The Diagnosis and Treatment of Antisocial Personality Disorder
The Diagnosis and Treatment of Antisocial Personality Disorder
Antisocial (dissocial) personality disorder is a person-oriented disorder which is majorly characterized by a universal pattern of violating other people’s rights.
It is a mental health condition in which a person has a long-term pattern of altering, exploiting, or violating the rights of others (Franz, 1993, p.4).
It is said to begin in childhood or early adolescence and continues all the way into the adulthood stage. A person suffering from antisocial personality disorder can be identified after noting a gross disparity between the person’s behavior and the prevailing social norms.
Symptoms of antisocial personality disorder:
Persistent attitude of irresponsibility and failure to regard the social norms, policies and duties. Marked readiness to blame other people for the behavior that is responsible for the person being into conflict with the society. Extremely low level of tolerance to frustration and a low threshold for discharge of aggression, with violence included. Conspicuous lack of concerns for the feelings of other people in the society. Lack of adequate capacity to gain positively from experience, more specific punishment.
Generally, the treatment and diagnosis of antisocial personality disorder can be viewed from several different perspectives; depending on the major factor associated with the disorder.
Despite the fact that, conduct disorder is different from antisocial personality disorder, the presence of conduct disorder in either the childhood or the adolescence stage may in one way support the diagnosis of antisocial personality disorder. The diagnosis of antisocial personality disorder is majorly based on behavioral patterns and personality traits of the person (.Frownfelter, Donna, & Elizabeth 2006, p.61).
The diagnosis is somehow faced with a critically complex situation that inhibits its success; it is very difficult to obtain a reliable measure of personality traits. The diagnosis of antisocial personality disorder can be effective after a few conditions have been met; the person must be at least 18 years old before the diagnosis. There should also be evidence of conduct disorder in the person as a child, whether or not it was ever formally diagnosed by a professional. In the general population, antisocial personality disorder is found to be more prevalent in males than in female with a ratio of 3:1, thus careful investigation should be made to the male population as it is more vulnerable to the disorder. Similar to most personality disorders, antisocial personality disorder will generally decrease in intensity with age; with the people in the 40s and 50s experiencing few of the most extreme symptoms of the disorder. The diagnosis of antisocial personality disorder is specifically done by a trained mental health professional, for instance, a psychologist or psychiatrist. This type of psychological diagnosis is beyond the level that can be addressed by family physicians and general practitioners due to inadequate skills to perform the operation.
There are no; genetic, laboratory, or blood tests that are used in the diagnosis of antisocial personality disorders. Most of the people suffering from antisocial personality disorder, generally, do not often seek out treatment until the disorder significantly starts to interfere or in other words impact a person’s life. This in most cases happens when the coping resources of a person are stretched too thin to take care of stress and other life events. In the diagnosis process, the mental health professional compares the person’s symptoms and life history with the majorly known symptoms of antisocial personality disorder. The conclusion from the comparison will make a determination of whether your symptoms meet the criteria necessary for an antisocial personality disorder diagnosis.
The major causes of antisocial personality disorder are most likely due to biological and genetic factors, social factors (for instance, how a person interacts in his or her early development with family and friends and also other children), and psychological factors (the individual’s personality and temperament, modified by their environment and acquired coping skills to cope up with stress. If a person is suffering from antisocial personality disorder, from analytical researches, there is a slightly high chance of “passing down” the disorder to his or her siblings (Barron & Frank, 1963, p.87).
The treatment of antisocial personality disorder majorly involves the employment of long-term psychotherapy with a therapist equipped with enough experience in the field of this disorder.
The population that is suffering from antisocial personality disorder experiences a state of lacking connections between feelings and behaviors. The practice of helping the subject population on how to draw the lines between feelings and behaviors is of great benefit to the people suffering from antisocial personality disorder. In the treatment of antisocial personality disorder, threats are never an appropriate motivating method; by threatening to report their noncompliance with therapy to the courts or warden. However, it is appropriate to put more efforts to assist the people suffering from this disorder find better reasons that may be needed to work on this problem; for instance, submitting themselves to additional psychological examinations. The effective psychotherapy treatment for antisocial personality disorder is limited. Psychoanalytic approaches that reinforce appropriate behaviors and trying to make connections between the person’s actions and feelings may be of greater assistance.
Emotions usually form a key element of treatment of antisocial personality disorder.
Patients often have had little or no significant emotionally-rewarding relationships in their lives.
In the treatment of antisocial personality disorder, a very close therapeutic relationship can only occur when a good and solid rapport has been established with the client and he or she can trust the therapist implicitly.
The issue of confidentiality is highly preserved in the treatment of antisocial personality disorder.
Since the clinician has to occasionally report on the patient’s progress in therapy, this should be done in a way that does not reveal the significant details of the therapy. The limitations of therapy should be discussed with the patient up-front, in a clear manner, to avoid later misunderstanding. The patient’s emotions form the basic platform of consideration from which various emotional states, like depression, are experienced. This calls for the clinician to be supportive and empathetic to the patient during this time (Gazzaniga, & Heatherton, 2006, p.38).
Dealing with “safe issues” and discussing more real-life concerns, (one way of treating this disorder), is rather less effective in long term behavioral change as compared with an approach emphasizing the discovery and labeling of appropriate emotional states. The therapist should usually take a neutral stance in the matter of interacting with the authority figures. Often people suffering from antisocial disorder find themselves in a group setting, simply because they are not given any choices of treatment. This inhibits treatment, since in most of the groups the individual can remain emotionally-closed and has little reason to share with others. Family therapy is of great assistance in boosting education and understanding amongst the family members (.Frownfelter, Donna, & Elizabeth 2006, p.84).
Philip W. Long, M.D. adds, ”This confusion, guilt, the temptation to make restitution for the patient’s criminal acts, and the frustrations of working with someone who is seen to be quite ill but who will not be treated should all be discussed openly with family members.”
Antisocial personality disorder can also be treated through hospitalization even though, inpatient care is rarely appropriate. With this type of disorder, loss of freedom is one of the major characteristics and it may be more of a motivating factor than in other personality disorders; thus some specialized treatment facilities have commenced to treat people suffering from this disorder. This method utilizes a strict behavioral approach of placing patients on a token economy mainly considering their treatment progress. Little research has been conducted to confirm the long-term effectiveness of this method. As with other treatments of personality disorders, this method focuses on feelings and connecting antisocial behavior to appropriate feeling states. Since inpatient programs are found to be intensive and expensive, the treatment gains are maintained by the community follow up and support, either by the hospital or professionals, or with the use of self-help support groups. Medication; no research has suggested the effectiveness of medication in the treatment of this disorder.
Medication should only be used to treat clear, acute and serious Axis concurrent diagnoses (Kirk, 2005, p.101).
Another method for the treatment of antisocial personality disorder is self-help strategies.
This method involves very few professionals hence it is often overlooked by the medical profession. Groups tailored specifically for antisocial personality disorder can facilitate the implementation of this method especially for the people with this disorder.
Individuals suffering from this disorder feel more at ease to discuss their feelings and behaviors in front of their peers in this type of supportive modality. Usually a group is of great help and beneficial to most people suffering from this disorder, only when they overcome their initial fears and hesitation to join such a group. There are several support groups existing in different parts of the world to help those who are affected by this disorder and share common experience and feelings. In a general field of view, antisocial personality disorder can be best managed if the affected are in a good rank to interact amongst them bravely (Barron & Frank, 1963, p.98).
Outpatient therapy is another method in the treatment of antisocial personality disorder even though it is found not to be very successful in the treatment.
This method is commonly executed with the children with the following specifications:-Have experienced serious injuries with them, are undergoing learning difficulties, arte experiencing some problems in the execution of their daily living obligations, have chronic as well as acute conditions that in one way or another inhibit their development (Zarit, 1980, p.76).
The treatment of antisocial personality disorders by the method of outpatient therapy involves a team of specialists conducts the exercise of evaluating each and every affected child after which a personalized treatment plan is formulated. The formulated team may comprise of highly skilled personnel such as; Language pathologists; whose main task is to evaluate the children’s communication with the world. Occupational therapists, who evaluate self care skills in the children with several types of diagnoses, and various levels of disabilities. Recreational therapists, whose main duty is to enhance and encourage high level of functional independence, leisure activities, and recreation via various techniques such as; group recreation and field trips, adaptive equipment specialists, who work in conjunction with the other therapists to establish a better way to assist the children in achieving their set of realistic goals. This is majorly achieved via the exercise of designing and fabricating special equipment or improving the status of existing equipment. Physical therapists also form a major component of the formulated team since they aim at enhancing the children’s flexibility and mobility via play and exercise (Mann, 1989, p.56).
In addition to the so far discussed methods of treating antisocial personality disorder, schema therapy is another effective method to serve the same purpose.
Schema therapy is an integrative approach to treatment that unites the best aspects of cognitive behavioral, interpersonal and psychoanalytic therapies into a single compact model.
It is best remarked to help people to change negative patterns with which they have long-lived.
The deeper patterns that are mainly targeted by this method in the treatment of antisocial personality disorder are enduring and self-defeating schemas which are said to begin early in life.
These patterns majorly comprise of dysfunctional thoughts and feelings; which pose obstacles for accomplishing one’s target goals as well as satisfying one’s needs. These patterns are worsened by enduring in most of the schema beliefs which in turn lead to enhancement of the antisocial personality disorder. This method (schema therapy) of treatment aims at assisting the affected person to disintegrate these negative schemas of thinking, behaving and feeling; (which are known to be very tenacious), to develop healthier alternatives to substitute them (Wade, & Tavris, 2000, p.49).
Stages of schema therapy
Firstly, the assessment phase; in this stage, schemas are identified during the initial sessions. Questionnaires can also be used to get a clear picture of the constituent schemas involved.
Secondly, the emotional awareness and experiential phase; in this stage, patients get in touch with the respective schemas and acquire some knowledge on how to deal with the schemas when they are carrying out their obligations in their day-to-day life (Vreeswijk, & Broersen, 2012, p.128).
Thirdly and lastly, the behavioral change stage; this is the focus stage during which the affected person is actively involved in substituting negative, behaviors and habitual thoughts with new and healthy behavioral patterns.
On a broad base, the goal of schema therapy is to assist patients to have their core emotional needs met. This is achieved by learning how to carry out the following practices:-
Heal schemas and vulnerable modes by having the needs met in and outside of the therapeutic relationship. Establish healthy behavioral patterns and modes. Abandon the usage of maladaptive coping styles and modes that pose an obstacle to contact with feelings. Adopt reasonable limits for angry, overcompensating or impulsive behavioral patterns and modes.
In schema therapy, an imagery dialogue between the “schema side” and the “healthy side”.
Schema therapy interventions are more experiential as well as emotion focused.
They can also be behavioral. Limited Re-parenting is one of the most distinctive and central areas in schema therapy.
According to Myers, 2004, p39, it is known to be the heart of treatment in schema therapy. Research has been conducted and it is clearly evident from the outcomes that; a relatively large percentage of those affected by this personality disorder can achieve full recovery across the complete range of symptoms.
The patients engaged in these studies attributed a great concern of the effectiveness of the treatment and the relatively low dropout rate to limited re-parenting. Limited re-parenting comprises of the establishment of a secure attachment via the therapist. A broadly conducted research supports that secure attachment is at the root of adaptive functioning, well-being as well as flourishing. Most of the maladaptive schemas are found to mainly relate to the state of generally unmet needs in the childhood as well as lack of appropriate relationships (Barlow, & David 2001, p.28).
They are generally considered as a pattern of established unstable behaviors to the daily life situations. Maladaptive schemas can as well be bodily sensations associated with traumas.
They have an overall negative result, that is; a person may view him or herself in collaboration with difficulties thus establishing one’s true identity. The antisocial behaviors may also comprise of schema modes; which are found to be emotional states as well as ways of coping which every person must experience in one moment or another. Conducted researches have outcome that; those people who are suffering from antisocial personality disorders in most cases tend to be hypersensitive and may be greatly affected by a simple image or a word of offense (Gelfer, 1996, p.59).
This calls for a special and soft procedure to be developed so as to sort out the issue of antisocial disorders in a non-harassing manner thus more effective methods were adopted to deal with the antisocial disorders. The focus of limited re-parenting extends over a broad range of needs such as early connection, sufficient limits and autonomy. The schema therapy group of treatment resulted in significant reductions in the disorder’s symptoms and global improvement in functioning. A collaborative randomly controlled trial with 14 sites in six countries is further in progress to explore the productive interaction between groups and schema therapy.
Schema therapy is generally cost effective and is much more accurate as far as treatment of antisocial personality disorder is concerned. To conclude, the ultimate goal of schema therapy is to assist patients to have their core needs met.
Furthermore, antisocial personality disorder can be treated using a method called Multisystem Therapy (MST); which is one of the most successful methods for the treatment.
This is an intensive, family-focused and community-based treatment technique for chronic as well as violent youth. This method is goal oriented with its objective being; to help caregivers manage and nurture their challenging adolescents in a much better manner (.Andrews, 1961, p.38).
Juvenile justice is one of the major forms of multisystem therapy; it deals with the problems of adolescents who have significant histories of committing crime. There are other systems whose task is to sort out the situations in other serious behavioral issues; for instance, drug abuse, abuse and neglect, as well as psychiatric disorders. The target goal for this method of treatment is to drastically reduce the antisocial behaviors as well as criminal activity amongst the youth. This is achieved at a relatively lower cost by reducing the rates of incarceration. Multisystem therapy empowers both the youth and the parents with the required skills as well as resources to facilitate independency and establish a way to deal with the complex environment as well as social problems. The method of multisystem therapy was specifically innovated to deal with adolescents’ antisocial behaviors. It typically aims at chronic as well as substance-abusing juvenile offenders aged between 12 and 17 years. This bracket of population is much more vulnerable to out-of-home placement.
Unlike other several methods of treatment where the affected person sees a therapist at a clinic; in multisystem therapy, the therapists go to the subject’s home and community (Levine, & Gallogly, 1985, p.39).
This clearly explains why this method is preferred in the treatment to other methods (it has direct exposure to the environment of the affected person hence effective decisions can be made to address the problem. In the process of designing a treatment plan, the multisystem therapists collaborate with parents, caregivers and family members. The plan builds on the strengths of in the family members’ lives; which creates success environment during and after treatment.
Generally, the major obligations of multisystem therapy include:- Enhance family relations, Assist the affected person develop a vocation, Expose the youth to friends who deviate from the antisocial behaviors, Create a support network which in turn assist the caregivers maintain the changes, and advance on the caregivers’ parenting skills.
Conducted research has shown that, multisystem therapy is more effective as compared to other standard treatments. This has been supported by the follow-up studies made with the youth and families. This guarantees the long-term effectiveness of the multisystem therapy. This method of treating antisocial personality disorder has been found to be cost effective as noted from a broadly conducted research over a great extent of the world (.Paris, 1996, p.98).
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