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Borderline Personality Disorder & Murder. Over the years, we have observed a noticeable percentage of defendants in murder cases having BPD or traits.

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Presentation on theme: "Borderline Personality Disorder & Murder. Over the years, we have observed a noticeable percentage of defendants in murder cases having BPD or traits."— Presentation transcript:

1 Borderline Personality Disorder & Murder

2 Over the years, we have observed a noticeable percentage of defendants in murder cases having BPD or traits. Began to Wonder, What are we seeing? Why have we seen BPD/Traits as Often as we Have? What is the connection between BPD and Murder? In such Cases, BPD can help us understand the Murder and is informative in reference to several forensic questions.

3 Workshop Objectives: Review BPD Characteristics and Describe the Connection with Emotions that Motivate Murder Identify and Describe the Type of Murder Most Often Associated with Individuals with BPD Discuss the Relevance of this Topic to Forensic Clinicians and Attorneys Demonstrate the Connection between BPD Characteristics and Murder and How it Can Help Explain the Psychological Factors that Contributed to the Homicidal Behavior in Sentencing Evaluations

4 (1) Frantic efforts to avoid real or imagined abandonment. (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) Impulsivity in at least two areas that are potentially self- damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating). (5) Recurrent suicidal behavior, gestures, or threats, or self- mutilating behavior. DSM-IV-TR CRITERIA A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts, as indicated by five (or more) of the following: DSM-IV-TR (2000)

5 (6) Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, 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. DSM-IV-TR CRITERA (CONT) DSM-IV-TR (2000)

6 Why do People Kill? Though we may like to think that murderers are either pathological misfits or hardened criminals…the vast majority of murders are committed by people who, until the day they kill, seem perfectly normal. David Buss (2005)

7 Emotions often Motivate Murder Jealousy Fear Hate Anger/ Rage Rejection Depression/Hopelessness Embarrassment (Self-Image) Combination of Emotions

8 DSM-IV-TR Cluster B Personality Disorders Referred to as the dramatic or erratic disorders Borderline Narcissistic Antisocial Histrionic Such disorders are best explained as disorders of emotion dysregulation, anger, stress reactivity and aggression. So….. DSM-IV-TR (2000)

9 If BPD is best explained theoretically as a disorder of emotion dysregulation, anger, stress reactivity and aggression… Then perhaps these individuals are more prone to have difficulty controlling/regulating... the emotions that often motivate murder.

10 Degree of Stimulation Environmental Situational Impulsive Catathymic Compulsive External (Sociogenic Factors) Internal (Psychogenic Factors)

11 Catathymic Murder – Emotional/Psychic Tension Builds resulting in Murderous Act Acute and chronic forms. Chronic Catathymic Murder has been conceptualized as being related to violent disorders of attachment (Meloy, 1992) Three Stages: Incubation period marked by a mix of anxiety and depression intertwined with homicidal-suicidal thoughts A sudden explosive homicidal act Psychic and emotional relief Is there a certain type of murder associated with BPD?

12 1 st Stage - Murderer develops continual emotional tension after experiencing a perceived psychological insult that he is unable to discharge. 2 nd Stage - In an attempt to discharge the internal tension, the murderer projects blame for the tension onto the victim. 3 rd Stage – The murderer becomes extremely self-centered in thoughts/behavior. 4 th Stage - Idea develops that the only manner in which to resolve the intense internal tension is suicide or murder. 5 th Stage – Extended period of ambivalence about whether to act on this idea, ending with an attempted or completed murder. 6 th Stage – Instantly after the violence, the internal tension is released with the murderer experiencing an intense feeling of relief without insight as to why. 7 th Stage – Murderer appears to return to normal functioning absent the emotional tension. 8 th Stage – Over time, the murderer develops a more stable cognitive and emotional state, accompanied by increased insight.

13 Linehan (1993) Conceptualizes individuals with BPD as those who experience severe dysregulation in multiple areas of their lives: Emotional Dysregulation Dysregulation in Interpersonal Relationships Behavioral Dysregulation Cognitive Dysregulation Dysregulation of the Sense of Self

14 What is the relevance of BPD and Murder to the Forensic Clinician? Examining a Defendant for BPD/Traits If Present, MAY help explain the murder from a psychological perspective. Ultimately, this is what society wants to know – WHY?

15 What is the relevance of BPD and Murder to the Forensic Clinician? Assessment of Criminal Responsibility Plea Bargaining Charge Bargaining Sentence Bargaining Sentencing Evaluations

16 Defense of These Cases May be Difficult Insanity Defense - might apply depending on specifics and jurisdiction Pleas of insanity usually rejected in such cases based on (Schlesinger, 2007): Psychosis not straightforward Jury does not entirely understand the relevance of dissociative symptoms Jury often associates the obsessive thoughts concerning the victim with premeditation CRIMINAL RESPONSIBILITY

17 As Meloy (1992) suggests, however, it is important for the forensic clinician to determine if the offender was experiencing psychosis at the time of the catathymic murder. As a borderline patient decompensates, there is a potential for psychotic symptoms to emerge. CRIMINAL RESPONSIBILITY

18 David Goldberger, Ohio State University Law Professor, states: The jury and judge must be made to understand what caused a crime, particularly in homicides…It is the role of psychiatry and related professions to provide that understanding so a rational approach to a penalty can be taken. Bonnie (1979): The law seeks to make the difficult moral distinction between a person who has chosen evil and the person whose homicidal behavior arose from significant impairment in his normal psychological controls. (Melton et al., 2007, p. 297) James Podgers (1980) The Psychiatrists Role in Death Sentence Debated in American Bar Association Journal December, 1980, Volume 66 SENTENCING EVALUATIONS

19 Role of MHPs in Sentencing Evaluations Explain the way in which the offender differs from stereotypical views the court might have about individuals convicted of certain offenses. Assist the judge or jury in understanding the psychological underpinnings that contributed to an offenders inability to control his behavior. SENTENCING EVALUATIONS (Melton et al., 2007)

20 Mitigating Factors Borderline Personality Disorder led to mental impairment which negatively affected the defendants capacity for judgment when the offense was committed As a result of his or her BPD, the defendant was under extreme mental or emotional distress The emotional and cognitive dysfunction characteristic of BPD caused the defendant to be substantially unable to appreciate the wrongfulness of his act or conform his act to the requirements of the law SENTENCING EVALUATIONS Melton et al. (2007)

21 Assessment of Culpability Situational Factors that contributed to the commission of the offense BPD – not really free choice Educate Judge or Jury about the Defendants Life in General, and about BPD in particular SENTENCING EVALUATIONS Melton et al. (2007)

22 Borderline Characteristics Dysfunction in Interpersonal Relationships Fear of Abandonment Dysfunction of Emotion Difficulty Regulating Anger Lack of Control Over-control Cognitive Dysfunction Behavioral Dysfunction Dysfunction of Sense of Self What characteristics of BPD can help explain the murder to the judge and jury in sentencing evaluations?

23 Unstable, chaotic, intense relationships characterized by SPLITTING Splitting Dividing the world into all good or all bad Alternating between these two views as applied to their partner As a result, alternating between clinging and distancing behaviors Trust Issues Sensitivity to Criticism/Rejection Feeling like Needing Someone Else to Survive Significant Difficulty Ending Relationships Intolerance of Being Alone Fear of Abandonment Resort to Extreme and Frenzied Behaviors in Attempt to Hold Onto the Relationship Exacerbated when involved in unstable, negative relationships Distorted Perceptions of Relationships (DSM-IV-TR, 2000; Millon, 1987; Linehan, 1993; Zanarini et al., 1989)

24 Unstable, chaotic relationships involving splitting We were always on again, off again. She had this way about her. She could be fabulous – the best person in the world you would want to be with. Then, there would be times she would be an absolute bitch. But I just loved her so much, you know?

25 Fear of Abandonment I felt that, somehow, Id be left behind or abandoned. We were latchkey kids. We took care of ourselves. Both of our parents worked most of the time. Wed get ourselves off to school, since first or second grade. We came home at three; I had a key. My parents came home after six.

26 Emotionally vulnerable Pervasive difficulties regulating negative emotions Extreme sensitivity to negative emotional situations Emotionally intense Slow return to baseline emotionality Low anxiety tolerance Shifts in Mood Lasting Only a Few Hours Anger, Inappropriate, Intense, Uncontrollable Subgroup of over-controlled hostility Emotional Responses are Highly Reactive Episodic Depression, Anxiety, Irritability (DSM-IV-TR, 2000; Millon, 1987; Linehan, 1993; Zanarini et al., 1989)

27 Over-controlled Anger/Hostility I know I didnt express anger. It wasnt like they told me not to, I just held my opinions in. I was afraid to say something to them, but I dont remember them doing anything to actually incite that fear. I just didnt want to rock the boat.

28 Odd thinking/unusual perceptual experiences Cognitive distortions/ dysfunctional thinking Arbitrary inferences, over-generalizations, exaggeration of the meaning or significance of events, attribution of blame to oneself, attribution of blame to others, catastrophizing, hopeless and pessimistic predictions Polarized/dichotomous thinking (Splitting) – either/or rigid and contradictory points of view they are unable to synthesize (Foundation of DBT) Transient stress related paranoid ideation or severe dissociative symptoms Tends to be short lived and non-psychotic, can be quasi-psychotic Depersonalization, dissociation, delusions Occurs in times of severe stress Feeling out of it Not being able to remember what you said or did (DSM-IV-TR, 2000; Millon, 1987; Linehan, 1993; Zanarini et al., 1989)

29 Dissociation When asked if she had pulled the trigger, she responded, I dont know. I cant understand why I did it. I was so afraid. I had never been paranoid like that. A witness stated, As I began to realize what had happened, I asked her Do you realize what you did? Youre going to jail. She wasnt looking at me. She was looking through me. She was not responding. After she did that, I dont think she understood the act that she had just committed, or what she did. She thought we were just going to go to the hotel for the reception.

30 Dissociation I dont remember anything after the initial confrontation. The next morning, I woke up in the jail cell and remembered thinking, this is not real.

31 Dissociation Im in the back, leaning against the door. I just see him (the pastor), nothing else in the Church. He looked so small, so far away, like two inches high. She then goes on to describe a feeling like there was no one else in the Church and that she didnt see anyone, including the victim. I walked to the back, then I walked down the side. Then all of a sudden, he was just sitting there. When I was walking down the aisle, I didnt know he was there. I didnt see anybody. It was like all of a sudden, he was just sitting there. I dont know what happened.

32 Paranoid Thoughts I got so scared. I was there alone. I thought he was going to come in at nighttime and do something to me. He has a martial arts background. I went and got my Beretta. I slept with my gun, but I didnt fall asleep. Saturday, I was a mess. I sat in my bedroom with my gun in my hand. I was so scared. I didnt sleep well Saturday night. I still had the gun with me.

33 Poor Impulse Control Impulsive Behaviors that are Radical and Create Severe Problems for the Individual (e.g., spending, sex, substance abuse, shoplifting, reckless driving, binge eating, etc.) Recurrent Suicidal Threats, Gestures, or Behavior Self-Injurious/ Self-Mutilating Behaviors Self-Destructive Behaviors (DSM-IV-TR, 2000; Millon, 1987; Linehan, 1993; Zanarini et al., 1989)

34 Impulsive, Self-Destructive, & Suicidal Behavior The results of psychological testing are also consistent with Mr. Smiths history of self-damaging and self-demeaning impulsive behaviors, particularly his alcohol abuse. Also consistent with the diagnosis of Borderline Personality Disorder are the findings reflecting Mr. Smiths suicidality, chronic feelings of emptiness, inappropriate, intense anger and severe dissociative symptoms.

35 Impulsive, Self-Destructive, & Suicidal Behavior James Smiths medical records are consistent with his self-report in documenting his dramatically deteriorating functioning over the months prior to the instant offense. During this period of decline, he was actively suicidal and was psychiatrically hospitalized on multiple occasions.

36 Impulsive, Self-Destructive, & Suicidal Behavior I had pills all over my car and I was going to take them. I was going to kill myself. No one was going to find me this time. I had wanted to die last November, and then in March and then again in July.

37 Feeling of having no sense of self Difficulty with boundaries between self and other Self-invalidation – tendency to invalidate or fail to recognize ones own emotional responses, thoughts, beliefs, and behaviors. Unrealistically high expectations and standards for oneself. Intense shame and self-hate. Identity disturbance/ Identity diffusion. Persistent and markedly disturbed, distorted, or unstable self-image or sense of self (e.g., feeling like one does not exist or embodies evil) Chronic feelings of emptiness Feelings of isolation, alienation, out of contact, or not fitting in at all (DSM-IV-TR, 2000; Millon, 1987; Linehan, 1993; Zanarini et al., 1989)

38 Dependency After dinner, he says to me, Im not happy. Im not in love. Im resentful. Im stifled. I cant live here anymore. If I had to, Id kill myself. He said he wanted to get an apartment and to date. He got up and walked away. I lost it. I was hysterical. I felt as if someone had taken a saw and cut me right in half. I couldnt stop crying. I went into the babys room and took some pills and went to sleep. I just wanted to die. I felt, how could someone hate me so much when all I did was try to help him? I never felt so bad in all my life. I had known this man for 23 years. I had never felt such pain. I felt useless. There was nothing left. He took everything away.

39 Distorted Self-Concept Regarding the development of her sense of identity and self-esteem, Mrs. Jones is rather immature and quite insecure. She would react with anxiety and undue emotionality to even minor threats to her sense of security. She requires frequent reaffirmation of her unique and special status. Her sense of self is based largely upon imagined rather than real experiences and interactions with others so that parts of her self-concept are likely distorted. These distortions about herself further weaken her ability to form realistic judgments and make effective decisions.

40 Begins with a perceived rejection, threat to the ego, psychological insult Internal psychic/emotional tension builds Offender attempts to relieve the tension by projecting blame for it onto the victim Fears imminent threat of being attacked, assaulted, threatened by victim; feels controlled by victim Idea develops that only suicide, murder, or both can relieve this tension Violent act takes place, resulting in release of tension Sensitive to rejection, trust issues, fear of abandonment Difficulty regulating emotions Commonly engage in projection and splitting as defense mechanisms Experience cognitive dysfunction in form of paranoid ideations, delusions, and dissociation Severe cognitive dysfunction sets the stage for poor decisions resulting in impulsive and self destructive behaviors Borderline individual often unable to reconcile/understand their impulsive behaviors, yet feel a sense of calm after engaging in such behaviors CATATHYMIC MURDERBORDERLINE PERSONALITY

41 There is an important connection between BPD traits and Murder. In such Cases, BPD can help us understand and explain the Murder Understanding the connection between BPD and murder is informative in reference to several forensic questions. Particularly important in Sentencing Evaluations SUMMARY & CONCLUSIONS:

42 Borderline Personality Disorder & Murder ? ? ? QUESTIONS ? ? ?

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