From the Research
The prognosis for antisocial personality disorder (ASPD) is generally considered poor, with symptoms often persisting throughout life, though they may gradually decrease in intensity with age, particularly after 40. Treatment outcomes are limited by several factors including patients' lack of insight, reluctance to engage in therapy, and difficulty forming therapeutic relationships. There is no FDA-approved medication specifically for ASPD, though pharmacotherapy may target specific symptoms like impulsivity, aggression, or co-occurring conditions.
Key Considerations
- Psychotherapy approaches showing some benefit include cognitive behavioral therapy, mentalization-based therapy, and contingency management, typically requiring long-term commitment of at least 6-12 months 1.
- Early intervention, especially in adolescents with conduct disorder, offers better chances for improvement.
- Substance abuse treatment is often necessary as comorbid addiction affects a significant portion of individuals with ASPD.
- Prognosis improves with stable employment, supportive relationships, and aging, as impulsivity and criminal behaviors tend to decrease naturally over time.
Evidence-Based Recommendations
- Contingency management (CM) + standard maintenance (SM) may improve social functioning measured by family/social scores on the Addiction Severity Index (ASI) for outpatients at six months 1.
- Cognitive behaviour therapy (CBT) + treatment-as-usual (TAU) versus TAU found no evidence of a difference between CBT + TAU and TAU for physical aggression and social functioning for outpatients at 12 months post-intervention 1.
- Impulsive lifestyle counselling (ILC) + TAU versus TAU found no evidence of a difference between ILC + TAU and TAU for trait aggression and the adverse event of death or incarceration for outpatients between three and nine months follow-up 1. However, the fundamental personality traits and interpersonal difficulties often remain, requiring ongoing management rather than expecting complete resolution.