Antisocial Personality Disorder: A Mentalizing Framework

Antisocial personality disorder (ASPD) is a common condition with major public health implications. Yet effective treatment remains elusive. In this paper the major descriptive symptoms of ASPD are considered using a mentalizing framework. Mentalizing is the implicit or explicit perception or interpretation of the actions of others or oneself as intentional, that is, mediated by mental states or mental processes. It is considered as four intersecting dimensions: automatic/controlled or implicit/explicit; internally/externally based; self/other orientated; and cognitive/affective process. People with ASPD show problems with self/other mentalizing particularly in terms of empathic understanding of others. Their focus is biased toward external mentalizing with little regard for the internal mentalizing of others. The translation of this understanding into a clinical treatment program is discussed. The program is based on the current, evidence-based, mentalization-based treatment (MBT) for borderline personality disorder but with adaptations targeting the mentalizing difficulties of people with ASPD. A group and individual program is used. Some clinical interventions are exampled in the paper.