Antisocial Personality Disorder Research Paper

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Antisocial Personality Disorder
J. Reid Meloy, Ph.D.

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ntisocial personality disorder is the most reliably

diagnosed condition among the personality disorders, yet treatment efforts are notoriously difficult. Therapeutic hope has not vanished, however, and one study indicated that almost two-thirds of psychiatrists think that “psychopathic disorder” is sometimes a treatable condition (Tennent et al. 1993). A similar finding was reported nearly 40 years ago (Gray and Hutchison 1964). Diagnostic refinement is critical before any treatment efforts are undertaken, especially the determination of the degree of psychopathy in the patient with or without DSM-IV-TR antisocial personality disorder.

Psychodiagnostic Refinements
The patient’s emotional life instead is dominated by feelings of anger, sensitivities to shame or humiliation, envy, boredom, contempt, exhilaration, and pleasure through dominance. The more psychopathic the patient with antisocial personality disorder, the more apparent his or her limited emotional repertoire will be to the clinician, evident in the coarseness, suddenness, and rapid dissipation of raw affect.
Affective dysfunction in the psychopathic patient is apparent in his or her inability to understand the emotional or connotative meaning of words (Williamson et al. 1991;
Kiehl, Smith, Hare, Mendrek, Forster, Brink & Liddle, 2001), and in less of a startle blink reflex in response to both pleasant and unpleasant stimuli (Patrick et al. 1993). Both male and female adults with antisocial personality disorder appear to modulate affect about as well as a 5- to 7-year-old child (Gacono and Meloy 1994).
These findings pose difficult treatment problems, but their absence in any one patient should support a more positive prognosis. Such findings in the patient with
What is forbidden is often what is most desired. If clinicians come to understand the fantasized extremes of their own aggressive and hedonistic desires, this fascination will often devolve into more realistic boredom, and then the clinical task becomes maintaining interest in a patient who offers little hope for change (Meloy & Reavis, 2006).
Understanding and management of these emotional reactions to patients with antisocial personality disorder, whether psychopathic or not, will not only increase staff safety but also contribute to diagnosis and treatment planning. Such countertransference reactions are most readily explored in individual or group supervision or in carefully led clinical staff meetings in which a wide range of emotional reactions toward patients are tolerated and accepted. Clinicians who are resistant to any understanding of their own emotional lives in relation to these patients should not be treating them and may put other mental health professionals at risk. As Meloy (1988) wrote, “The interpersonal encounter

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Antisocial Personality Disorder with the patient fundamentally defines the humanity, or lack of humanity, of