Pathways to antisocial behavior: a framework to improve diagnostics and tailor therapeutic interventions

Abstract

The Antisocial Personality Disorder (ASPD), and antisocial behavior (ASB) in general, is associated with significant impact on individuals themselves, their environment, and society. Although various interventions show promising results, no evidence-based treatments are available for individuals with ASPD. Therefore, making informed choices about which treatment can be applied to an individual patient is complicated. Furthermore, contradictory findings on therapy effectiveness and underlying factors of ASB, such as cognitive impairments and personality traits, fuel the debate whether the conceptualization of ASPD in the DSM-5 is accurate and whether this population can be seen as homogeneous. A conceptual framework, based on the reciprocal altruism theory, is presented in which we propose different pathways to ASB. These pathways suggest underlying dynamics of ASB and provide an explanation for previous contradictory research outcomes. This framework is intended to serve as a clinically relevant model that provides directions for improving diagnostics and matching treatments to underlying dynamics in the antisocial population.

Antisocial personality disorder and therapeutic pessimism – how can mentalization-based treatment contribute to an increased therapeutic optimism among health professionals?

“…National Institute for Health and Care Excellence (2010) focuses on recommendations for early interventions for children diagnosed with, or at risk of developing, conduct disorder. Current research now supports the idea that some variants of ASPD can be understood as a developmental disorder rooted in insecure attachment ( Yakeley and Williams, 2014 ; De Visser et al, 2023 ). In terms of future research, it would be useful to extend the current findings by examining what implications this could have for the prevention of ASPD and early intervention for individuals with conduct disorder.…”

“…Although the effectiveness of MBT-ASPD is still uncertain, our findings indicate that there is ground for therapeutic optimism concerning ASPD. Newer perspectives on psychotherapeutic treatment of ASPD is encouraging and optimistic (for example; Van den Bosch et al, 2018 ; Bateman, 2022 ; De Visser et al, 2023 ).While awaiting an effective treatment of ASPD, we hope that this review can contribute to an alternated view on the treatment opportunities of ASPD, increase focus on structural components around psychotherapy and emphasize the societal and economic benefits of finding an effective psychological treatment. Additionally, we hope that this review can contribute to an alteration of punitive attitudes toward ASPD in society to foster therapeutic initiatives to better help an underserved patient group.…”

“…Additionally, the mentalizing abilities in individuals with ASPD with and without psychopathy seem to differ ( Dolan and Fullam, 2004 ). De Visser et al (2023) points out that for individuals with psychopathy there is a lack of motivation to mentalize others, while for ASPD patients without psychopathy there is a lack of ability to mentalize others. It is probably difficult to engage psychopathic individuals in authentic curious investigation of other people’s mind, MBT would therefore be a bad fit.…”

“…For individuals with psychopathic traits, their main difficulties are not primarily related to mentalizing deficits, but rather to their lack of concern for other people ( Dolan and Fullam, 2004 ; De Visser et al, 2023 ). For that reason, MBT may not be as effective for this group.…”

“…This could imply a need for different treatment options for the two groups. De Visser et al (2023) has given some nuanced perspectives on how to tailor psychotherapeutic treatment better for ASPD patients with various levels of severity and deficiencies in social cognition, including those with psychopathic features. De Visser suggests that for ASPD with psychopathic features specific treatment approaches are recommended, like cognitive remediation training or risk reduction approaches.…”