Antisocial Personality Disorder

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Antisocial Personality Disorder

Antisocial personality disorder is among many personality disorders. Personality is the pattern of characteristic of how a person thinks, how he or she experiences and shows or expresses emotions and how he or she makes relations with the people around (Masterson & Parker, 2019). Antisocial personality disorder has a very high prevalence of 70% and above among the males who have alcohol use disorder, from clinics of substance abuse and prisons (APA, 2013). Additionally, there is also a high prevalence among people who have been affected by extreme socioeconomic factors like poverty and sociocultural factors like migration (APA, 2013). Therefore, the condition is common in particular settings as opposed to others. This paper shall focus on the diagnostic and criteria, management through psychotherapy and psychopharmacologic means and clinical features of antisocial personality disorder.

Diagnostic Criteria

The DSM-5 diagnostic criteria for antisocial personality disorder includes presence of a pervasive pattern of having no regard for and violating the rights of other people with its onset being fifteen years of age (APA, 2013). The patient should at least three of a list of symptoms that include not conforming to the social norms by respecting behaviors that are lawful, being deceitful, presence of impulsivity, being aggressive and irritable, recklessness when it comes to regarding the safety of other people and self, consistently irresponsible and having no remorse (APA, 2013). Further, the patient should be at least eighteen years of age, have evidence that the disorder began before the patient was fifteen years of age and that the antisocial behavior does not occur exclusively when there is schizophrenia or bipolar disorder (APA, 2013).

There are also supporting features for the diagnosis of antisocial personality disorder. Among them is having no empathy and being cynical about the feelings of other people, their rights and problems or sufferings (APA, 2013). The may be too much self-assured and may display superficial charm (APA, 2013). They can also be very exploitative when it comes to their sexual relationships, show irresponsibility as parents and have a high prevalence of dying at an early age or prematurely because of violence like suicide, homicides or even accidents (APA, 2013).these features can help with supporting the diagnosis of the condition.

Evidence-based Psychotherapy and Psychopharmacologic Treatment

It is important to note that personality disorders do not directly originate from a disease, damage or any other mental disorder (Masterson & Parker, 2019). It can be addressed and dealt with through an outpatient setting. Treatment of antisocial personality disorder can be done through psychotherapeutic means or psychopharmacologic treatment. However, there is absence of pharmacologic intervention that has shown efficacy in the treatment of antisocial personality disorder (Fisher & Hany, 2019). Despite this challenge and lack of information on medicine efficacy, psychopharmacologic interventions are greatly recommended for the treatment of conditions that are co-occurring or comorbid (Fisher & Hany, 2019). This helps in dealing with some of these conditions that occur with the antisocial personality disorder. For example, aggressive behavior can be medicated using second generation antipsychotics like risperidone and quetiapine as first line therapy (Fisher & Hany, 2019). Selective serotonin reuptake inhibitors (SSRI) like sertraline or fluoxetine can be used as second line therapy (Fisher & Hany, 2019). Third line therapy for aggressive behavior includes mood stabilizers and carbamazepine (Fisher & Hany, 2019). For pharmacological treatment of impulsivity, anticonvulsants like oxcarbazepine can be utilized (Fisher & Hany, 2019). From this information, it is evident that there is no medication for antisocial personality disorder itself, but the conditions that occur with it or are comorbid can be managed using medications.

Due to the lack of psychopharmacologic interventions for treating antisocial personality disorder, psychotherapy has become the mainstay of the condition’s treatment. The National Institute of Health and Care Excellence recommends for treatment of antisocial personality behavior to focus on offering cognitive behavior therapy (CBT) together with metallization behavior therapy (MBT) (Masterson & Parker, 2019). CBT focuses on the ways feelings together with thoughts and patient’s behavior affect one another and how the patients can switch these patterns (Masterson & Parker, 2019). MBT on the other hand is a long-term treatment plan that involves talking. It focuses on improving the ability of the patient to be able to identify and comprehend his or her mental state and that of other people, in addition to helping the patient examine his or her thoughts and those of others (Masterson & Parker, 2019).

Clinical Features

The clinical features of antisocial personality disorder include disregarding write and wrong, lying persistently, being cynical, manipulating other people through charm, violating other people’s rights repetitively, being arrogant, being hostile, lacking empathy for other people, being abusive in relationships, being irresponsible persistently, stealing, being aggressive towards animals and violating rules in a serious manner (Masterson & Parker, 2019). These clinical features or signs and symptoms can be observed in a patient with antisocial personality disorder.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub.

Fisher, K. A., & Hany, M. (2019). Antisocial Personality Disorder.

Masterson, S., & Parker, C. (2019). Antisocial personality disorder: diagnosis and management. The Pharmaceutical Journal, 1–6. https://doi.org/10.1211/pj.2019.20206699

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