Friday, April 19, 2013

Living on the Border

Amid explosions in Boston and West, Texas life skims along and somehow manages to go on. So too does the trial of Jody Arias. Even with hundreds of more important news items breaking instantly, a good portion of the country seems to be fascinated by this case and the violent death of Jody's ex-boyfriend Travis Alexander. It's hard to believe that CNN's sister station HLN devotes just about all their programing to the trial. It's got a following and ratings that most stations would be proud to own. There is something both intriguing and disturbing about that fact. If anything good comes from this obsession, perhaps it will be a better understanding of mental disorders and how dangerous and irresponsible it can be to engage in light-hearted diagnosis of people on trial for capital murder. Some weeks back I labeled Miss Arias a "good little psychopath." Flippant as that may sound, it was hardly my intention to be glib. That she is a pathological liar there can be no doubt. She freely admits to changing her story of the horrific death of her ex at least three times. The pathology is that it is extremely easy for her to lie. Probably easier than to tell the truth. Since most people tend to be trusting, the psychopathic liar easily compiles a long history of duping people. That they don't seem to feel any guilt or other emotions connected with morality only adds to the depth of the pathology. But Jody Arias is probably not a psychopath or sociopath. Most psychologists use the terms interchangeably. As the current witness for the prosecution has suggested, she displays traits consistent with Borderline Personality Disorder. BPD is a relatively new disorder and its definition and characteristics have been recently revised for the DSM V soon to be released. In case you are unfamiliar with the DSM, it is the Diagnostic and Statistical Manual (5th addition) used by most licensed mental health professionals.

 The latest set of descriptors includes the following: A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsively beginning by early adulthood and present in a variety of contexts, as indicated by five (5) or more of the following: 1. frantic efforts to avoid real or imagined abandonment. NOTE: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 2. a pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation 3. identity disturbance: markedly and persistently unstable self-image or sense of self 4. impulsively in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). NOTE: Do not include suicidal or self-mutilating behavior covered in Criterion 5. 5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior 6. affect instability due to a marked reactivity of mood (e.g., intense episodic dysphoria [unpleasant mood], irritability, or anxiety usually lasting a few hours and only rarely more than a few days) 7. chronic feelings of emptiness 8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights) 9. transient, stress-related paranoid ideation or severe dissociative symptoms [i.e., the affect does not match the emotional tone, etc.] Like any mental disorder, there are degrees or gradations of the illness.

 Best to think of these characteristics as a continuum. Certainly we know folks who have some of the traits without having the full-blown disorder. Often the symptoms are subtle, on occasion they explode fully developed and highly destructive. That's where the metaphor of a border comes in. In brief, the underpinnings involve self concept, a sense of abandonment, high-risk, impulsive behavior. Add t that mix the possibility of suicidal or other forms of self-destructive behavior and you have the basic profile. Occasionally a Borderline personality will exhibit extreme emotional states not unlike Bi-polar disorder. I recall an example from a case history book where a person diagnosed with BPD complemented a therapist after only a couple of sessions, as the best, most intelligent, most caring therapist he had ever known. A week later, in a rage, the words "worst" "useless" and cold-hearted" came from his raging mouth. When someone shoots and then slashes the throat of a former lover, concocts various stories ranging from an attack by Ninjas, to "I wasn't there," I guess it doesn't much matter what what you call it.

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