[indiajade]

I have come here to seek help for a dear friend of mine (actually, an ex-boyfriend) who I believe has ASPD. He has not been formally diagnosed with any disorder, mainly due to him not seeking professional help; however, based on his symptoms, I firmly believe he has this. I would like to attempt to steer him in the right direction, although I have read about the difficulties in finding professional help that would be appropriate, and at least be able to present him with options if he did in fact want help (chances are he may be using this "I am willing to get help" scheme to keep me in his life to continue using me at his disposal, but hey, I figure why not play the game with the chance he may actually get some effective treatment). Does ANYONE know of any particular specialists that may actually benefit him (vs making it worse) or treatment centers in the US that have positive results?

By the way, hi guys! Interesting place here.....dark, but definitely interesting (by the way, I am somewhat of a "Clarise" type from Silence of the Lambs.....intrigued by the dark side, and always trying to shed light where I'm able). I also now believe my father had this condition even though it was never diagnosed before his suicide several years back, which may explain my history of unhealthy relationships with dark types, my drive to solve rubix cubes (complicated individuals), my desire to fix everything (by the way, I am an occupational therapist for a living), and my ability to build connections with people deemed "difficult to work with".

[shay78]

Perhaps someone can name treatment centers and/or particular specialists that could be considered, I can't and am not aware of any. I don't know how usual it would be that the therapy would, in fact, make things worse but there's a possibility that it'll offer little or no help either. Much depends on your friend, of course.

As I see it, your friend should be the one to take the first step and go see a professional to be diagnosed. Hopefully because he wants to take it, not because someone (you, the society, or the court) asks him to. The best guess is that most people with AsPD don't want to take that step. If your friend would go to see a professional and would be diagnosed, he just might lie to just get it over with -perhaps even getting a false diagnosis.

Medications rarely do any good and there is no certain AsPD drug to use (of course, some meds might be used/tried for example to make it easier for him to deal with aggression or to stabilize his moods) but medication usually is not affective.
Therapy may or may not help. If your friend wants to receive help, he might find some benefit. Maybe. Hospitalization is rare, and even if it was a possibility, I doubt if it'd do much good either. My guess would be that most hospitalized AsPD's are in programs because of getting in trouble with the law. Self-help groups designed for people with AsPD might be helpfull, but I don't know how common groups like that are. And yes: again we come down to the question if you friend wants to try to make changes or not.

If your friend has AsPD, you'll be lucky if he accepts or wants help and/or is honest about it.
Like you wrote,
"may be using this "I am willing to get help" scheme to keep me in his life to continue using me at his disposal, but hey, I figure why not play the game with the chance he may actually get some effective treatment)"
Well. Playing games with someone who has AsPD might not end up the way you hope, and there's a fair chance that he won't even get effective treatment in the process of playing. I don't think therapy'll do much good if it's all about lies, games and not wanting to receive help in the end of the day.
AsPD just might be the rubix cube that you can't solve.

[indiajade]

Shay78:

First, I want to thank you for taking the time to read and respond to my question! I was starting to think it was a ghost town in here You made some very good points regarding my inquiry, and believe me, I have thought about many of these issues you describe and have maneuvered carefully while still trying to find answers and clear a visible pathway for my friend.

I agree 100% with the following statement:

As I see it, your friend should be the one to take the first step and go see a professional to be diagnosed. Hopefully because he wants to take it, not because someone (you, the society, or the court) asks him to. The best guess is that most people with AsPD don't want to take that step. If your friend would go to see a professional and would be diagnosed, he just might lie to just get it over with -perhaps even getting a false diagnosis.

As a therapist myself (for those of you unfamiliar with what an occupational therapist is, our main focus is facilitating increased function for people with mental/physical impairments in order to perform daily activities performed prior to injury/disease), I am VERY aware that one of the single most important factors for progress in therapy is the internal motivation and desire to get better. Without this, even people with an excellent prognosis (from a medical standpoint) tend make little to no progress as compared to their internally motivated counterparts.

Because of this, I have been careful on my approach, although I was very vague on my original post when I made the following statement:

(although he may be using this "I am willing to get help" scheme to keep me in his life to continue using me at his disposal, but hey, I figure why not play the game with the chance he may actually get some effective treatment)

As I explained, he is a dear friend of mine (also ex-boyfriend); however, I didn’t mention that after our separation, I moved to a town 6.5 hours away from him for a different job. I remain in touch with him via calls/texts, but our physical contact with each other is far and few between. He has made the comments that he knew something was not right with him and that he needs/wants help, but the reason I worded my above statement the way I did is because I am still unsure of his sincerity due to his lack of action thus far. I have never given ultimatums such as “If you don’t get help, I will stop talking to you/being in your corner” or “If you want to keep me in your life you will.....”, nor do I allow him to literally “use me at his disposal” in hopes of it motivating him to seek help to prevent losing this access. He does make comments that losing me in his life is a huge fear for him, and although I don’t say it out loud to him in hopes that it will spark some intrinsic motivation to be more accountable for his actions, the truth is I am here for him unconditionally and will always be in his corner, regardless of how far away I physically am from him......I am this way with most of people I consider as friends.

What I consider “games” in the original post are strategies I have used with him in order to promote this intrinsic motivation. I call them games, because in a sense they are. When interacting with people I consider “wolves” (people with a strong manipulative nature), I first try to figure out what “game” (in his case, it is a mix between chess and command and conquer) they are playing so we are on even playing grounds and to prevent victory (when one wins a game, they tend to seek the next opponent). In my opinion, knowing this much is half the battle of effective interactions with people who have a “darker” nature. My friend moves very fast in life, taking little time to stop and reflect on his actions, their consequences, and the effects it may have on others around him, so the strategies I have used were ones to slow him down and to promote self-reflection.

I posted my original post in response to a recent visit with my friend. I got a call from another friend who was worried about him because his roommate kicked him out after an altercation, so I planned a visit in order to physically assess his mental state (it fluctuates depending on the amount of stress in his life) because if I call, he tends to tell me he is okay whether he really is or not. Prior to this visit, I always thought he had bipolar disorder and that he was in a manic state ~95% of the time (his depressive states appeared to be infrequent and short lived). However, I began researching some things online because it accounts for most of his behaviors, but there has always seemed to be a missing link with this explanation. The one thing he told me that has always stuck out in my mind is that when he was 16 years old, he was asked to testify in a trial, and I clearly remember him bragging about how he didn’t know how he did it, but he passed a lie detector test at some point during the process (I was aware that this is rare unless you have been trained, although I had remembered sociopaths were able to do this often times). In my research, I found literature about ASPD, and it seemed to explain some of the missing links. I am not exactly sure this is the problem since my expertise is limited (only a qualified psychologist or psychiatrist could make this determination in my opinion); however, this makes more sense than my previous assumption.

When I did have a chance to speak with him, I used the following strategies to present this information to him:

- I assessed his mental state of mind to ensure immediate safety of him and potentially for myself (I am fully aware of his dangerous side if confronted the wrong way, and over the last couple years of having known him, I’ve learned ways of treading carefully.....if he is too far in the fog, I stay away until it clears, because it is not safe)

- I presented him with literature to read; however, it was not the clinical perspective of ASPD (in my research, I found a touching article written from the perspective of a person with the condition). Here is the article I found:

Think about it: you know something isn't right, but you can't tell other people, because you have not the slightest idea how to phrase what's wrong. Plus, for some odd reason, everyone keeps getting rubbed the wrong way by you.

You try to get ahead in life, but everybody keeps telling you about these strange rules you're supposed to obey, that they all seem to know by heart, but you don't. So you study them and try to memorize them and use them by rote, but keep messing up because you have no mechanism to tell you (from within) that you're stumbling over the line again, and inevitably, you do. Then everyone gets mad at you and among other things tells you that you know perfectly well what the rules are, so why don't you obey them? You start to secretly suspect they're adding new ones or changing the old rules around just to get you to screw up, but actually that isn't true -- however, you have no real way of knowing that, either.

As if all this isn't enough, you feel at the very least uncomfortable, and at the worst like a human bomb, most of the time you're awake, which at times can be several days in a row.

You notice that the very things that make other people happy have a very opposite effect on you: your head fills with jarring "static," like a radio playing with the tuner caught between two or more stations. Reacting instinctively to this, you try to push people away because their closeness causes the static to get worse, but then you discover a new problem: you seem to need them anyway.

You seem to need something from other people, but you don't know why. That hug each other and smile, not a phony smile but a real one, and their eyes light up. They get close and they talk to each other without having to closely study the other's eyes to try to figure out what to do in response.

This seems to be a delicious pleasure to them, much better than anything you've ever experienced. But if you try it, and if you are actually lucky enough to persuade one of them to attempt such a relationship and interaction with you, it immediately starts to turn sour on you. Their touch does not warm you; you feel colder and deader than ever. You don't know how to give back, so you end up grasping for words you've heard used by other people and trying to fake your way through it so they won't figure out how you are; you've experienced enough to know by this time that when others figure out your difference, they hate you for it; in fact, you've been told you're "not a real person" and that you "have no soul" (you're not too sure what a soul is, anyway) and that people like you "ought to be lined up and shot"!

After trying several times in this new relationship to get the pleasure other people are always basking in, and failing, you start to get angry at all of this -- and the anger builds into a terrible, towering rage that begins to make you feel like a human bomb. "I will actually, physically explode if I don't..." you're thinking, and yet under the rage there is a weird, disconsolate feeling that even your burgeoning hatred is as hollow and empty and starved as you are.

You consider taking your life, and certainly you think about taking lives of some of these lucky, smugly superior others. You settle for embezzling money, or something of the sort; you're clever and manipulative and you don't get caught. Triumph!

Or not. The things you buy please you for five minutes; a day, tops. Then...flat, meaningless, like everything else in your life.

Of course, you don't HAVE a life -- and you never will. That's starting to become increasingly clear to you by this time.

But WHY???? You see "The Others," as you're starting to think of them, studying diligently to help and even to cure other kinds of weird things wrong with people's minds, most of which seem to have to do with the brain. But no one seems to know what's going on in you. It occurs to you that to get some kind of attention from them, you might pretend you have one of those other problems they study, and then once they're paying attention to you, maybe somehow it'll lead somewhere. What have you got to lose?

You're about to find out you can still lose more.

You go into a clinical situation presenting with carefully-memorized symptoms of the mental illness you have decided would get you the attention you want. But faking whatever it is turns out very quickly to be a lot more complex than you'd thought. In fact, it turns out to be impossible. And, branded a malingerer, you are rejected yet again, told that all that's really wrong with you is that you don't want to try to better yourself.

That, and you're "evil," and it's not paranoia on your part to realize that EVERYONE HATES YOU. Once they figure you out. Yes: to know you is to hate you.

And you will go to your grave (as gloats Martha Stout of "The Sociopath Next Door" book fame) never knowing the wonders of real human interaction, meaning, and warmth.

It might just make you decide to go off the rails and kill everyone you can before turning the weapon on yourself.

Except for one thing: the mere fact that some scientists know that much about the brain of a sociopath means that solving the problem is no longer an impossible and obscure wish -- it's moving within the realm of concrete possibility.

As soon as large numbers of sociopaths begin to be treated in a way that actually helps them, that corrects as much as possible the chaos of misdirected signals in their confused and disorganized brains, and then a form of therapy that in addition to that, by necessity, teaches them to cope with the resulting maelstrom of emotion and impression that was formerly impossible, so that they can put it in order and start to develop the heretofore dormant and silent segments of their brains and better use those formerly mixed-up areas where no recognizable order ruled, THEN THE OTHERS MAY BEGIN TO NOTICE WHAT IS GOING ON...and they will know at least this much: instead of "the kiss of death," a diagnosis of ASPD (the DSM-IV way of saying sociopathy or psychopathy) will lead someplace; that there will be things done that actually make a difference.

Crippled as they are neurologically, sociopaths are yet shrewd, and they're always looking out for themselves in a way similar to that of a loner predator.

Seeing others like them actually benefiting from treatment will have to start persuading them that there's something to gain in going for help after all. Not being rejected or met with "We can't help you; you're evil incarnate," or the equivalent thinly disguised in euphemistic psychology jargon; NOT being met with a situation where they'd have to substitute symptoms of an "acceptable" illness in place of those they bear in secret -- that would almost certainly, if gradually, have an effect: if a sociopath can clearly see a benefit coming from admitting his or her real situation, there's nothing to stop him or her from doing just that.

It's already started to happen, if in a tiny, barely perceptible trickle.

Right now, all science has at the ready for them is to use various types of preexisting medication given in attempts to counteract the chaotic way the brain of a sociopath functions.

That and types of talk therapy carefully altered to avoid the pitfalls that have in the past caused regular therapies to make sociopaths worse instead of better.

But the more that scientists such as Robert Hare and his colleagues delve into and experiment with the new types of brain scans and learning what makes sociopaths tick like human bombs, the more likely that it becomes with each passing year that a means will soon be isolated to defuse those bombs.

The primary source of a sociopath's infamous rage is frustration, of a sort so alien and so extreme that almost no one else can understand what it means. Once they start getting taken seriously, that frustration, and the wild rage it provokes, will lessen, and since it is a primary source of the constant distrust that makes regular therapy fail sociopaths, the defusing of that rage and its maddening causes will be a huge step in the right direction.

And that will benefit everyone.

Just thought I'd add, to the people (besides me) who have spoken about BEING a sociopath, here and there in WikiAnswers:

First off, be sure the clinician who diagnosed you isn't mistaking you for a sociopath from prejudice or ignorance; not all people with advanced degrees in psychology have genuinely earned them! (Some psychologists are sociopaths themselves!)

Secondly, if it turns out you really are a sociopath after all, lots of people will tell you they cannot treat you because you can't be helped.

That's simply not true. They just don't have the guts, to put it bluntly. So, forget the wimps and find someone who will treat you.

It took me more than ten years. But I did.

SabrinaSingularity

Although I have witnessed this man cry on occasion, I know him well enough to know that it is only during a very extreme situations where, for a brief moment, he has breakthroughs where he reflects upon himself and sees how dark the dark side really is at times. The man cried in public (we were having breakfast @ a restaraunt) while reading this material beginning with the statement “you have no soul” (during our relationship we had a bad fight one day, and I said this to him out of nowhere and he has never forgot it since....still brings it up now and then) and was unable to stop reading until he got to the end (most papers would have been pushed to the side after he nonchalantly scanned it/pretended to read it). I didn’t discuss much more after this, I really just wanted to give him the perspective that he is not alone and give him something he may finally be able to identify with. He did, however, bring it up again before I went back home (I was hoping to spark this!) and had a calm and productive conversation with me......kind of his own personal evaluation based on his recent self-reflection. He also layed out a plan of action, one that involved him taking steps necessary to creating a better life for himself.

My only part of this I am concerned about is him being able to find the “right kind” of help since this is a very difficult disorder due to the lack of understanding about it (which is why I feel like I may be able to assist with this part along with providing my own personal ”call me if you need to talk” support). I am having trouble finding resources that are helpful, hence, why I have come here to see if people with more experience or those who have this condition have had any luck at all. I did run across some interesting information about ASPD that provides explanation on the physiological aspect of the disorder (this was on the same webpage that I gave to my friend):

It's true that traditional therapy makes sociopaths (psychopaths, people with Antisocial Personality Disorder) WORSE.

But specialized therapy, combined with either meds or even neurosurgery once it becomes possible, CAN.

Studies (see the masterful work "Without Conscience" by Robert D. Hare, PhD.) have now conclusively demonstrated that the way emotional information is stored in the brain of a sociopath is not at all like the way it is for others.

Instead of things being organized into those specific regions in one or other of the brain's two hemispheres depending upon the type of information it is, the sociopath has a brain that operates a little bit like a computer hard drive: it breaks all data down into tiny fragments and stores it all over the place and in both hemispheres. Thus, to retrieve any given segment is formidable and leads to omissions and errors far more often than most people experience:

(Patient in an inpatient unit, to an NP who is organizing an outing.) "No, I'm not going out with you guys this time, and I'm going to buy some magazines when I'm there." HUH???? This kind of thing, as Hare demonstrates, happens all the time.

Clinicians give numerous (including some erroneous) reasons for not wanting to treat sociopaths, and one of the more surprising ones is that it's very difficult at times to make sense of what the patient is saying.

Unlike the jumbled mess of a schizophrenic's speech, the sociopath's speech makes sense within the fragments, but when these parts of speech are strung together, they are often jarringly incompatible.

Did the sociopath in the inpatient hospital intend to go out and buy some magazines? Or did she decide to stay in? She seemed to think she could do both at the same time. If the NP who had asked her was astute enough, she might've said, "Miss Smith, if you don't want to go out, why don't you write down what you want us to pick up and give us the money to buy it?" Although that's a realistic way to do both things at the same time, one might wonder why the patient didn't just say so in the first place!

Well, we know that when you speak, your brain is going through a staggering feat of juggling and data-organization at a speed that makes broadband look like a snail trail. If your cerebral cortex is storing your vocabulary and the related ideas behind it, as well as all of the other numerous types of information it must handle, in the right places, this isn't so hard; if your brain has to fumble all over the place for tiny fragments of data and try to assemble it fast enough to keep up with your conversation, it is not going to be easy -- and trained professionals will know that something, at least, is awry.

So, now scientists know that the seemingly meaningless and frequent lies that the sociopath tells may not all be actual lies. Some are lies, particularly in sociopaths who have broken the law and are trying to charm or bully their way out of trouble. But some -- especially impulsive-sounding bragging or announcements of lofty intent ("I'm gonna get out of this bugbox and write a best-selling novel, climb Mount Everest, and go work for NASA!") -- are not intended to deceive others so much as to tell them "I want to do something with my life!" But, sadly, lacking the means and wherewithal to do this, the sociopath will undoubtedly end up in trouble all over again.

This portion of the article was helpful for me to understand ASPD better, and also indicates that although there are few treatment methods that are known to work, it is possible for new discoveries to be made and/or current practices that do help.

I am also ready for the possibility that you are correct when you say:

AsPD just might be the rubix cube you can’t solve.

I know that not all rubix cubes can be solved, and I mentally prepare myself for that, but at the same time, I thrive on the challenge it presents me with while I am trying to solve them. I look at it this way: sometimes its not about actually solving the rubix cube, but more about the journey you took when you attempted it.

　
　

　
　
　

Originally Posted by indiajade

As a therapist myself

You sounded like a therapist. With that in mind, I refer you to Understanding and Treating the Psychopath by Dennis M. Doren.

(although he may be using this "I am willing to get help" scheme to keep me in his life to continue using me at his disposal, but hey, I figure why not play the game with the chance he may actually get some effective treatment)

If you like being in his life, then what's the trouble anyway?

What I consider “games” in the original post are strategies I have used with him in order to promote this intrinsic motivation.

I don't know a lot about your particular antisocial, his likes, dislikes, and so forth. But a few psychopaths I know and I have willingly entered into therapy simply out of curiosity and the chance to talk about ourselves. If he's interested in himself (which, if he's a psychopath or antisocial, he more than likely is), you could probably work that angle.

- I presented him with literature to read; however, it was not the clinical perspective of ASPD (in my research, I found a touching article written from the perspective of a person with the condition). Here is the article I found:

You notice that the very things that make other people happy have a very opposite effect on you: your head fills with jarring "static," like a radio playing with the tuner caught between two or more stations. Reacting instinctively to this, you try to push people away because their closeness causes the static to get worse, but then you discover a new problem: you seem to need them anyway.

What a wonderful analogy. I've never heard it described that way.

(Patient in an inpatient unit, to an NP who is organizing an outing.) "No, I'm not going out with you guys this time, and I'm going to buy some magazines when I'm there." HUH???? This kind of thing, as Hare demonstrates, happens all the time.

Wait until you see four or five of us try to have a conversation, haha.

Where did you find this article?

I don't know of any psychologists or psychiatrists who specialize solely in ASPD or psychopathy off hand. But I, personally, have had therapists who were very helpful simply by discussing things with me and providing an environment where I felt I could let my guard down and talk openly about myself. But, as mentioned before, the patient has to be able to trust the therapist at least enough to not be manipulative, which is why it's important to emphasize to the patient that it's beneficial to him.

[indiajade]

Thank you Michael for all your suggestions and I will definitely check that book out! Here is the link to that article I found:

http://wiki.answers.com/Q/Is_it_a_fa...ped_by_therapy

[indiajade]

If you like being in his life, then what's the trouble anyway?

I missed this part of the question (or subconsciously ignored it, who knows )! My gut reaction is to tell you how concerned I am for this man’s well-being and how I want to see him have less trouble in life (he has difficulty holding down a job, place to live, and has run-in’s with the law time to time), which don’t get me wrong, I do! But, to be completely honest, there seems to be more to it than just that.

He reminds me ALOT of how my dad was (except my dad’s behaviors were much more self-controlled compared to my friend’s chaotic nature) in terms of charm and manipulation skills. My dad never got any real diagnosis before committing suicide several years back (except of course depression, which was only a piece of the puzzle in my opinion), but after stumbling upon this forum, I’m starting to see many ASPD traits in him (I initially thought bipolar with him as well).

I guess I would have to say that deep down, I am also looking for answers for myself, and the more I learn about ASPD in terms of symptoms, research, possible causes, possible treatments, ect, the more I am able to form connections about the relationship between my dad and I, possible genetic influences, and the effects it has on me now (I have and experience strong emotions when it comes to relationships with others; only problem is they scare the F**K out of me, because there is no logic, rhyme, or reason behind them......they just pop up out of the blue and tap me on the shoulder when I least expect them!). So instead of embracing them like “normal” people do and enjoying them like many, I reason my way out of them, bury them, lock them in closets and hide the keys, or whatever is necessary to restore order in my life. OR, my recent discovery looking back on life, I find emotionally unavailable/limited individuals to connect with; which is not as scary because their needs are low (ask any “normal” man who has encountered me and attempted to pin me down and they would describe me as: “flitty”, “wishy-washy”, “hot and cold”, ect). In addition to the emotional aspect of relationships, I become intrigued when there are games involved, and the more skilled a person is at games, the more appealing they become (my end goal: to win of course!).

However, as fun and frightening as all the above may be, it is not the way I want my life to continue forever. I do want to have meaningful relationships in my life, one’s that are not superficial in nature and that do not involve “one up” games. I want answers to certain questions, and I want to find a path that will fill the voids I currently have in my life. Additionally, this area of psychology (various personality disorders) is very intriguing to me, and I would like to learn more in order to possibly expand my career into waters that are still, to some degree, uncharted.

[indiajade]

Ok, apparently I can't edit my post?! I missed the last part when I copy/pasted it:

(And yes, Michael, I’m sure your regretting asking this by now because I tend to over-answer just about everything; most people would have just responded with the simple first paragraph and left it at that; but thats how I operate if you haven’t noticed by now......if my answer is short and sweet like the previous post, I am avoiding the question in most circumstances!)