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Treatment of antisocial personality disorder

Donald W Black, MD
Section Editor
Andrew Skodol, MD
Deputy Editor
Richard Hermann, MD


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 [1]. ASPD is usually a lifelong disorder that begins in childhood and is fully manifest by the late 20s or early 30s [2].

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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Literature review current through: Nov 2017. | This topic last updated: Apr 20, 2017.
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  1. North C, Yutzy S. Goodwin & Guze’s Psychiatric Diagnosis, 6th ed, Oxford University Press, New Yrok 2010.
  2. Robins LN, Price RK. Adult disorders predicted by childhood conduct problems: results from the NIMH Epidemiologic Catchment Area project. Psychiatry 1991; 54:116.
  3. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), American Psychiatric Association, Arlington 2013.
  4. Black DW. Bad Boys, Bad Men – Confronting Antisocial Personality Disorder, Oxford University Press, New York 1999.
  5. Barratt ES, Stanford MS, Felthous AR, Kent TA. The effects of phenytoin on impulsive and premeditated aggression: a controlled study. J Clin Psychopharmacol 1997; 17:341.
  6. National Collaborating Centre for Mental Health, National Institute for Health and Clinical Excellence (NICE), NICE Clinical Guideline 77, Antisocial Personality Disorder: Treatment, Management, and Prevention, January 2009.
  7. Khalifa N, Duggan C, Stoffers J, et al. Pharmacological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2010; :CD007667.
  8. Walker C, Thomas J, Allen TS. Treating impulsivity, irritability, and aggression of antisocial personality disorder with quetiapine. Int J Offender Ther Comp Criminol 2003; 47:556.
  9. Hirose S. Effective treatment of aggression and impulsivity in antisocial personality disorder with risperidone. Psychiatry Clin Neurosci 2001; 55:161.
  10. Coccaro EF, Kavoussi RJ. Fluoxetine and impulsive aggressive behavior in personality-disordered subjects. Arch Gen Psychiatry 1997; 54:1081.
  11. Salzman C, Wolfson AN, Schatzberg A, et al. Effect of fluoxetine on anger in symptomatic volunteers with borderline personality disorder. J Clin Psychopharmacol 1995; 15:23.
  12. Rinne T, van den Brink W, Wouters L, van Dyck R. SSRI treatment of borderline personality disorder: a randomized, placebo-controlled clinical trial for female patients with borderline personality disorder. Am J Psychiatry 2002; 159:2048.
  13. Müller-Oerlinghausen B, Lewitzka U. Lithium reduces pathological aggression and suicidality: a mini-review. Neuropsychobiology 2010; 62:43.
  14. Sheard MH, Marini JL, Bridges CI, Wagner E. The effect of lithium on impulsive aggressive behavior in man. Am J Psychiatry 1976; 133:1409.
  15. Huband N, Ferriter M, Nathan R, Jones H. Antiepileptics for aggression and associated impulsivity. Cochrane Database Syst Rev 2010; :CD003499.
  16. Jones RM, Arlidge J, Gillham R, et al. Efficacy of mood stabilisers in the treatment of impulsive or repetitive aggression: systematic review and meta-analysis. Br J Psychiatry 2011; 198:93.
  17. Mattes JA. Oxcarbazepine in patients with impulsive aggression: a double-blind, placebo-controlled trial. J Clin Psychopharmacol 2005; 25:575.
  18. Stanford MS, Helfritz LE, Conklin SM, et al. A comparison of anticonvulsants in the treatment of impulsive aggression. Exp Clin Psychopharmacol 2005; 13:72.
  19. Davis JM, Janicak PG, Ayd FJ. Psychopharmacotherapy of the personality disordered patients. Psychiatr Ann 1995; 25:614.
  20. Corrigan PW, Yudofsky SC, Silver JM. Pharmacological and behavioral treatments for aggressive psychiatric inpatients. Hosp Community Psychiatry 1993; 44:125.
  21. Campbell M, Adams PB, Small AM, et al. Lithium in hospitalized aggressive children with conduct disorder: a double-blind and placebo-controlled study. J Am Acad Child Adolesc Psychiatry 1995; 34:445.
  22. Donovan SJ, Stewart JW, Nunes EV, et al. Divalproex treatment for youth with explosive temper and mood lability: a double-blind, placebo-controlled crossover design. Am J Psychiatry 2000; 157:818.
  23. Aman MG, De Smedt G, Derivan A, et al. Double-blind, placebo-controlled study of risperidone for the treatment of disruptive behaviors in children with subaverage intelligence. Am J Psychiatry 2002; 159:1337.
  24. Reyes M, Buitelaar J, Toren P, et al. A randomized, double-blind, placebo-controlled study of risperidone maintenance treatment in children and adolescents with disruptive behavior disorders. Am J Psychiatry 2006; 163:402.
  25. Strasburger LH. The treatment of antisocial syndromes: The therapist's feelings. In: Unmasking the Psychopath: Antisocial Personality and Related Syndromes, Reid WH, Dorr D, Walker JI, Bonner JW (Eds), WW Norton, New York 1986.
  26. Beck A, Freeman A, Davis DD, et al. Antisocial personality disorder. In: Cognitive Therapy of Personality Disorders, 2nd ed, Guilford Press, New York 2004.
  27. Hare RD. Without conscience: The disturbing world of psychopaths among us, Pocket Books, New York 1993.
  28. McCord W, McCord J. Psychopathy and delinquency, Grune and Stratton, New York 1956. p.84.
  29. Davidson KM, Halford J, Kirkwood L, et al. CBT for violent men with antisocial personality disorder: reflections on the experience of carrying out therapy in MASCOT, a pilot randomized controlled trial. Personal Ment Health 2010; 4:86.
  30. Gibbon S, Duggan C, Stoffers J, et al. Psychological interventions for antisocial personality disorder. Cochrane Database Syst Rev 2010; :CD007668.
  31. Davidson KM, Tyrer P, Tata P, et al. Cognitive behaviour therapy for violent men with antisocial personality disorder in the community: an exploratory randomized controlled trial. Psychol Med 2009; 39:569.
  32. Huband N, McMurran M, Evans C, Duggan C. Social problem-solving plus psychoeducation for adults with personality disorder: pragmatic randomised controlled trial. Br J Psychiatry 2007; 190:307.
  33. Thylstrup B, Schrøder S, Fridell M, Hesse M. Did you get any help? A post-hoc secondary analysis of a randomized controlled trial of psychoeducation for patients with antisocial personality disorder in outpatient substance abuse treatment programs. BMC Psychiatry 2017; 17:7.
  34. Thylstrup B, Hesse M. Impulsive lifestyle counseling to prevent dropout from treatment for substance use disorders in people with antisocial personality disorder: A randomized study. Addict Behav 2016; 57:48.
  35. Lipsey MW. The effect of treatment on juvenile delinquents: Results from Meta-analysis presented at a meeting sponsored by the National Institute of Mental Health. Bethesda, MD. October 31 to November 3, 1992.
  36. Brown WK, Miller TP, Jenkins RL. The favorable effect of juvenile court adjudication and delinquent youth on the first contact with the juvenile justice system. Juv Fam Court J 1987; 38:21.
  37. Robins L. Deviant Children Grown Up, Williams and Wilkins, Baltimore, MD 1966.
  38. Sholevar GP. Family therapy for conduct disorders. Child Adolesc Psychiatr Clin N Am 2001; 10:501.
  39. Kazdin AE. Treatment of antisocial behavior in children: current status and future directions. Psychol Bull 1987; 102:187.
  40. Scott S, Briskman J, O'Connor TG. Early prevention of antisocial personality: long-term follow-up of two randomized controlled trials comparing indicated and selective approaches. Am J Psychiatry 2014; 171:649.
  41. Petrosino A, Turpin-Petrosino C, Buehler J. "Scared Straight" and other juvenile awareness programs for preventing juvenile delinquency. Cochrane Database Syst Rev 2002; :CD002796.
  42. Ullrich S, Coid J. Antisocial personality disorder: co-morbid Axis I mental disorders and health served use among a national household population. Personal Ment Health 2009; 3:151.
  43. Shapiro S, Skinner EA, Kessler LG, et al. Utilization of health and mental health services. Three Epidemiologic Catchment Area sites. Arch Gen Psychiatry 1984; 41:971.
  44. Black DW, Braun D. Antisocial patients: a comparison of those with and those without childhood conduct disorder. Ann Clin Psychiatry 1998; 10:53.
  45. Carney FL. Inpatient treatment programs. In: The Psychopath: A comprehensive study of Antisocial Disorders and Behaviors, Reid WH (Ed), Brunner/Mazel, New York 1979.
  46. Reich JH, Green AI. Effect of personality disorders on outcome of treatment. J Nerv Ment Dis 1991; 179:74.
  47. Cowdry RW, Gardner DL. Pharmacotherapy of borderline personality disorder. Alprazolam, carbamazepine, trifluoperazine, and tranylcypromine. Arch Gen Psychiatry 1988; 45:111.
  48. Westmoreland P, Gunter T, Loveless P, et al. Attention deficit hyperactivity disorder in men and women newly committed to prison: clinical characteristics, psychiatric comorbidity, and quality of life. Int J Offender Ther Comp Criminol 2010; 54:361.
  49. Black DW, Simsek-Duran F, Blum N, et al. Do people with borderline personality disorder complicated by antisocial personality disorder benefit from the STEPPS treatment program? Personal Ment Health 2016; 10:205.
  50. Cacciola JS, Alterman AI, Rutherford MJ, Snider EC. Treatment response of antisocial substance abusers. J Nerv Ment Dis 1995; 183:166.
  51. Brooner RK, Kidorf M, King VL, Stoller K. Preliminary evidence of good treatment response in antisocial drug abusers. Drug Alcohol Depend 1998; 49:249.
  52. Neufeld KJ, Kidorf MS, Kolodner K, et al. A behavioral treatment for opioid-dependent patients with antisocial personality. J Subst Abuse Treat 2008; 34:101.