Antisocial personality disorder (ASPD) is a mental health condition that can impact an individual’s mood, behavior, and interpersonal relationships. Common symptoms include violent and criminal behavior, a lack of empathy and remorse, and volatile relationships. Evidence for effective ASPD treatment is limited, but there are various options that may be helpful.
Key takeaways
- Evidence for effective antisocial personality disorder treatment is limited, partly because engagement and completion can be difficult.
- Psychological therapies may target thinking patterns, emotional regulation, relationships, and co-occurring substance use.
- Medication may address particular symptoms or additional conditions, while healthy routines and support can complement care.
Antisocial personality disorder therapies
Evidence for ASPD treatment is limited, but a diagnosis should not exclude someone from care. NICE emphasizes a trusting relationship and treatment of co-occurring conditions. Options should be individualized[1][2][3].
Group-based cognitive and behavioral therapies
The purpose of group-based therapy for individuals with ASPD is to provide a setting to learn skills to improve interpersonal relationships and difficulties. Additionally, these group therapies help people reduce antisocial and criminal behaviors and learn to control impulsive behaviors[4].
Alcohol or substance use therapy
Co-occurring alcohol or drug problems deserve treatment in their own right. Addressing them can be an important part of an individualized care plan[2][4][1][5].
Cognitive behavioral therapy (CBT)
CBT can be a helpful intervention for individuals with milder symptoms who wish to engage in treatment. The purpose of CBT is to learn how to identify and challenge harmful thoughts and behaviors, and then develop new and more positive patterns[6][7].
CBT techniques can be applied to symptoms of ASPD, such as aggression and violence, helping the individual to adapt these behaviors. Similarly, it can be applied to comorbid symptoms, such as depression and anxiety, by allowing the individual to learn coping strategies for emotional distress and reduce the risk of self-harm or suicide[3].
Mentalization-based therapy
Mentalization-based therapy is a therapeutic approach that teaches individuals to be more aware of their thoughts and emotions and how these impact their behaviors. This can help individuals with ASPD to identify the mental processes that occur in reaction to others or challenging situations. Thus, they may learn how to regulate their responses and reduce antisocial or violent behaviors[7][8].
Dialectical behavior therapy (DBT)
DBT is not established here as a universal ASPD treatment. Discuss the target symptoms and evidence with the clinician; NICE specifically advises considering group cognitive and behavioral interventions[9][1].
Schema-focused therapy (SFT)
Schema-focused approaches aim to address longstanding patterns. Their suitability should be assessed individually; the NICE guidance cited here does not establish schema therapy as a standard ASPD treatment[1][3].
Antisocial personality disorder medication
There are no FDA-approved medications for the treatment of ASPD, as there is limited evidence for the effectiveness of medicinal treatment for this condition[6]. Additionally, there is a high risk within this population of medication noncompliance, misuse, or drug and alcohol interaction, so medications can potentially create additional risks[4].
Many people with ASPD have comorbid conditions, such as depression, alcohol or substance use disorders, and anxiety disorders, which can often be effectively treated with medication. Medications are sometimes prescribed to individuals with ASPD to help manage these conditions or specific symptoms[6][10].
Subject matter expert
Personality disorders, anxiety, and depression
View profileAntidepressants
For example, antidepressant medications can be used to manage low mood, suicidal ideation, anxiety symptoms, impulsive behaviors, and addiction or withdrawal symptoms. This might include selective serotonin reuptake inhibitors (SSRIs), such as sertraline, fluoxetine, and citalopram[10][11].
Antipsychotics
Antipsychotic medications may be prescribed to individuals with ASPD to help manage symptoms, such as aggressive or violent behaviors, impulsivity, and extreme mood changes. This might include medications such as risperidone and quetiapine[2][10].
Mood stabilizers
Anticonvulsant or mood stabilizer medications may be prescribed to manage symptoms such as impulsivity, aggression, violence, and extreme mood changes. This could include medications such as lithium and carbamazepine[7].
Addiction and withdrawal
Medications might also be prescribed to people with ASPD to help reduce substance and alcohol use or manage withdrawal symptoms. This could include[11]:
- Disulfiram or naltrexone for alcohol dependence
- Methadone or buprenorphine for opioid dependence
- Bupropion, benzodiazepines, or anxiolytics for withdrawal symptoms
Do people with antisocial personality disorder ever require hospitalization?
NICE generally reserves inpatient care for crisis management or treatment of co-occurring disorders, with a clear purpose and planned endpoint[1][4].
It is recommended that ASPD inpatient treatment should have a clear purpose and end date to prevent unnecessarily prolonged hospitalization. It is believed that ASPD can only be effectively treated in hospitals in specific circumstances. As such, hospitalization is unlikely to be beneficial and may potentially cause unnecessary risks to the individual or others and may worsen symptoms[4][10].
When people with ASPD receive inpatient treatment, it should be in specialized or forensic services, with staff specifically trained to work with this condition. This ensures that risks are effectively managed, boundaries managed and enforced, and violence or specific needs are responded to appropriately[4].
It is more common for individuals with ASPD to be in prison than in a psychiatric hospital, as this group has a high prevalence of drug- or violence-related crime. It is debated among professionals whether this is a suitable placement for these individuals, as they may pose a risk of harm to others, and their symptoms may be exacerbated if appropriate care is not provided[2][5].
Self-care strategies for people with antisocial personality disorder
People should be involved in their care decisions and offered practical support. Self-care can complement professional treatment, including help for co-occurring symptoms. Options include:[1][2][12]
- Reducing alcohol or substance use: Symptoms may be improved by reducing the use of alcohol or illicit substances. Some may be able to achieve this without needing professional intervention, although various services and resources can help if required.
- Seeking professional help: Asking for help can feel challenging and frightening. However, it is often much easier to cope with emotional distress with the support of a trained professional. Additionally, professionals can provide advice and information about ASPD and any co-existing conditions that may help to understand and manage symptoms.
- Talking to friends and family: Speaking to loved ones about worries and negative emotions can help to reduce their impact. Having a support network can significantly improve symptoms such as low mood, loneliness, and anxiety and make it easier to cope with distressing circumstances.
- Making healthy choices: Forming healthy habits can significantly improve mental and physical health. This might include eating a healthy and balanced diet, utilizing a sleep routine, and exercising regularly.
- Mindfulness and relaxation exercises: Utilizing mindfulness and relaxation exercises can help to improve several symptoms, such as stress, anxiety, depression, and agitation. This could include breathing exercises, yoga, meditation, body scanning, or relaxing activities such as going for a walk or taking a bath.
