antisocial personality disorder psychotherapy

prospective, controlled trials in which participants with aspd were randomly allocated to a psychological intervention and a control condition (either treatment as usual, waiting list or no treatment). antisocial personality disorder (aspd) is one of the ten personality disorder categories in the current edition of the diagnostic and statistical manual of mental disorders (dsm-iv; apa 2000). for example, davies 2007 reported that 20 years after discharge from a medium secure unit almost half of the patients were reconvicted, with reconviction rates higher in those with personality order compared to mentally ill patients. it is important to consider all relevant studies without restriction on the type of psychological therapy and to consider psychological interventions where drugs are also given as an adjunctive intervention. this review aims to evaluate the potential beneficial and adverse effects of psychological interventions for people with antisocial personality disorder. we included all relevant randomised controlled trials, with or without blinding of the assessors, and published in any language. we searched the reference lists of included and excluded studies for additional relevant trials. we made significant efforts to contact the primary trial investigator for missing data on any subgroup of participants diagnosed with aspd where this was not published. for dichotomous data, we report missing data and drop-outs for each included study and report the number of participants who are included in the final analysis as a proportion of all participants in each study. data on participants with antisocial personality disorder (aspd)were available for five of the 11 studies (davidson 2009; huband 2007; messina 2003; neufeld 2008; woodall 2007) and these are summarised in this review. the number of participants completing was reported in only four studies where the proportion that completed ranged from 78.8% to 100% (mean 89.1%). the total number of white participants randomised expressed as a proportion of total randomised was 58% for those studies where this information was available. full details are provided in the characteristics of included studies table but can be summarised as follows and in table 5 below. there were five studies that did not report on any of the primary outcomes defined in the protocol for this review (havens 2007; mckay 2000; messina 2003; tyrer 2004; woody 1985); of these, only messina 2003 had data available for participants with aspd.

a further six were excluded because there were less than five participants with antisocial or dissocial pd for reasons that are now explained in the selection of studies section. we judged that blinding of participants and personnel involved in the delivery of the intervention was not practical in the design of trials of psychological interventions summarised in this review. we classed all six studies as ‘unclear’ because it was not possible, in the absence of data from the subgroup with antisocial or dissocial pd, to judge the extent and nature of any missing data, and whether the reasons for such missing data balance across intervention groups. this analysis is based on summary data of completers supplied by the trial investigators and derived from a mixed regression model that included time-specific random effects and an interaction term (see table 1). neufeld 2008 report data indicating no statistically significant difference between treatment and control conditions in the proportion of participants transferred due to poor or partial treatment response by six months (or 0.42; 95% ci 0.17 to 1.04, p = 0.04, analysis 1.1). the trial investigators, while providing data on the aspd subgroup, noted that their trial was not designed to have sufficient power to detect significant change in subgroups of this size, and also that 20 of the 24 had at least one other axis ii diagnosis. trial investigators used diagnosis of aspd as one criterion for assignment to high (rather than low) risk category, but no data was available for the aspd subgroup. the trial investigators report on aspd subgroup with data for the experimental condition, but not for control condition for the aspd subgroup. the trial investigators concluded that “a diagnosis of aspd was not a predictor of differential response to the two continuing care interventions in the study. a proportion of the quantitative data available from the studies included in this review met our criteria for skewed data as described in the section on measures of treatment effect. we were aware of a potential for bias that might be seen as arising because two of the review authors (cd and nh) were investigators in one of the studies included in this review (huband 2007). the results from this review are that there is insufficient trial evidence to justify using any psychological intervention for those with a diagnosis of aspd. only three studies reported outcome measures that were originally defined in the review protocol as being of particular importance in this disorder (reconviction and aggression). nick huband: investigator in a completed randomised controlled trial of social problem-solving therapy plus psychoeducation for people with personality disorder (huband 2007); because this study was included in this review, nh and cd excluded themselves from data extraction and summarising the risk of bias for this trial. methodological quality summary: review authors’ judgements about each methodological quality item for each included study.

if a person has full-blown aspd, “their personality structure cannot really change, though there may be some progress with harm reduction if the person can be convinced that it is in their own best interest to avoid certain behaviors and their consequences,” says dr. reiss. the most recent systematic review on behavioral therapy for antisocial personality disorder treatment was done in 2010. but researchers found only 11 studies, and only three were related to actual symptoms of antisocial personality disorder. the difference in whether a therapy works or not may depend on whether an individual with antisocial personality disorder wants it to work.

one study found that the antidepressant drug pamelor (nortriptyline) helped treat misuse of alcohol in people with antisocial personality disorder. even if antisocial personality disorder itself cannot be treated, people with the condition can seek treatment for other mental health problems. (13) similarly, vivitrol (naltrexone), acamprosate, and antabuse (disulfiram) can be used to treat alcohol dependence in a person with (or without) antisocial personality disorder. none of these drugs are specifically approved to treat antisocial personality disorder, but if they successfully treat another condition in a person with antisocial personality disorder, that may reduce the person’s antisocial tendencies as well.

psychotherapy, also called talk therapy, is sometimes used to treat antisocial personality disorder. therapy may include, for example, how can psychotherapy help antisocial personality disorder (aspd)? cognitive behavioral therapy is a type of counseling that focuses on psychoanalytic therapies (which include dynamic psychotherapy, transference-focused psychotherapy, mentalisation-based therapy and group psychotherapy) aim to, antisocial personality disorder test, antisocial personality disorder test, what causes antisocial personality disorder, antisocial personality disorder diagnosis, antisocial personality disorder dsm-5.

like most personality disorders, antisocial personality disorder is difficult to treat. to date, no medication or behavioral therapy option therapies for antisocial personality disorder cognitive behavioral therapy (cbt) mentalization-based treatment (mbt) democratic therapeutic the goal of this therapy is to help people manage strong emotions and possibly decrease the number of self-harm days in adults with aspd. like cbt, antisocial personality disorder symptoms, treatment of antisocial personality disorder: development of a practice focused framework.

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