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Antisocial personality disorder is listed in the Diagnostic and Statistical Manual of Mental Health Disorders as a cluster B (dramatic/erratic) personality disorder. It is characterized by frequent antisocial behavior and a lack of regard for others. While being the most reliably diagnosed personality disorder, it is also notoriously difficult to treat.
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Diagnostic Criteria for Antisocial Personality Disorder
To receive a diagnosis of antisocial personality disorder an individual must:
- Be at least 18 years of age
- Have shown evidence of conduct disorder before the age of 15
- Show a pervasive pattern of disregard for the rights of others since at least age 15
They must also show at least three of the following:
- Repeated law breaking
- Irritability and aggressiveness
- Reckless disregard for others and own safety
- Irresponsibility as illustrated in an unreliable employment history or failure to meet financial obligations
- Lack of remorse
Once a diagnosis of antisocial personality disorder has been made the Psychopathy Checklist-Revised (Hare, 2003) should be administered. Scores of between 10 and 19 would be considered mild psychopathy, scores of between 20 and 29 would be considered moderate psychopathy and scores of over 30 would be considered severe psychopathy. It is the level of psychopathy that a person with antisocial personality disorder presents with that has important implications for treatment prognosis. Psychopathy is closely related to antisocial personality, but they are not synonymous. In fact, only one out three patients with antisocial personality disorder at most has severe psychopathy.
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Cognitive Behavioral Therapy and Antisocial Personality Disorder
Along with social learning techniques, cognitive behavioral techniques are the most commonly used treatment methods for antisocial personality disorder. Although there is not a sufficient body of research investigating cognitive behavioral therapy and antisocial personality disorder, its techniques show promise in some cases.
Cognitive behavioral relapse prevention theory in particular, is associated with successful correctional treatment programs. It works on the premise that antisocial behavior (and indeed all behaviors) are learned, motivated and reinforced by internal (within the person) and external (within the environment) factors. Various cognitive behavioral methods can be used to implement new cognitive and behavioral strategies to break the chain of antisocial behavior.
Cognitive behavioral methods may be effective in treating antisocial personality disorder patients with mild to moderate psychopathy who are motivated to change, respond in the same way as the general population to aversive consequences, and who have realized the consequences of their antisocial behavior.
However, cognitive behavioral methods are unlikely to be effective on antisocial personality disorder patients with severe psychopathy. This is due to several reasons. Firstly, as psychopathy increases anxiety decreases and with it the personal discomfort that motivates a person to change. Secondly, many patients with severe psychopathy have been to found to lack an attachment capacity and will therefore be unable to form an alliance with their therapist. The ability to form an alliance with a therapist has been shown to be related to the effectiveness of all treatments. Lastly, those with severe psychopathy are unable to forsee the long term consequences of their actions, or reflect on the past consequences of their actions.
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Meloy, J.R. (2007) Antisocial Personality Disorder. Read it here.
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edition. Washington DC: American Psychiatric Association.
Hare, R. (2003) Hare Psychopathy Checklist-Revised (PCL-R): 2nd edition technical manual. Toronto: Multihealth Systems.
Antisocial Personality Disorder and Cognitive Behavioral Therapy
Cluster B personality disorders are notoriously difficult to treat. This series of articles explores some effective treatments for different cluster B personality disorders.