Diagnosis+and+Treatment

= = =Diagnosis= toc To diagnose ASPD, a person must exhibit symptoms of ASPD before the age of 15, but must be over 18 to diagnose. A doctor will submit the patient to a variety of tests which may include:  score possible. Psychopaths are known for not feeling anxiety or depression since they are without conscience. This always needs to be taken into consideration. (Cherry, 2012)
 * **Interview-** this method will either help or hurt the relationship with the client. If he or she is sincere in reaching a therapeutic goal, then interview therapy will be a good choice. However, if this method is met with lies, irrational aggresiveness, and/or apathy, therapy will not help.
 * ** Rorshach- ** This test is the classic inkblot test. The subject is asked to identify anything they may see in a particular inkblot card. Dr. Niolon describes the results to this test as " Low to average number of responses, sometimes reject cards, more Pure C (from their impulsiveness), as well as more Animal content and FM than M. You may also see more Popular responses, given their social perceptiveness, and few if any shading, since they don't feel much anxiety or depression" (Niolon, 2000).
 * **MMPI-2 (Minnesota Multiphasic Personality Inventory Revised Version)-** First developed in the 1930's, clinicians revised the questions in this survey-type test to rid it of sexist and racist connotations. The client must be 18 years of age or older to take the test, and by studying the answers to the questions given, the clinician assigns a number value based on the personality type of the client. The numbers and according types are as follows: *Asterisks mark the typical readings on this test for clients with ASPD. However, some of those with ASPD will 'play along' with whatever they may see fit to acquire the best
 * 1) Hyperchondriasis
 * 2) Depression
 * 3) Hysteria
 * 4) Psychopathic deviate*
 * 5) Masculinity/Femininity*
 * 6) Paranoia*
 * 7) Psychasthenia (Anxiety)*
 * 8) Schizophrenia
 * 9) <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 13.33px;">Hypomania*
 * 10) <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 13.33px;">(0) Social Introversion
 * <span style="color: #000000; font-family: Arial,Helvetica,sans-serif; font-size: 13.33px;"> *Asterisks mark the typical readings on this test for clients with ASPD. However, some of those with ASPD will 'play along' with whatever they may see fit to acquire the best
 * **<span style="font-family: Arial,Helvetica,sans-serif; font-size: 13.33px;">TAT (Thematic Apperception Test)- **<span style="font-family: Arial,Helvetica,sans-serif; font-size: 13.33px;">This particular test, developed in 1935, is used to monitor a person's pattern of thought, their observational threshold, attitude towards hypothetical self-constructed situations, and emotional responses towards 'ambiguous test materials.' This test is quite simple: the client is given a set of images all including people. With these images in hand, the client is then asked to tell a story that includes the situation on the card, the preceding events, emotions hypothetically felt by these people, and what the situation at hand is explaining. There are two particular ways to interpret the answers given by the client: nomothetic and idiographic. Nomothetic establishes norms of the typical person based on gender, ethnicity, race, etc. while idiographic focuses on the particular person and their interactions and relations with another human being (Encyclopedia, 2012).<span style="font-family: Arial,Helvetica,sans-serif; font-size: 13.33px;"> Clients with ASPD will usually weave stories that include a hero, punishment, and an antagonist (Niolon, 2000).

Dr. Robert Hare created a checklist and Dr. Theodore Millon constructed 10 overlapping subjects used to diagnose ASPD. The subject must exhibit three or more of these particular traits in order to be diagnosed with ASPD.

Table 1: Functional (F) and Structural (S) Domains (Millon, 2006)

 * < <span style="font-family: Arial,Helvetica,sans-serif;">(F) **Expressively** **Impulsive** ||< <span style="font-family: Arial,Helvetica,sans-serif;">(e.g., is impetuous and irrepressible, acting hastily and spontaneously in a restless, spur-of-the-moment manner; is short-sighted, incautious and imprudent, failing to plan ahead or consider alternatives, no less heed consequences). ||
 * < (F) **Interpersonally** **Irresponsible** ||< (e.g., is untrustworthy and unreliable, failing to meet or intentionally negating personal obligations of a marital, parental, employment or financial nature; actively intrudes upon and violates the rights of others, as well as transgresses established social codes through deceitful or illegal behaviors). ||
 * < (F) **Deviant** **Cognitive Style** ||< (e.g., construes events and relationships in accord with socially unorthodox beliefs and morals; is disdainful of traditional ideals, fails to conform to social norms, and is contemptuous of conventional values). ||
 * < (S) **Autonomous** **Self-Image** ||< (e.g., construes events and relationships in accord with socially unorthodox beliefs and morals; is disdainful of traditional ideals, fails to conform to social norms, and is contemptuous of conventional values). ||
 * < (S) **Debased** **Object-Relations** ||< (e.g., internalized representations comprise degraded and corrupt relationships that spur revengeful attitudes and restive impulses which are driven to subvert established cultural ideals and mores, as well as to devalue personal sentiments and to sully, but intensely covet, the material attainments of society denied them). ||
 * < (F) **Acting-Out** **Regulatory Mechanism** ||< (e.g., inner tensions that might accrue by postponing the expression of offensive thoughts and malevolent actions are rarely constrained; socially repugnant impulses are not refashioned in sublimated forms, but are discharged directly in precipitous ways, usually without guilt or remorse). ||
 * < (S) **Unruly** **Morphologic Organization** ||< (e.g., inner morphologic structures to contain drive and impulse are noted by their paucity, as are efforts to curb refractory energies and attitudes, leading to easily transgressed controls, low thresholds for hostile or erotic discharge, few subliminatory channels, unfettered self-expression, and a marked intolerance of delay or frustration). ||
 * < (S) **Callous** **Mood-Temperament** ||< (e.g., is insensitive, irritable and aggressive, as expressed in a wide-ranging deficit in social charitableness, human compassion or personal remorse; exhibits a coarse incivility, as well as an offensive, if not reckless disregard for the safety of self or others). ||

=Treatment= Treatment is not always implemented when subject with ASPD are involved since many do not believe they have a problem. When treatment is used, interviews and face-to-face meetings with their mental health provider are best. There are medications to aid in suppressing impulsivity and aggressive behavior, but the underlying problems that created the disorder in the first place are untouchable. People with ASPD will decieve the mental health evaluator more than ask for help, so there is no widely known 'best' treatment for this disorder. The prognosis is generally bleak concerning those with the disorder.