How Antisocial Personality Disorder Is Treated

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Antisocial personality disorder (ASPD) is a mental health disorder characterized by a long-term pattern of manipulating, exploiting, or violating the rights of others without any remorse. ASPD causes significant problems in relationships and other areas of life. People with ASPD may also commit criminal acts.

ASPD is very challenging to treat. Often people with ASPD don't seek treatment unless they are required to by a court. When in treatment, they may be disruptive, unengaged, or even hostile toward the therapist.

No treatment has shown to be the most effective treatment for ASPD. There also isn't a first-line recommended treatment.

Some treatments have shown promise, and some people with ASPD see improvement in at least some of their symptoms with treatment.

Treatments that target certain behaviors and some forms of psychotherapy (talk therapy) interventions may help. Treating comorbid (coexisting) conditions, such as mood disorders or substance use disorders, can also be beneficial.

Read on to learn about how ASPD treatment is approached.

A young woman crosses her arms angrily while having a therapy session with a psychologist.

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Therapies for Antisocial Personality Disorder

There is limited research to support any specific psychotherapy for antisocial personality disorder (ASPD), although psychotherapy approaches are commonly tried.

The goals of therapy for ASPD are usually to help the person:

  • Manage their negative behaviors
  • Build interpersonal skills and understand how their behavior affects others
  • Reduce impulsive behaviors that can lead to harm (to themselves or others) or arrest

Treatment can involve individual therapy for the person, group therapy, family therapy, or a combination. Family members and those close to the person with ASPD may find value in therapy for themselves, as ASPD affects people close to the person with the condition too.

Therapy may also involve aspects of anger management, substance use disorder treatment, and other treatments that target specific symptoms, behaviors, or comorbid conditions.

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy (CBT) is a type of psychotherapy. It involves helping a person learn to identify thinking patterns and behavior that are maladaptive (not adequate or appropriate to the situation), dysfunctional (abnormal), or otherwise unhealthy. Over time, under the guidance of the therapist, the person learns to change these problematic thinking patterns and behaviors into ones that are healthier and more productive.

For people with ASPD, CBT may help them think about how their behavior affects others and gets them into trouble.

CBT is offered as individual therapy, group therapy, and/or family therapy.

Mentalization-Based Treatment (MBT)

People with ASPD often have difficulty mentalizing (recognizing and understanding the mental state of themselves and others).

Mentalization-based therapy focuses on the interaction between the person and the therapist. In this therapy, the therapist will focus on the present rather than the past and will work with you to enhance your emotional recognition and connection.

A 2016 study examined the effects of MBT on ASPD-associated behaviors in patients with comorbid borderline personality disorder (BPD) and ASPD. The treatment involved 18 months of weekly combined individual and group psychotherapy sessions provided by two different therapists.

The study found the participants who received MBT experienced a reduction in anger, hostility, paranoia, and frequency of self-harm and suicide attempts, as well as an improvement in negative mood, general psychiatric symptoms, interpersonal problems, and social adjustment.

More research is needed on how MBT affects people with ASPD, but the results are promising.

The authors of the study note that previous research suggests the ability to identify others’ emotions and intentions may help with social functioning and reduce the risk of antisocial behavior.

They also state that mentalizing has been shown to protect against aggression in people with violent traits and that encouraging mentalizing has been shown to reduce school violence.

Democratic Therapeutic Community (DTC)

According to some research, community-based programs can be an effective long-term treatment method for people with ASPD. It is becoming increasingly used in prison settings, particularly in Great Britain.

Democratic therapeutic community (DTC) is a type of social therapy involving large and small therapy groups. It addresses the person's emotional and psychological needs, as well as their risk of committing a criminal offense.

DTC focuses on community issues. In a prison setting, it aims to foster an environment in which both staff and incarcerated people contribute to the decisions of the community.

Educational and vocational work may also be offered.

A course of DTC treatment is recommended to run for 18 months.

Impulsive Lifestyle Counselling

Impulsive lifestyle counseling is a brief psychoeducational (the process of providing education and information to those seeking or receiving mental health services) program. It was developed for people with coexisting ASPD and substance use disorder.

The program involves six one-hour sessions. It has been tested as an add-on to outpatient substance use disorder treatment, with promising results.

Research suggests impulsive lifestyle counseling can improve the likelihood the person will stay in treatment and reduce substance use compared with typical treatment alone.

A 2015 trial found moderate short-term improvements in substance use with impulsive lifestyle counseling, suggesting providing psychoeducation to outpatients with antisocial personality disorder would be useful.

A 2016 study showed support for the use of impulsive lifestyle counseling programs as a method for preventing treatment dropout for patients with comorbid antisocial personality disorder in substance use disorder treatment.

How Does ASPD Change Over Time?

ASPD starts in childhood or early adolescence with 80% of people with the disorder having developed symptoms by the age of 11.

Before the age of 18, children who exhibit symptoms of ASPD are diagnosed with conduct disorder (a serious behavioral and emotional disorder). Not every child with conduct disorder will go on to develop ASPD, but if the symptoms persist past age 18, and the criteria are met, a diagnosis of ASPD is made.

Symptoms of ASPD can improve with age. Often symptoms are at their most challenging in the late teens and early 20s and improve by the time the person reaches their 40s.

Prescription Medications for ASPD

There is no medication approved for specifically treating ASPD. Typically, if medication is prescribed, it is to target certain symptoms, such as aggression, depression, or erratic moods, or to treat comorbid conditions.

Some medications that may be prescribed to people with ASPD include:

  • Antidepressants: These medications can help regulate levels of certain mood-boosting neurotransmitters in the brain.
  • Antipsychotics: This class of drugs may help control impulsive aggression.
  • Mood stabilizers: These drugs help manage severe changes in mood.

A 2020 review of studies on using medication to treat ASPD found that the reliability of current data is very low and that there was not enough evidence to determine whether medication is effective at treating people with ASPD.

More research is needed to determine which medications, if any, are recommended for the treatment of ASPD. In the meantime, people with ASPD should discuss all their symptoms with their healthcare provider or mental health professional to see if medication would be right for them and their needs.

Can ASPD Be Effectively Treated?

Antisocial personality disorder is one of the most difficult types of personality disorders to treat, but evidence suggests behavior can improve over time with therapy.

It may be important to involve the family and friends of the person with ASPD in their treatment and care.

Having a support system and learning to maintain healthy relationships are key factors in managing ASPD over the long term.

Summary

ASPD is difficult to treat and there are no clearly validated therapies or medications indicated specifically for treating it.

Some people with ASPD find therapy and/or medication helps them, especially for certain symptoms and for comorbid conditions.

For some people with ASPD, certain symptoms improve on their own by the time they reach their 40s.

Help Is Available

If you or a loved one are struggling with antisocial personality disorder, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Helpline at 800-662-4357 for information on support and treatment facilities in your area.

For more mental health resources, see our National Helpline Database.

A Word From Verywell 

ASPD is difficult both for the person living with it and their loved ones. If you have ASPD, talk to your healthcare provider or mental health professional. They can help you find ways to manage your symptoms, foster healthier relationships, and make it easier to function within a community.

If you have a loved one with ASPD, encourage them to seek help. Remember it's important to take care of yourself too. Getting help from a mental health professional can help you find ways to support your loved one, and help you manage your own needs and mental well-being.

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8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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