Category Archives: Personality Disorder

Antisocial Personality

Criminal Minds (2005-2010)

Hands-down the most disturbing of personality disorders is Antisocial Personality Disorder (ASPD). Many mainstream TV dramas base the content of their shows on people with ASPD – Criminal Minds, Bones, Law and Order, The CSI Series, and the list goes on….

In psychiatry, the meaning of antisocial is not the same as the layman’s term used often to describe the shy and sort of awkwardly charming introvert who embarrasses easily. Think Micheal Cera in Superbad or Juno, or any of his other roles. Instead, antisocial refers to people who are sociopaths or psychopaths. They lack a moral compass and have utter disregard for social norms. These people are entitled, deceitful, and remorseless of any type of wrongdoing. They lie, con, and cheat – not the type of person you’d want to meet on Match.com! Their inability, or refusal, to abide by rules and laws may give rise to criminal behavior and consequently overcrowded prisons – more than 80% of inmates are ASPDs. Unlawful acts can vary widely from vandalism, petty theft, and identity fraud to arson, rape, and killing sprees. They can be an acquaintance, co-worker, or even a friend or relative. Not all ASPDs are violent criminals, but Ted Bundy, Jeffrey Dahmer, and Charles Manson  have been described as some of  the most notorious and infamous ones.

Currently in psychiatry, per our bible the DSM-IV, there isn’t a distinction between a sociopath and a psychopath (pending revision). Although they’re both diagnosed as ASPD, and occasionally used interchangeably,  some experts believe they are separate entities.  A key difference between a sociopath versus a psychopath seems to be related to the underlying cause of their behavior, which summons the nature versus nurture argument.  Sociopaths are thought to have been shaped by an invalidating and traumatic upbringing, whereas psychopaths are born emotionally and morally deficient. The latter is hard-wired differently from the get-go. Thus, fearlessness and stimulation-seeking are seen at an early age. Imaging studies have shown brain abnormalities implicated in emotional detachment and physiologic responses characteristic of psychopathic behavior.

ASPDs tend to possess superficial charm and allure, which serves them well in manipulating others for personal gain. Their bodies may be covered with ostentatious tattoos. This is, of course,  not an absolute sign of an ASPD; otherwise, I can’t imagine what it’d be like to be NBA Commish David Stern, given the growing prevalence of tattooed bodies in the league. Also of note, a juvenile history consisting of the triad of bedwetting, fire-setting, and animal cruelty seems to be a harbinger of violent criminal behavior.

Clinically, ASPDs don’t seek treatment for their symptoms per se as they don’t see anything wrong with their antisocial behavior. They typically present for psychiatric treatment in the context of prescription drug-seeking, substance abuse problems, malingering – feigning an illness to get something they want – and violent behavior. Unfortunately, there is no demonstrated effective mental health intervention for treating ASPD itself. Thus, the criminal justice system becomes their de facto treatment system. Somewhat reassuringly, it has been observed that antisocial behavior in ASPDs attenuates over time, particularly beginning in their late 30s.

Many TV watchers become enthralled by crime drama shows like an unsuspecting victim is drawn to an antisocial’s charm and deceit. Entertaining and seemingly preposterous as the shows may be, the reality is that people with antisocial personality disorder do exist and live amongst us. The next time you feel captivated by someone’s charisma, yet feel like you’re being manipulated, follow your gut instinct and change the channel.

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Filed under Personality Disorder, Television

Borderline Personality

Ryder and Jolie in Girl Interrupted (1999)

Hollywood is rich in mainstream movies with characters with Borderline Personality Disorder (BPD)- Winona Ryder in Girl Interrupted, Penelope Cruz in Vicky Cristina Barcelona, and Uma Thurman in My Super Ex-Girlfriend to name a few.  Even celebrities themselves have been associated with the disorder- Angelina Jolie, Megan Fox, Lyndsey Lohan, Amy Winehouse, and Christina Ricci to name several. I wouldn’t be surprised if the list of celebrity borderlines ran longer than that of their fictional counterparts.

So what is Borderline Personality Disorder?

Borderline originally earned its name in psychiatry from being thought to be on the “border” between psychosis and neurosis. In lay terms- almost but not entirely crazy (now refer to the aforementioned celebs to see if you get an aha reaction). The disorder is characterized by pervasive instability in mood, self-image, behavior, and interpersonal relationships. This typically means people suffering from BPD have chronic feelings of emptiness and low self-esteem, suicidal thoughts and gestures (cutting), anger issues, and even bisexual tendencies. Marsha Linehan, an expert on BPD, describes borderlines as “the psychological equivalent of third-degree-burn patients. They simply have, so to speak, no emotional skin. Even the slightest touch or movement can create immense suffering.”

Relationships tend to be very intense and unstable. I don’t watch much reality TV, but I’d bet network executives cast borderlines primarily to inject drama into their shows to boost ratings. Borderlines are capable of switching from deep affection and adoration to hostile rage and contempt quicker than you can say Britney Spears.  Breakups are especially difficult. Due to fear of abandonment, borderlines may threaten to hurt themselves if their partner wants to move on or date others.

The cause of BPD is unknown, but almost certainly there is a history of childhood trauma. This includes parental abandonment and neglect, poor communication and disruption in the family, and physical and sexual abuse. Clinically, BPD is often misdiagnosed as Bipolar Affective Disorder (BAD) because of the overlap in mood instability symptoms. The main difference is that borderline symptoms are triggered by interpersonal difficulties while bipolar symptoms are autonomous and independent of relationship stressors. Medications are far less effective for treatment of BPD than BAD.

The treatment of choice for BPD is Dialectical Behavioral Therapy (DBT). It’s a form of talk therapy that helps borderlines learn to manage intense emotions to minimize self-destructive, maladaptive behaviors and thus function better in relationships. The goal is to promote acceptance, yet encourage change, which is inherently contradictory and confusing.

For simplicity’s sake, let me use Bruce Banner and his emotional self-destructive alter ego, the Hulk, as a case in point to illustrate the theory behind DBT. In order for Bruce to have a functional relationship with any woman, he cannot transform into the Hulk. But the Hulk is an inseparable part of Bruce, which he can never truly get rid of.  Similarly, borderlines can never get rid of their childhood trauma. DBT will help Bruce learn to accept that he is the Hulk, while concurrently teaching him to harness his emotions so he will not become the Hulk.

BPD can be quite a severe and debilitating disorder. Relationships are particularly intense and unstable. In the entertainment world where steady relationships are already few and far between, an aging celebrity borderline probably stands a better chance of sustaining a career without needing cosmetic touch-up surgery than maintaining a lasting marriage.

Good luck Brangelina.

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Filed under Celebrities, Personality Disorder