Despite the ease of use and availability of self-report
measures and (semi)structured interviews, clinicians
should be aware of the circumstances under which a
diagnosis of ASPD is not warranted. First, a diagnosis
of ASPD should not be given to individuals who dis-
play antisocial behavior only during acute phases of
psychotic or mood disorders (e.g., a manic episode). In
cases where the examinee has a substance use disorder
and adult antisocial behaviors are observed, ASPD
should be diagnosed only if features of the disorder
were present during childhood. Also, given the high
degree of comorbidity between PDs, differentiating
between features of ASPD that are similar to those of
other PDs is critical. Of course, ASPD also needs to be
differentiated from certain Axis I disorders with similar
symptoms (e.g., grandiosity and impulsivity, observed
in bipolar disorder). Finally, collateral information is
useful to consider in assessments in light of the charac-
teristic deceitfulness of individuals with the disorder.Treatment
ASPD is extremely difficult to treat, and at present,
the prognosis for antisocial individuals typically is
considered poor. The empirical treatment literature
bearing on ASPD is in its infancy, with few controlled
studies having been conducted. In addition, research
in this area tends to examine the outcomes of inter-
ventions for behaviors associated with ASPD, such as
substance abuse and violence, rather than treatments
aimed at altering the underlying personality features
of the disorder. In addition, relatively little research
has examined intervention outcomes with women—
and when women are included in samples, results
typically are not disaggregated by gender. Neverthe-
less, the body of literature on this topic has grown
over the past decade, and some broad trends are
apparent.
Several studies have investigated the outcomes of
substance abuse treatment among individuals with
ASPD. Most results indicate that persons with co-
occurring substance abuse problems and ASPD make
treatment gains on par with those of individuals in
substance abuse treatment without ASPD. However,
other studies on this topic suggest less improvement
in individuals with ASPD than in others. Furthermore,
research suggests that broad classifications such as
“substance abuser” may be too generic and that differ-
ences based on an individual’s drug of choice and the
severity of the impact on daily functioning may be
important to treatment outcome.Given the nature of the diagnosis, it is not surpris-
ing that most treatment outcome studies on ASPD
have been conducted with offender samples. Although
at this time, research data do not endorse a specific
type of treatment for ASPD, there is strong empirical
support for the effectiveness of certain guiding princi-
ples. The principles of risk, need,and responsivity
indicate that treatment outcome will be maximized as
a function of a treatment program’s match with an
individual’s level of risk, criminogenic needs (change-
able risk factors), and learning style. Meta-analytic
reviews indicate that the strongest predictor of success
across different correctional programs and offender
groups—including both men and women—is treat-
ment that adheres to these three principles.
Another aspect of treatment with empirical support
is the multimodal hypothesis, which suggests that
correctional treatment is most effective when multi-
ple need areas of an offender are targeted. Research
demonstrates that multimodal programs that incorpo-
rate cognitive-behavioral and social learning strate-
gies are associated with substantially larger treatment
gains than are nonbehavioral interventions. In addi-
tion, there is a positive association between the num-
ber of criminogenic needs targeted for intervention
and subsequent reductions in recidivism. In contrast,
approaches that are contraindicated for treating ASPD
because they are viewed as unresponsive to offenders’
criminogenic needs and/or learning style include tra-
ditional “talk” psychotherapy of the psychodynamic,
client-centered, and insight-oriented ilk.
Programs that include a relapse prevention element
are associated with enhanced reductions in recidi-
vism. Relapse prevention is a cognitive-behavioral
approach to self-management that entails teaching
individuals alternate (more effective) responses to high-
risk situations. Components of relapse prevention that
seem to be especially effective in reducing recidivism
include identifying one’s offense-chain and high-risk
situations and, subsequently, role-playing alternate
(more effective) ways of handling such situations.Etiology
Specifying etiological mechanisms for ASPD is diffi-
cult because of the nonspecificity of the disorder. That
is, there are innumerable symptom combinations that
can give rise to a diagnosis. Furthermore, a diagnosis
can arise almost solely from a person having engaged
in chronic criminal and violent behavior. That is, there
are no pathognomonic, necessary, or sufficient signsAntisocial Personality Disorder——— 31A-Cutler (Encyc)-45463.qxd 11/18/2007 12:41 PM Page 31