Treating antisocial personality disorder

In the past, antisocial personality disorder was thought to be a lifelong disorder, but that's not always the case and it can sometimes be managed and treated. Evidence suggests that behaviour can improve over timewith therapy, even if core characteristics such as lack of empathy remain.

However, antisocial personality disorder is one of the most difficult types of personality disorders to treat. A person with antisocial personality disordermay also be reluctant to seek treatment and may only start therapy when ordered to do so by a court.

The recommended treatment for someone with antisocial personality disorder will depend on their circumstances, taking into account factors such as age, offending history and whether there are any associated problems, such as alcohol or drug misuse.

The person's family and friends will often play an active role in making decisions about their treatment and care. In some cases, substance misuse services and social care may also need to be involved.

The National Institute for Health and Care Excellence (NICE) has published guidelines about the management and prevention of antisocial personality disorder .

Talking therapies

Cognitivebehavioural therapy (CBT) is sometimes used to treat antisocial personality disorder. It's a talking therapy that aims to help a person manage their problems by changing the way they think and behave.

Mentalisation-based therapy (MBT) is another type of talking therapy that's becoming more popular in the treatment of antisocial personality disorder. The therapist will encourage the person to consider the way they think and how their mental state affects their behaviour.

Democratic therapeutic communities (DTC)

Evidence suggests community-based programmes can be an effective long-term treatment method for people with antisocial personality disorder, andis becoming increasingly popular in prisons.

DTC is a type of social therapy that aims to address the person's risk of offending, as well astheir emotional and psychological needs. It's based around large and small therapy groups and focuses on community issues, creating an environment where both staff and prisoners contribute to the decisions of the community. There may also be opportunities for educational and vocational work.

The recommended length of treatment is 18 monthsas there needs to be enough time for a person to make changes and put new skills into practice. Self-motivation is another important factor for acceptance on to this type of scheme. For example, the person must be willing to work as part of a community, participate in groups and be subject to the democratic process.

The Ministry of Justice has more information about DTC in their guide Working with personality disordered offenders (PDF, 969kb) .

Medication

There's little evidence to support the use of medication for treating antisocial personality disorder, although certain antipsychotic and antidepressantmedicationsmay be helpful in some instances.

Carbamazepine and lithiummay help control symptoms such as aggression and impulsive behaviour, and a class of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may improve anger and general personality disorder symptoms.