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NICE guidance published yesterday outlined how healthcare professionals can treat, manage and prevent antisocial personality disorder (ASPD).

Antisocial personality disorder is a condition that affects a person’s thoughts, emotions and behaviour in a way that is disruptive to, and may be harmful to, other people. People with ASPD exhibit traits of impulsivity, anger and associated behaviours including irresponsible, recklessness and deceitfulness. They have often grown up in fractured families in which parental conflict is typical and parenting is harsh and inconsistent. Many people with antisocial personality disorder have a criminal conviction and are imprisoned or die prematurely as a result of reckless behaviour.

Antisocial personality disorder is not usually diagnosed before the age of 18 but characteristics of the disorder can be recognised in younger people as conduct problems. Early treatment of children (aged 5–11 years) and young people (aged 12–17 years) with conduct problems may help to prevent antisocial personality disorder from developing later

Key recommendations from the guideline include:
• Staff working with people with antisocial personality disorder should recognise that a positive and rewarding approach is more likely to be successful than a punitive approach in engaging and retaining people in treatment.
• Cognitive problem-solving skills training should be considered for children aged 8 years and older with conduct problems.
• For people with antisocial personality disorder with a history of offending behaviour who are in community and institutional care, consider offering group-based cognitive and behavioural interventions (for example,
programmes such as ‘reasoning and rehabilitation’) focused on reducing offending and other antisocial behaviour.

Dr Stephen Pilling, Joint Director, National Collaborating Centre for Mental Health said: “Antisocial personality disorder is a common condition effecting 2 million people in the UK with devastating effects on the person with the condition, their families and the wider community. Despite this ASPD is not being properly addressed within the healthcare system and many people do not realise that it is preventable. There is evidence to show that working with children who are at risk of developing conduct disorder and their families could prevent them from developing ASPD as adults. It is important that we make these investments early on to realise the benefits to these families and society in the future.”

Professor Conor Duggan, Professor of Forensic Mental Health, University of Nottingham, and GDG Chair said “People with antisocial personality disorder can show traits of irresponsibility, recklessness and deceitfulness, which often leads to this group being treated very negatively and overlooked within the healthcare system and wider society. Many people with antisocial personality disorder have a criminal conviction and are imprisoned. There is often too much focus on what the person has done wrong rather than why. The prevalence of ASPD in prisoners is 50%. The cost of keeping a young offender in institutes can be up to £192k per annum per individual. Because 70% of all prisoners released reoffend within 2 years, there are potentially huge savings to be made by investing in behavioural and psychological therapies to prevent people with ASPD from reoffending thereby benefiting the person and society as a whole.

We are not excusing people with ASPD for their bad behaviour but we need to focus on the cause so that we can prevent it from happening in the future. Through this guideline we want to break down these preconceptions and encourage healthcare professionals to focus on helping people with ASPD in a positive and progressive environment.”

Carol Rooney, Deputy Director of Nursing, St Andrew’s Healthcare and GDG member said: “People who have a diagnosis of Antisocial Personality Disorder have historically been at great risk of being marginalised by healthcare services. My perspective as a nurse contributing to this guideline was focussing on ways in which the experience of care for these individuals can be improved, and on how those providing services could be better trained and supported in working with these individuals. I hope this guideline will promote a wider awareness of the needs of these individuals, both in prevention and in treatment; and that training in
understanding and helping individuals with a diagnosis of ASPD can be developed, from pre-registration to ongoing professional development.”

For more information call the NICE press office on 0845 003 7782 and (out of hours) 07775 583 813.

Notes to Editors

1. The guidance is available at www.nice.org.uk/CG77

About NICE

2. The National Institute for Health and Clinical Excellence (NICE) is the independent organisation responsible for providing national guidance on the promotion of good health and the prevention and treatment of ill health.

3. NICE produces guidance in three areas of health:
• public health – guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies – guidance on the use of new and existing medicines, treatments and procedures within the NHS
• clinical practice – guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS