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How to Treat Antisocial Personality Disorder
A proper understanding of mental health problems and the acknowledgment that they can be addressed is much overdue, especially for disorders such as antisocial personality disorder or ASPD, which deeply affect the individual with the illness as well as the people around them.
Antisocial Personality Disorder is a particularly difficult mental health issue to deal with as it could escalate into criminal actions and pose a hardship for families and communities around the affected individual.
In this article, we will look at what Antisocial Personality Disorder is, in terms of its manifestations in different individuals, as well as prove ways to treat and assist those suffering from this disorder.
Antisocial Personality Disorder is a mental disorder, usually occurring around adolescence age (14-15) and aggravating towards the early '20s, which is marked by a certain disrespect for society, law, and rules.
People with ASPD tend to be disruptive and can also be destructive during manic phases.
They tend to be manipulative, hurt the people around them either physically or emotionally, do not display any remorse for the actions they have committed, and are hostile towards people and impulsive in their actions.
They may also engage in illegal conduct during their teenage and adult years which could include acts such as arson, vandalism and destruction of property, cruelty towards animals, and a tendency to lie or be dishonest to law enforcement officials.
There is a propensity for the more violent, criminal facets to mitigate as the individual reaches middle age, although this is dependent on the effect of aging on the individual and the person’s inclination to change or ability to gauge the adverse impacts of their disease on themselves and others.
APSD can be made worse, with co-morbidities such as borderline personality disorder (BPD), substance abuse problems, and mood disorders like depression.
Treatment of Antisocial Personality Disorder
Treatment of Antisocial Personality Disorder can be extremely tough, most of all because the individuals themselves are against treatment.
When they are coerced or persuaded into getting treatment, they tend to be vehemently opposed to external help, as they do not see themselves as having a problem.
Another issue is the lack of specified therapeutic interventions or medications to target only antisocial personality disorder.
This means that medications and therapies used for other mental health challenges need to be deployed in some workable permutations to provide the individual with some amount of relief. This strategy will work with differing efficacy depending on the context, as almost 90% of people with APSD also have additional co-occurring psychiatric problems like
The first step in treatment would generally be medication, to get the symptoms under control, so that the individual concerned is more amenable to opening up to suggestions and improvement.
Medications for Antisocial Personality Disorder
Since there is no specific medicine for antisocial personality disorder, medications that work on similar symptoms in other psychiatric disorders are used to fair effect.
For example, certain anti-epileptics like phenytoin, valproate, lithium, and oxcarbazepine may be prescribed to stabilize mood.
Likewise, certain antipsychotics like aripiprazole, olanzapine, risperidone, quetiapine, or haloperidol may also be prescribed to control aggression, irritability, and impulsivity.
Since anxiety and depression often co-occur with ASPD, selective- serotonin reuptake inhibitors, (SSRIs), NRIs i.e., norepinephrine reuptake inhibitors, or similar classes of drugs to elevate mood, anhedonia, and lethargy could be used as well.
The same class of medicines may also be helpful if co-morbidities like attention deficit hyperactivity disorder i.e., ADHD are diagnosed as well.
Substance use disorder or SUDs that accompany antisocial personality disorder can be treated with different medications.
Naltrexone or methadone could be used for opioid addictions, whereas bupropion works for nicotine addictions, and disulfiram or acamprosate can be employed for alcohol dependence.
Psychotherapy for Antisocial Personality Disorder
In addition to medication, different forms of psychotherapy may help the individual, caregivers, and family members to deal with the disorder and cope with its fallouts. The therapy offered could be individual, family, or group therapy.
However, there is not enough evidence to prove the beneficial impact of therapy on people with ASPD alone.
The most common method used is cognitive behavioral therapy or CBT, in which counseling is offered to change thought and behavioral patterns that are maladaptive.
This has been seen in limited studies to be helpful for teenagers with antisocial personality disorder who have been institutionalized.
Talk therapy can also help correct dysfunctional relationships and make the individual more aware of the consequences of his/her actions and their adverse nature.
However, talk therapy hasn’t been seen to be particularly useful. Instead, if children with the warning signs of this disorder are identified and treated between the ages of 3-7 years, their academic performance and familial relationships may improve.
Another type of useful therapy could be mentalization-based therapy (MBT) which focuses on building interpersonal skills and evaluating emotional connections in the present circumstances rather than dwelling on past events and actions.
Democratic therapeutic community i.e., DTC is one more type of group therapy often used in prisons, which emphasizes a family-like setting where the individual's psychological needs and problems are addressed and relationships of trust and responsibility are built.
This type of therapy along with other forms like contingency management is, however, seen to have the most effect in substance abuse and suicidal scenarios by creatin attachments that form a barrier to negative patterns.
The impulsive lifestyle counseling model also addresses substance abuse alongside antisocial personality disorder by providing mental health education and counseling so that people can identify their problematic habits.
It has been seen that some combination of therapies and medications have to be worked out to help people with ASPD and their family members to manage the disorder as best as possible.
The extremes of ASDP are known as psychopathy or sociopathy, in which the individual displays a complete disregard for what is right or wrong, doesn’t care about harming others, being irresponsible, or breaking the law.
Psychopaths also have a complete lack of empathy. Treating such individuals can be impossible – hence, it is important to identify the signs early and attempt to create an understanding of ethical behavior and the repercussions of their illness on society.
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