Treatment plan goals for antisocial personality disorder

About 1–4% of the general population meet the standard diagnostic criteria for antisocial personality disorder (ASPD or sometimes APD)—the official name for sociopathy—according to a 2015 paper published in Psychiatric Annals.

"Antisocial personality disorder is not about being unsociable or unfriendly," Susan Masterson, PhD, a psychologist based in Lexington, Kentucky, told Health. Think about it this way: anti = against, social = society/people. "Someone with APD is ultimately concerned with his or her own needs. Social norms and laws are mere obstacles and challenges to their goals, not barriers," Masterson explained.

"Relationships are only addressed in the context of how treating others well will result in something pleasurable, or reduce something negative," Masterson added. "And how their behavior impacts others is only of concern if it creates a problem for them."

To be diagnosed with ASPD, according to the Diagnostic and Statistical Manual of Mental Disorders V (the authoritative guide to the diagnosis of mental disorders), someone must show certain impairments in personality functioning.

These impairments might be in terms of identity, like egocentrism or self-esteem derived from personal gain, power, or pleasure; or self-direction, like goal-setting based on personal gratification and lacking the internal standards to conform to lawful or culturally normative ethical behavior. People with ASPD would also have issues with interpersonal functioning, like a lack of empathy or concern for the feelings, needs, or suffering of others; a lack of remorse after hurting or mistreating another; and an incapacity for intimate relationships.

Someone with ASPD would also probably be antagonistic and deceitful, using manipulation and subterfuge to influence or control others; callous and remorseless, with a lack of concern for the feelings or problems of others or the effects their actions might have on others; aggressive and hostile; and impulsive and irresponsible, failing to consider or disregarding the consequences of their actions.

As with most mental health conditions, nailing down the cause of ASPD is difficult—if at all possible, Masterson said. It has a lot to do with how you're brought up. "It can run in families, but it's unclear if it's nature or nurture—a genetic disposition or learned behaviors and environmental influences—at play," Masterson said.

Treatment is tough. "There's no true cure for the mental and behavior issues that come with APD," GinaMarie Guarino, a licensed mental health counselor based in New York, told Health. "People with ASPD are not motivated to change their behavior; they don't see a need to change," Guarino explained. "Instead, they feel that their behaviors are fine and that everyone else needs to change their own behaviors and expectations, and they're more inclined to blame or redirect responsibility for their actions onto other figures of authority."

Personality disorders aren't a chemical issue, which is why there's no medicinal answer for antisocial personality disorder (although a healthcare provider may prescribe medication to treat overlapping mood issues). Rather, "it's a mindset that someone carries everywhere they go and is the filter through which they base all their impressions and decisions on how to behave," Masterson said.

Treatment, then, revolves around managing the symptoms of the disorder and learning coping skills as well as how to deal with triggers and modify behavior.

But it's rare that someone with ASPD would even seek help on their own (unless it would somehow eliminate or ameliorate a consequence, like a potential prison sentence or significant material loss, Masterson said). And ASPD is "one of the hardest personality disorders to treat," according to the National Library of Medicine's MedlinePlus resource.

That's why many of the ASPD cases you actually hear about have to do with people in the criminal justice system, Guarino said, as "therapy is often a condition of probation or parole for people with APD," Guarino explained.

For those who do seek help, one of the most common treatments for ASPD is CBT, or cognitive behavioral therapy. "CBT helps affected people learn how to slow down reaction times, reduce impulsive behavior, and incorporate consequential thinking into decision-making," Guarino said.

Any psychotherapy, though, would focus on improving conduct to reduce negative consequences in the person's life, like "how to modify expectations to be more in line with reality, or use relaxation techniques to calm down the flare of an angry reaction when a sense of entitlement conflicts with what they're getting out of a situation," Masterson said.

But there's a major catch: Psychotherapy for ASPD only works if the affected person is actually motivated to change, Guarino said. "Like most mental health disorders, the desire for change must come from the person. They must have their own personal reasons for changing their behavior," Guarino explained.

And that's why it's especially hard to treat someone with ASPD. "People with APD often do not see a problem with their behaviors, and so they don't want to be cured," Guarino added.

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