According to the Diagnostic and Statistical Manual of Mental Disorders, sociopathy, officially known as antisocial personality disorder, affects 4 percent of the population. According to the Mayo Clinic, someone with ASPD can "often violate the law and the rights of others...[he] may lie, behave violently, and have drug and alcohol problems." These individuals often have disregard for right and wrong. No treatment specific to ASPD exists, but several options are available.
Treatment Difficulties
In his book "Personality-Guided Cognitive-Behavioral Therapy," Dr. Paul Rasmussen writes that people diagnosed with ASPD will not typically pursue treatment unless made to do so by another entity, such as a court, employer or other authority. If the sociopath appears for treatment, he'll like contest the viability of effective treatment. This belief stems from the sociopath's tendency to externalize blame, thinking that difficulties are always the fault of others. The reluctance to accept responsibility for behavior creates a significant barrier to effective treatment. An individual's motivation for change might be absent if he believes fault lies elsewhere.
A Treatment Team
The Mayo Clinic suggests taking a team approach to the treatment of ASPD. Members of the team could include a primary medical physician, psychiatrist, psychotherapist, pharmacist, family and social workers. Because of the manipulative nature of individuals with ASPD, every member of the treatment team should have experience in working with this population.
Importance of a Therapeutic Relationship
The sociopath in treatment will likely deceive and manipulate. Health professionals must be aware of this while working to build trust with the individual. Rasmussen provides recommendations that might enhance a therapeutic relationship. These include an emphasis on collaboration, maintaining focus, avoidance of "direct confrontation," and an awareness of feelings by the treatment provider in order to keep control of responses toward the individual.
Treatment Approach
Dr. Gunter Krampen suggests in an article for the 2009 issue of the Journal of Pyschotherapy Integration five treatment objectives believed "significant in treatment and preventions programs for [ASPD]." These objectives include building empathy, morality and "socio-emotional skills;" improvement of impulse control; altering self-statements and learning anger control; building good relationships and a capacity for trust; and avoiding negative peers and finding healthier friends.
Treatment Options
The Mayo Clinic suggests several methods for the treatment of ASPD, with psychotherapy as the primary treatment. Cognitive-behavioral therapy examines an individual's thoughts and resulting behavior. Negative and unhelpful thoughts and behaviors are replaced with positive, healthier ones. Psychodynamic psychotherapy works to build understanding of unconscious thoughts and behaviors. Insight into why an individual does what he does grows through guided self-examination of motivations. Psychoeducation is often offered to the individual with ASPD, along with family and friends. Education includes information about the disorder and how treatment works.
Other treatment types include teaching stress and anger management skills, and psychotropic medications, such as antidepressants, antipsychotics and anti-anxiety medications. Treatment have the best chance of effectiveness in a hospital or residential treatment program. These environments offer a controlled, structured setting, a benefit in working with this difficult population. These options should be considered when the individual with ASPD poses a danger to himself or others.
Getting Help
An individual with concerns regarding a diagnosis or treatment of ASPD for himself, friend or family member should consider consulting a licensed health professional with experience working with this disorder.
References
- "Journal of Psychotherapy Integration"; Psychotherapeutic Processes and Outcomes in Outpatient Treatment of Antisocial Behavior: An Integrative Psychotherapy Approach; Gunter Krampen, Ph. D.; 2009
- The Mayo Clinic: Antisocial Personality Disorder
- "Personality-Guided Cognitive Behavioral Therapy; Paul Rasmussen; 2005
