What is Antisocial Personality Disorder & Can It Be Treated?

In the summer of 1976, David Berkowitz (aka the Son of Sam) terrorized New York City with a series of shootings that continued for a year before he was arrested. He killed six people and wounded seven others. Many media reports, books, and movies have since followed, often painting him as evil personified. It raises the question, are psychopaths born or made? And can these individuals be treated?

Of course, the psychology of a violent person is not that simple. Brain abnormalities, genetic vulnerability, and adverse childhood experiences all play a role in the development of a personality disorder, which affects both thinking and behavior.

Antisocial personality disorder (ASPD), also called sociopathy or psychopathy, is a serious mental health condition characterized by harmful behaviors without remorse. While it’s a particularly challenging condition to treat, individuals with ASPD can learn to manage and minimize their symptoms to lead better lives.

Remarkably, it appears that’s what David Berkowitz has done. A psychologist who recently spent 34 sessions and 100 hours with him reports that he is a rehabilitated man. Prison officials describe Berkowitz as a model inmate. His story is a hopeful one.

Here are the facts on ASPD and what treatments are most effective.

WHAT IS ANTISOCIAL PERSONALITY DISORDER?

Antisocial personality disorder is one of many personality disorders, which all share the traits of unhealthy, inflexible thinking patterns and behaviors that negatively impact daily functioning and relationships.

Specifically, ASPD is characterized by an established pattern of manipulating, exploiting, and taking advantage of others for personal gain. Showing little respect for the law or the rights of other people is another common trait.

Importantly, a key defining feature of ASPD is a lack of remorse. Individuals with this disorder are cruelly indifferent to the pain their behavior causes to others.

ASPD is also referred to as sociopathy or psychopathy. Unfortunately, these non-diagnostic terms tend to conjure images of frighteningly callous characters or violent criminals depicted in films and television, which are mostly inaccurate. This has added to the disorder being highly stigmatized and greatly misunderstood.

In fact, a 2022 survey found that ASPD and schizophrenia are the most stigmatized psychiatric disorders. In truth, the condition can range in severity from occasional bad behavior to committing serious, and sometimes violent crimes.

SYMPTOMS OF ANTISOCIAL PERSONALITY DISORDER

Individuals with antisocial personality disorder will typically demonstrate at least several of the following symptoms:

• Disregarding and violating the rights of others
• Frequently breaking laws and social norms
• Deceitfulness (repeated lying, cheating, stealing, using aliases, or conning others)
• Lack of remorse (indifference) for harms caused to others
• Inflated sense of self-worth (grandiosity)
• Heightened irritability
• Aggressive or violent behavior
• Recklessness and lack of concern for safety for self or others
• Impulsivity
• Consistent irresponsibility, resulting in financial and/or work problems

ASPD is not diagnosed until adulthood (age 18). In most ASPD diagnoses, a patient will have previously received a conduct disorder (CD) diagnosis before the age of 15. The small percentage of adults with ASPD who never received a CD assessment or didn’t meet the criteria in their youth usually have milder symptoms.

Antisocial personality disorder symptoms can get better with age. They tend to be most challenging in an individual’s late teens/early 20s and improve by their 40s. The lifetime prevalence of ASPD amongst the general population is estimated to be 1 to 4%, and it is three times more common in men than women.

WHAT CAUSES ANTISOCIAL PERSONALITY DISORDER? 

Unfortunately, people with antisocial personality disorder are often labeled as simply bad or evil, which is inaccurate and unhelpful. It also overlooks its real causes and conditions.

Antisocial personality disorder is a brain disorder. Indeed, neuroimaging research has found both structural and functional abnormalities in the brains of people with ASPD.

Additional factors that play a role in the development of the condition include:

• Genetics: If you have a close relative with a personality disorder, it may increase your risk of developing the condition, research
• Emotional trauma: Exposure to traumatic events or experiencing abandonment, neglect, or abuse (especially violent abuse) as a child is highly associated with the development of ASPD, research

There’s also some evidence showing that negative behavior modeling by parents and peers is linked to the development of antisocial traits. In addition, decreased serotonin function is associated with the impulsiveness and aggression commonly seen in ASPD.

ANTISOCIAL PERSONALITY DISORDER TREATMENT

Antisocial personality disorder is inherently difficult when it comes to treatment. Without remorse about their own behavior, individuals with ASPD often don’t think they need help.

It usually takes having a co-occurring substance use disorder or mental health condition like depression and anxiety, ADD/ADHD, or PTSD for them to reach out to a mental health professional. They may also receive treatment if they end up incarcerated.

On a brighter note, if a person with ASPD does see a mental health professional, they can receive a comprehensive treatment evaluation that utilizes brain imaging, lab testing, and more, from which a customized treatment plan can be developed.

Treatment for antisocial personality disorder may include:

• One or more types of psychotherapy
• Lifestyle changes that support brain health and overall health
• Medication to treat any co-occurring mental health conditions (there are no medications specifically approved for ASPD)

Some of the lifestyle changes may include a nutritional supplement protocol, breathing techniques, exercise, and getting restful sleep. The elimination of foods known to disturb the microbiome or blood sugar levels can also improve brain function and mood.

Critically, individuals with ASPD need family and friends involved in their treatment and care. They must also learn to maintain healthy relationships and create a sustaining support network.

A 2022 report from the American Psychiatric Association (APA) states that psychotherapy can be helpful in treating some facets of the disorder. For example, some evidence indicates benefits from cognitive behavioral therapy (CBT), mentalization-based treatment, motivational interviewing, and/or skills training.

• Cognitive behavioral therapy helps an ASPD person, over time, learn to change their problematic thinking patterns and behaviors into healthier and more productive ones with the guidance of the therapist.
• Mentalization-based treatment focuses on helping an individual with ASPD better recognize and understand mental states in themselves and others.
• Motivational interviewing involves activating an individual’s own motivation and resources for change. They may make a commitment to change with the help of the clinician and formulate a specific plan of action.
• Skills training for ASPD may include social skills training, anger management, and conversational skills.

Early interventions may be helpful as well. In one study, the parents of young children exhibiting signs of severe antisocial behavior received specific training, which led to improved behavior and academic performance. The study found that this intervention may help prevent the development of ASPD later on.

Additionally, the APA reports that some evidence shows treating impulsivity early in adolescence could help prevent the development of ASPD.

HOPE FOR ANTISOCIAL PERSONALITY DISORDER

People with antisocial behavioral disorder do not need to be labeled as bad, ostracized, or judged. Instead, they need to be met with understanding.

Families and friends of those who have the condition can learn how to take care of themselves while learning to support their loved one in effective ways.

Early diagnosis and treatment results in better outcomes. If you or someone you love is showing signs of ASPD, reach out to a qualified mental health professional for a psychiatric evaluation.

Antisocial personality disorder and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.