Few individuals seek medical attention specifically for antisocial personality disorder (ASP). People with antisocial personality disorder who seek care do so for other problems such as marital discord, alcohol or drug abuse or suicidal thoughts. Family members or the courts may send some people with ASP to a mental health counselor for evaluation. People with ASP often appear to have poor insight and may reject the diagnosis or deny their symptoms.
People with antisocial personality who seek help (or are referred) can be offered evaluation and treatment as outpatients. Patients can be offered an array of services, including neuropsychological assessment, individual psychotherapy, medication management, and family or marital counseling.
Unless the person risks harming himself or others, hospital care is not needed. In fact, people with ASP can be disruptive in inpatient units — for example, becoming belligerent when their demands are unmet or using manipulation to gain favors.
Psychotherapy for people with ASP should focus on helping the individual understand the nature and consequences of his disorder so he can be helped to control his behavior. Exploratory or insight-oriented forms of psychotherapy are generally not helpful to people with ASP.
Cognitive therapy for Antisocial Personality
Cognitive therapy — first developed to help patients with depression — has recently been applied to ASP. The therapist should set guidelines for the patient’s involvement, including regular attendance, active participation and completion of any necessary work outside of office visits. The patient who submits to therapy only to avoid a jail term is not intent on improving. Therapy must be more than a means by which the antisocial tries to elude the consequences of his behavior. The cognitive therapy’s major goal is to help the patient understand how he creates his own problems and how his distorted perceptions prevent him from seeing himself the way others view him.
Because people antisocial personality tend to blame others, have a low tolerance for frustration, are impulsive and rarely form trusting relationships, working with these individuals is difficult. People with ASP often lack the motivation to improve and are notoriously poor self-observers. They simply do not see themselves as others do.
Therapists must be aware of their own feelings and remain vigilant to prevent their emotional responses to their patients from disrupting the therapy process. No matter how determined the therapist may be to help an antisocial patient, it is possible that the patient’s criminal past, irresponsibility and unpredictable tendency toward violence may render him thoroughly unlikable. The best treatment prospects come with professionals well versed in ASP, who can anticipate their emotions and present an attitude of acceptance without moralizing.
Medications for Antisocial Personality
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.