David Chirko A.B.
Sudbury, Canada
Treating AsPD in Group Therapy
The Manuals: Terminology
Antisocial personality disorder, AsPD, is a cluster B (dramatic) personality disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision–DSM–5-TR (American Psychiatric Association, 2022). The monikers psychopathy and sociopathy were previously dropped in DSM-III (American Psychiatric Association, 1980). DSM-IV states, AsPD “…has…been referred to as psychopathy, [and] sociopathy….” (p. 645, American Psychiatric Association, 1994). The APA Dictionary of Psychology, Second Edition, defines both psychopath (p. 861) and sociopath (p. 1004), thusly: “…former name for an individual with antisocial personality disorder” (Gary R. VandenBos, 2015). Below those definitions psychopathy is defined as a synonym for AsPD, but sociopathy, a former name for AsPD. Various clinicians herein employ one of those three terms, or utilize them interchangeably, while some use them all differently. Unlike four or five features needed for diagnosing other personality disorders, AsPD requires only three, from DSM–5-TR criteria: “1. Failure to conform to laws and social norms…. 2. Deceitfulness…. 3. Impulsivity or failure to plan ahead. 4. Irritability and aggressiveness…. 5. Reckless disregard for safety of self or others. 6. Consistent irresponsibility…. 7. Lack of remorse….” (p. 748).
The Psychodynamic Diagnostic Manual (PDM Task Force, 2006) explains adult psychopaths (sociopaths being the adolescent version) are not observably socially conflicted, like AsPD patients; have a large threshold for emotional stimulation; manipulate; experience envy and rage; believe they can do anything; think others are dishonest, manipulative, and selfish; and strive for omnipotent control. Subtypes are the aggressive and the passive/parasitic kinds.
Tatiana M. Matlasz (UNM Dept of Psychiatry, 2022) asserts psychopathy is not a diagnosis, but an extreme, violent form of AsPD. Conduct disorder and/or oppositional defiant disorder, with limited pro-social emotions as a specifier present before 15 years, is found in psychopathy, later designated at 18 years.
Further, she says, AsPD diagnoses are excessively inclusive, heterogeneous, misdiagnosed, stigmatized, and overlap copiously with other disorders. Fundamental to psychopathy are interpersonal and affective traits, exuding callousness, grandiosity, irresponsibility, lack of empathy, manipulation, risk taking, shallow affect, and superficial charm. AsPD involves behavioral criteria (since DSM-III), not embodying totally the features, but entailing criminality. Criminals, behaving through expediency, may not have AsPD or psychopathy, but respond adaptively to the environment, underplaying the prelisted traits.
Psychopathy, Sociopathy: Differences
Unmentioned by Matlasz is sociopathy, which is more erratic and impulsive than psychopathy. Sociopaths may find keeping a stable family and vocation challenging, unlike psychopaths. However, sociopaths do not find it difficult to ratify attachments with those mentally similar to them, unlike psychopaths, who find attachments a testy issue (Calendar-Canada.ca, n.d.).
Martha Stout (2005), transcended sociopathy’scharacteristics propounded in DSM-IV (American Psychiatric Association, 1994), whose criteria was critiqued by W. John Livesley (1995). Stout declaring many, like Robert D. Hare (1996) architect of, now called, The Hare Psychopathy Checklist Revised (PCL-R), second edition, 2003 (see APA PsycNet, 2025),found DSM-IV focused on criminality exorbitantly. Hare and others thus concentrated on sociopaths as a group, pointing to the sham, loquacious, seductive charm in their personalities. Sociopaths are also more spontaneously intense than regular people. They may exhibit a grandiosity, regarding their worth (from dearth of insight), that is risible. Also witnessed, pathological mendacity; conning friends they behave ghoulish towards; and regard as possessions, whom they have no feeling for. William Adams (2024) says sociopaths are prone to emotive displays, or being detached emotionally, whereas psychopaths are more relaxed in their countenance, exhibiting more superficial pizzazz, with a deliberateness in manipulating relationships. Denise Winn (1980) states psychopaths cannot learn from past experience, feeling no anxiety over anything they do.
The aforementioned characterological facets meld largely with American Psychiatric Association DSM-5-TR’s AsPD criteria, especially number A7; encapsulating–for group, as antisocial personalities exhibit no empathy–a personality profile devoid of guilt and shame because AsPD, psychopathy, and sociopathy are intrinsically conscienceless entities.
Causes
Winn (1980)avers psychopathic etiology entails parents who are behaviorally volatile, therefore do not rear offspring to differentiate wrong from right. Also, emotional isolation stemming from early separation from the mother is evident. She admits conventional therapy may be futile because it is not feasible to ratify a superego in someone without such to begin with. Nevertheless, she adds, “It has been noted…people often ‘grow out’ of psychopathy as they get older….” (p. 231), mirroring alterations in the brain’s electrical functioning. Thus, early brain abnormality may be connected to causation. Adams (2024) asserts psychopathy has a stronger genetic component, while sociopathy evolves from the environment intertwined with genetics.
Group Treatment of AsPD
Adams (2025) claims group therapy purveys rich insights for those with AsPD. Their interactions with peers enhance learning of new social skills and perspicuity on how their behavior affects others. Although they resist treatment, being deficient emotionally, progress and being responsible are stimulated in group through cognitive behavioral therapy, dialectical behavior therapy, plus chemotherapy for relevant symptoms.
Exercising compassionate responses, by ascertaining minute facets of the AsPD character, are important on a social level to amply support them. Ultimately, having one’s rehabilitation personalized, in favor of being amerced for offending, assists in treating AsPD individuals.
Thomas Percy Rees and Max M. Glatt (1956) encourage psychopathic mental hospital patients to be part of at least one group, wherein members share a commonality. Cultural, recreational, social, and friend oriented, they “…seem to take to one another….” (p. 26), as they cultivate a loyalty because they all resent authority. Rees and Glatt allude to Samuel Richard Slavson (1947), who was incredulous as to the psychopaths’ appropriateness for group therapy. They believe there is no viable treatment; advocating programs entailing bodily exercises, group discussions, and occupational therapy. Helen E. Durkin (1956) thought psychopathic mothers of disturbed children could benefit from group therapy directed at them, but were not beneficial to the group, so they could be disruptive to the advancement of group. Regarding delinquents, Irving Schulman (1956) refers to Charles Gersten (1951), who evaluated male delinquents in institutional group therapy, which augmented scholastic, intellectual functioning, and emotional maturity. Schulman also mentions James J. Thorpe and Bernard Smith (1952), who ascertained institutional adjustment improvement in male delinquents, via testing and acceptance operations phases centered on therapists, later, group.
Hare, quoting page 110 of his 1970 book, avers, “[With] few exceptions… traditional…psychotherapy, including…group therapy…proved ineffective in the treatment of psychopathy….” (Hare, 1993, p. 193). Further, “Psychopaths don’t feel they have…problems, and…see no reason to change their behavior to conform to societal standards…which they do not agree” (p. 195). Moreover, they possess potent defense mechanisms, which extinguish fear and anxiety, thereby precluding them from responding to danger signals. Thus, foolishness and intrepidness cannot be differentiated. They see themselves as felicitous, entitled, and bereft of any fragility. Hare also remarks that group therapy programs help psychopaths to exploit the naivete of their families, court system, or parole board, leading everyone to believe they have changed. Group therapy, in prison, can worsen them, making them more violent upon release. They plunder the vulnerability of others, by mentally manipulating the leader and members. Psychopaths dominate group therapy, introducing discussion(s) they want, wherein they can rationalize their insincere behavior via excuses for criminal actions, concurrently halting communication with members—whom they deem insignificant. Nevertheless, it is incarceration where experimental programs can work, using tighter controls. Hare’s Psychopathy Checklist was ultimately employed to measure group amelioration. He says, forgo cultivating conscience and empathy in psychopaths, but evince them of why and how their current behaviors and attitudes are not propitious, thus making them more responsible, pleasing their desires in a more socially acceptable manner. Fortuitously, psychopaths improve as they age.
Recent Developments with Group
Bryan Leopold (2025) states that, regardless of the hurdles treating those with AsPD, group therapy can be special and auspicious. It features an essential structure where AsPD patients can convene with others confronting similar challenges, assisting them in a customized, dynamic, expeditious, interactive, and stick-to-itive fashion. Thus, enabling them to face their thinking and behavior in a demanding, but nonjudgmental, community setting. Members then comprehend the nature of their disorder, where cultivation of empathy, peer support mechanisms, and social skills are maintained.
Therapists’ Mentalization With AsPD/Drug Patients
Mentalization, or reflective functioning, is the adeptness in comprehending the mental states of oneself and other people, thus understanding the emotions and intentions in oneself and others, like attachment to parent shortcomings earlier in life. With mentalization-based treatment (MBT) this could be moderated, decreasing unpleasant affects and impulses, which ameliorates functioning at an interpersonal level, molding a healthier personality. Reflexivity is how the researcher ponders the premises behind a study, particularly how their own history, motives and slants affect how said study was undertaken (VandenBos, 2015).
In a Norwegian auto ethnographical study, five researchers, Katharina TE Morken, et al (2021), studied a cultural group they belong to with their own subjective experience, where mentalization-based therapy or treatment was applied to those with anti-social personality disorder (MBTASPD). They concede it is arduous to treat and has a paucity of empirical evidence regarding efficacy. Thematically, therapists experienced four trends:
First, when better acquainted with AsPD clients and how they meshed with contemporaries in group, therapists were hampered by less unpleasant preconceptions, emboldening them with a more limpid, incisive stature.
Second, therapists discovered that facilitation of an all-encompassing methodology in MBTASPD was achieved via being non-judgmental, ratifying boundaries, and purveying concise expectations for group patients.
Third, countertransference and varying psychological states therapists undergo require scrutiny.
Fourth, therapists must remember MBTASPD groups can be impetuous, mimicking jocose encounters. Therapists can be left titillated, and jaded.
They showed openness regarding the processes to be analyzed, employing reflexivity when confronting potential glitches therein, as entertained by a qualitative methodology. Collaboration amongst researchers may reduce the necessary complexity of essential data. They found, “…a need for process studies and qualitative investigations on how patients experience mechanisms of change in MBT groups….”
AsPD: Disorder of Mentalization
Anthony W. Bateman (2021) found that mentalizing in a system grounded in values which emboldens we-ness–a team with an identity–in group, more protected and controlled than a patient’s regular social gatherings, is essential for transformation and education.
Authority figures and group leaders are challenged or embraced, and the group will be affected by intricate and hardly detectable influences impeding interrelations. Confronting these challenges and culturally contributing to the integrity of group are important in assisting patients to experience their own agency. One acknowledges their subjectivity socially, solidifying mentalization. Violence becomes a less favored vehicle of communication when we-ness is achieved.
Conclusions
Psychopathy and sociopathy mostly share DSM-5-TR antisocial personality disorder descriptive criteria, particularly category number A7, being remorseless. Their conscienceless, unempathetic participation in group amounts to indifference, adversely affecting overall dynamics.
Psychopathy is socially less observable than AsPD (PDM Task Force, 2006). Psychopaths have strong defense mechanisms, vanquishing apparent anxiety (Hare, 1993). Attachment, emotive, environmental, genetic, and social differences between sociopathy and psychopathy were delineated (Calendar-Canada.ca, n.d.; Adams, 2024).
Matlasz claims miscreants exist who are not psychopaths or antisocials; their lawless attitudes an adaptation process to successfully commit crime. AsPD involves behavioral descriptors, and psychopathy, affective and interpersonal aspects (UNM Dept of Psychiatry, 2022). DSM-IV overplayed the significance of criminality in sociopathy (Stout, 2005; Hare, 1996).
The Hare Psychopathy Checklist became the benchmark for measuring AsPD (APA PsycNet, 2025).
Behaviorally inconsistent parenting and early maternal separation instigates the etiology behind sociopathy, which patients can outgrow (Winn, 1980; Hare, 1993). Psychopathic mothers of disturbed children benefit from groups, but do not improve it (Durkin, 1956). Group boosts delinquents’ intellectual performance (Gersten, 1951).
Some clinicians are skeptical of efficacy treating psychopaths in group (Winn, 1980; Rees & Glatt, 1956; Slavson, 1947; Hare, 1993). AsPD patients can be deleterious to group, which they dominate and manipulate with haughty, wreckless actions. Pleasing acceptable desires over conscience cultivation was recommended (Hare, 1993). Community atmosphere in groups helps AsPD patients adapt (Leopold, 2025). Psychopaths should share commonality in cultural, recreational hospital groups, anticipating collective loyalty from their disrelishing of authority (Rees & Glatt, 1956). Psychopharmacology for some symptoms, as a therapeutic complement, were advanced (Adams, 2025).
Mentalization and reflexivity assists in comprehending AsPD emotions and intentions in group (VandenBos, 2015). Mentalization-based treatment is encouraging, for group leaders and members, achieving “we-ness”—a team with identity. Scrutinized countertransference is achievable (Morken, et al, 2021; Bateman, 2021).
References
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