Is There Any Hope for My Son With Dissocial Personality Disorder?

Reader’s Question

My son has “Dissocial Personality Disorder.” I cannot seem to find any kind of treatment, in fact I find there is no treatment. I cannot believe that there is nothing out there to help him. Please let me know if you know of anything that can be done.

Our Clinical Psychologist’s Reply

The term Dissocial Personality has only recently come into common professional use. Various labels have been given to personalities whose main attributes cause them to come into constant conflict with generally accepted norms of society.

The term antisocial (as in Antisocial Personality Disorder) has been used to describe the patterns of behavior (e.g., frequent lawbreaking) that pit this type of personality against the social order. The terms sociopathic and psychopathic have also been used to describe the tendencies of some of these individuals to engage in acts of callous, senseless, and remorseless use and abuse of others.

Because the DSM diagnostic criteria were deliberately designed to be based on objective, observable behavior patterns, the affective and interpersonal deficits associated with the more severe personality disturbances (e.g., psychopathy, sociopathy, dissociality) and their role in antisocial behavior was not given primary focus.

The ICD-10’s description of dissociality, however, focuses heavily on the affective and interpersonal deficits associated with the disorder. The criteria include:

• Callous unconcern or disregard for the feelings of others and a diminished capacity for empathy
• Persistent, gross disregard for rules, obligations, etc. and a persistent attitude of irresponsibility
• Incapacity to establish and maintain enduring mutually-respectful relationships
• Low tolerance for frustration and a low threshold for discharging anger and aggression
• Incapacity to experience guilt, to profit from experience, or to deter behavior patterns when punished
• Marked proneness to offer excuses for misdeeds and blame others for problems
• Persistent irritability

At the present time, the prevailing professional opinion is that dissocial personality disordered individuals are untreatable. Further, there is some evidence from research studies that indicate that attempting to treat such individuals with methods to which most individuals respond only serves to make the dissocial personality more aware of the “dynamics” at play in normally-functioning individuals and therefore gives them information and “ammunition” to prey more effectively on others (in other words, traditional treatment makes them worse). A small minority of professionals, however, believe that such individuals can indeed be rehabilitated but just not with any of the methods or techniques most commonly employed in therapy. Some of the techniques advocated test both ethical and humane boundaries and almost always stir up controversy when they are tried.

Fortunately, these severe personality disturbances are rare, though they appear to be diagnosed more frequently in recent years. This could be because of better detection techniques being available, environmental factors promoting an actual increase in the incidence of the disorders, or a tendency to over-diagnose them.

It’s important to be sure that your son has been thoroughly evaluated and that the diagnosis is solid. Given the poor prognosis, some families are willing to take the risk of seeking out some of the more rare, avant-garde therapies because they believe they have virtually nothing to lose.