Antisocial Personality Disorder: Can It Be Treated?

Antisocial personality disorder (ASPD) can be challenging to treat, but it is not impossible

Dr.
Ding, I have dysthymic disorder and antisocial personality disorder.
When I was three years old, I stood alone in a large room and suddenly realized that my life was surrounded by monotony.
At that moment, a warm feeling flowed away from my heart and disappeared.
This distant memory may record the origin of all my sadness.
Is antisocial personality disorder a mental illness, a psychological disorder, or merely a personality trait? Can it be completely changed or eliminated? I tend to use people as tools, to manipulate and control them, often engaging in deceptive behavior, especially when hiding my past wrongdoings.
I struggle to develop responsibility, honesty, and integrity, frequently making empty promises, likely to please others.
I find it impossible to trust anyone, including myself; I act without planning, except when deceiving others; I fear being hurt and betrayed, yet I also inflict pain on others due to accumulated hostility and anger from my childhood experiences.
I have spontaneously hit someone four times in my life without any apparent reason or emotional drive.
My first impressions often leave people with a favorable opinion of me.
I lack insight and creativity, unable to read others' behaviors to learn and grow.
I resist adhering to social etiquette and rules, being extremely willful and entirely self-centered, unwilling to invest emotions in others, including love, respect, understanding, and forgiveness.
This can also be interpreted as a failure to develop various human emotions, while simultaneously yearning for love, attention, and trust from others.
My life lacks goals, plans, and direction, often only changing course when faced with obstacles.
My emotions seem limited to hate, anger, and pain, lacking the complex and rich emotions of adulthood.
I feel no shame, and even when my lies are discovered, I experience no emotional response.
My emotional state is apathetic and numb, lacking variation and sensitivity; I cannot express emotions, suppressing them intensely, and even when alone, I do not smile spontaneously.
I lack the ability to discern right from wrong, unable to judge whether others are trustworthy, as my self-serving mindset often leads me to be deceived by the sweet words of those who wish to harm me, requiring time to observe their flaws.
I refuse to establish any relationships, hence I have never had friends and dislike caring for others.
I cannot grow from failures or setbacks, likely due to a lack of ability to extract growth elements from those experiences.
I am often contradictory and hesitant, frequently overturning previous decisions.
I rely on cleverness to get through my studies.
I view people through a biased lens, only "liking" physically attractive women, and if I am harmed by someone beautiful, I find it hard to resist the urge to hurt those I perceive as ugly.
My emotions are often triggered only after events have occurred.
I have difficulties in learning: my short-term memory is acceptable, but I cannot develop long-term memories or memories that last a lifetime.
During college, I switched majors three times, as if I needed to continuously discard what I had.
I am competitive and often wish to surpass others, yet I feel very fragile inside.
In terms of sexuality, I can engage with any attractive woman.
I have a fetish; if given a choice, I would prefer to be born a girl.
At six, I stole money several times and learned to lie; at 23, I stole six cookies I had made myself.
I cheated academically once at age 12 by submitting a plant I had not grown to my biology teacher.
At 15, I framed several classmates, experiencing incontinence due to peer pressure; at 21, I once peeked at someone else's letter; at 24, I submitted an address that was not my own.
These are all the actions I have taken in my life besides lying.
I share all of this not because I acknowledge my wrongs, but as if I am discarding something.
Before I was six, I attended a school close to home where I was bullied, physically harmed, ostracized, and isolated.
From ages 7 to 18, I attended another school where I was merely bullied, ostracized, and isolated.
I ran away from home at four; at 17, I avoided school for over a month, and I usually am never late in a year.
Dr.
Ding, no one can choose their origins; this chain of origins can create a lifetime of tragedy.
I cannot grow, can I? How can the structure of my brain, which has already developed, be changed? How can this personality be completely altered or eliminated? Some people are truly fortunate; at least they originate from families filled with love, attention, and emotional interactions, allowing them to become doctors or psychologists.
Why do people need to become kind? Those who grow up in love can love and be loved, while I am destined to be alone for life? No one desires a tragic life, yet I seem indifferent to everything.
What motivation do I lack? Is it because no one has ever taught me how to live or hope? What should I do? What is the right course of action, Dr.
Ding? I once tried taking 12 mg of clonazepam but could not sleep; now I have only been sleeping 1.5 hours every two days and cannot perform basic arithmetic.
I can only remember half an hour of conversations with others.
Since a night in March 2015, I experienced two conflicting feelings in bed: one that tensed my entire nervous system and another that resisted sleep, lasting only a few seconds before disappearing, and I could not retrieve it.
Since that moment, relaxation exercises have become much less effective.
In September 2015, while at the airport, I fell asleep sitting in a chair, terrified of my mother.
In November 2015, while doing relaxation exercises in bed, I felt the urge to sleep, but my closed eyes opened due to a feeling resisting sleep.
What is wrong with me? Since then, I have been unable to achieve the relaxation effect that induces sleep.
It is very strange.
When 12 mg of clonazepam fails, what medication should I use? I have always struggled with the inability to relax my nerves.
Lastly, I would like to ask you to recommend a trustworthy and sincere clinical psychologist.
I know I have asked too much for an online consultation, but I felt that writing all of this was necessary to describe my issues.
I hope Dr.
Ding can provide as much guidance as possible.

Qingfeng Mingyue, 20~29 year old female. Ask Date: 2016/03/23

Dr. Ding Shuyan reply Psychiatry

Hello, individuals with antisocial personality traits typically do not possess the self-reflection and desire for change that you exhibit.
Of course, the diagnosis of personality disorders is not a strict binary; everyone has certain traits to varying degrees, and it is a matter of whether these traits are extreme enough to cause problems for the individual.
Assuming you are one of those individuals, I believe that having the motivation to change is the beginning of transformation.
I often tell my patients that modern medicine cannot regrow a lost limb, but the potential for improvement in psychological issues is very optimistic.
Personality tends to stabilize in early adulthood, with the brain and genetics determining a significant portion, while childhood experiences contribute another part.
As one ages, personality becomes increasingly difficult to change.
At 26 years old, you still have the potential for change, but as you know, some values and behavioral patterns have already begun to solidify, forming habits.
Changing these requires considerable effort.
I sometimes tell people that it’s akin to making a vow; it may sound old-fashioned or like a joke, but just like quitting smoking, drinking, or any bad habit, the determination and motivation to continue is the power of that desire for change.
We cannot choose our parents or the families we grow up in, and many childhood experiences must be passively accepted.
Instead of lamenting our fate, we are at least free in thought and action, with a significant capacity for self-awareness, which is incredibly valuable.
This allows us to live very different futures.
I have seen many inspiring examples of this.
Despite the innate limitations of the brain or genetics, current scientific discoveries show that psychological changes can also alter the brain's structure.
Repeatedly practicing a certain activity strengthens the corresponding areas of the brain.
Even practicing meditation, which may seem like doing nothing, can lead to certain brain areas becoming more robust; these examples are increasingly common.
We all desire happiness and dislike suffering.
Happiness built on selfishness or at the expense of others contradicts our inner nature, leading to superficial joy that brings more doubts and insecurity.
Altruistic behavior results in deeper, more genuine, and lasting happiness, positively impacting our mental health.
This is why, even if we feel unloved or unfairly treated in childhood, we cannot harbor hatred, as that is not the remedy and does not lead to happiness in life.
We can absolutely move beyond sorrow; it is best to love ourselves and others, and at the very least, to let go of the mindset of harming or exploiting others.
Relaxation training will definitely be beneficial; if it is ineffective, it may be due to your ability to relax being less than the stress you are currently experiencing.
Relaxation techniques are not like riding a bike; once learned, you don't forget.
Without regular practice, relaxation skills can diminish.
Therefore, it is essential to practice daily to maintain familiarity; each practice session can be short but frequent, which makes it more likely to be sustained every day.
Recommending therapists online can be awkward.
It’s better to visit a hospital and ask for a referral from a physician.
The effectiveness of a therapist can depend on personal rapport, which is sometimes quite important.
A well-known therapist may not connect with you, making it difficult to engage in meaningful conversation.
It’s like buying a car; you should test drive it yourself rather than just relying on what others say online.
Wishing you all the best,
Dr.
Ding Shuo-Yan

Reply Date: 2016/03/23

More Info

Antisocial Personality Disorder (ASPD) is a complex and challenging mental health condition characterized by a pervasive pattern of disregard for the rights of others, lack of empathy, and often manipulative or deceitful behavior. Understanding and treating ASPD requires a nuanced approach, as it is not merely a psychological disorder but also involves deep-rooted personality traits that can be difficult to change.

Nature of Antisocial Personality Disorder
ASPD is classified as a personality disorder, which means it is more about enduring patterns of behavior and inner experience than acute mental illness. Individuals with ASPD often exhibit traits such as impulsivity, irritability, aggression, and a lack of remorse for their actions. This disorder can stem from a combination of genetic, environmental, and social factors, including childhood trauma, neglect, or abuse. The origins of these behaviors can often be traced back to early life experiences, as you have described in your reflections.

Treatment Options
1. Psychotherapy: While there is no cure for ASPD, psychotherapy can help individuals understand their behavior and develop healthier coping mechanisms. Cognitive Behavioral Therapy (CBT) is often used to address the distorted thinking patterns that contribute to antisocial behaviors. However, individuals with ASPD may be resistant to therapy, as they often do not see their behavior as problematic.

2. Motivational Interviewing: This approach can be particularly useful in engaging individuals with ASPD in the therapeutic process. It focuses on enhancing motivation to change by exploring ambivalence and fostering a sense of personal responsibility.

3. Medication: While there are no specific medications approved for ASPD, certain medications may help manage symptoms such as irritability, impulsivity, or aggression. Antidepressants, mood stabilizers, or antipsychotic medications may be prescribed based on individual symptoms.

4. Group Therapy: Participating in group therapy can provide individuals with ASPD an opportunity to interact with others and learn from their experiences. However, this setting can also be challenging, as individuals may struggle with trust and empathy.

The Potential for Change
You expressed concerns about whether it is possible to change or eliminate the traits associated with ASPD. While personality traits are relatively stable, research suggests that change is possible, especially when individuals are motivated and engaged in the therapeutic process. The brain is capable of neuroplasticity, meaning it can adapt and change in response to new experiences and learning. Engaging in therapy, practicing empathy, and developing social skills can lead to meaningful changes over time.

The Role of Early Experiences
Your reflections on early experiences of isolation and trauma highlight the importance of understanding the roots of ASPD. Early childhood experiences can significantly shape personality development. While you cannot change your past, recognizing how it has influenced your current behavior is a crucial step toward healing. Therapy can provide a safe space to explore these experiences and their impact on your life.

Seeking Help
Finding a trustworthy and empathetic therapist is essential for your journey. A therapist experienced in working with personality disorders can help you navigate the complexities of your feelings and behaviors. It may take time to find the right fit, but persistence is key. Consider seeking recommendations from trusted sources or mental health professionals.

Conclusion
In summary, while Antisocial Personality Disorder presents significant challenges, it is important to remember that change is possible. Through therapy, self-reflection, and a commitment to personal growth, individuals with ASPD can develop healthier relationships and a more fulfilling life. It is crucial to approach this journey with patience and an open mind, recognizing that progress may be gradual but attainable. Your willingness to seek help and reflect on your experiences is a positive step toward understanding and managing your condition.

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