Antisocial Personality Disorder Treatment & Therapy That Supports Meaningful Change

The DSM-5 diagnostic criteria for ASPD require a pervasive pattern of at least three of the following:

• Failure to conform to social norms — Repeated violations of the law or widely accepted social expectations
• Deceitfulness — Repeated lying, using aliases, or manipulation of others for personal gain or pleasure
• Impulsivity — Failure to plan ahead or acting without consideration for consequences
• Irritability and aggression — Frequent fights, assaults, or threats toward others
• Reckless disregard for safety— A reckless disregard of self or of others
• Irresponsibility — Consistent inability to maintain steady employment or fulfill financial obligations
• Lack of remorse — Indifference to or rationalization of the harm caused to others

In addition to the above, many individuals with ASPD exhibit a lack of empathy toward others, use superficial charm to manipulate others, display grandiose feelings of self-importance, and feel entitled to special treatment. In cases with psychopathic features, emotional detachment and callousness are more prominent.[7]

Symptoms of ASPD can significantly disrupt occupational functioning, interpersonal relationships, and safety, both for the individual and for those around them. Many people with ASPD do not recognize their patterns as problematic, which presents particular challenges for treatment engagement.

ASPD typically responds best to treatment if the person affected chooses to seek help and does so as soon as possible. ASPD rarely improves on its own and usually becomes increasingly entrenched over time unless treated. 

Treatment is generally recommended when:

• Antisocial behavior is producing serious legal issues, job loss, or relationship consequences
• Substance use disorders develop alongside ASPD
• Co-occurring conditions such as depression, ADHD, or borderline personality disorder are present
• Anger management difficulties or aggression are creating potential safety risks
• A family member or loved one expresses extreme concern about how the person’s behavior is impacting them
• The individual themself acknowledges that their behavior is causing harm and would like to get professional help

Motivation plays a crucial role in the treatment process for individuals with ASPD. Someone who enters into treatment based on personal choice, versus only because of legal or external coercion, will generally show better treatment compliance and outcomes. When motivation is there, regardless of whether it is complete or partial, it is always worth supporting.

Treating antisocial personality disorder is perhaps one of the most clinically challenging areas of care in personality disorders and is very important to approach with effective clinical intervention and genuine compassion. All treatment plans begin with a comprehensive clinical evaluation designed to assess the severity of a client’s symptoms, identify the unique aspects of their presentation, evaluate co-existing disorders and substance use histories, and provide insight into each patient’s own goals and motivations. 

Commonly used treatments include:

• Cognitive-Behavioral Therapy (CBT) — Currently the most researched psychotherapeutic treatment method for ASPD; CBT targets distorted thinking patterns that lead to antisocial behavior, impulsivity, and repetitive behavioral patterns. CBT for ASPD focuses on changing cognitions related to perceived rights and intentions of others, becoming aware of consequences of actions, and learning alternative responses to the impulses that lead to aggressive or deceptive behavior.
• Dialectical Behavior Therapy (DBT) — DBT may be particularly helpful for ASPD presentations characterized by excessive emotional dysregulation, impulsivity, or co-occurring borderline personality disorder. DBT teaches patients skills that improve their abilities to tolerate distressing emotions, regulate their emotions, and interact effectively with others.
• Anger Management — Anger management programs specifically designed for adults with anger-related issues are another form of evidence-based treatment for reducing the irritability and aggression that is characteristic of ASPD. These programs focus on helping participants learn ways to recognize triggers for anger and arousal, de-escalate angry feelings, and respond to conflicts without using physical violence.
• Group Psychotherapy — Group therapy offers a particular advantage in treating ASPD. The group provides a live interpersonal context where antisocial patterns can emerge and be worked with directly with real-time feedback. Feedback from peers in a structured therapeutic community can sometimes offer greater positive reinforcement than individual therapy alone.