Treatment of antisocial personality disorder
- Donald W Black, MD
Donald W Black, MD
- Professor of Psychiatry
- University of Iowa Carver College of Medicine
Antisocial personality disorder (ASPD) is defined as a pattern of socially irresponsible, exploitative, and guiltless behavior that begins in childhood or early adolescence and is manifested by disturbances in many areas of life . ASPD is usually a lifelong disorder that begins in childhood and is fully manifest by the late 20s or early 30s .
Typical behaviors include criminality and failure to conform to the law, failure to sustain consistent employment, manipulation of others for personal gain, and failure to develop stable interpersonal relationships. Other features of ASPD include lacking empathy for others, rarely experiencing remorse, and failing to learn from the negative results of one’s experiences [3,4].
This topic describes treatment for antisocial personality disorder. The epidemiology, pathogenesis, clinical manifestations, course, assessment, and diagnosis of antisocial personality disorder are discussed separately. (See "Antisocial personality disorder: Epidemiology, clinical manifestations, course and diagnosis", section on 'Diagnosis'.)
We suggest that patients with antisocial personality disorder (ASPD) not be routinely treated with medication for the disorder. No medications have been found to be efficacious in the treatment of ASPD. Medications may be useful in the treatment of severe aggressive behavior in patients with ASPD. (See 'Aggressive behavior in ASPD' below.)
Medication may also be appropriate to treat a comorbid psychiatric disorder in persons with ASPD, although medications with abuse potential should be avoided when possible. (See 'Treatment of co-occurring disorders' below.)
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- Aggressive behavior in ASPD
- - Efficacy in aggressive behavior
- Antipsychotic medications
- Selective serotonin reuptake inhibitors
- Other medications in adults
- Children with conduct disorder
- Cognitive behavioral therapy
- - Efficacy
- Other psychotherapies
- - Group parent training
- - Other interventions
- TREATMENT OF CO-OCCURRING DISORDERS
- - Addictive medications
- SUD treatment
- SUMMARY AND RECOMMENDATIONS