Antisocial and psychopathic individuals.

Abstract

Few diagnoses generate as much therapeutic pessimism as antisocial personality disorder (APD) or psychopathy. Frequently, clinicians maintain a pervasive belief that individuals with an antisocial or psychopathic personality style cannot be successfully treated. Whether because of these individuals' lack of motivation to change, the absence of psychological distress that typically drives treatment engagement, or an impaired ability to form meaningful relationships, clinicians often assume that treatment will be inherently frustrating and ultimately unsuccessful.This chapter briefly reviews the nature and distinctions between these related disorders, 1 as well as the research literature pertaining to their treatability. Following this review, an application of dialectical behavior therapy (DBT) is presented as a promising framework for the treatment of individuals with APD or serious antisocial behaviors. The specific adaptation of DBT 'Although we are aware that psychopathy is not currently classified by the DSM-IV-TR (American Psychiatric Association, 2000) as a mental disorder (i.e., it is not one of the 10 personality disorders listed), the language of disorder will be used in this chapter both for simplicity and because it accurately captures the nature of this phenomenon.

Under the Surface

“…The DSM-IV (APA, 1994) and the ICD-10 (WHO, 1993) specific criteria for most personality disorders describe various types of personal distress (e.g., “excessive efforts to avoid abandonment,” “persistent and pervasive feelings of tension and apprehension”). Psychopaths’ lack of the kind of personal distress that typically drives treatment engagement (Galietta, Finneran, Fava, & Rosenfeld, 2010) has been a hallmark in clinical descriptions of psychopathy (see Cleckley, 1941). If PCL-R psychopaths can be diagnosed with comorbid personality disorders normally associated with personal distress (e.g., avoidant, paranoid, and emotionally unstable traits), then we can conclude that unless the investigation is flawed, the psychological functioning of the psychopath is not purely shallow or cold.…”

Mental health treatment of criminal offenders.

“…Another treatment approach with rapidly growing popularity for criminal offenders in general, and antisocial/psychopathic offenders in particular, is DBT (Linehan, 1993). Using a model that was developed for the treatment of court-ordered probationers, Galietta, Rosenfeld, and colleagues (Galietta, Fineran, Fava, & Rosenfeld, 2010;Galietta & Rosenfeld, 2012) described an adaptation of DBT that was designed to target the unique problems that are common to antisocial and psychopathic offenders. These authors provided a theoretical justification for their use of DBT, with particular emphasis on issues such as emotion regulation (or, in the case of psychopaths, overregulation) and impulsivity.…”