Antisocial Personality Disorder Treatment for Lasting Change

Living with antisocial personality disorder can affect more than behavior. It can also affect relationships, employment, impulse control, legal stability, substance use, and your ability to safely and consistently interact with others. This can cause a great deal of pain and confusion to those who love you, watching you continue to exhibit the same negative behaviors, deny any wrongdoing, and appear unaffected by the consequences of your actions.

But someone with antisocial personality disorder is not “bad” or beyond hope. The condition is treatable. The goal of treatment is to recognize the behavioral patterns that have developed due to this condition and provide a framework for change.

At SOBA NJ, we build individualized treatment plans for antisocial personality disorder based on personalized mental health care, emotional stability, accountability, and providing support for any co-occurring disorders if they are present.

What Is Antisocial Personality Disorder?

Antisocial personality disorder, or ASPD, involves a long-term pattern of disregard for others’ rights, safety, or feelings, and is marked by impulsive behavior, deceitfulness, manipulation or exploitation of others, aggressive behavior, irresponsible behavior, or a lack of remorse for having harmed or mistreated another person. [1]

ASPD is classified as a Cluster B personality disorder, which means it is in a category characterized by dramatic, emotional, impulsive, or unpredictable behavior.[2] Examples of other Cluster B personality disorders include borderline personality disorder, narcissistic personality disorder, and histrionic personality disorder.

It is essential to understand that being introverted, socially withdrawn, or unwilling to participate in social activities does not classify a person with antisocial personality disorder. Terms like “sociopath” or “psychopath” are informally used to describe this condition, but do not accurately describe a formal clinical diagnosis.

A diagnosis of ASPD is only given to adults over 18 years of age and will require documentation of conduct disorder symptoms before the age of 15.[3] In many cases, ASPD can develop simultaneously with ADHD, substance use disorders, mood disorders, bipolar disorder, borderline personality disorder, or issues related to impulse control, which is why comprehensive treatment must address all aspects of someone’s clinical presentation.

Signs and Symptoms of Antisocial Personality Disorder

The primary characteristic of antisocial personality disorder includes a continuous disregard for the well-being and safety of others, as well as an inability to take responsibility for the harm caused through their behavior.

While symptoms can vary among individuals, some common signs include:

• Repeated deceptive or manipulative behavior such as lying, using multiple aliases, conning others, or using others for personal gain
• Making spontaneous decisions without concern for potential consequences, or acting without planning for future events
• Aggressive or irritable behavior, such as frequently fighting, threatening or intimidating others, or angry outbursts
• Consistent disregard for safety, including behaving recklessly and putting oneself or others at risk
• Chronic irresponsibility that presents as persistent problems with work, finances, commitments, or legal obligations
• Lack of remorse for causing harm, taking advantage of others, or rationalizing harm caused to others
• Ongoing relationship difficulties, including unstable, conflict-filled, or exploitative relationships
• Co-occurring disorders like substance use disorders, anger management problems, depression, anxiety, ADHD, or other mental health issues

Each symptom listed above should be assessed by a professional trained in the diagnosis of mental illness. Someone may display some antisocial characteristics without demonstrating enough of the required characteristics for a formal diagnosis. This is why a thorough psychiatric examination is helpful for distinguishing between antisocial personality disorder and something else, such as substance-induced behavior, bipolar disorder, borderline personality disorder, trauma responses, or other conditions that share similar impulsive or high-risk behaviors.

When to Get Help for Antisocial Personality Disorder

People with antisocial personality disorder rarely seek help for their disorder. Instead, treatment may begin due to other factors like relationship issues, substance use, legal issues, employment issues, family pressure, or a mental health crisis.

Even if someone is uncertain about seeking counseling, there are many benefits associated with receiving professional support. Support from professionals can help identify patterns, reducing harm and potentially helping them develop alternative solutions.

It may be time to seek treatment for antisocial personality disorder if:

• Impulsivity or aggressive behavior is impacting relationships, employment, housing, or leads to legal trouble
• Lying, manipulation, or exploitative behavior is becoming a repeated pattern
• Anger, irritability, or taking risks is creating a dangerous situation for oneself or others
• Substance use is making symptoms or consequences worse
• There are co-occurring psychiatric diagnoses including major depressive disorder, generalized anxiety disorder, attention deficit hyperactivity disorder (ADHD), or bipolar disorder
• A family member feels threatened, overwhelmed, or is unsure how to set boundaries
• Prior attempts to make changes were unsuccessful

Treating ASPD is generally challenging, especially when the client may not acknowledge or accept that their behaviors are problematic. However, long-term treatment combined with regular check-ins and treatment with therapists who have worked extensively with clients with personality disorders and co-occurring conditions can be beneficial [4].

Treatment for Antisocial Personality Disorder

Antisocial personality disorder treatment should be structured, consistent, and focused on behavior change. Though the disorder cannot be “cured,” behavior can be improved. The goal is to reduce harmful patterns, improve impulse control, address co-occurring disorders, and help the person build safer ways to respond to anger, conflict, stress, and consequences.[5]

Below are some common approaches:

• Individual therapy: Therapy provides a way for clients to gain insight into their maladaptive behaviors. Clients will learn to be accountable for their actions, learn how to solve problems, and understand how their choices negatively impact other people.
• Cognitive-behavioral therapy (CBT): Cognitive-behavioral therapy helps clients recognize their thoughts and behaviors related to acting impulsively, aggressively, deceptively, or exploitatively, and then teaches them how to replace those behaviors with healthier alternatives.
• Anger management and impulse-control work: Treatment programs designed to teach clients skills to manage impulses, slow down reactions to frustration, and manage frustration before engaging in aggressive or high-risk behaviors.
• Mentalization-based treatment (MBT): MBT may help some clients better understand their own thoughts and emotions, as well as the thoughts, feelings, and intentions of others.
• Medication management: While no medication can cure antisocial personality disorder, medications can be used to treat symptoms that frequently co-occur with it, including depression, anxiety, ADHD, aggression, mood instability, or substance use-related symptoms [6].
• Family education or support: If clinically indicated or safe for the family, educating loved ones about setting boundaries and communicating effectively can help families create an environment where healthy habits are fostered while unhealthy habits are discouraged.

Antisocial Personality Disorder and Substance Use

Antisocial personality disorder and substance use can become closely connected when alcohol or drugs are tied to impulsive behavior, aggression, risk-taking, legal problems, or difficulty considering consequences. Substance use can make ASPD symptoms harder to manage by lowering impulse control, increasing conflict, and making deceitful or exploitative patterns more likely to continue.

When antisocial personality disorder and substance use occur together, treatment should address both concerns in the same plan. At SOBA NJ, care may focus on accountability, impulse control, anger management, relapse prevention, safer decision-making, and healthier ways to respond to stress, conflict, and consequences.

Frequently Asked Questions About Antisocial Personality Disorder Treatment