Afterthought: I wonder if there is also Borderline BPD? The lacking a consistent and integrated sense of identity thing is not something I have experienced, and the 'splitting' only at a low level. I suppose it makes sense that anything with diagnostic criteria will have some people at the margins.
If only these terms were as clear in everyone's head as they are in this article. And then replaced altogether.
I will look up Elinor Greenberg's writing.
From what you say, borderline psychopaths would be fascinating to hear more from, with that complex and individually varied interplay between the emotional and the psycopathic traits. People who straddle two worlds- cultural, psychological, neurotypes, gender, all areas really- can have a great insights and a lot to say.
I would add two comments to the BPD treatment list. Medication can be of help not just for the comorbid conditions. There's the familiar story of people quickly going off their antidepressants because they hate that their feelings are dampened just too much. Well, some of those old fashioned heavy meds will do that. And while you might not want to take them for a lifetime, the partial numbness can for quite a while be a blessed relief for someone with BPD. Brain and body healing can occur, the patient can get a hopeful glimpse of an undreamt of possible existence with less pain, and then in time, all the practical steps can be taken to improve things. Also, it is a boon if a patient is lucky enough to have or find an important relationship with a safe person who will not compound the patients emotional deregulation with their actions and responses, but is prepared to work with them.
I had not considered the sexism angle for BPD diagnosis. I made me think of an opposite example, the atypical borderline who acts inwards more than outwards, where meltdowns do occur but much of the time the patient seems composed. (And half the time the meltdowns occur because of the cumulative strain of maintaining this composure while in turmoil!) For many women, who have been trained since childhood to be nice, accommodating, a good sport, and to behave a certain way to men/perform femininity, I believe that could result in a misdiagnosis of simple depression. The therapist may misjudged the severity of the problem if they haven't enough wild material to go on.
Diagnostic criteria based on purely outsider's (doctor's) observation can create much misunderstanding too. We definitely need the insider experiences taken into consideration as well. That is why I appreciate Elinor Greenberg's work. Although I'm not an expert, PCL-R seems to only list mostly shallow observations of test founder(s), based on prison population, but not the inner experience of actual psychopathic people. There is a similar case with schizoid pd, that I think I may be most familiar with. Also its name might raise confusion with schizophrenia while they are very different concepts. Different root causes and mechanisms. I think the psych field isn't that good at looking for root causes yet, or just starting, I hope. We could save many misdiagnoses and mis-treatments with it. Mismedication isn't an affordable thing, knowing the horrible side-effects of psychiatric drugs.
Yes, I agree with everything in your comment. The PCL-R is a poorly constructed tool that is massively misused. Elinor provides invaluable work that I think allows for a much clearer understanding for all of the adaptations that she writes about.
I think that schizoid, schizophrenia, and schizotypal having such similarities in their names leads to a lot of misunderstandings about all three.
If you look into the PCL-R you really don't even see very many psychopathic traits even in the factor 1 section. Who says psychopaths have to be pathological liars? I would think that if anything when psychopaths lie it's for some kind of calculated gain or reason. In reality the PCL-R is a clusterfuck of ASPD, NPD, BPD and HPD traits. The poor behavioral controls, impulsivity, promiscuity, short-term marital relationships, that all makes sense for BPD and of course someone can have antisocial traits with BPD that's how it often works with a lot of cluster B disorders, there's overlap. True psychopaths could never meet the whole criteria for BPD or NPD unless there was some kind of masking involved.
BPD as a "female psychopath" is horseshit, if anything HPD is a better representation but even then it's a reach. 50% of HPD is dually diagnosed with ASPD but this idea that one disorder is "female" and the other is "male" is absurd. Female psychopaths are harder to spot just like males with BPD are harder to spot.
Do you mean to say that HPD and BPD are similar, or HPD and psychopathy in females are similar. HPD and psychopathy in females is nothing alike, and are as far apart as BPD and psychopathy, so I assume that is what you are referring to.
HPD and BPD are similar? Sure, kind of. But HPD definitely has more overlap with ASPD. BPD hardly belongs with the rest of cluster B and is far easier to treat than the other three. The way people view "female psychopathy" is probably more in line with HPD considering the frequent ASPD comorbidity (two thirds of HPD patients). They often have overlapping traits (shallow affect, egocentrism, manipulativeness etc.) and because they're so much more antisocial than borderlines I see more room for confusion there even if some other traits of HPD virtually rule them out in terms of being psychopaths (sensitivity, attention seeking, gullibility).
I don't see why anyone even considered BPD as an indicator of female psychopathy either, one would think that it would be just that. The problem that is the stem of misconception may be that since women are diagnosed less since men are more blatantly aggressive. No professional is going to confuse or conflate psychopathy and BPD, especially if the subject is evaluated - they're just too different.
There are borderlines who are antisocial as well, but more often the pwBPD who I come across are the kind who can hardly leave their house without anxiety medications. They aren't exactly bold the way histrionics or psychopaths are.
Histrionics and psychopathy couldn't be further apart. HPD and BPD have far more overlap, and as you said, they share very little when closely examined.
ASPD and psychopathy are not the same thing. Most people with ASPD are neurotypical, and most psychopaths are not antisocial. ASPD describes behavior only, and is a different and totally separate entity from psychopathy.
Females with HPD are nothing like female psychopaths. They can be antisocial, sure, but anyone can. Someone with HPD and ASPD would be much closer to a neurotypical with antisocial personality disorder than they would ever be remotely similar to female psychopaths. Even if both a psychopath and HPD person had antisocial traits, their behavior would be extremely different.
I suppose histrionics may genuinely feel things intensely even if it's very shallow? Doesn't make sense to me but I don't have HPD. While psychopaths largely don't feel outside of proto-emotions. Honestly, I haven't seen much compelling research literature on HPD in general so forgive my ignorance there.
Most psychopaths are not antisocial is a new one but I suppose not every conception of psychopathy includes antisocial behavior even if the behavior isn't necessarily illegal. Lack of guilt or remorse implies that you've done something that would warrant remorse being present and failed to show it.
I can agree that lots of people with ASPD may be neurotypical but some studies definitively link ASPD to ADHD for example. Everyone's PD story is different though and to qualify for a PD dx, usually 5 criteria must be met, so there's hundreds of combinations. Even among genuine antisocials though, the behavior seems to diminish with age.
Histrionics feel things extremely deeply. It is described as:
A person with histrionic personality disorder seeks attention, talks dramatically with strong opinions, is easily influenced, has rapidly changing emotions, and thinks relationships are closer than they are.
Their emotional experience is described this way:
"People with these disorders have intense, unstable emotions and distorted self-images."
That is nothing like psychopathy. I spoke about the difference between ASPD and psychopathy here:
Fallon had a PET scan that was consistent with psychopathy. He states that he is a borderline psychopath, which means that he does not cross the diagnostic threshold, but is high on the spectrum.
Every diagnosis, I believe, can be applied to a spectrum - some people display more active traits than others. Is this mitigated with a solid, happy, healthy upbringing? I think that might play a role. It’s logical. The first people who model behaviours and actually teach/reinforce them are parents. I think childhood socialization has a huge influence on every person, with a diagnosed psychiatric issue or not. And as far as psychopathy, it is my belief that, although childhood experiences may not influence the biological facts of it, they definitely would help or hinder the psychopath’s ability to successfully navigate social experiences and learned self-regulation etc. A psychopathic child (impossible to diagnose completely, I agree, until adulthood) who is taught clear social emotional norms (and expected to uphold them) may not be able to experience them, per see, but is much better at mimicking them, I would think, although intelligence may play a part here, too.
I would be interested in knowing associated IQ’s of BPD and Psychopathy. Does higher intelligence “help” the person learn to control emotion, or help the person’s learned cognitive empathy, or not? Is IQ a byproduct of the “illness” for huge lack of a term, or is it completely separate? IQ has its’ basis also in the physical structure of the brain, after all. And, is intelligence inherited (partially genetic, definitely) or can it be influenced by childhood experience, for example compare the keener parents teaching language at birth to those who are criminally neglectful. Is that considered intelligence or just education? Of course the multitude of issues surrounding intelligence testing are known, but I’d still be interested in this.
Another very well-written, and spot on article (with references!!). I can’t say how much I thoroughly enjoy them!!
So who are these mysterious people who had a solid, happy, healthy upbringing? 😁I don't know anyone personally from my generation, and just hope that things really have changed since.
I am inclined to agree with you that whatever condition you have, high intelligence can only help, it's an advantage in everything really.
Afterthought: I wonder if there is also Borderline BPD? The lacking a consistent and integrated sense of identity thing is not something I have experienced, and the 'splitting' only at a low level. I suppose it makes sense that anything with diagnostic criteria will have some people at the margins.
I would imagine that it does exist, yes.
If only these terms were as clear in everyone's head as they are in this article. And then replaced altogether.
I will look up Elinor Greenberg's writing.
From what you say, borderline psychopaths would be fascinating to hear more from, with that complex and individually varied interplay between the emotional and the psycopathic traits. People who straddle two worlds- cultural, psychological, neurotypes, gender, all areas really- can have a great insights and a lot to say.
I would add two comments to the BPD treatment list. Medication can be of help not just for the comorbid conditions. There's the familiar story of people quickly going off their antidepressants because they hate that their feelings are dampened just too much. Well, some of those old fashioned heavy meds will do that. And while you might not want to take them for a lifetime, the partial numbness can for quite a while be a blessed relief for someone with BPD. Brain and body healing can occur, the patient can get a hopeful glimpse of an undreamt of possible existence with less pain, and then in time, all the practical steps can be taken to improve things. Also, it is a boon if a patient is lucky enough to have or find an important relationship with a safe person who will not compound the patients emotional deregulation with their actions and responses, but is prepared to work with them.
I had not considered the sexism angle for BPD diagnosis. I made me think of an opposite example, the atypical borderline who acts inwards more than outwards, where meltdowns do occur but much of the time the patient seems composed. (And half the time the meltdowns occur because of the cumulative strain of maintaining this composure while in turmoil!) For many women, who have been trained since childhood to be nice, accommodating, a good sport, and to behave a certain way to men/perform femininity, I believe that could result in a misdiagnosis of simple depression. The therapist may misjudged the severity of the problem if they haven't enough wild material to go on.
Diagnostic criteria based on purely outsider's (doctor's) observation can create much misunderstanding too. We definitely need the insider experiences taken into consideration as well. That is why I appreciate Elinor Greenberg's work. Although I'm not an expert, PCL-R seems to only list mostly shallow observations of test founder(s), based on prison population, but not the inner experience of actual psychopathic people. There is a similar case with schizoid pd, that I think I may be most familiar with. Also its name might raise confusion with schizophrenia while they are very different concepts. Different root causes and mechanisms. I think the psych field isn't that good at looking for root causes yet, or just starting, I hope. We could save many misdiagnoses and mis-treatments with it. Mismedication isn't an affordable thing, knowing the horrible side-effects of psychiatric drugs.
Yes, I agree with everything in your comment. The PCL-R is a poorly constructed tool that is massively misused. Elinor provides invaluable work that I think allows for a much clearer understanding for all of the adaptations that she writes about.
I think that schizoid, schizophrenia, and schizotypal having such similarities in their names leads to a lot of misunderstandings about all three.
If you look into the PCL-R you really don't even see very many psychopathic traits even in the factor 1 section. Who says psychopaths have to be pathological liars? I would think that if anything when psychopaths lie it's for some kind of calculated gain or reason. In reality the PCL-R is a clusterfuck of ASPD, NPD, BPD and HPD traits. The poor behavioral controls, impulsivity, promiscuity, short-term marital relationships, that all makes sense for BPD and of course someone can have antisocial traits with BPD that's how it often works with a lot of cluster B disorders, there's overlap. True psychopaths could never meet the whole criteria for BPD or NPD unless there was some kind of masking involved.
BPD as a "female psychopath" is horseshit, if anything HPD is a better representation but even then it's a reach. 50% of HPD is dually diagnosed with ASPD but this idea that one disorder is "female" and the other is "male" is absurd. Female psychopaths are harder to spot just like males with BPD are harder to spot.
Do you mean to say that HPD and BPD are similar, or HPD and psychopathy in females are similar. HPD and psychopathy in females is nothing alike, and are as far apart as BPD and psychopathy, so I assume that is what you are referring to.
HPD and BPD are similar? Sure, kind of. But HPD definitely has more overlap with ASPD. BPD hardly belongs with the rest of cluster B and is far easier to treat than the other three. The way people view "female psychopathy" is probably more in line with HPD considering the frequent ASPD comorbidity (two thirds of HPD patients). They often have overlapping traits (shallow affect, egocentrism, manipulativeness etc.) and because they're so much more antisocial than borderlines I see more room for confusion there even if some other traits of HPD virtually rule them out in terms of being psychopaths (sensitivity, attention seeking, gullibility).
I don't see why anyone even considered BPD as an indicator of female psychopathy either, one would think that it would be just that. The problem that is the stem of misconception may be that since women are diagnosed less since men are more blatantly aggressive. No professional is going to confuse or conflate psychopathy and BPD, especially if the subject is evaluated - they're just too different.
There are borderlines who are antisocial as well, but more often the pwBPD who I come across are the kind who can hardly leave their house without anxiety medications. They aren't exactly bold the way histrionics or psychopaths are.
Histrionics and psychopathy couldn't be further apart. HPD and BPD have far more overlap, and as you said, they share very little when closely examined.
ASPD and psychopathy are not the same thing. Most people with ASPD are neurotypical, and most psychopaths are not antisocial. ASPD describes behavior only, and is a different and totally separate entity from psychopathy.
Females with HPD are nothing like female psychopaths. They can be antisocial, sure, but anyone can. Someone with HPD and ASPD would be much closer to a neurotypical with antisocial personality disorder than they would ever be remotely similar to female psychopaths. Even if both a psychopath and HPD person had antisocial traits, their behavior would be extremely different.
I suppose histrionics may genuinely feel things intensely even if it's very shallow? Doesn't make sense to me but I don't have HPD. While psychopaths largely don't feel outside of proto-emotions. Honestly, I haven't seen much compelling research literature on HPD in general so forgive my ignorance there.
Most psychopaths are not antisocial is a new one but I suppose not every conception of psychopathy includes antisocial behavior even if the behavior isn't necessarily illegal. Lack of guilt or remorse implies that you've done something that would warrant remorse being present and failed to show it.
I can agree that lots of people with ASPD may be neurotypical but some studies definitively link ASPD to ADHD for example. Everyone's PD story is different though and to qualify for a PD dx, usually 5 criteria must be met, so there's hundreds of combinations. Even among genuine antisocials though, the behavior seems to diminish with age.
Histrionics feel things extremely deeply. It is described as:
A person with histrionic personality disorder seeks attention, talks dramatically with strong opinions, is easily influenced, has rapidly changing emotions, and thinks relationships are closer than they are.
Their emotional experience is described this way:
"People with these disorders have intense, unstable emotions and distorted self-images."
That is nothing like psychopathy. I spoke about the difference between ASPD and psychopathy here:
https://athenawalker.substack.com/p/psychopathy-and-aspd
and antisocial psychopaths here:
https://athenawalker.substack.com/p/antisocial-psychopaths
Psychopathy is not a personality disorder, it is a genetic difference in the brain.
Ok, I wasn't sure.
Ok so he didn't have the MRI?
He might have later on, but not one that I know of.
Didn't X Fallen have an MRI done that confirmed that his brain showed that he is a psychopath? That he was born that way.
So isn't he a psychopath, but just on a lesser or lower end of the spectrum?
Fallon had a PET scan that was consistent with psychopathy. He states that he is a borderline psychopath, which means that he does not cross the diagnostic threshold, but is high on the spectrum.
Every diagnosis, I believe, can be applied to a spectrum - some people display more active traits than others. Is this mitigated with a solid, happy, healthy upbringing? I think that might play a role. It’s logical. The first people who model behaviours and actually teach/reinforce them are parents. I think childhood socialization has a huge influence on every person, with a diagnosed psychiatric issue or not. And as far as psychopathy, it is my belief that, although childhood experiences may not influence the biological facts of it, they definitely would help or hinder the psychopath’s ability to successfully navigate social experiences and learned self-regulation etc. A psychopathic child (impossible to diagnose completely, I agree, until adulthood) who is taught clear social emotional norms (and expected to uphold them) may not be able to experience them, per see, but is much better at mimicking them, I would think, although intelligence may play a part here, too.
I would be interested in knowing associated IQ’s of BPD and Psychopathy. Does higher intelligence “help” the person learn to control emotion, or help the person’s learned cognitive empathy, or not? Is IQ a byproduct of the “illness” for huge lack of a term, or is it completely separate? IQ has its’ basis also in the physical structure of the brain, after all. And, is intelligence inherited (partially genetic, definitely) or can it be influenced by childhood experience, for example compare the keener parents teaching language at birth to those who are criminally neglectful. Is that considered intelligence or just education? Of course the multitude of issues surrounding intelligence testing are known, but I’d still be interested in this.
Another very well-written, and spot on article (with references!!). I can’t say how much I thoroughly enjoy them!!
Thank you, I appreciate that.
Yes, childhood influences are very significant in how a person adapts to the world around them. It makes or breaks a person's chances quite often.
So who are these mysterious people who had a solid, happy, healthy upbringing? 😁I don't know anyone personally from my generation, and just hope that things really have changed since.
I am inclined to agree with you that whatever condition you have, high intelligence can only help, it's an advantage in everything really.
No, it is a painting by Anne Stokes. I can't draw at all