Treating Profound Shame States in Men With Antisocial Personality Disorder (ASPD) With Mentalisation-Based Treatment (MBT): A Case Illustration.

Shame is a fundamental human affect that plays a central role in social regulation and psychopathology. In some individuals with antisocial personality disorder (ASPD), chronic and pathological shame-shaped by early experiences of abuse, neglect, and attachment disruption-may contribute to difficulties in affect regulation, mentalization, and interpersonal functioning, and is frequently implicated in violent and antisocial behavior. The authors describe a long-term, psychodynamically informed mentalization-based treatment (MBT) group for men with ASPD. The paper focuses on shame as a clinically organizing affect, examining how unmentalized experiences of shame and humiliation may precipitate transient collapses in mentalization, paranoia, and violent acting out. Drawing on detailed clinical material, the authors consider the developmental origins of pathological shame in early attachment relationships and explore the technical challenges of working therapeutically with profound shame states in a group context. It is proposed that addressing both individual and collective experiences of shame within a stable therapeutic group can foster a sense of safety, support the restoration of mentalizing capacity, and reduce vulnerability to violent behavior. The paper aims to extend existing mentalization-based formulations of ASPD by foregrounding shame as a central affective process within long-term group treatment.