Treatment for Antisocial Personality Disorder
No medications are routinely used or specifically approved for ASP treatment. Several drugs, however, have been shown to reduce aggression, a common problem for many antisocials.
The best-documented medication is lithium carbonate, which has been found to reduce anger, threatening behavior and combativeness among prisoners. More recently, the drug was shown to reduce behaviors such as bullying, fighting and temper outbursts in aggressive children.
Phenytoin (Dilantin), an anticonvulsant, has also been shown to reduce impulsive aggression in prison settings.
Other drugs have been used to treat aggression primarily in brain-injured or mentally retarded patients. These include carbamazepine, valproate, propranolol, buspirone and trazodone.
Antipsychotic medications also have been studied in similar populations. They may deter aggression, but potentially induce irreversible side effects. Tranquilizers from the benzodiazepine class should not be used to treat people with ASP because they are potentially addictive and may lead to loss of behavioral control.
Medication may help alleviate other psychiatric disorders that coexist with ASP, including major depression, anxiety disorder or attention-deficit/hyperactivity disorder, thus producing a ripple effect that can reduce antisocial behavior. Mood disorders are some of the most common conditions accompanying ASP and are among the more treatable. For reasons that remain unknown, depressed patients with personality disorders tend to not respond as well to antidepressant medication as depressed patients without personality disorders.
Antisocials with bipolar disorder may respond to lithium carbonate, carbamazepine or valproate, which can help stabilize moods and may lessen antisocial behavior as well. Stimulant medication can be used to reduce symptoms of attention deficit disorder, a condition that can compound the aggression and impulsivity that may accompany ASP. Stimulants must be considered judiciously because they can be addictive. Uncontrollable and dangerous forms of sexual behavior may be targeted by injections of medroxyprogesterone acetate, a synthetic hormone that reduces testosterone levels.
Addiction and Family Counseling
Alcohol and drug abuse present major barriers for treatment of a person with underlying ASP. Although abstinence from drugs and alcohol does not guarantee a reduction in antisocial behavior, people with ASP who stop abusing drugs are less likely to engage in antisocial or criminal behaviors and have fewer family conflicts and emotional problems. Following a treatment program, patients should be encouraged to attend meetings of Alcoholics Anonymous, Narcotics Anonymous or Cocaine Addicts Anonymous.
Pathological gambling (a separate disorder that is quite different from social or professional gambling) is another addictive behavior common to antisocials. Although few formal treatment programs exist for people so preoccupied with gambling that nothing else matters, antisocials with the disorder should be encouraged to attend Gamblers Anonymous.
Antisocials with spouses and families may benefit from marriage and family counseling. Bringing family members into the process may help antisocial patients realize the impact of their disorder. Therapists who specialize in family counseling may help address the antisocial person’s trouble maintaining an enduring attachment to his spouse or partner, his inability to be an effective parent, problems with honesty and responsibility, and the anger and hostility that can lead to domestic violence. Antisocials who were poorly parented may need help learning appropriate parenting skills.
Incarceration may be the best way to control the most severe and persistent cases of antisocial personality disorder. Keeping antisocial offenders behind bars during their most active criminal periods reduces their behaviors’ social impact.
Black, D. (2013). Treatment for Antisocial Personality Disorder. Psych Central. Retrieved on April 28, 2015, from http://psychcentral.com/lib/treatment-for-antisocial-personality-disorder/000656