ANTISOCIAL PERSONALITY DISORDER

Antisocial Personality Disorder or ASPD is a mental condition in which a person has a long term pattern of manipulating, exploiting, or violating the rights of others without any remorse.

People with antisocial personality disorder may act rashly, destructively and unsafely without feeling guilty when their actions hurt other people. This behavior may cause problems in relationships or at work and is often criminal.

Like other types of personality disorder, antisocial personality disorder is on spectrum, which means it can range in severity from occasional bad behavior to repeatedly breaking the law and committing serious crimes.

What causes Antisocial Personality Disorder (ASPD)?

It is not known why some people develop antisocial personality disorder, but both genetics and traumatic childhood experiences, such as child abuse or neglect, are thought to play a role. A person with ASPD will have often grown up in difficult family circumstances such as inconsistent parenting, parental conflict or misuse of alcohol or drugs by one or both parents.

What are the symptoms of Antisocial Personality Disorder ASPD?

🔵 Repeatedly performing unlawful acts such as destroying property, harassing others, stealing or pursuing illegal occupations that are grounds for arrest (whether they are arrested or not).

🔵 Persistent lying or conning others for their own profit or pleasure such as to obtain money, sex or power. They may use an alias.

🔵 Acting impulsively, not planning ahead and not considering the consequences for the safety of self or others. This may lead to sudden changes of jobs, residences or relationships.

🔵 Repeatedly engaging into physical fights or committing acts of physical assault such as spouse beating or child beating.

🔵 Disregarding the safety of themselves and others as evidenced in their irresponsive driving behavior like driving recklessly, over speeding, driving while intoxicated, which sometimes may lead to crashes, etc.

🔵 Consuming excessive amount of alcohol or taking illegal drugs that may have harmful effects.

🔵 Being consistently irresponsible and repeatedly failing to fulfil work or financial obligations such as abandonment of several jobs without a realistic plan for getting another job, absences from work without a valid reason, failing to provide child support or failing to support other dependants, defaulting on debts, etc.

🔵 Lack remorse and empathy when mistreating others and rationalize their actions by blaming those they hurt (e.g., they blame victims to be foolish or helpless) or the way life is (e.g., unfair).

🔵 Failure to consider the negative consequences of their behavior or learn from them. They generally fail to compensate or make amends for their behavior.

🔵 Being arrogant, self-assured and very opinionated (e.g., they have a high opinion of themselves). They may be charming, voluble and verbally facile in their efforts to get what they want.

How common is Antisocial Personality Disorder (ASPD)?

ASPD affects 2% to 4% of the population and is more common in men. The highest prevalence of antisocial personality disorder (greater than 70%) is among most severe samples of males with alcohol use disorder and from substance abuse clinics, prisons, or other forensic settings. Prevalence is higher in samples affected by adverse socioeconomic (i.e., poverty) or sociocultural (i.e., migration) factors.

How is Antisocial Personality Disorder (ASPD) diagnosed?

A diagnosis of ASPD cannot be made in people younger than 18. Symptoms that resemble ASPD in those people may be diagnosed as a conduct disorder. People who are older than 18 can be diagnosed with ASPD only if there’s a history of conduct disorder before the age of 15. Diagnosis involves a psychiatrist or clinical psychologist observing and interviewing the person with suspected antisocial personality disorder, and asking other people about their behavior.

What is the treatment of Antisocial Personality Disorder (ASPD)?

Treatment for antisocial personality disorder may prove challenging. People with this disorder rarely seek treatment, because they do not think there is anything wrong with the way they behave. They may only start therapy when required to by a court. The doctor may recommend different types of psychotherapy based on the person’s situation.

🔵 Cognitive Behavioral Therapy (CBT) focuses on challenging dysfunctional thoughts and beliefs and teaches the clients strategies, exercises and behavioural experiments in order to acquire more socially acceptable behaviour. A therapist can help a person manage negative behaviors and build interpersonal skills they may lack.

🔵 Mentalisation- based Therapy (MBT) is a type of talking therapy that’s becoming more popular in the treatment of ASPD. The therapist will encourage the person to consider the way they think and how their mental state affects their behavior.

🔵 Contingency Management is a type of behavioural therapy in which individuals are ‘reinforced’ or ‘rewarded’ for evidence of positive behavioral change. It is most often used in treating substance used disorders. This intervention can be used to reduce misuse of drugs or alcohol in patients with ASPD.

🔵 Medication may sometimes be prescribed to reduce the aggressive or impulsive behaviors, depression or erratic mood in people with ASPD. The doctor may recommend antidepressants, antipsychotics or mood stabilizers. There has been no research that supports the use of medications for antisocial personality disorder.

Tips for people with ASPD

🔵 If you are feeling angry, frustrated or restless; you can try a breathing exercise, listen to your favourite music, dance or sing, do something creative such as painting, playing musical instrument, write a journal. You can try taking a cold shower- some people find it really helpful.

🔵 You can talk to others with similar experiences which can be helpful. Peer support gives you a chance to share your experience, give and receive support and hear and learn from others.

🔵 You can try mindfulness which will help you in becoming more self-aware, feel calmer and less stressed, cope with difficult thoughts, and feel more able to choose how to respond to your thoughts and feelings.

🔵 Keep yourself connected with your family and loved ones as it will help you to feel valued, confident and more able to face difficult times.

🔵 Try to make changes in your diet. Eating healthy food and taking proper meals helps in making a difference to your mood and energy levels. Abstain from smoking and drinking.

🔵 Exercise regularly as it will helpful for your mental wellbeing.

Tips for partners, families and carers

• It is important to look for your mental wellbeing too. It could be quite distressing seeing someone you care about engaging in disruptive behavior. You can talk to someone if you are struggling to cope.
• Encourage and support them to seek professional help. It is important to reassure your loved ones that it’s ok to ask for help and that there is help out there.
• You can participate in individual counselling to help manage emotions and learn to set appropriate boundaries with the family member.
• Family psycho education is a typical way for parents to get involved and is especially useful for families of patients with personality disorders. It focuses on teaching you more about the condition and ways that you can positively support your loved one. You will learn more effective ways of communicating and action-based steps for building a better relationship.
• Support groups are immensely helpful, because they allow you to interact with people who know what you are going through. Together you support each other, sharing stories as well as practical advice. These groups help you make connections and friendships that last and that can continue providing support in the future.

Myths v/s Facts about Antisocial Personality Disorder

References

https://www.rcpsych.ac.uk/

• https://www.msdmanuals.com/professional/psychiatric-disorders/personality-disorders/antisocial-personality-disorder-aspd
• https://medlineplus.gov/ency/article/000921.htm
• https://www.psycom.net/antisocial-personality-disorder/#symptoms
• https://www.nhs.uk/mental-health/conditions/antisocial-personality-disorder/
• https://www.therecoveryvillage.com/mental-health/antisocial-personality-disorder/related/aspd-myths/
• American Psychiatric Association. Paranoid personality disorder. Diagnostic and Statistical Manual of Mental Disorders. 5th ed.