What To Know About Antisocial Personality Disorder (ASPD) Treatment

Treatment for antisocial personality disorder (ASPD or sometimes APD), also called sociopathy, often includes talk therapy, medication, or a combination of both. ASPD is a personality disorder that causes symptoms like a lack of empathy or remorse and egocentrism. People with ASPD often use manipulation to control others and can be aggressive. Treatment may help a sociopath change, but it can be a difficult disorder to treat.

"[ASPD] is not about being unsociable or unfriendly," Susan Masterson, PhD, a psychologist based in Lexington, Kentucky, told Health. Think about it this way: anti means against, while social means society or people. "Someone with APD is ultimately concerned with [their] own needs. Social norms and laws are mere obstacles and challenges to their goals, not barriers."

The goals of treatment are to help someone with ASPD develop empathy for others, reduce violent behavior, and avoid complications like imprisonment. Read on to learn if sociopathy can be cured and what the best treatment for ASPD is.

What Is ASPD?

According to the "Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition" (DSM-5-TR), someone must show certain impairments in personality functioning. These impairments might be:

• Identities (e.g., egocentrism or self-esteem) derived from personal gain, power, or pleasure
• Incapacity for intimate relationships
• Issues with interpersonal functioning, like a lack of empathy or concern for the feelings, needs, or suffering of others
• Lack of remorse after hurting or mistreating others
• Lacking the internal standards to conform to lawful or culturally normative ethical behavior
• Self-direction (goal-setting) based on personal gratification

People with ASPD are often antagonistic and deceitful, using manipulation and subterfuge to influence or control others. They may appear to be callous and remorseless, with a lack of concern for the feelings or problems of others or the effects their actions might have on others. They can be aggressive and hostile, and impulsive and irresponsible. People with ASPD often fail to consider or disregard the consequences of their actions.

Nailing down the cause of ASPD is difficult, if at all possible. It has a lot to do with how you're brought up. "[ASPD] 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," said Masterson.

Diagnosis

Diagnosing ASPD can improve impairments in personality functioning. A healthcare provider can perform a psychological evaluation using the DSM-5-TR to diagnose ASPD. They will ask about your symptoms to determine how advanced and severe your condition is.

ASPD is typically diagnosed in people aged 18 and older. You must have previous behavioral or emotional problems during childhood to be diagnosed with the disorder.

How Is ASPD Treated?

Treatment for ASPD is tough. "There's no true cure for the mental and behavioral issues that come with [ASPD]," GinaMarie Guarino, a licensed mental health counselor based in New York, told Health.

Treatment often revolves around managing the symptoms of the disorder and learning coping skills as well as how to deal with triggers and modify behavior. ASPD is one of the most difficult personality disorders to treat. It's rare that someone with the disorder 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. 

Treatments for ASPD, such as talk therapy and medication, only work if the affected person is actually motivated to change. "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," said Guarino.

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

Talk Therapy

One of the most common treatments for ASPD is cognitive behavioral therapy (CBT). "CBT helps affected people learn how to slow down reaction times, reduce impulsive behavior, and incorporate consequential thinking into decision-making," said Guarino.

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," said Masterson.

Democratic Therapeutic Communities (DTC)

Democratic therapeutic community (DTC) is a type of social therapy in which you work with others to solve issues within the group. Research has shown that DTC can be an effective treatment for people with personality disorders who are incarcerated.

DTC helps you listen to and work with people and develop concern for others. This intervention is most effective when you participate for at least 18 months.

Medications

Personality disorders aren't a chemical issue, which is why there's no medicinal answer for ASPD. 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," said Masterson.

The Food and Drug Administration (FDA) has not approved medications to treat ASPD. A healthcare provider may prescribe medication to treat anxiety or depression and stabilize your mood due to the comorbidity (having two or more conditions at once) and the possibility of anxiety or depression resulting from a mismatch between self and societal expectations.

Medications may include:

• Antidepressants: Drugs like fluoxetine and sertraline help regulate levels of the hormone serotonin in the brain.
• Antipsychotics: These medications can decrease aggression and violent behavior. A healthcare provider may prescribe risperidone and quetiapine.
• Mood stabilizers: You might take a medication like carbamazepine or lithium if you have severe mood changes.

When To Contact a Healthcare Provider

People with the disorder often do not recognize anything wrong with their behavior. It's important to contact a healthcare provider if a person you know displays signs and symptoms of ASPD. Early diagnosis and treatment may improve long-term outcomes.

Complications can include:

• Alcohol use
• Drug use
• Imprisonment
• Self-harm or suicide
• Violence

You can contact the 988 Suicide and Crisis Lifeline at 1-800-273-TALK if you or someone you know has suicidal ideation, or thoughts of suicide. Call 911 or go to the nearest emergency room right away if someone you know has attempted self-harm.

A Quick Review

ASPD is a personality disorder that causes symptoms like a lack of empathy or remorse and egocentrism. People with ASPD are often aggressive and manipulative and likely don't understand that there's anything wrong with their behavior. It's difficult to treat ASPD if a person is unwilling to change.

Talk to a healthcare provider if a person you know may have ASPD. Early diagnosis and treatment can help prevent complications like imprisonment, self-harm, and violence.