Treating Antisocial Personality Disorder

Psych CentralI feel sorry for any therapist who diagnoses a patient with Antisocial Personality Disorder (APD). Not only can reaching a diagnoses be a difficult decision, but I am convinced that clinical psychologists wince slightly when they realize that their patient/client has APD.

If a person with APD ever ends up in a therapist’s office, you know that there is a pretty substantial trail of destruction behind them, and this is likely to continue on into the future. Even more disheartening, you know that therapy is going to be tremendously difficult, especially given the facts that those with APD do not think there is anything intrinsically wrong with themselves, they have problems with authority figures (they are likely to see the therapist as one), and they experience emotions in a very limited way.

I recently came across a page on Psych Central that lists the challenges therapists face with treating Antisocial Personality Disorder (APD treatment). It’s worth a read for anyone interested in how APD is approached, but the exhaustive explanations really just seem to demonstrate the frustration with treating it, coupled with the frustration of how it is misunderstood.

I don’t know what the answer is for ‘curing’ APD, but I suspect it involves figuring out its development, and stopping those factors coming together in future generations. It would also be worth figuring out why those with Conduct Disorder before they hit puberty are likely to have APD in adult life, and why those who develop it in their teen years have a better chance of not having APD.

9 thoughts on “Treating Antisocial Personality Disorder

  1. Paula

    I think the best place to start is to retrain them how to relinquish control of situations involving others. Control and power. They need to be okay with having neither. They also need to be retrained in basic interpersonal communication skills. If they can at least learn to communicate using different patterns, those involved with them can avoid being ‘harmed’ to a certain degree. It’s a different approach than used for non-pathological people and needs to be, in my opinion. Instead of first focusing on their thoughts and feelings about themselves, they need to focus on their behavior toward others. Opposite treatment from how psychoanalysts deal with helping the rest of us. 🙂


    1. Jack Pemment Post author

      I’m not sure how well you can train antisocials or psychopaths to do anything. I think this is partly because of subtle brain differences that essentially equates to trying to teach a person with no legs to walk. I know that there has been some success with Dialectical Behavior Therapy with Borderline Personality Disorder, which helps the person to live with their condition, but Borderlines at least recognize that something is amiss. I think those with APD just get shrewder about avoiding interactions with the law and therapists, so they teach themselves to function in the world – usually by emotionally/physically abusing others, training them, ironically, to feel guilty and protect the abuser.


  2. positivagirl

    This is interesting.

    If they think there is nothing wrong with them – why are they in a therapists office?

    If it is because they are forced to, because of instructions as part of a legal order – well that is not a good reflection, as people with ASPD will rebel against being forced to do something that they do not want to do.

    If it is not through a legal order….. surely they wouldn’t be in the therapists office, if they thought that there was nothing wrong with them? – Maybe it is the attitude of the therapist – and the assumption that ‘nothing works’ is partly to blame.

    I think that the problem is more –

    1. This is more common than is reported
    2. Only the most severe cases will be forced into treatment – why would they change if they don’t want to? (they could pretend that they had)…. just to pass the time (sociopaths do experience difficulties with boredom)

    There is so much that is not understood about sociopathy. Really I know that working more than 20 years in homeless sector, I worked with loads and loads…. people who would kick off to other members of staff. But I saw improvements. People who had been long term rough sleepers, or repeat prolific offenders, I saw move into their own places and stabilise their lives.

    It is quite sad that a lot of people said to me ‘you are the first person who has really listened to me and not judged me’….. some were diagnosed sociopaths, others no diagnosis, but – yes they were.

    I talked to these people, who often faced attitudes that they were ‘beyond help’…. I have seen words where they are ‘scum of society, should be shot and placed on an island’ etc etc ….

    Would we say this about paranoid schizophrenic’s? Would we say it about bi polars, borderlines etc?

    I don’t feel sorry for the therapist. As this is what the therapist goes into the job for 🙂 This is what they are paid to do. I do wish that people were not just ‘written off’ there can be change… I have worked with it, seen it, and witnessed it….


    1. Jack Pemment Post author

      You’ve raised many fantastic points.

      In criminology, David Farrington helped to popularize what is known as the age-crime curve, and it’s a beautiful bell shaped curved that increases from the age of 18, peaks over 25-30, and then drops off at the age of 40. The area underneath the curve reflects the number of crimes committed by individuals of that age. I think I read somewhere that the activity of serial killers, too, drops off after 40 or the “cooling off” period is much much longer. I’m also convinced that those with APD learn to adapt and live in society, and can do so quite successfully after the age of 35; this might be a reflection of the changes in physiology, where they now have better impulse control and have learned enough about the world to avoid getting into trouble with the law – this might be because they avoid criminal behavior or have just become smarter about it.
      My point here is that those with APD are often stigmatized as unable to change, but just by the nature of their biology and the aging process, changes are going to happen.

      A false diagnosis of psychopathy is going to be anathema for living a normal life afterwards – you’ve basically been tarred and feathered. Psychopaths are often pathological liars, and so trying to prove you’re not a psychopath after a diagnosis is almost impossible. Diagnosing a person with anything is obviously crucial for formulating a treatment plan, and this is another example where getting the diagnosis wrong could ruin the person’s life. This is why I do feel sorry for clinical psychologists and psychiatrists, because this can be difficult for the best of them.

      When it comes to APD and Conduct Disorder, you certainly need some of the best therapists on the case.

      Nobody feels sorry for Antisocials or Psychopaths, and so it is easier just to write them off as lost causes and let the legal system take care of the problem. But then, these people are often guilty of such extreme abuse and victimization, perhaps they are best left to the mercy of the courts. This is part of the ethical quandary that makes the field so interesting.

      I waffle, but thank you for your input 🙂


  3. positivagirl

    An excellent answer, and I find it difficult to write a short response. As it makes me think of so many things.

    1. I agree I also witnessed this in my work, with age. Over the age of 40 most clients were alcoholic. Whether that was a reflection of a) they didn’t get caught or b) they simply didn’t use the service or c) they had improved with time, I don’t know? Where did the long term drug users, or long term prolific offenders go? Almost all were involved with alcohol.

    2. I do question the figures, as most wouldn’t get a diagnosis and the rest are already in the system, so are used to playing the system. Yes sociopaths do this, but so do a lot of other groups (in the Uk you just have to look at people that are welfare dependent) – they can’t all be sociopath’s. If the only people they are analysing are either a) the worst cases or b) young people – how accurate are the findings?

    I also believe strongly that a therapist, should treat anybody with an open mind. My experience of sociopaths and those people I worked with is that they can read someone – are very analytical and can read what is going on with somebody. So I would imagine that they would pick this up with a therapist (you are also right that they would be stigmatised as well, and not believed as they are compulsive liars). So, therefore therapy would NOT be effective.

    Imagine, you had a rape victim who had gone for therapy, but the victim had the impression that the therapist didn’t believe them, and thought they were lying…… how effective would the therapy be? 🙂


  4. Lynette d'Arty-Cross

    This is an interesting post, Jack. I had never occurred to me before – and it should have – that therapists need to be very cautious in their diagnoses because a misdiagnosis of APS or any other disorder could follow someone throughout life. *Lightbulb!*


  5. horsewelfarenews

    Psychopaths cannot be cured. Once caught (that is the trickiest part) and then affirmatively diagnosed, they need to be incarcerated permanently in order to protect society. There are no other logical and safe options.


  6. Shane West

    I am pretty much amazed of the anti social personality disorder symptoms. I learned a lot from the interesting topics that are being discussed. It’s my pleasure to visit and learned things and facts of this page. I will be visiting this site more often for I am very intrigue with the topic that indeed catches my interest.


  7. Pingback: Can A Sociopath Be Treated? | Sociopathic Strategy

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