Antisocial personality disorder (ASPD) is a type of mental health disorder that belongs to the cluster B personality disorders of the DSM-5 which are behaviors described as dramatic, emotional, or erratic. This condition is characterized by behavioral patterns of manipulation, exploitation, or violation of other people’s rights without any remorse.
Patients suffering from ASPD may break the law, lie and deceive others for personal gain, behave aggressively or recklessly, and deny responsibility for their actions.
While the cause of ASPD is unknown, some factors increase a person’s risk of developing this personality disorder. Risk factors of ASPD include environmental factors like childhood abuse or trauma, genetics, family dynamics, and alcohol or drug abuse.
Traits associated with ASPD are often seen during late childhood though before age 15. A formal diagnosis cannot be made until 18 years of age. The signs of conduct disorder can often be missed as they can overlap with other conditions like depression, oppositional defiant disorder, or attention deficit disorder (ADHD). When an early and accurate diagnosis is missed, it can develop into ASPD.
Early diagnosis and intervention for children with conduct disorder are often considered the least costly and most effective management for this condition.
Psychiatric medications may be indicated such as antipsychotics to treat symptoms like impulsive aggression. Additionally, psychotherapy or behavioral therapy may also be indicated in individual or group settings.
Nursing Process
Patients with personality disorders are not often hospitalized specifically for their disorder, but may require inpatient care for physical ailments and will also require monitoring of their mental health.
With ASPD, patients may receive psychiatric treatment as an alternative to imprisonment as this disorder is often characterized by an inability to follow laws and careless behavior such as fighting or drunk driving. In this instance, trained psychiatric nurses understand the symptoms and how to maintain the safety of these patients.
Nurses trained in psychiatric care understand the importance of assessing and monitoring behaviors, preventing violent or suicidal behavior, and communicating therapeutically to address issues with coping and social interactions.
Nursing Care Plans
Once the nurse identifies nursing diagnoses for an antisocial personality disorder, nursing care plans help prioritize assessments and interventions for both short and long-term goals of care. In the following section, you will find nursing care plan examples for an antisocial personality disorder.
Impaired Social Interaction
Patients with ASPD often lack empathy and regard for other people, leading to toxic and strained relationships.
Nursing Diagnosis: Impaired Social Interaction
Related to:
- Manipulative behaviors
- Aggression
- Negative role-modeling
- Altered self-concept
- Depressive symptoms
- Disturbed thought processes
- Environmental constraints
- Inadequate social skills
- Neurobehavioral manifestations
As evidenced by:
- Anxiety or discomfort in social interactions
- Dysfunctional interaction with others
- Family reports altered interaction
- Inability to communicate a satisfying sense of social engagement
- Inability to develop or maintain an intimate relationship
- Physical and verbal hostility toward others
- Unhealthy competitive focus
Expected Outcomes:
- The patient will report increased satisfaction in socialization and relationships
- The patient will identify personal behaviors that are responsible for impaired social interaction
- The patient will participate in group therapy twice per week
Assessment:
1. Assess the patient’s behaviors.
Patients with ASPD often exhibit impulsive, manipulative, exploitative, and irresponsible behaviors. Having a better understanding of these behaviors and how the patient interacts with other people can help in identifying the most appropriate approach to providing care.
2. Inquire about support systems.
Assess for the availability of family members or friends. Observe how the patient speaks about them and if relationships are strained or nonexistent. Assess the dynamic of relationships with parents and other adults.
Interventions:
1. Establish trust and develop a therapeutic relationship with the patient.
Patients with ASPD often have bad experiences in their childhood and develop an impaired ability to trust. A trusting relationship promotes feelings of safety, reduces anxiety, and enables the patient to openly talk about past traumas.
2. Act upon inappropriate behavior immediately.
When manipulative or unacceptable behavior is observed, the nurse must immediately respond and intervene. Consistent feedback is necessary to establish boundaries and prevent future poor behavior.
3. Rotate staff who work with the patient.
Allowing interaction with more than one staff member enables the patient to develop interaction skills. Ensure that all staff who care for the patient interact in a consistent non-judgemental and trusting manner.
4. Model interactions.
The nurse can role-model appropriate and expected interactions so the patient can learn and practice interacting in acceptable manners.
5. Encourage the patient to comply with cognitive and behavioral therapies.
Patients with ASPD can benefit from group rehabilitation programs that focus on promoting positive interaction skills and reducing offending, manipulative, exploitative, and other antisocial behaviors.
Ineffective Coping
Patients with ASPD often experience ineffective coping due to an inability to recognize and develop strategies to effectively and safely manage behaviors.
Nursing Diagnosis: Ineffective Coping
Related to:
- Lack of motivation to change behaviors
- Underdeveloped ego
- Inadequate social support
- Ineffective tension release strategies
- Inadequate resources
- Dysfunctional family systems
As evidenced by:
- Manipulative behaviors
- Inability to ask for help
- Destructive behavior toward others
- Demonstration of unacceptable behaviors
- Anger and hostility
- Absence of guilt
- Inability to learn from punishment
- Failure to achieve an optimal sense of control
- Failure to change behavior based on experience
- Intense emotional dysregulation
- Destructive behavior (drinking, drugs, physical violence)
Expected Outcomes:
- The patient will express needs directly without ulterior motives
- The patient will demonstrate decreased attention-seeking and manipulative behaviors
- The patient will demonstrate newly learned coping skills to modify frustration and behavior
Assessment:
1. Assess life stressors.
Attempt to ascertain individual life stressors such as living situations, finances, or illnesses that may be contributing to the patient’s ineffective coping.
2. Assess for maladaptive coping mechanisms.
Assess for negative or dangerous coping behaviors such as drugs, excessive alcohol, or self-harm. The patient may require substance abuse or other forms of rehabilitation.
Interventions:
1. Set behavioral limits.
Patients with ASPD will test boundaries and may not follow rules. Strict adherence to rules must be set from the beginning and consequences for not adhering must be instituted to prevent future behaviors.
2. Help the patient gain insight.
Patients with ASPD often will not take responsibility for their actions. Attempt to educate on normalized societal behaviors and how and why consequences are required for inappropriate actions.
3. Consistently approach the patient in all interactions.
This enhances feelings of security and provides the patient with structure. Exceptions tend to encourage manipulative behavior.
4. Provide positive reinforcement.
Providing positive reinforcements for acceptable coping behavior will keep the patient motivated to repeat appropriate behaviors.
5. Assist the patient in developing problem-solving skills.
Encourage group therapy sessions as this setting mimics how the patient must behave in society. Patients may be more inclined to listen and consider feedback from peers than authority figures.
Social Isolation
People with ASPD tend to isolate themselves from other people due to their disregard for and violation of other people’s rights along with deceit and manipulation.
Nursing Diagnosis: Social Isolation
Related to:
- Ineffective interpersonal relationships
- Difficulty establishing satisfactory reciprocal interpersonal relations
- Difficulty sharing personal life expectations
- Inadequate social skills
- Inadequate social support
- Unacceptable social behavior
As evidenced by:
- Expresses dissatisfaction with respect from others
- Expresses dissatisfaction with social connection
- Expresses dissatisfaction with social support
- Hostility
- Impaired ability to meet expectations of others
- Low levels of social activities
- Minimal interaction with others
- Manipulative behavior
Expected Outcomes:
- The patient will implement two strategies to effectively interact with other people
- The patient will demonstrate increased control of unacceptable social behaviors
Assessment:
1. Assess patient history.
Patients with ASPD often report disturbed early relationships with their family members. They often experience childhood abuse or may have witnessed unhealthy family dynamics. The modeling of previous relationships has an impact on current behaviors.
2. Assess the patient’s feelings and perceptions.
Self-perception is important to better understand the patient’s concept of how their behaviors contribute to or hinder relationships. Assess if the patient is self-aware of their influence on their relationships with others.
3. Assess if the patient feels isolated.
The patient with ASPD may or may not be bothered by their lack of friendships or intimate relationships. Inquire if the patient is interested in developing social skills to improve isolation.
Interventions:
1. Set limits and intervene in manipulative behaviors.
Patients with ASPD will repeatedly test limits. Once they understand that boundaries are firm, they will be motivated to work on acceptable ways to interact and communicate.
2. Assist the patient in identifying issues that cause the isolation.
Anger, deceit, violence, irritability, and manipulation are common traits in ASPD that prevent connection with others. Identifying these issues first is the initial step to overcoming isolation.
3. Encourage and assist the patient in practicing social skills.
Enabling the patient with the necessary social skills will help increase self-esteem and prepare them for social situations. Group therapy with other participants can offer exposure to social settings.
4. Provide environmental stimuli.
Even simple stimuli such as TV and radio can assist in preventing isolation. The patient may be more comfortable with online or virtual interaction instead of in-person.
References
- Antisocial Personality Disorder. Mayo Clinic. Dec. 10, 2019. https://www.mayoclinic.org/diseases-conditions/antisocial-personality-disorder/symptoms-causes/syc-20353928
- Antisocial personality disorder (ASPD). Merck Manual Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/personality-disorders/antisocial-personality-disorder-aspd
- Antisocial Personality Disorder. MentalHealth.gov. Last Updated: 03/01/2022. https://www.mentalhealth.gov/what-to-look-for/personality-disorders/antisocial-personality-disorder
- Fisher KA, Hany M. Antisocial Personality Disorder. [Updated 2021 Nov 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK546673/
