Treatment for antisocial personality disorder can be challenging, but there are ways to manage the condition and its associated symptoms.
Antisocial personality disorder (ASPD) can affect the way a person thinks, behaves, and how they relate to others.
People who live with ASPD often have trouble following social norms and laws, leading to challenges that may affect their day-to-day life. Sometimes it can result in job difficulties, financial problems, and even trouble with the law.
Treatment for ASPD can be a challenge because most people with the condition don’t tend to seek treatment on their own, believing their behaviors aren’t objectively wrong. Some may seek treatment after their behaviors and actions begin to negatively affect them or someone else. For example, if they’re facing incarceration.
Others with ASPD seek treatment for a co-occurring condition, such as depression or substance use disorder.
While ASPD can be difficult to manage, it is not impossible to treat. Treatment often involves therapy and may include medications to help manage the symptoms of a co-occurring condition.
If you’ve been diagnosed with ASPD, reaching out to a healthcare or mental health professional can help you explore options that may suit you.
There are no medical tests (i.e., blood tests) that can determine if a person has ASPD.
If you think you may have ASPD, consider reaching out to a healthcare professional. They can do a medical evaluation to rule out other conditions that may be causing your symptoms.
They can also refer you to a mental health professional for further evaluation, if necessary.
If you’re referred to a mental health professional, they will likely conduct a psychological evaluation that may include a series of tests.
According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), three or more of the following behaviors must be evident to receive a diagnosis of ASPD:
- lack of concern for the safety of self or others
- failure to follow social norms
- engaging in actions that may be grounds for arrest or incarceration
- lying and deceiving others for personal profit or gain
- lack of remorse or empathy
- irritable and aggressive; often displaying violence towards others
- unable to keep a job or meet obligations
To avoid a misdiagnosis, try to be as honest as you can about your symptoms. This will ensure that an accurate diagnosis can be made and a treatment plan developed, if needed, that best fits your unique symptoms.
There’s no conclusive one-size fits all therapy for ASPD. There are treatments you might consider trying, however, to help you manage associated symptoms.
Parent management training (PMT)
Parent management training focuses on teaching children and young people with antisocial and other aggressive behaviors to learn new skills. Parents learn new strategies and guiding principles, which may help with socialization and behavior problems.
This therapy is based on incorporating these ideas:
- principles and strategies to improve how the person reacts, behaves, and thinks socially and emotionally
- teaching methods such as role play, practice, and other strategies aimed at improving behavior
- assessing treatment goals regularly to ensure progress
Some behaviors it may help include:
- improving behaviors in various situations
- preventing delinquent behaviors
- improving day-to-day functioning skills
- helping with employment issues
Contingency management (CM)
In contingency management, abstinence may be rewarded with money or privileges.
These types of incentives may hold the potential to encourage clients to stick to medication and treatment plans.
This approach integrates elements from cognitive behavioral therapy, attachment object relations therapy, and other experimental therapies.
Cognitive behavioral therapy (CBT)
CBT works to identify and change unhelpful thinking and may address distorted thought patterns that may be an underlying feature of ASPD. Some of these negative thought patterns include:
- black and white thinking
In CBT, a therapist will work with you to identify these negative thought patterns and learn techniques and strategies to manage them.
Attachment object relations therapy
This form of therapy addresses how individuals perceive and relate to others. It brings awareness to secure and insecure attachments to other people.
It can potentially shed light on the results of avoidant, dismissive, or clingy behavior in relationships and encourage more helpful ways of relating.
Dialectical behavioral therapy (DBT)
The goal of this therapy is to help people manage strong emotions and possibly decrease the number of self-harm days in adults with ASPD.
Like CBT, dialectical behavior therapy can be helpful with black-and-white thinking and impulsiveness, which are symptoms of ASPD. DBT works to strengthen:
- emotional regulation
- interpersonal relations
- ability to handle discomfort
Psychotherapy or meeting with a therapist to discuss problems and goals can be useful in addressing anxiety or depression — symptoms often associated with ASPD. It may also help with learning to read social cues.
Additionally, psychotherapy can be a safe place to consider issues with addiction, relationship problems, or interpersonal skills.
There’s not enough evidence to support medications for ASPD. However, they may be helpful in managing the co-occurring conditions associated with ASPD.
Some medications that may be recommended for aggression include:
- antipsychotics, such as risperidone (Risperdal) or quetiapine (Seroquel)
- antidepressants, including the selective serotonin reuptake inhibitors (SSRIs) sertraline (Zoloft) or fluoxetine (Prozac)
- mood stabilizers, such as lithium or carbamazepine (Tegretol)
To help manage impulsivity, anticonvulsants such as oxcarbazepine (Trileptal) and carbamazepine may be used.
If you also have attention deficit hyperactivity disorder, bupropion (Wellbutrin) or atomoxetine (Strattera) may be recommended because they’re considered non-addictive in nature.
Hospitalizations are not considered effective for people with ASPD. They can be costly and ineffective. Also people with ASPD can be disruptive in hospital settings.
Hospitalizations may be the best option, however, for managing problems associated with related issues, such as substance use disorder.
You may not be able to directly manage your ASPD with self care at home, however, there are things you can consider doing to help soothe associated symptoms, including:
- cutting back or stopping alcohol or drug use; a support group like Alcoholics Anonymous or Narcotics Anonymous might help
- practicing at-home techniques, like deep breathing or exercise, to manage anxiety
If you’re helping someone with ASPD
Your involvement may be key to your loved one’s treatment, but remember that it may also be beneficial to prioritize your own wellness. You can try one of the following:
- yoga, meditation, or massage
- getting connected with a support group for family members and caregivers
- learning new coping skills
- joining groups like Alanon, if substance use is also an issue
Treating ASPD can be a challenge, but working collaboratively with a team of specialists can be effective for managing symptoms.
A collaborative team might include:
- a psychological specialist
- nursing or healthcare staff with psychological training
- a family or healthcare physician
- family support
- a pharmacist
Everyone working together can ensure continued engagement in the treatment plan.
If you’re not sure where to start, you can check out our find a therapist tool for guidance.