Meeting-The-Challenge-Making-a-Difference-Practitioner-Guide

ANTISOCIAL PERSONALITY
DISORDER
Antisocial personality disorder
is often linked in people’s
minds with criminal behaviour,
and around 50% of people in
prisons might meet criteria for
antisocial personality disorder;
however, only 47% of the
people who meet criteria for
antisocial personality have
significant arrest records (NICE
CG77, 2009).
The companion guide to this
one,‘Working with Offenders
with Personality Disorders in
the Community’ (Ministry of
Justice, 2011; www.justice.gov.uk)
contains a great deal of
helpful information and advice
about working with offenders
with personality disorders,
whether this is antisocial or
other personality disorders.
Whether or not someone with
antisocial personality disorder
has a criminal record, all people
with antisocial personality
disorder have mental health
needs, and antisocial personality
disorder is often co-morbid
with depression, anxiety and
alcohol and drug use.
The NICE guideline for antisocial
personality disorder (ASPD) spells
out some recommendations for
good practice:
• People with ASPD tend to be
excluded from services and
staff should work actively
to engage them.
• Positive and reinforcing
approaches to treatment
are more likely to be helpful
than those that are
negative or punitive.
• Work in partnership with
people with ASPD in order to
develop their autonomy by
encouraging them to be
actively involved in finding
solutions to their problems,
even when in crisis, and
encouraging them to
consider different treatment
options or life choices
available to them, and the
consequences of choices
that they make.
• Provision of services for
people with ASPD often
involves significant interagency
working. Pathways
between services should be
clear, and communication
between organisations
should be effective.
• Pharmacological
interventions (drug
treatments) should not
be routinely used for the
treatment of antisocial
personality disorder or
associated behaviours of
aggression, anger and
impulsivity. Pharmacological
interventions for comorbid
mental disorders, in
particular depression
and anxiety, should be in
line with recommendations
in the relevant NICE
clinical guideline.
As yet there is limited evidence
about effective treatments for
antisocial personality disorder.
This does not mean that
‘nothing works’, only that this
group are less easily studied
than, say, people with anxiety
symptoms or depression, and
interventions have tended to
focus on reducing criminal
behaviour rather than treating
the underlying personality
difficulties. NICE recommend
group based cognitive and
behavioural interventions
focused on reducing offending
and other antisocial behaviour,
and to address problems such
as impulsivity and
interpersonal difficulties.
As more research is conducted
on helpful treatments for
people with personality
disorder, it may well be that
the recommendations for
effective treatments for
people with ASPD will broaden
to include a wider range of
treatment options.
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