To the Editor: Several actions and recommendations made by Daniel Antonius, Ph.D., et al. (1) in their Clinical Case Conference, published in the March 2010 issue of the Journal, are laudable. Much of the case conference was focused on assessing and treating assaultive behavior in patients with antisocial personality disorder comorbid with an axis I major mental illness. The authors' assertion that "Mr. J" had a major mental illness, however, appears to be erroneous. They stated, "In the case of Mr. J, the presence of an axis I diagnosis of mental illness is relatively obvious (1, p. 255). This statement was confusing in light of the lack of substantiation for an axis I disorder in the clinical vignette. The symptoms Dr. Antonius et al. cited for an axis I disorder were self-injurious behavior, mood lability, "hopelessness about the future, and reported insomnia due to nightmares, which [the patient] attributed to a previously undisclosed sexual assault that occurred during a past incarceration" (1, p. 254). The patient was given the axis I diagnosis of mood disorder not otherwise specified in addition to antisocial personality disorder. However, DSM-IV-TR criteria for antisocial personality disorder include impulsivity, irritability, and disregard for the safety of self or others, which would explain the mood lability and self-injurious behavior (2). It is unclear why an additional diagnosis of mood disorder not otherwise specified was made.