relatively high. The prevalence rate in outpatient psy-
chiatric settings is about 1%. The lower prevalence rate
in psychiatric settings may be due to the culturally
adaptive characteristics associated with the symptoms
of the disorder.NNaarrcciissssiissttiicc PPeerrssoonnaalliittyy DDiissoorrddeerr
Individuals with narcissistic personality disorder
(NPD) have a grandiose view of their own unique-
ness or worth, a preoccupation with being admired, a
preoccupation with fantasies of success, and a lack
of empathy for others. They often present as con-
ceited and boastful, they are self-centered, they have
a sense of entitlement, and they have a tendency to
try to dominate conversations with others. They,
therefore, frequently alienate others, and their lack
of empathy makes the creation and maintenance of
meaningful relationships difficult. Although they are
sensitive to criticism, they present as arrogant and
superior as a way of protecting themselves. They are
often envious of others or believe that others are
envious of them. When their expectations of others
are not met, they are likely to react with rage, avoid-
ing shame or dysphoria. Like individuals with bor-
derline personality, those with NPD are likely to
vacillate between idealizing and devaluing others,
depending on how the other person makes them feel
about themselves. Recent epidemiological studies
indicate that the prevalence rate of NPD in the gen-
eral population is less than 1% and that prevalence in
outpatient psychiatric populations is about 2%.
Some studies suggest that it may be more frequently
observed in men than in women.AAnnttiissoocciiaall PPeerrssoonnaalliittyy DDiissoorrddeerr
Individuals with antisocial personality disorder
(ASPD) consistently violate and show disregard for
the law or the rights of others. They control or manip-
ulate others without remorse or shame. This pattern of
deceit and manipulation begins in childhood or early
adolescence and is reflected in at least three of the fol-
lowing DSM-IVdiagnostic criteria: failure to conform
to social norms as indicated by unlawful behaviors;
deceitfulness; impulsivity, aggressiveness, and irri-
tability; reckless disregard for the safety of self or oth-
ers; irresponsibility in work or financial matters; and
lack of remorse. Furthermore, a prerequisite for the
diagnosis is the presence of conduct disorder prior to
age 15. Thus, for a diagnosis of ASPD, not only shouldthere be antisocial behavior, but this pattern of behav-
iors should have begun in childhood. Historically, the
diagnosis was synonymous with psychopathy, but this
term has come to have a specific meaning (see below).
Behaviorally, antisocial individuals may be described
as aggressive and controlling, and interpersonally, they
manipulate others through deceit or coercion. Antiso-
cial individuals are likely to take risks, break laws, and
seek excitement and sensation. They fail to plan ahead,
as evidenced by impulsive and reckless behaviors.
They seldom take responsibility for their behaviors,
and they are motivated by their own selfish needs.
They lack the responsibility and feelings for others that
are required to maintain meaningful long-term rela-
tionships and are likely to be occupationally and finan-
cially irresponsible. They may be cunning, glib, and
socially skilled, thereby hiding their selfish motives
from others. They are likely to be easily bored and
have a low tolerance for frustration or depression, act-
ing out aggressively in response to negative emotions.
Once they have acted out aggressively, they are unlikely
to experience remorse for any harm to others. Any
overt expression of shame or remorse is likely to be
shallow, transient, or insincere. Antisocial individuals
are unlikely to seek mental health treatment indepen-
dently, instead presenting for treatment when coerced
by others, especially legal authorities. Epidemiological
research suggests that prevalence rates in the general
population is about 1% to 4% and prevalence in outpa-
tient psychiatric settings between 3% and 4%. The
prevalence is thought to be three times higher in men
than in women and much higher among young adults
than older adults. Diagnosis is also more common
among people of low socioeconomic status. It has been
estimated that about 75% of convicted felons meet the
diagnostic criteria for ASPD. ASPD is comorbid with
a number of other diagnoses, especially substance abuse.PPssyycchhooppaatthhyy
Although psychopathy is not included in the DSM-
IV, it is a widely accepted and clearly defined personal-
ity disorder supported by a growing body of empirical
research. Despite a significant overlap in the diagnostic
criteria for antisocial personality disorder, psychopathy
remains a distinct disorder. Whereas the diagnosis of
antisocial personality disorder focuses primarily on
overt behaviors, psychopathy also includes affective
and interpersonal deficits. Although the majority of
psychopaths would meet the diagnostic criteria for anti-
social personality disorder, only a minority of antisocial556 ———Personality DisordersP-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 556