Does Borderline Personality Disorder Overlap With Psychopathy?

Part Three...

I am so tired of this meta-analysis. It’s like they’re trying to be obnoxious with it. This is it though, guys. Last one. Next week will be a totally different post. It might be about anime, or it might be about human darkness. Cute or awful… decisions… decisions…

We have yet to look at the discussion and conclusion sections, and I bet they are just lovely, so here we go with it. Keep in mind, I just finished part two, it’s like midnight, and I don’t particularly want to give these people any more of my time, but I’m going to, so either embrace the snark, or don’t read. Your choice.

Discussion

In this review, we have synthesized the existing literature on the relationship between psychopathy and borderline personality disorder.

If you mean to say that you made a bunch of crap up but dressed it in language that made it sound impressive, then yes, sure you did. Well done.

The selected studies suggest an association between BPD and factor 2 of psychopathy whereas only the study by Khan, et al. [22] finds a significant correlation between BPD and factor 1 although to a lesser extent than for F2.

Did it though? Let’s see:

Participants

Using opportunity sampling, 187 students were recruited in classes and public areas across a large University in the North-West of England. Respondent age ranged from 16 to 54 years (M = 22.6 years, SD = 6.5 years) with the majority being female (64.2%). This student sample reflected the demographic profile of the University, being mostly White European with a minority of British Asians. Three research assistants distributed questionnaire booklets to students, who were approached randomly on campus

So in other words, no, you demonstrated nothing. You spoke to a bunch of people who do not have developed brains, including teenagers and not like nineteen, but sixteen, and think that you accomplished anything? Well, I suppose you did, wasting time. Your results are worthless. You cannot be looking at these things in people who do not have fully developed brains. In case you need a reminder, that would be twenty-five, not a mean of twenty-two and a half. Also, self assessment, so also garbage. People lie and lack insight.

These results agree with those observed in the previous literature, where studies such as those of Widiger [10], Miller, et al. [11] and Huchzermeier, et al. [12] establish a stronger association between BPD and F2 than between BPD and F1.

Hmm…. seems sus…

This study examines the relationship between DSM-cluster B personality disorders (PDs) and psychopaths according to Hare's criteria as detected by the Psychopathy Checklist (PCL:SV) in 299 violent offenders.

You are looking at the correlation between BPD and the factor two traits in criminals… I really feel like I have complained about this recently. Like very recently. I can’t imagine where… oh that’s right, parts one and two.

They explain this relationship through the fact that secondary psychopaths and BPD patients share symptoms such as impulsivity, emotional instability and reactive aggression [13]. This explanation found also agrees with the results of the study by Miller, et al. [11], who explains the association between BPD and F2 by an overlap of shared personality traits.

Did they seriously manage to shaft psychopathy, sociopathy, and BPD all in one paragraph? *rereads paragraph* Sure enough, they certainly did. BPD is not secondary psychopathy, which is sociopathy under a different title. Secondary psychopathy (sociopathy) has nothing to do with psychopathy, and neither of them have anything to do with BPD. They are about as related as puppies and skip loaders.

This association is also confirmed in genetic and neurobiological data with the results from the study by Hunt, et al. [20] and the study by Sarkar, et al. [17]. The first study observed that factors increasing F1 are protective of BPD symptoms and that those increasing F2 produce BPD symptoms and vice versa, due to a non-shared genetic and environmental overlap between F1 and BPD and a positive overlap between F2 and BPD. The second study showed how in BPD and in psychopathy similar structural and functional deficits are observed in frontal, temporal and limbic regions, which implies a series of neuropsychological alterations. However, it highlights the scarcity of experimental neurobiological and neuropsychological data that defend the superposition of traits. More information on this could influence both the concept and the treatment of both disorders.

Seriously, they need to stop calling it “psychopathy” when they have already stated that it is totally different. They make the distinction between ASPD and psychopathy, but then do everything in their power to erase that distinction. It’s irritating.

Also, criminals. Do I need to repeat the criminal part? They are studying criminals. They are antisocial by nature. It may or may not have anything to do with having BPD, but to know for certain, stop studying criminals. It’s a self-fulfilling prophecy.

Huchzermeier, et al. [12] and Murphy and Vess [28] results also associate F2 with Antisocial Personality Disorder. However, Murphy and Vess [30] indicated that the correlation between APD and F2 is weaker than the correlation between BPD and F2, according to Stanlenheim and Von Knorring [7], since BPD includes symptoms of emotional and interpersonal instability, observed in the psychopath, which does not occur in APD, limited to behavioral alterations.

What are you talking about? Hare himself says that factor two traits have to do with ASPD. You can’t possibly say that factor two has a weaker correlation with ASPD than it does with BPD, because it is literally what defines ASPD in most cases when dealing with the prison population. This is just an egotistical redefining of things, and as much as I dislike him, I think Hare would have a thing or two to say about your mishandling of his precious checklist.

Previous research suggests a higher comorbidity between psychopathy and BPD in women than in men [15]. Certain researchers argued that psychopathy represents a feminine phenotypic expression of personality disorder [16]. The influence of gender in the BPD-psychopathy association has shown little consistency in the results of this review. The articles showed a greater association between men with psychopathy and between women with BPD. However, only one study [21] showed a stronger relationship between the borderline traits and F2 in women, while another [13] showed a greater correlation between F1 and BPD symptoms in men. The rest of articles observed a strong association between psychopathy and BPD for both sexes.

Finally, a diamond in the rough, however small it may be. They managed to say, BPD and psychopathy are not the same thing, but then go on to say, but BPD and factor two traits have significant overlap. Again… criminals and prison. Seriously, you can’t be this dull. Also, stop saying, there isn’t an overlap between BPD and psychopathy, but then continue on to say “psychopathy” when you mean ASPD, or APD because you had to redefine yet another thing for reasons.

Oh my, wait till you see this next part:

Finally, only two articles studied a common treatment for psychopathy and BPD. Specifically, both studies have studied the efficacy of treatments applied to BPD, such as scheme therapy [29] or Dialectical Behavior Therapy (DBT) [28], in psychopathic patients, obtaining in both cases positive results.

The first one we have already discussed. It’s the one dude that decided, for whatever reason, to not reoffend if in fact, he didn't, and we are just taking their word on that. The second one though, it is so misleading. Look at this title:

Psychopathy scores reveal heterogeneity among patients with borderline personality disorder

That sounds official, right? We go into this hopeful of a good cohort and we get this:

The overall sampling frame for the MacArthur Violence Risk Assessment Study comprised psychiatric patients recruited from inpatient units in three cities (Pittsburgh, Pennsylvania; Kansas City, Missouri; and Worcester, Massachusetts). Participants were included if they were between the ages of 18 and 40 years, spoke English as a primary language, had been hospitalized for less than 21 days, and carried a medical chart diagnosis of schizophrenia, schizophreniform disorder, schizoaffective disorder, major depression, dysthymia, bipolar disorder, brief reactive psychosis, delusional disorder, alcohol or other drug abuse or dependence, or a personality disorder. A total of 1695 patients met the inclusion criteria and were recruited, 1136 (71%) of whom agreed to participate. Approximately half (57%) of the participants were male, and a majority were Caucasian (69%) or African American (29%), with ages ranging between 18and 40 years (M ¼ 30.00, SD ¼ 6.00). Participants were diagnostically heterogeneous and evaluated using the DSM-III-R checklist (J’anca &Helzer, 1990), with 40% diagnosed with a depressive disorder, 24% with a substance abuse/dependence disorder, 17% with schizophrenia, 13% with bipolar disorder, 4% with a psychotic disorder other than schizophrenia, and 2% with a personality disorder only. Most participants (71%) had at least one prior psychiatric hospitalization and 42% were hospitalized involuntarily at the time of study recruitment

So… everyone in the entire hospital system? Because that sounds like everyone. What on earth is anyone supposed to draw from such an overly inclusive sample? Where is the kitchen sink? That is what I would like to know. So we now know that this is a useless study, we will have to move on.

These common features between BPD and psychopathy are reminiscent of the heboidophrenia historical concept described by Kahlbaum [33]. This disorder affects mental and social behavior changing character and personality and includes antisocial behavior and criminal actions. For Kahlbaum, heboidofrenia is manifested in adolescents who do not follow the norms of coexistence behavior, that are characterized by their own limits search that derive from their own identity, which leads them to impulsive and risky behaviors.

No.

For a few reasons.

1. No kids. I thought I made that very clear. Stop messing with the kids.

2. No one knows what “heboidophrenia” is. I looked it up and the best I could come up with is a quote that reads, “By heboidophrenia, I mean a psychological disorder, which affects the young, and whose particular symptoms defy incorporation under other psychological disorders.
   
   So, back to the kids, and back to the, no.

3. I went to the study that they are citing, and it is insane:

Atascadero State Hospital (ASH) is a maximum-security forensic hospital that houses male patients with a wide range of psychiatric diagnoses. Psychopaths at this institution appear to be a heterogeneous group of individuals who, while sharing core personality characteristics, manifest substantial variability in their behavior. Identifying subtypes within this clinical classification can have implications for patient treatment and management, as well as for the safety of the staff who work with them and for the communities to which they will eventually return. Several means of identifying subtypes have been proposed in the literature, and potential subgroups have been identified. Clinical observations at ASH have suggested 4 possible subtypes of psychopathy: narcissistic, borderline, sadistic, and antisocial. Issues related to the conceptualization of psychopathy are addressed, recognizing that additional data are needed to understand the observed variations in cases of psychopathy.

Let me be very clear, if you think that there are four subtypes of psychopathy that are narcissistic, borderline, sadistic, and antisocial, you get no points. There are antisocial psychopaths, yes. There are antisocial everyones. That’s not weird or unusual. The rest, however? Those are ridiculous. I know how you came to this conclusion. I spent the last two weeks going through this nonsense meta-analysis that conflates psychopathy and ASPD so badly you would think it was a head on impact between two bullet trains at high speed, however, that doesn’t make you right, it makes you illogical. It also tells me that you have never spent a moment with a psychopath that netted any positive results. Not positive as in it made you feel good, but positive as in you were actually with a psychopath, able to pay attention, drop your biases, and gather good data without them messing with you. That has never happened, and I know that because of the ridiculous claims about the “four subtypes of psychopathy”.

According to the findings compilated in this review, an epidemiological and phenomenological relationship of BPD syndrome and the psychopathic syndrome can be confirmed. BPD features are highly represented in subjects with psychopathy as well as psychopathic traits are highly prevalent in patients with BPD. However, whether this relationship reflects real comorbidity or is the result of a nosological overlapping of the impulsive/unstable diagnostic criteria of BPD and the impulsive items of factor 2 of psychopathy cannot be resolved as yet.

Nope. Can’t. The only reason they are making this insane claim is because they keep redefining words to meet their goals. They have conclusively demonstrated that they will say whatever they have to, contradicting themselves repeatedly, to be able to arrive at a conclusion that has no merit. All they have managed to do is show that prisoners that have BPD also have a tendency to have ASPD, but considering that all prisoners have a tendency to have ASPD, that isn’t really saying much.

An interesting line of future research might address how psychopathic features, in a dimensional way, could affect the phenomenological presentation of the different BPD subjects, probably defining distinct clinical subtypes associated to different functional outcomes. This could improve our predictive capacities over the course and outcome of the patients and should provide further knowledge about specific treatment needs for BPD patients with increased psychopathic rates.

I have a suggestion for you researchers. Research why criminals are prone to be antisocial. That would get you closer to your goal. Perhaps they are antisocial because they are in prison, maybe they have had head injuries, maybe they had a bad childhood, maybe it’s drugs, who knows? What it isn’t, however, is that they are all psychopathic. ASPD and psychopathy are not the same thing, nor are they remotely close to one another. Some psychopaths are antisocial, and some people with BPD are antisocial. That doesn’t mean that the antisocial aspects come from remotely similar motivations. They don’t, and calling them “psychopathic” makes it look like critical thinking is outside your abilities.

Conclusions

This review suggests an overlap between borderline personality disorder and factor 2 of psychopathy, which refers to a series of impulsive behaviors such as a lack of planning and irresponsibility and antisocial behavior such as aggression and delinquency [5]. No relationship has been found between the BPD and factor 1, which refers to interpersonal and affective symptoms such as a lack of guilt and empathy, grandiosity, etc. [5].

Translation:

This review suggests that criminals tend to be antisocial, and we are all just shocked at this revelation. We thought that the people that did these studies that we used would go to the prison and find a bunch of sweet old grannies knitting and baking us cookies. It was just mind-blowing how wrong we were about that. Now our whole world has turned upside down, and dogs are marrying cats. Oh yeah, and BPD and psychopathy cannot coexist, but we phrased it differently to be obtuse.

Although preliminary research suggests that the relationship between psychopathic traits and BPD may be conditioned by gender, specifically by a greater presence of psychopathy in female BPD, [14,16], review of literature did not show consistent evidence for an association with sex.

Again, I am guessing that the gender bit is more associated with who they consider BPD in more regularly than anything else.

However, whether this relationship reflects real comorbidity between BPD and factor 2 of psychopathy cannot be resolved as yet. So, future research could focus on the way that psychopathic characteristics affect the phenomenological presentation of BPD and defines different clinical subtypes or different functional outcomes in BPD patients.

That’s what happens when you overly complicate things unnecessarily. People in prison have a higher tendency to be antisocial. Disconnect that idea from psychopathy, and you will see a whole world open up that makes a lot more sense. Keep trying to define ASPD as psychopathy, and you will continue making ridiculous claims that conflate things and make life more complicated for everyone. I get it, research is your bread and butter, but you are dealing with real people, not test subjects, and when you put out “data” this bad, it does nothing to help them get along in their lives. Psychopaths will do just fine with or without your help. We have that perma-resilence aspect to us. People with BPD come from abuse. Considering that and the reasons that they might choose antisocial behavior, that will get you a lot further in research.

All right guys. That’s it. I am so done with this analysis, and it is time for me to go away from my computer now.