We assessed the degree to which:. The odds ratio is chosen because it has statistical advantages relating to its sampling distribution and its suitability for modelling, and because it is a relative measure and so can be used to combine studies. Where possible, we made these comparisons at specific follow-up periods: 1 within the first month, 2 between one and six months, and 3 between six and 12 months. Where possible, we presented endpoint data.
Where both endpoint and change data were available for the same outcomes, then we only reported the former. We reported continuous data that are skewed in a separate table, and did not calculate treatment effect sizes to minimise the risk of applying parametric statistics to data that depart significantly from a normal distribution.
We define skewness as occurring when, for a scale or measure with positive values and a minimum value of zero, the mean is less than twice the standard deviation Altman Change-from-baseline data may be preferred to endpoint data if their distribution is less skewed, but both types may be included together in meta-analysis Higgins , page In any meta-analysis, we intended to use the mean difference MD where the same outcome measure was reported in more than one study and the standardised mean difference SMD if different outcome measures of the same construct had been reported.
See Table 4 for information about future updates of this review. We will seek statistical advice before attempting meta-regression; if meta-regression is performed, it will be executed using a random-effects model. All eligible outcome measures for all trial arms were included in this review. For dichotomous data, we report missing data and drop-outs for each included study and report the number of participants who are included in the final analysis as a proportion of all participants in each study.
We provide reasons for the missing data in the narrative summary where these are available. For missing continuous data, we provide a qualitative summary. We aimed to assess the extent of between-trial differences and the consistency of results of any meta-analysis in three ways: by visual inspection of the forest plots, by performing the Chi 2 test of heterogeneity where a significance level less than 0.
The I 2 statistic describes approximately the proportion of variation in point estimates due to heterogeneity rather than sampling error. We had planned to use meta-analyses to combine comparable outcome measures across studies. In carrying out meta-analysis, the weight given to each study is the inverse of the variance so that the more precise estimates from larger studies with more events are given more weight.
See: Characteristics of included studies ; Characteristics of excluded studies ; Characteristics of studies awaiting classification. We carried out electronic searches over two consecutive time periods to minimise the difficulty of managing large numbers of citations.
Searches to December produced in excess of 10, records. From inspection of titles and abstracts we identified 70 citations that appeared to describe randomised studies on psychological interventions for personality disorder.
Twenty-one of these appeared to include participants with a diagnosis of antisocial or dissocial personality disorder PD. Searches from December to September produced records.
After excluding studies that focused exclusively on borderline PD, we identified 38 citations that appeared to describe randomised trials on psychological interventions for personality disorder. Twenty-seven of these had the potential to have included participants with a diagnosis of antisocial or dissocial PD.
Full copies were obtained of the 48 records of studies where all or part of the sample appeared to meet diagnostic criteria for antisocial or dissocial PD.
Of the 48 studies, we identified 11 that fully met the inclusion criteria. Ten included participants with antisocial personality disorder under DSM criteria. One study Tyrer included participants with dissocial personality disorder under ICD criteria. Data on participants with antisocial personality disorder AsPD were available for five of the 11 studies Davidson ; Huband ; Messina ; Neufeld ; Woodall and these are summarised in this review.
Data on the subgroup of participants with antisocial or dissocial PD from the other six studies Ball ; Havens ; Marlowe ; McKay ; Tyrer ; Woody were not available at the time this review was prepared. The 11 included studies involved a total of 14 comparisons of a psychological intervention against a relevant control condition i.
There were some important differences between the studies. We summarise these differences and the main characteristics below. Further details are provided in the Characteristics of included studies table. Only three of the included studies addressed the primary outcomes defined in this review. Two studies reported on reconviction Marlowe ; Woodall and one reported on aggression Davidson Ten of the 11 studies were parallel trials with allocation by individual participant, and one Havens was a cluster-randomised trial where the unit of allocation was treatment site.
The 10 parallel trials included one two-condition comparison Woody and one three-condition comparison Messina against a control group. There was some variation in sample size between studies.
Overall, participants with antisocial or dissocial PD were randomised in the nine trials where this allocation was reported unambiguously, with the size of sample ranging from 15 to mean However, data were available to us for only five of these trials. In these, participants with antisocial or dissocial PD were randomised, and sample size ranged from 24 to mean The number of participants completing was reported in only four studies where the proportion that completed ranged from Five were multi-centre trials: Davidson with two sites; Havens with 10 sites; Huband with five sites; Messina with two sites; and Tyrer with five sites.
Nine studies took place in an outpatient or community setting, and two Marlowe ; Woodall in a prison or custodial environment. None were carried out in a hospital inpatient setting. Participants were restricted to males in three studies Davidson ; McKay ; Woody The remaining eight studies had a mix of male and female participants. With one exception Tyrer , all studies randomised more men than women.
The overall mix was All eleven studies involved adult participants, with the mean age per study ranging between Eight studies focused on participants with substance misuse difficulties. The remaining three studies did not recruit participants on the basis of substance misuse.
For these, the focus was on recurrent self-harm Tyrer , violence Davidson and meeting DSM-IV criteria for any personality disorder Huband Only two of the 11 studies focused exclusively on participants with a diagnosis of antisocial PD Davidson ; Neufeld For the remaining nine, participants with antisocial or dissocial PD formed a subgroup.
The size of this antisocial subgroup ranged from 15 to 52 participants, representing 3. Data on the antisocial subgroup were available to us for only three Huband ; Messina ; Woodall of these nine studies. The precise definition of antisocial personality disorder and the method by which it was assessed varied between the studies. Ethnicity of participants was not always reported. The following types of interventions were represented: behaviour therapy, cognitive behaviour therapy, schema therapy, and social problem-solving therapy.
Interventions that were group-based may have included elements of group psychotherapy, depending on how group psychotherapy is defined. None of the 11 studies evaluated psychodynamic psychotherapy, therapeutic community treatment, dialectical behaviour therapy, cognitive analytic therapy, mentalisation-based therapy or nidotherapy.
Eleven different psychological interventions were compared to a control condition. Full details are provided in the Characteristics of included studies table but can be summarised as follows and in Table 5 below. Dual-focus schema therapy Ball for homeless adults with substance abuse, but with no data available for the AsPD subgroup. Individualised relapse prevention aftercare McKay for male outpatients with cocaine dependence, but with no data available for the AsPD subgroup. Strengths-based case management Havens for intravenous drug-using outpatients, but with no data available for the AsPD subgroup.
Optimal judicial supervision Marlowe for adult drug court offenders, but with no data available for the AsPD subgroup. Social problem-solving therapy with psychoeducation Huband for community-living adults with personality disorder and an AsPD subgroup.
It is important to note that participants allocated to the experimental condition in these studies commonly received some degree of treatment as usual in addition to the intervention under evaluation. For example, standard maintenance for participants with opioid dependence commonly includes counselling sessions in addition to methadone maintenance, which could be seen as introducing an additional CBT component. The duration of the interventions excluding the very short intervention described by Havens ranged between four and 52 weeks mean Seven studies followed up participants beyond the end of the intervention period by, on average, The inclusion criteria required a control condition that was either treatment as usual, waiting list or no treatment see Types of studies.
We considered that all 11 studies had a control condition that could be described as treatment as usual TAU. This decision was straightforward for six of the 11 studies, as follows. For Davidson and Tyrer it was clear that TAU simply comprised whatever treatment the participants would have received had the trial not taken place.
For Huband , treatment as usual pertained whilst on a wait-list for the intervention under evaluation. For the remaining five studies, all of which focused on participants with substance misuse difficulties, we were forced to consider carefully whether the control condition was treatment as usual or an intervention in its own right.
In each case we concluded that the control condition could properly be described as TAU because it represented what a treatment-seeking participant with similar substance misuse problems would normally experience had the trial not taken place.
The control conditions for these five studies can be summarised:. One study included self-reported aggression as an outcome: Davidson summarised the number of participants reporting any incident of physical or verbal aggression, as measured with the MacArthur Community Violence Screening Instrument MCVSI interview, plus additional questions on four other behaviours shouting angrily at others; threatening harm to others; causing damage to property; self-harm.
Two studies included reconviction as an outcome: Woodall reported drink-driving reconviction using data from the New Mexico State Citation Tracking System, and Marlowe assessed re-arrests and convictions using state criminal justice databases although with no data available for the subgroup with AsPD.
Adverse effects, which are generally reported only rarely in studies of psychological interventions, were mentioned only by Marlowe where the investigators noted the absence of any study-related adverse events. Four studies included self-reported social functioning as an outcome. Investigators obtained composite scores for this domain ranging from zero to 1. Other domains relevant to this review are those concerning alcohol use, drug use and employment problems see paragraph below on secondary outcomes.
There were five studies that did not report on any of the primary outcomes defined in the protocol for this review Havens ; McKay ; Messina ; Tyrer ; Woody ; of these, only Messina had data available for participants with AsPD. Studies varied widely in their choice of secondary outcomes. Seven reported on leaving the study early, measuring this as the proportion of participants discontinuing treatment before endpoint. The mean number of continuing care sessions attended was additionally reported by McKay One study considered employment status: Neufeld reported mean composite scores on the employment domain of the Addiction Severity Index ASI.
Economic outcomes were considered by two studies: Davidson examined the total cost per participant of healthcare, social care and criminal justice services measured using case records and the Client Service Receipt Inventory CSRI ; Tyrer calculated as total costs per participant, including costs incurred by all service-providing sectors and productivity losses resulting from time off work due to illness, although with no data available for the subgroup with dissocial PD.
In addition, Woodall reported the frequency of drink-driving in 30 days prior to arrest, or in previous 30 days, measured via questionnaire. The outcome of engagement with services was considered only by Havens where the investigators report numbers entering into drug addiction treatment services as a key outcome, although with no data available for the AsPD subgroup.
Tyrer reported number of completed suicides and frequency of self-harm episodes via the Parasuicide History Interview PHI. We identified three studies of psychological treatments for samples with a mixture of personality disorders where it remains unclear whether a subgroup of participants with a diagnosis of antisocial or dissocial PD had been included Berget ; Evans ; Linehan Clarification has been sought from the trial investigators but no further information was available at the time this review was prepared.
Details are provided in the Characteristics of studies awaiting classification table. These may be summarised as follows. Berget compared animal-assisted therapy with a control condition in individuals with psychiatric disorders, and may have recruited a subgroup with dissocial PD since 22 of the 90 participants had a disorder diagnosed under sections F in ICD disorders of adult personality and behaviour.
Evans compared manualised cognitive therapy with treatment as usual in adults with recent self-harm and cluster B personality disturbance. The investigators may have recruited a subgroup with dissocial PD since, although formal Axis II diagnoses are not reported, all participants scored on the Personality Assessment Schedule at least to the level of personality disturbance within the flamboyant cluster of ICD Linehan compared DBT and community treatment by experts for adults with suicidal behaviour and BPD, and may have recruited a subgroup with AsPD since 11 of the participants The remaining 34 studies that failed to meet all inclusion criteria were categorised as excluded studies.
Fifteen were excluded because on close inspection, and following translation into English and contact with the investigators where necessary, it became clear that the sample did not include a subgroup with antisocial or dissocial PD.
A further six were excluded because there were less than five participants with antisocial or dissocial PD for reasons that are now explained in the Selection of studies section. Five were excluded because participants had not been allocated at random, and a further six because of lack of a relevant control condition. One study was excluded because it was a trial of assessment rather than of psychological treatment, and one because a proportion of the sample had bipolar disorder.
Reasons for exclusion of each of these 34 studies are given in the Characteristics of excluded studies table. We paid particular attention to five of the excluded studies described in seven separate reports that compared one psychological treatment against another. Each was excluded because there was no control condition that could be regarded as treatment as usual, waiting list or no treatment.
Although none of these studies focused exclusively on AsPD, and none provided data on their AsPD subgroup, each reported information that we considered would be of interest to a clinician who was seeking treatment options for clients with AsPD.
Because of this, we have summarised briefly the characteristics of each of these five studies and conclusions drawn by the trial investigators in the Discussion section. There was considerable variation in how the included studies were reported. We attempted to contact the investigators wherever the available trial reports provided insufficient information for decisions to be made about the likely risk of bias, and were successful in respect of four studies.
We summarise below the risk of bias for the 11 included studies. This allows the reader to make a separate judgement about possible bias associated with the quantitative data from which conclusions are drawn in this review. Full details of our assessment of the risk of bias in each case are tabulated within the Characteristics of included studies section.
Graphical summaries of methodological quality are presented as Figure 1 and Figure 2. We considered the generation of allocation sequence to be adequate in three studies where allocation was by random numbers which were computer-generated Davidson ; Huband or derived from a table Messina , and in one study where the toss of coin was used Neufeld We considered concealment of the allocation sequence adequate for Davidson , Huband , Neufeld and Messina where we considered that there was sufficient evidence that the person enrolling participants could not have foreseen assignment.
In each case the investigators reported that participants had been allocated at random but provided no further information on how this had been achieved. We considered concealment of the allocation sequence adequate for Tyrer We judged that blinding of participants and personnel involved in the delivery of the intervention was not practical in the design of trials of psychological interventions summarised in this review. We considered adequacy of blinding of outcome assessors to be adequate in two studies Davidson ; Neufeld and that it was unlikely that this blind could have been broken.
In Messina the outcome assessors were not blinded. We judged none to have adequately addressed incomplete outcome data. This generally arose because participants failed to complete endpoint measures without providing a reason. The overall proportion of missing data treatment and control conditions combined varied significantly between studies.
Missing data rates for the five studies with data were calculated as number with endpoint scores in comparison with number randomised and ranged from 8. Mean rates by type of intervention, calculated similarly, were as follows: CBT These percentages should be regarded with caution for studies where the sample size is small.
We judged that all five studies appeared to have reported on all the measures they set out to use and at all time scales in as far as could be discerned from the published reports without access to the original protocols. We judged the remaining four studies free of other potential sources of bias.
This analysis is based on summary data of completers supplied by the trial investigators and derived from a mixed regression model that included time-specific random effects and an interaction term see Table 1.
Both Neufeld and Messina provide data on leaving the study early. Meta-analysis of data from these two studies indicates no statistically significant difference between treatment and control conditions OR 0. Messina report data indicating a statistically significant difference between treatment and the control condition in numbers with cocaine-negative specimens by week 17 OR 8.
The strong treatment effect for AsPD patients was primarily due to the contingency management condition. Abstract, p. Neufeld report data indicating no statistically significant difference between treatment and control conditions in adjusted mean composite drug domain scores via the Addiction Severity Index at six months data presented graphically; hierarchical regression model with variables at one, two, three and six months including condition, time, time-by-condition interaction and polydrug use at baseline; analysis of completers by the trial investigators, see Table 1.
Neufeld also report summary data see Table 3 indicating no statistically significant difference between treatment and control conditions at six months for overall percentage of opioid-negative urine specimens OR 1. Neufeld report data indicating no statistically significant difference between treatment and control conditions in adjusted mean composite alcohol domain scores via the Addiction Severity Index at six months data presented graphically; hierarchical regression model with variables at one, two, three and six months including condition, time, time-by-condition interaction and polydrug use at baseline; analysis of completers by the trial investigators, see Table 1.
Neufeld report data indicating no statistically significant difference between treatment and control conditions in adjusted mean composite employment domain scores via the Addiction Severity Index at six months data presented graphically; hierarchical regression model with variables at one, two, three and six months including condition, time, time-by-condition interaction and polydrug use at baseline; analysis of completers by the trial investigators, see Table 1.
Neufeld report summary data see Table 4 indicating a greater, statistically significant, overall number of counselling sessions attended in proportion to the total number of sessions offered for treatment compared to the control condition by six months OR 4.
The experimental intervention increased attendance in subjects with low and high levels of psychopathy and with and without other psychiatric co-morbidity.
Neufeld report data indicating no statistically significant difference between treatment and control conditions in the proportion of participants transferred due to poor or partial treatment response by six months OR 0. Messina report data indicating no statistically significant difference between treatment and control conditions for leaving the study early OR 0.
Woody provide data on leaving the study early, but with no data for the AsPD subgroup. Messina report data indicating no statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 17 OR 2. However, Messina also report data indicating a statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 52 OR 8.
Woody provide data on drug domain scores via the Addiction Severity Index, but with no data for the AsPD subgroup. Woody provide data on psychiatric symptoms via scores on the SCL and on depression via scores on the Beck Depression Inventory, but with no data for the AsPD subgroup.
Messina report data indicating no statistically significant difference between treatment and control conditions in leaving the study early OR 0. Messina report data indicating no statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 17 OR 3. However, Messina also report data indicating a statistically significant difference between treatment and control conditions in numbers with cocaine-negative specimens by week 52 OR Davidson report data indicating no statistically significant difference between treatment and control conditions at 12 months in number reporting any act of verbal aggression OR 1.
Davidson report data indicating no statistically significant difference between treatment and control conditions from baseline to endpoint at 12 months in the change reduction in number reporting any act of verbal aggression OR 0.
Davidson report data indicating no statistically significant difference between treatment and control conditions in mean scores for satisfaction with taking part in the study MD 0. Davidson report data indicating no statistically significant difference between treatment and control conditions for leaving the study early by three months OR 0.
Davidson provide data on the total cost of health, social work and criminal justice services received over 12 months, and the average cost per participant for NHS services alone over 12 months see Table 8 but with no statistics. Tyrer provide the total costs per patient over one year for the whole sample, but with no data for the dissocial PD subgroup.
Tyrer provide data on number of completed suicides for the whole sample and on frequency of self-harm episodes via the Parasuicide History Interview, but with no data for the dissocial PD subgroup. The trial investigators, while providing data on the AsPD subgroup, noted that their trial was not designed to have sufficient power to detect significant change in subgroups of this size, and also that 20 of the 24 had at least one other Axis II diagnosis.
Huband report data indicating no statistically significant difference between treatment and control conditions for leaving the study early OR 1. Huband report data indicating no statistically significant difference between treatment and control conditions in mean Barrett Impulsiveness Scale scores at six months MD 6.
Huband report data indicating no statistically significant difference between treatment and control conditions at six months in mean SPSI social problem-solving ability scores MD 0. Woodall report data indicating no statistically significant difference between treatment and control conditions in reconviction for drink-driving Cox regression of re-arrest rates over 24 months HR 0.
Woodall provide descriptive and graphical summaries p. AsPD participants reported heavier and more frequent drinking but showed significantly greater decline in drinking from intake to post-treatment assessments. Woodall report skewed summary data indicating no statistically significant difference between treatment and control conditions for mean number of days driving after drinking in past 30 days see Table 10 and for mean number of days driving after five or more drinks in past 30 days see Table 11 at six, 12 and 24 months post incarceration P values not provided, but not significant for the group-by-time interaction; ANOVA mixed factorial design; completer analysis by the trial investigators.
Trial investigators used diagnosis of AsPD as one criterion for assignment to high rather than low risk category, but no data was available for the AsPD subgroup. S4, Marlowe The trial investigators report on AsPD subgroup with data for the experimental condition, but not for control condition for the AsPD subgroup.
Woody provide data on leaving the study early, substance misuse drugs self-report via the Addiction Severity Index , psychiatric symptoms scores on the SCL90 , and depression scores on the BDI , but with no data for the AsPD subgroup in the control condition. Patients with opiate dependence alone or with opiate dependence plus depression improved significantly and in many areas.
Opiate-dependent patients with AsPD plus depression responded almost as well as those with only depression. AsPD alone is a negative predictor of psychotherapy outcome, but the presence of depression appears to be a condition that allows the patient to be amenable to psychotherapy, even though the behavioural manifestations of sociopathy are present. This study describes an RCT comparing dual-focus schema therapy with treatment as usual TAU in homeless substance abusers.
However, clients with more severe personality disorder symptoms demonstrated better utilization of standard group substance abuse counselling than dual-focus schema therapy. Havens provide data on engagement with services as entry into treatment for the whole sample, but with no data for the AsPD subgroup. Providing case management services to intravenous drug users with comorbid AsPD may facilitate treatment entry and reduce negative consequences of drug abuse.
However, AsPD patients had worse medical and psychiatric problem severity than non-AsPD patients at entrance to continuing care and during follow-up. These results suggest that cocaine patients with AsPD who are in the continuing care phase of outpatient rehabilitation might benefit from additional medical and psychiatric treatment services.
As described in the introduction, antisocial personality disorder AsPD is a prevalent condition associated with considerable personal and societal adverse consequences. It also has major negative economic consequences as it is associated with poor occupational productivity and increased criminal justice costs.
Consequently, one might expect that the identification of interventions that might reduce this impact would be a research priority. Unfortunately, the conclusion of this review is similar to many that preceded it in that there is little good quality evidence as to what might or might not be effective for this condition. As only 11 studies could be included in the review, the first point to make therefore is how few studies there were to consider.
The second refers to the design and methodological quality of the few studies that could be included. Disappointingly few of the included studies addressed the primary outcomes defined in this review. While the underlying personality structure of AsPD comprises dissociate traits such as impulsivity, lack of remorse and irritability, its most common behavioural manifestation is persistent rule-breaking. Although the focus on behaviour, rather than on the underlying personality structure, has been frowned upon by some commentators e.
Livesley , we argue that persistent rule-breaking is akin to a final common pathway manifestation of the underlying personality structure. If one accepts this argument, it is disappointing that only two of the included studies Marlowe ; Woodall had reconviction as their primary outcome.
Another Davidson used self-reported aggression. In the light of the important adverse cost consequences of the condition and likely need for complex and expensive interventions, it was also disappointing that only two studies Davidson ; Tyrer considered the economic impact of their intervention.
Furthermore, the majority of the included studies were trials to reduce substance misuse. As many within the sample of substance misusers also satisfied criteria for AsPD, there was an opportunity to report on these separately.
Hence, strictly speaking, these were not interventions for AsPD; rather, they were interventions to reduce substance misuse in a sample, some of whom also satisfied criteria for AsPD. While these studies were not without their limitations, there is evidence that contingency management is effective in reducing substance misuse in this population.
A proportion of the quantitative data available from the studies included in this review met our criteria for skewed data as described in the section on Measures of treatment effect. Consequently, in the absence of raw data from the trial investigators, we have presented all skewed data as Additional tables and have reported statistics on comparisons between conditions as calculated by the trial investigators rather than performing our own analysis.
We did not carry out any synthesis of primary or secondary outcome data via meta-analysis other than for the outcome of leaving the study early because a data for an outcome was available from only one study, or b we wanted to minimise the risk of applying parametric statistics to skewed data that was not normally distributed.
The summaries that follow below are therefore essentially descriptive. The focus of this review is relatively broad since it seeks evidence on effectiveness of any psychological intervention in the treatment of antisocial or dissocial personality disorder. We found considerable differences between the studies in terms of participants, size of sample, intervention modality and choice of outcome measures. Each of these interventions had been developed for people with substance misuse problems.
No study reported significant change in any specific antisocial behaviour, such as offending, aggression or impulsivity. However, contingency management was superior in terms of social functioning and counselling session attendance in Neufeld These differences may have arisen because of differences in the nature of the behavioural intervention. In contrast, the positive reinforcement in the Neufeld trial comprised greater control over methadone clinic attendance and dosage in reward for drug abstinence and attendance at counselling sessions.
We excluded five studies described in seven separate reports that compared one psychological treatment against another because there was no control condition that could be regarded as treatment as usual, waiting list or no treatment. Although none of these five studies focused exclusively on AsPD, and none provided data on their AsPD subgroup, each reported information that we consider to be of interest to a clinician seeking treatment options for this client group.
Because of this, we now summarise briefly the characteristics of each of these five studies and the conclusions drawn by the trial investigators. Ball conducted a randomised trial comparing dual-focus schema therapy DFST with step facilitation therapy 12FT in 30 opioid-dependent outpatients who were receiving methadone maintenance.
Teens with antisocial behavior do appear to respond to CBT. A review of the evidence on treating youth with antisocial behaviors found 12 studies evaluating this therapy during institutionalization on teens who had committed crimes. Teens who underwent cognitive behavioral therapy showed less criminal behavior during the year after their release than teens who received standard treatment. While research doesn't show that psychotherapy or talk therapy can treat ASPD very effectively, Harvard Health notes that it may help a person with ASPD learn to be more sensitive to others' feelings, possibly encouraging more socially acceptable and productive behavior.
As mentioned above, the current research on treatment outcomes for ASPD is conflicting, but not particularly optimistic. The difference in whether a therapy works or not may depend on whether an individual with antisocial personality disorder wants it to work.
If a person with this disorder wants to decrease their aggressiveness or increase their ability to use empathy, therapy may be more successful. But there is debate among researchers about whether antisocial personality disorder can be or should be treated at all.
Another systematic review in examined the evidence on medication for antisocial personality disorder. But none of the eight studies the researchers found included only people with ASPD as participants, and most focused on treating substance dependence. One study found that the antidepressant drug Pamelor nortriptyline helped treat misuse of alcohol in people with antisocial personality disorder.
Researchers have also studied antiepileptic drugs for treating aggression in people with antisocial personality disorder. These drugs are typically used to control seizures in people with epilepsy as well as to treat mood disorders, such as bipolar disorder.
They are additionally prescribed to treat aggression or impulsivity in certain psychiatric or neurological disorders. But in a different, third study, valproate, carbamazepine , and phenytoin had no effect on aggression. A study published in in BMC Psychiatry found that for these people, MBT improved mood, general psychiatric symptoms, and helped with interpersonal problems.
Contradictory results of studies can be frustrating for families who want a person with this condition to get help. Unfortunately, scientists have not been able to find treatments that consistently work. Psychologists and psychiatrists diagnose ASPD and provide psychotherapy for individuals.
They can also lead group and family counseling, which may be helpful for those with a family member is diagnosed with ASPD, notes the Cleveland Clinic. Even if antisocial personality disorder itself cannot be treated, people with the condition can seek treatment for other mental health problems. Psychiatric conditions in general are much more common in this population than in the general population.
In one study, 90 percent of people with antisocial personality disorder had another mental illness. The most common coexisting diagnosis is a substance dependence disorder. Women with antisocial personality disorder are at higher risk for substance use disorders than men with the disorder.
Substance dependence may be treated with medication, depending on the specific addiction a person has. For example, a person with an opioid addiction may be prescribed Subutex buprenorphine , methadone , or extended-release naltrexone. People with an antisocial personality disorder diagnosis are also at higher risk for anxiety and depression. About half of all people with antisocial personality disorder have an anxiety disorder , and about one-quarter of them have depression.
But there is not much research on whether those treatments are as effective in people with antisocial personality disorder. People with antisocial personality disorder with spouses and families may benefit from marriage and family counseling.
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