Personality disorders involve personality traits that differ markedly from societal norms, often emerging in childhood. Antisocial personality disorder involves disregard for others, aggression, deceitfulness, impulsivity, irritability, recklessness and lack of remorse. It is defined in the DSM-IV and ICD-10 and commonly diagnosed more in males. Those with ASPD are at risk for substance abuse, depression and other disorders. Genetics play a role and biological relatives of those with ASPD are also at higher risk. Treatment involves psychotherapy and medication management to increase self-awareness and move towards a healthier perspective.

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