Antisocial personality disorder (or ASPD) is a personality disorder that frequently co-occurs with borderline personality disorder (BPD). How does the addition of ASPD affect the course and prognosis of BPD?
What Is Antisocial Personality Disorder?According to the Diagnostic and Statistical Manual of Mental Disorders (4th edition, text revision) (DSM-IV-TR), antisocial personality disorder is a “pervasive pattern of disregard for, and violation of, the rights of others that begins in early childhood or early adolescence and continues into adulthood.”
People with antisocial personality disorder have been described as lacking empathy, and they may often be deceitful or break the law.
Antisocial personality disorder is also associated with impulsive behavior, aggression (such as repeated physical assaults), disregard for their own or other’s safety, and irresponsible behavior (such as difficulties sustaining a job).
In addition, some people with ASPD lack the capacity to feel remorse; that is, they do not feel bad when they have hurt someone else. However, not all people with ASPD have that symptom; many people with ASPD do feel guilt and remorse about their actions.
How Often Do ASPD and BPD Co-Occur?
Very few studies of the co-occurrence of ASPD and BPD have been conducted. One study in a treatment-seeking sample found that about 23 percent of patients with BPD also meet the diagnostic criteria for ASPD. However, another study that drew from a community sample found that only about 14% of people with BPD also have ASPD.
Antisocial Personality Disorder Treatment
For many years, ASPD was considered an untreatable disorder. More recently, a growing body of literature suggests that ASPD can be treated successfully.
A number of psychological treatments for ASPD have empirical (i.e., research) support. Cognitive behavioral therapy has been shown to be effective in reducing the symptoms of ASPD (including delinquent or criminal behavior). In addition, some psychodynamic and family-based treatment have proven effective. Medications, however, do not appear to reduce symptoms of ASPD (although they may be indicated for comorbid conditions).
Treatment for Antisocial Personality Disorder and Co-Occurring BPD
There are currently no published clinical trials of treatments for ASPD co-occurring with BPD; this is clearly an area in need of more research. There are a few published case studies that have applied Dialectical Behavior Therapy (DBT) in the treatment of ASPD. Since DBT is an empirically supported treatment for BPD, these preliminary reports suggest that this treatment may be an appropriate choice for someone with both disorders.
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