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Treatments for Antisocial Personality Disorder and Psychopathy

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.


For the most part, people seek treatments for their illnesses because they want relief from the distress and suffering that their symptoms cause them, or because they want to avoid having worse symptoms down the road. It is thus not surprising that people with Antisocial Personality Disorder or Psychopathy tend to see little reason for seeking treatments to change their behaviors. It is usually their victims, and not themselves, who feel the immediate negative consequences of their actions. And as for worrying about the long-term consequences of their behaviors and life-styles, this is not something they are likely to do very often, given that one of the main features of these conditions is a tendency to be very impulsive and a failure to think much about one's responsibilities and long-term goals.

Moreover, the goals of treatment for these conditions would be to have these individuals become less likely to act criminally, violently and deviously, and to develop more of a capacity for remorse, compassion and empathy. Yet antisocial or psychopathic individuals do not act criminally or deviously out of some compulsion or drive that is out of their control; they would be perfectly capable of choosing not to act in these ways if they saw that it was no longer to their benefit. And it is difficult to see why someone who is callous and remorseless would find any virtue in learning to become more compassionate towards others.

Therefore, not surprisingly, there are no treatments or interventions that have been shown in any clear way to work for these conditions [ref, ref]. Various approaches have been tried, including individual and group psychotherapy, therapeutic communities where patients live together in a residence and are responsible for the management of the residence and the privileges granted to individual members, and even rather extreme and experimental programs, such as ones where patients are sent into the wilderness to learn how to cooperate to brave the elements. It has been difficult to conclude from the reports of those interventions that there are any treatment elements that can be expected to work in a consistent way for antisocial or psychopathic individuals [ref, ref].

There are also no medications that have been shown to be helpful for treating the core symptoms of Antisocial Personality Disorder or Psychopathy [ref]. Certain classes of medications, like Atypical Antipsychotics, Mood Stabilizers, and SSRI Antidepressants, could in some cases be helpful to curb a person's impulsive or aggressive tendencies. However, the person in question would have to be taking these medications regularly for them to be effective.

As a result, these individuals are usually handled by the police and justice systems, rather than the medical system, which may be the most appropriate option. They tend to be seen by medical professionals mainly when they are suffering from other medical and psychiatric conditions. Furthermore, the symptoms of Antisocial Personality Disorder or Psychopathy usually subside once an individual reaches their fourth decade of life [ref].


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Course & Prevalence