From the Guidelines
Antisocial Personality Disorder (ASPD) should be treated with a combination of psychotherapy, particularly cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT), and medications such as low-dose antipsychotics, mood stabilizers, and SSRIs to manage specific symptoms and improve quality of life. When diagnosing ASPD, it is essential to consider the individual's history of disregard for others' rights, lack of empathy, and manipulative behaviors. Treatment is challenging and requires long-term commitment, typically lasting years rather than months. Some key points to consider in treatment include:
- Developing empathy and impulse control through therapy
- Managing aggression with low-dose antipsychotics like risperidone (0.5-2mg daily) 1
- Using mood stabilizers such as lithium (600-900mg daily) or valproate (750-1500mg daily) for impulsivity
- Prescribing SSRIs like sertraline (50-200mg daily) for co-occurring depression or anxiety
- Focusing on prosocial behaviors and repairing relationships damaged by the individual's behaviors through family therapy
- Addressing comorbid addiction and substance abuse It is crucial to prioritize early intervention, especially in adolescents showing conduct problems, as it yields better outcomes 1. The disorder has strong genetic and environmental influences, with childhood trauma and neglect being significant risk factors, and treatment should be tailored to address these underlying factors. Overall, a comprehensive treatment approach that incorporates psychotherapy, medication, and family support can help improve the quality of life for individuals with ASPD and reduce the risk of morbidity and mortality associated with the disorder.
From the Research
Diagnosis of Antisocial Personality Disorder (ASPD)
- Antisocial Personality Disorder (ASPD) is associated with a wide range of disturbances, including persistent rule-breaking, criminality, substance use, unemployment, homelessness, and relationship difficulties 2.
- The diagnosis of ASPD is often challenging due to the complexity of the disorder and the lack of effective treatment methods 3.
Treatment of ASPD
- Psychological interventions for ASPD have shown limited effectiveness, with few studies addressing the primary outcomes of aggression, reconviction, global functioning, social functioning, and adverse effects 2, 4.
- Cognitive-behavioral therapy (CBT), contingency management, and motivational interviewing have been found to be effective in improving certain outcomes, such as substance misuse and social functioning, but the evidence is limited and of low certainty 2, 4.
- Pharmacological interventions for ASPD have also been found to be ineffective, with most studies having methodological issues and limited sample sizes 5.
- Mentalisation-based treatment (MBT) tailored for ASPD has shown promise in reducing aggressive behaviors in males convicted of an offense on community probation in England and Wales 6.
Effective Interventions
- Contingency management, CBT, and the "Driving Whilst Intoxicated" program have been found to be effective in improving certain outcomes, such as substance misuse and social functioning, in individuals with ASPD 2, 4.
- MBT-ASPD has been found to be effective in reducing aggressive behaviors in males with ASPD, with a medium-to-large effect size 6.
Limitations and Future Research
- The current evidence base for ASPD treatment is limited, and further research is needed to develop effective interventions and to address the methodological issues of previous studies 2, 4, 3, 5.
- Future studies should focus on recruiting participants with ASPD, using relevant outcome measures, and exploring the generalizability and sustainability of treatment gains 6.