Treating the Untreatable: An Unfortunate Outlook on Antisocial Personality Disorder

By Vidya Koesmahargyo 

Antisocial personality disorder (ASPD) is one of the hardest personality disorders to treat. Not much is known on ASPD compared to more common mental illnesses. According to Lenzenweger, et al. only 0.6% of the U.S population has been diagnosed with ASPD (2007). 

Now, 0.6 % percent may not seem like a large percentage. However, when multiplied with the U.S. population of 318 million people, over 1.9 million people in the U.S. are living with ASPD. Even though it is not as prevalent as mood or anxiety disorders, it does not discount the importance of ensuring individuals with ASPD receive the treatment and care they deserve.

One of the factors that contribute to the lack of success in treating ASPD is tied to the nature of the disorder. The symptoms associated with ASPD are: consistent irresponsibility, failure to conform to social norms, and lack of remorse (American Psychiatric Association, 2013).  This might contribute to an individual’s reluctance to seek or go through with treatment. People may only start therapy when required to by a court. In fact, court referrals for assessment and treatment for individuals with ASPD are likely the most common referral source for this disorder. (Grohol, 2013)

The situation for these individuals is not ideal. According to a study by James & Glaze, almost 61% of prisoners in the United States have a mental health disorder. These individuals face a markedly higher chance of abuse from other inmates and staff than non-mentally ill prisoners, further decreasing a successful prognosis. (2006) In another study done throughout several correctional facilities in Connecticut, 34.6% percent of inmates have ASPD. (Trestman, et al. 2007) Mental illness in the United States is highly criminalized, which poses as a problem because incarceration is an abhorrent and inefficient way to treat mental illness. (NYTimes)

For individuals with ASPD who aren’t facing a jail sentence, their outlook isn’t necessarily any better. There is simply not enough research that has been conducted on antisocial personality disorder. Many psychotherapists argue that treatment for this disorder does not yield much success. However, only one randomized controlled trial has been conducted, which tested cognitive-behavioral therapy (CBT) as a viable treatment for ASPD. The study concluded that the treatment didn’t work. This contrasts other illnesses such as depression or bipolar disorder, where researchers have conducted numerous studies looking at the effectiveness of medications and psychotherapies. Psychologists do not have enough information to determine which approach is best to treat this disorder. (Tartakovsky)

It is safe to conclude that additional research on antisocial personality disorder is highly needed. The information gathered can help find better diagnostic techniques, treatment options, and outreach possibilities to reduce the criminalization and under treatment of individuals with ASPD.

Sources:

Lenzenweger, M. F., Lane, M. C., Loranger, A. W., & Kessler, R. C. (2007). DSM-IV personality disorders in the National Comorbidity Survey Replication.Biological Psychiatry, 62(6), 553–564. http://doi.org/10.1016/j.biopsych.2006.09.019

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). doi:10.1176/appi.books.9780890423349

Grohol, J. (2013, October 9). Antisocial Personality Disorder Treatment. Retrieved from http://psychcentral.com/disorders/sx7t.htm

James, D. & Glaze, L. (2006, December 14). Mental Helth Problems of Prison and Jail Inmates. Retrieved from http://www.bjs.gov/content/pub/pdf/mhppji.pdf

Trestman, R., Ford J., Zhang W., and Wiesbrock, V. (2007). Current and Lifetime Psychiatric Illness Among Inmates Not Identified as Acutely Mentally Ill at Intake in Connecticut’s Jails. The Journal of the American Academy of Psychiatry and the Law, volume 35(4), 493-495.

Kristof, N. (2014). Inside a Mental Hospital Called Jail. New York Times. Retrieved from http://www.nytimes.com/2014/02/09/opinion/sunday/inside-a-mental-hospital-called-jail.html?_r=0

Tartakovsky, M. (2013). Surprising Myths & Facts About Antisocial Personality Disorder. Psych Central. Retrieved on October 6, 2015, from http://psychcentral.com/blog/archives/2013/04/06/surprising-myths-facts-about-antisocial-personality-disorder/