2. Personality Disorder
 Whose personality differ markedly from the normal
population.
 Under endowed and socially misfit.
 Usually manifest since childhood or adolescence and
continuing throughout adulthood.
 Conduct disorder (persistent abnormalities of behavior
Frequently )

3. ASPD Clinical criteria
 Pervasive disregard for the violation of the right of others .
 Onset at 15 yrs age
 Evidence of conduct disorder ( repetitive serious violation of
rules , aggression aimed to people / or animals and
Deceitfulness )

4. Diagnostic features
 Failure to confirm social norms
 Dishonest , including lying and conning other for personal
profit or pleasure.
 Impulsivity or failure to plan ahead
 Irritability and aggressive including physical fights
 Recklessness and disregard for the safety of self and others
 Irresponsibility , indicated by the failure to honor financial
obligation
 Lack of remorse

5. Diagnostic features
 Associated features
 Promiscuity
Lack of empathy
Inflated and arrogant self appraisal
 abusiveness and irresponsibility towards children
 The APA Diagnostics and statistics manual of mental Disorder
, fourth edition (DSM-IV-TR), defines antisocial personality
disorder (in Axis II cluster B)
 Tenth edition (ICD-10), has a diagnosis called dissocial
personality disorder ( F60.2)

6. Complication
 Dysphoria
 Depressed mood
 Low tolerance for boredom
 tension
 Premature violent Death

7. Comorbidity
these patient are at risk for ……
 Impulsive control Disorder
 Major depression
 Substance abuse
 Pathological gambling
 Anxiety Disorder
 Somatization Disorder

8. Epidemiology
 Prevalence rates 3 % male and 1% for female in general
population
 According to ( DSM-IV-TR), commonly (3:1)
diagnosed in male.
 High frequency is associated with low socioeconomic
Status and urban setting

9. Differential Diagnosis
 Antisocial Personality can be distinguished from Bipolar
Disorder
 Narcissistic (rarely manifest serious criminal aggression
and deceit )
 Histrionic (which include seductiveness and attention
seeking )
 Borderline ( which include manipulativeness to gain
nurturance )
 Paranoid(which include suspiciousness)
 Adult antisocial behavior ( with no personality pathology in
back ground )

10. Familial pattern and genitics
 ASPD more frequent with first degree of biological
relatives
 Biological relative of female with ASPD are at more
risk compare to male relatives
 Genetics suggest substance use and somatization is
first two characteristic of male and only last in female .
 Both adopted and biological children are increased
risk of ASPD.

12. Clinical Criteria
 Pervasive
 Excessive self dramatization
 Excessive emotionally
 Attention seeking
 The APA Diagnostics and statistics manual of mental Disorder
, fourth edition (DSM-IV-TR), defines antisocial personality disorder
(in Axis II cluster B)
 Tenth edition (ICD-10), has a diagnosis called dissocial personality
disorder ( F60.4)

13. Diagnostic feature
 Inappropriate Sexual seductiveness or provocativeness.
 Excessive need to be at the centre of attention
 Rapidly shifting and shallow expression of emotion .
 Suggestibility
 Use of physical appearance for attention seeking purposes
 Impressionistic speech lacking details
 Self dramatization, theatricality, exaggerated
expression of emotions

14. Associated Features
 Difficulties in achieving emotional intimacy in
romantic or sexual relationship.
 Craving for excitement and stimulation.
 Promiscuity or complete sexual naivete
 low tolerance for delayed gratification.

15. Complication
 Frequent suicidal gesture and threats to coerce better
care giving
 Interpersonal relation are unstable
 Shallow and ungratifying
 Marital problems ( secondary to tendency to neglect
long term of relationship for the excitement of new
relationship)

16. Comorbidity
 Major depression
 Conversion disorder
 Somatization disorder
 Most common
 Narcissistic
 Border line
 Antisocial
 Dependent

17. Epidemiology
 The DSM-IV-TR report prevalence rates 2 - 3 %in the
general population
 10- 15 % in psychiatric inpatient and outpatient

18. Differential diagnosis
 ASPD ( which includes antisocial Behavior and crime
to gain profit , power . No excessive self
dramatization, no exaggerated emotional expression)
 Borderline ( which include unstable self concept
, chaotic behavior , self destructive gesture)
 Narcissistic ( which include fear of having hidden
imperfections and flaws revealed , sense of grandiosity
and specialness0

19. Familial pattern and genetics
 Genetic link connecting histrionic , antisocial
personality disorder and alcohol has been suggested

20. Spectrum disorder
1- Anti Social
2-Histrionic
3- Narcissistic
 Three disorder have been
shown to aggregate in the
same family and co-occur in
same person
 Some time reflect differential
expression of the same
liability
 Anti social behavior increase
in severity as one proceed
from histrionic via
narcissistic to antisocial

21. Assessment of Disorders
 Categorical
 MMPI (self report )
 PDQ-R (self report )
 SIDP- IV( interview )
 Dimensional
 Temperament and
character inventory
scale
Both self reports and interviews depends on the p/t accuracy honest and level of
insightfulness . Hence collection of data from collateral informant and expert rating
is usually is considered critical to ensuring high quality personality diagnosis

22. Clinical and psychometric issues
 Ego-syntonic(patient blame others for circumstances )
 Alloplastic ( try to change others )
 Social or clinical diagnosis?
 Categorical vs. dimensional approach
( categorical model is medical model which suggest disorder is
absent or present and individual is affected or not affected )
(dimensional models define a number of graded and continuous
behavior dimension and specify individual differences as
quantitative variation along these dimension )

23. Treatment
Self awareness and well being
 PD p/t do not recognized that they are ill and seldom
seek Help.
 In general p/t with PD require multi faceted Treatment
Plan that combine with psychotherapy &
Pharmacotherapy.
Stages of self awareness
 0- immature child like ego state
1-purposeful but egocentric
2-Aware of own subconscious , mindfulness
Effortless calm

24. Treatment
 Crisis management or stabilization
 Awakening of positive perspective
 Other centered awareness
 Integrated intelligence

25. Thank you