ANSWER
Antisocial Personality Disorder (ASPD) as a Focus on Personality and Paraphilic Disorders
The Antisocial Personality Disorder Controversy
Because of its stigma, connection to criminal activity, and uncertainties surrounding its diagnosis and treatment, antisocial personality disorder (ASPD) is one of the most contentious personality disorders. Critics contend that rather than addressing the psychological complexity of the condition, the DSM-5-TR criteria, which place an emphasis on patterns of disdain for others and repeated law-breaking acts, may pathologize criminality (Paris, 2022). Furthermore, there is a great deal of disagreement on the efficacy of ASPD treatment; some medical professionals believe that people with ASPD cannot be helped because they lack regret or the will to change (Blair, 2021).
The intersection between psychopathy and ASPD adds another level of contention. Despite not being formally acknowledged in the DSM-5-TR, psychopathy is frequently discussed in forensic situations, which can lead to misunderstandings and overdiagnosis. Clinical therapies and ethical considerations are further complicated by the media’s representation of people with ASPD as violent or dangerous, as well as by societal stigma (Skeem et al., 2022).
Professional Opinions Regarding ASPD
My professional views of ASPD are consistent with a sophisticated and fact-based comprehension of the condition. Even though treating ASPD might be extremely difficult, I think that people with this diagnosis are not always incurable. Rather, customized strategies that target certain behaviors and co-occurring diseases, like substance use disorders, are necessary for successful therapies.
Multimodal Treatment Approaches: Cognitive-behavioral therapy (CBT) has been shown to be effective in assisting people with ASPD in identifying and changing maladaptive behaviors (Gannon et al., 2022). Reducing injury, enhancing social functioning, and controlling impulsivity are frequently the main objectives of therapy.
Early therapies: Studies emphasize the value of early adolescent therapies, especially for individuals with conduct disorder, which is a prelude to ASPD. The chance of getting ASPD as an adult can be decreased by early behavioral treatments and family-based therapy (Burke et al., 2020).
Avoiding Stigma and Bias: Clinicians should treat ASPD with compassion, understanding that treatment and diagnosis may be influenced by societal biases. Working with marginalized groups that are disproportionately impacted by systemic injustices—which can lead to behaviors that are classified as antisocial—makes this even more important.
Techniques for Preserving the Therapeutic Alliance
Because of their propensity for manipulation, lack of empathy, and mistrust of authoritative people, individuals with ASPD can be difficult to establish and maintain a therapeutic connection with. The following are some tactics to create a successful therapeutic alliance:
Clearly Defined limits: Because individuals with ASPD may push limits, it’s critical to provide consistent and unambiguous guidelines for the therapeutic alliance. This entails remaining impartial while demonstrating empathy and respect.
Focusing on Realistic Objectives: Finding specific, attainable goals that suit the patient’s interests, including enhancing work or lowering legal issues, is frequently essential to the effectiveness of therapy.
Building Trust Gradually: With patients who frequently view people as hostile, building trust takes time. Building rapport can be facilitated by avoiding aggressive methods and exhibiting dependability.
Using Motivational Interviewing: This method encourages patients to pinpoint their own internal motives for changing negative habits, which helps them overcome ambivalence regarding change (Gannon et al., 2022).
Legal and Ethical Aspects to Consider
Because ASPD is linked to actions that could injure other people or go against social standards, it poses particular ethical and legal issues. Clinicians must carefully handle these dilemmas to maintain moral behavior while abiding by the law.
Mandatory Reporting: Clinicians are required by law to violate confidentially in order to alert prospective victims when a patient with ASPD expresses intent to harm others (for example, under the Tarasoff verdict). Careful ethical consideration is needed to strike a balance between patient confidentiality and public safety.
Informed Consent: It may be difficult for patients with ASPD to participate truthfully in therapy. Getting their informed consent requires making sure they are completely aware of the goals, dangers, and restrictions of the therapy.
Preventing Harmful Bias: Healthcare professionals need to be careful not to engage in discriminatory behavior or let stigma affect how they treat patients. For instance, treating ASPD patients poorly may result from presuming they are all violent.
Documentation: When working with patients who have been diagnosed with ASPD, comprehensive and objective documentation is essential due to the possibility of legal ramifications (such as forensic evaluations or criminal procedures).
In conclusion
The diagnosis of antisocial personality disorder is complicated and contentious, necessitating a careful and moral approach to diagnosis, care, and treatment. Even if there are obstacles including stigma and poor treatment results, using evidence-based practices and developing a therapeutic partnership can result in significant advancements. In order to deliver compassionate and efficient care, clinicians must carefully negotiate the legal and ethical environment, striking a balance between patient autonomy and confidentiality and public safety.
Citations
R. J. R. Blair (2021). Examining the etiology and treatment issues of psychopathy and antisocial personality disorder in relation to violent crime. Mental Health and Criminal Behavior, 31(4), 245-260.
Pardini, D. A., Burke, J. D., and Loeber, R. (2020). Youth conduct issues’ developmental paths and how they relate to adult antisocial personality disorder. 129(6), 634-645, Journal of Abnormal Psychology.
Collie, R. M., Ward, T., and Gannon, T. A. (2022). A useful manual for cognitive-behavioral therapies for antisocial personality disorder. 451-464 in Behavior Therapy, 53(2).
Paris, J. (2022). The intricacies of antisocial personality disorder: Present discussions and potential paths forward. Personality Disorders Journal, 36(3), 250-263.
Polaschek, D. L. L., Skeem, J. L., and Manchak, S. M. (2022). Different approaches to diagnosing and treating violent offenders include psychopathy and antisocial personality disorder. Clinical Psychology Annual Review, 18(1), 121-145.
QUESTION
- Review this week’s Learning Resources and consider the insights they provide on assessing, diagnosing, and treating personality and paraphilic disorders.
- Select a specific personality or paraphilic disorder from the DSM-5-TR to use for this Assignment.
- Use the Walden Library to investigate your chosen disorder further, including controversial aspects of the disorder, maintaining the therapeutic relationship, and ethical and legal considerations.
In 2–3 pages:
- Explain the controversy that surrounds your selected disorder.
- Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature.
- Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.
- Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are important.