TREATMENT

TREATMENT
Antisocial personality disorder is often misunderstood by both professionals and laypeople. Confused with the popular terms, "sociopath" or "psychopath," someone who suffers from this disorder can be discriminated against within the mental health system, because of the symptoms of their disorder. Because there is usually a pervasive lack of remorse, and many time any feelings at all, they are assumed not to have any real feelings by many professionals. This can lead to difficulties within treatment.


 * Psychotherapy **

Psychotherapy is nearly always the treatment of choice for this disorder; medications may be used to help stabilize mood swings or specific and acute Axis I concurrent diagnoses. There is no research that supports the use of medications for direct treatment of antisocial personality disorder.

As with most personality disorders, individuals with this disorder rarely seek treatment on their own without being mandated to therapy by a court or significant other. Court referrals for assessment and treatment for this disorder are likely the most common referral source. A careful and thorough assessment will ensure that the person has antisocial personality disorder. This can often be confused with simple criminal activity (all criminals do not have this disorder), adult antisocial behavior, and other activities which do not justify the personality disorder diagnosis. As with a thorough assessment of any suspected personality disorder, formal psychological testing should be considered invaluable.

People who suffer from this disorder will be mandated to therapy, sometimes in a forensic or jail setting, motivation on the patient's part may be difficult to find. In a confined setting, it may be nearly impossible and therapy should then focus on alternative life issues, such as goals for when they are released from custody, improvement in social or family relationships, learning new coping skills, etc. In an outpatient setting, the focus of therapy can also be on these types of issues, but a part of the therapy should be devoted to discussing the antisocial behavior and feelings (or lack thereof). Common in the population who suffer from antisocial personality disorder is the lack of connections between feelings and behaviors. Helping the client draw those lines between the two may be beneficial.

Effective psychotherapy treatment for this disorder is limited. It is likely, though, that intensive, psychoanalytic approaches are inappropriate for this population. Approaches reinforce appropriate behaviors and attempting to make connections between the person's actions and their feelings may be more beneficial. Emotions are usually a key aspect of treatment of this disorder. Patients often have had little or no significant emotionally-rewarding relationships in their lives. The therapeutic relationship, therefore, can be one of the first ones. This can be very scary for the client, initially, and it may become intolerable. A close therapeutic relationship can only occur when a good and solid rapport has been established with the client and he or she can trust the therapist implicitly. By John M. Grohol, Psy.D. on 1 Jun 2010

Rarely is inpatient care appropriate or necessary for this personality disorder. Like most personality disorders, most people will go through their lives with little realization of the difficulty they have. In this case, though, the person is more likely to be seen as a criminal and have a history of difficulties with the law. Loss of freedom may be more of a motivating factor than in other personality disorders, so some specialized treatment facilities have started to treat people with this disorder. When hospitalization is required, the most effective treatment is best carried out in a specialized unit. Inability to trust, fantasize, feel or learn should be specifically addressed. Firm limits are needed in addition to defining acceptable alternatives for deviant behaviors. Medications do not cure the disorder, but may be used to control the underlying symptoms of anxiety, depression, and physical violence. As there is a high incidence of substance abuse in this disorder, caution must be used in selecting and prescribing psychiatric medications. Some individuals with antisocial personality disorder may also have attention-deficit/hyperactivity disorder. (ADHD) and may require a central nervous system stimulant to control the associated symptoms. Medications should only be utilized to treat clear, acute and serious Axis I concurrent diagnoses. No research has suggested that any medication is effective in the treatment of this disorder.
 * Hospitalization **
 * Both group and individual psychotherapy may be utilized for the treatment of antisocial personality disorder. However, outpatient treatment is especially difficult and unlikely to provide long-lasting benefit. Treatment in a residential therapeutic setting or community is usually more effective. Manipulation and undesirable behavior are better controlled and incentive to change increases. Self-help groups have also been used as well as family education and counseling. Dialectical behavioral therapy is a relatively new psychotherapeutic approach that has shown promise in treating borderline personality disorder and may have application in treating antisocial personality disorder.

Kelesha Mcknight ||