Antisocial personality disorder (ASPD) is thought by many to be an untreatable disorder. In 1968, L. Ron Hubbard described those with an antisocial personality as being “unable to feel any sense of remorse or shame.” He described them as “approving only of destructive actions whilst appearing quite rational and being very convincing.” Antisocial personality disorder manifests itself as a set of core personality traits which allow one to disregard the rights of others in pursuit of impulsive, self-serving goals. Individuals with this disorder tend to disregard the welfare of others, demonstrate extreme superficial charm in social situations, show a lack of guilt or regret over situations, break the law, often behave irresponsibly, manipulate or lie to others, act impulsively, participate in reckless activities in order to seek stimulation and have an inflated sense of self-importance.
Antisocial personality disorder can be a devastating condition thus having a considerable impact on individuals, families and society. ASPD has the same prevalence in men as schizophrenia, which receives the greatest attention from mental health services. Furthermore, ASPD is associated with significant costs, arising from emotional and physical damage to victims and property, use of police resources and involvement of the criminal justice and prison services. Related costs include increased use of healthcare facilities, lost employment opportunities, family disruption, gambling and problems related to alcohol and substance misuse (1).
In 2001 a study by Scott revealed that the lifetime public services costs for a group of adults with a history of conduct disorder (of which 50% will go onto develop adult ASPD) were found to be 10 times those for a similar group without the disorder. ASPD is closely associated with criminal offending and any intervention that seeks to improve the outcome of ASPD is also likely to impact upon this offending.
It’s not clear exactly what causes ASPD, but as with other types of personality disorders, it is thought to result from a combination of the genes a person inherits and early environmental influences – for example, a distressing childhood experience (such as abuse, neglect and/or inadequate attachments to caregivers). Research also shows that broader environmental factors, such as antisocial peer groups, and growing up in impoverished and violent communities play an important role in the development of Antisocial Personality Disorder. These influences are likely to interact with genetic vulnerabilities, such as inherited predispositions to emotional callousness and impulsivity thus increasing the risk for antisocial behaviour.
Historically, there has been a deficit in hard evidence on successful treatment interventions for those diagnosed with ASPD. Unfortunately, the pessimism with regard to antisocial personality disorders has persisted with regard to this particular client group’s level of motivation for treatment. In fact, there is a widespread belief that therapy will only make them worse, teaching them the psychological skills to better con and manipulate other people. Research also shows that patients with ASPD have deficits in emotional functioning. The most famous study to show that treatment made psychopaths worse, carried out at a Canadian prison in the 1960’s, wouldn’t come close to getting the green light from an ethical review board today. The patients in the study were given a number of bizarre treatments, including psychedelic drugs such as LSD and participating in naked encounter groups, in an effort to break down their defences. The “treatment” was largely given by the patients themselves, who could even prescribe their own medications, with little involvement from professionals. However, new scientific evidence is beginning to challenge the pessimistic view regarding such patients. Jeffrey Young introduced Schema Therapy which focuses on patients’ unmet emotional needs, reduces suicide risk whilst also improving core symptoms such as identity confusion and unstable relationships thus enhancing the quality of life with a client group suffering from another type of personality disorder, borderline personality disorder (BPD).
The schema therapy approach draws from ‘cognitive-behavioural therapy, attachment theory, psychodynamic concepts, and emotion-focused therapies.[2]’ In comparison to cognitive-behavioural therapy, schema therapy ‘emphasises lifelong patterns, affective change techniques, and the therapeutic relationship, with special emphasis on limited reparenting. Schema therapy is particularly well-suited for difficult, so called resistant clients with entrenched, chronic psychological disorders, including personality disorders[2]’ such as BPD and is now being used to treat those with ASPD. It is also used for the treatment of eating disorders, intractable couples problems, and criminal offenders. It is also effective for relapse prevention in depression, anxiety, and substance abuse.
A 3 year study undertaken by David Bernstein resulted in The Netherlands’ Erkenningscommissie (“Recognition Commission”) being sufficiently impressed by his findings that they certified Schema Therapy as the first officially recognised evidence-based treatment for those with ASPD in forensic patients. This makes Schema Therapy the only evidence-based treatment for forensic patients with ASPD that is recognised in any country. Perhaps similar research can begin to change some attitudes about supposedly untreatable patients with antisocial personality disorder in the not too distant future.
If you have a client, or know of someone who is struggling to find the right help for antisocial personality disorder, reach out to us at Khiron Clinics. We believe that we can improve therapeutic outcomes and avoid misdiagnosis by providing an effective residential program and out-patient therapies addressing underlying psychological trauma. Allow us to help you find the path to realistic, long lasting recovery. For information, call us today. UK: 020 3811 2575 (24 hours). USA: (866) 801 6184 (24 hours).
Sources:
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4167848/%252523R92
- http://www.schematherapytraininguk.com/schema-therapy accessed 27/2/2020
- Tan, Yeow May et al. “Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions.” PloS one vol. 13,11 e0206039. 21 Nov. 2018, doi:10.1371/journal.pone.0206039
All References:
Bernstein, D.P., Nijman, H., Karos, K., Keulen-de Vos, M., de Vogel, V., & Lucker, T. (2012). Schema Therapy for forensic patients with personality disorders: Design and preliminary findings of multicenter randomized clinical trial in the Netherlands. International Journal of Forensic Mental Health, 11, 312-324.
Myres MG (1998). Progression from Conduct Disorder to Antisocial Personality Disorder following Treatment for Adolescent Substance Abuse. American Journal of Psychiatry, April; 155 (4): 479-85.
Ronson J (2012). The Psychopath Test. London. Picador.
Scott, S., Knapp, M., Henderson, J., & Maughan, B. (2001). Financial cost of social exclusion: Follow up study of antisocial children into adulthood. British Medical Journal, 323(7306), 191.
Tan, Yeow May et al. “Schema therapy for borderline personality disorder: A qualitative study of patients’ perceptions.” PloS one vol. 13,11 e0206039. 21 Nov. 2018, doi:10.1371/journal.pone.0206039
Young, J. E., Klosko, J., & Weishaar, M. (2003). Schema Therapy: A Practitioner’s Guide. New York, USA: The Guilford Press.
