As the term antisocial indicates that this personality disorder constitutes the behaviors that are deviant or against the norms set by society. It is a form of mental disorder, i.e. the inability to think clearly and behave in a controlled fashion, in which the intellectual faculties are not impaired, but the moral principles of the mind are deviant, and the individual is incapable of acting with decency and politeness in the matters of his or her life. The prevalence rate of antisocial personality disorder is between 0.2%-3.3% in the general population but in correctional or forensic settings this rate is increased up to 70%.
The terms of antisocial personality disorder (ASPS) have been interchangeably used as ASPD and psychopathy does have a similarity in some of the facets yet they differ in the other. Due to this most psychopaths meet the essential criteria for the diagnosis of antisocial personality disorder but most individuals with ASPD are not psychopaths.
Symptoms of ASPD in Four domains
An antisocial personality disorder is characterized as the pervasive pattern of disregard and violation of the rights of others which have been occurred since 15 years of age. The following are the four domains or realm of antisocial personality disorder constituting a total of seven symptoms out of which three needed to be present for diagnosis.
The failure to conform to social norms is indicated in terms of breaking the law that may result in arrest by the police or fine e.g. crossing the red signal.
Irresponsibility might be manifested as e.g. staying unemployed without available job opportunities. This irresponsibility may also be observable in terms of poor parenting of children.
Deceitfulness is indicated in the form of repeated lying or using others for personal gains e.g. to obtain money, sex or power.
Lack of guilt is shown as an antisocial individual may minimize the harmful consequences of their actions or they may completely stay indifferent to their acts.
Recklessness may be seen by executing several risky behaviors such as recurrent speeding or having multiple accidents.
Impulsivity may be apparent in terms of taking decisions without giving it a thought e.g. changing jobs all of a sudden, breaking relationships, etc.
Irritability or aggressiveness is manifested in the form of repeated acts of physical assaults e.g. beating children or wives. This aggression is not planned aggression such that found in criminal activity but rather an impulsive act.
These individuals have also found to be exploitative in their sexual relationships and used to indulge in the use of various types of drugs.
Two major complications of this disorder are
These are more prone to use drugs of abuse
Uncontrolled aggression can result in physical injury towards others.
What are the likely causes of antisocial personality disorder?
The following factors play an important role in the development of antisocial personality disorder.
Modules for Treatment
Four main goals of treatment
Improve patient’s motivation to comply with societal laws.
Improve occupational productivity.
Making the patient have a respectful attitude towards the privacy, rights, and property of others.
Fulfilling the expectations and being responsible in terms of sexual relationships and avoiding substance abuse.
Treatment with Medicine
The main part of the treatment of antisocial personality disorder is psychological interventions. However, the drugs are sometimes necessary to management aggression and impulsivity. The need for medicine also becomes necessary when psychological interventions are not working. For this purpose, a low dose of antipsychotic drugs or mood stabilizers is prescribed. Benzodiazepines are avoided as maximum as possible.
A multifaceted approach integrating the concepts of various psychological therapies is adopted for the effective treatment of ASPD. Since it is a personality disorder that has a pervasive pattern so the duration of treatment is a little longer that is 12-24 months of weekly individual sessions. Following is the brief summary of the main targets of psychological interventions for ASPD:
The cognitive focus for antisocial personality disorders is primarily focused on identifying and modifying the negative thoughts that underlie aggressive acts and criminal lifestyles.
The behavioral focus is aimed at bringing the behavioral change in self-damaging behaviors.
Problem-solving training is employed to improve interpersonal problem-solving skills. These interventions are employed to make up for the deficits that the individual has in behaving and encountering situations. This is done by providing direct instruction, modeling, and opportunities for rehearsal with the therapist.
The antisocial individuals lack the ability to effectively process their emotions, due to which the treatment also incorporates the emotional regulation strategies.
The involvement of the significant other family members is also crucial as through this the families are informed about the nature of the disorder and also to build tolerance for the affect and effect of patient’s behaviors are also addressed.
Relapse prevention planning is directed at enabling the patient to identify the precursors of his or her unhelpful behaviors and if they will occur then adopting the effective strategy taught in the therapeutic sessions.
Two Major Hindrances in the Process of Recovery
The resistance of patients with ASPD to change and seek treatment is been a major challenge as it hinders the course of improvement.
Difficulty forming a strong therapeutic relationship is another challenge since the patients with ASPD are indifferent and are not empathetic so the chance of therapist burnout is very likely.
Mr. X, 28 years old male, referred to a psychiatrist, after getting into a fight with one of his friends over ten rupees bet. He was brutally beaten by the policemen. E.A. was previously being jailed twice before for cheating cases and for assaulting one friend. When being interrogated of his action he confessed that he has beaten the other inmate who refused to pay money. He wanted to show his power and there was no guilt for his action. Family history showed his neglected childhood, father left home when he was 6 years of age and his mother had an extramarital affair with a man in her neighborhood. He didn’t have a good educational background as he failed twice and then left school. He had also indulged in smoking and drinking alcohol at an early age. After a detailed evaluation, he is diagnosed with suffering from an antisocial personality disorder. He entered in a comprehensive psychological intervention program.