histrionic and antisocial personality

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 )

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 )

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

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)

Complication Dysphoria

Depressed mood

Low tolerance for boredom

tension

Premature violent Death

Comorbidity

these patient are at risk for ……

Impulsive control Disorder

Major depression

Substance abuse

Pathological gambling

Anxiety Disorder

Somatization Disorder

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

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 )

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.

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)

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

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.

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)

Comorbidity Major depression

Conversion disorder

Somatization disorder

Most common Narcissistic

Border line

Antisocial

Dependent

Epidemiology

The DSM-IV-TR report prevalence rates 2 - 3 %in the

general population

10- 15 % in psychiatric inpatient and outpatient

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

Familial pattern and genetics

Genetic link connecting histrionic , antisocial personality disorder and alcohol has been suggested

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

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

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 )

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 , mindfulnessEffortless calm

Treatment

Crisis management or stabilization

Awakening of positive perspective

Other centered awareness

Integrated intelligence

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