance of early intervention, especially in adolescence
- The use of medications to manage specific symptoms
- The need for a comprehensive and persistent therapeutic approach
- The potential benefits of MBT-ASPD in reducing aggressive behaviors and improving social functioning 1.