Antisocial personality disorder is the most reliably diagnosed condition among the
personality disorders, yet treatment efforts are notoriously difficult. Therapeutic hope has not
vanished, however, and one study indicated that almost two-thirds of psychiatrists think that
“psychopathic disorder” is sometimes a treatable condition. A similar finding was reported
nearly 40 years ago. Diagnostic refinement is critical before any treatment efforts are undertaken,
especially the determination of the degree of psychopathy in the patient with antisocial
personality disorder.
Circulation
Heart Rate: Slight increase may be demonstrated when anticipating stress (correlates with
electrodermal responses indicating minimal anxiety)
Ego Integrity
Lacks motivation for change, often not seeking therapy voluntarily (unless client can no
longer tolerate the mess he or she has made of own life or is facing long-term imprisonment)
Use of aliases
Neurosensory
Mood: Adaptive to individual’s intended goal, mood may range from charming and
pleasant to intensely angry
Affect: Emotional reactions may be erratic and extreme, with lack of concern for other
people’s feelings
Thought Processes: Client is preoccupied with own interests and has grandiose
expressions of own importance, poor insight/judgment, and impulsivity or failure to plan ahead
Signs of personal distress possibly evident (e.g., tension and poor tolerance for boredom)
Diagnosis
Aversive Stimuli: Tends to be slower in learning to avoid shock, associated with a lower than
normal level of physiological arousal; heightened ability to tune out aversive stimuli.
A) There is a pervasive pattern of disregard for and violation of the rights of others
occurring for as long as either childhood, or in the case of many who are influenced by
environmental factors, around age 15, as indicated by three (or more) of the following:
New evidence points to the fact that children often develop Antisocial Personality
Disorder as a cause of their environment, as well as their genetic line. The individual does not
need to meet a certain age requirement in order to be diagnosed with this disorder.
Subtypes
Theodore Millon identified five subtypes of antisocial. Any individual antisocial may exhibit
none, one or more than one of the following:
covetous antisocial - variant of the pure pattern where individuals feel that life has not
given them their due.
reputation-defending antisocial - including narcissistic features
risk-taking antisocial - including histrionic features
nomadic antisocial - including schizoid, avoidant features
malevolent antisocial - including sadistic, paranoid features.
Differential diagnosis
Anxiety disorders
Depressive disorder
Substance-related disorders
Somatization disorder
Pathological risk-seeking
Borderline personality disorder
Histrionic personality disorder
Narcissistic personality disorder
When combined with alcoholism, people may show frontal function deficits on
neuropsychological tests greater than those associated with each condition.
Treatment
To date there have been no controlled studies reported which found an effective treatment
for ASPD, although contingency management programs, or a reward system, has been shown
moderately effective for behavioral change. Some studies have found that the presence of ASPD
does not significantly interfere with treatment for other disorders, such as substance abuse,
although others have reported contradictory findings. Schema therapy is being investigated as a
treatment for antisocial personality disorder, as well as medicinal marijuana treatments.
Nursing Management
Discharge Goals
1. Self-control maintained.
2. Assertive behaviors used to gain desired responses.
3. A trusting relationship initiated.
4. Anxiety recognized and diminished/managed.
5. Client/family involved in ongoing therapy/support groups.
6. Plan in place to meet needs after discharge.