The Mad, the Bad and The Sad

A common tool that is often used in academia for remembering the DSM’s (the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders) ten personality disorders is to group them into three sets: the mad, the bad, and the sad – these names represent the three different clusters that the manual uses. Those that are considered “mad” (Cluster A), are the disorders where the psychosis is significant enough to cause the sufferer to act in bizarre/eccentric ways, such as having a rigid pattern of thinking which makes the individual believe that everybody is conspiring against them e.g., Paranoid Personality Disorder etc. Those disorders in “Cluster C”, the “sad”, are those that result in anxiety, fear, and depression etc., such as those who have a Dependent Personality Disorder. The “bad” (Cluster B), personality disorders are those that put others at risk, such as Anti-Social Personality Disorder (which includes Psychopathy). Whilst many violence prevention programs talk about the importance of this last group of disorders and the need to be able to understand and recognize, Narcissists and Psychopaths etc. This is perhaps not the most effective way to make use of the DSM in real world self-defense. Firstly, it is impossible for the lay person to make a diagnosis e.g., just because somebody is extremely self-centered, and believes they are extremely important, this doesn’t make them a Narcissist, other conditions have to apply. Likewise, many people may fit our definition of Psychopath, but not score highly on the PCL (the Psychopathy Checklist). Secondly, many violent people (but certainly not all) have comorbidities, such as suffering both from Anti-Social and Borderline Personality Disorder etc., and unless you are trying to treat that individual, understanding which one is “driving” the violent offending, is of little importance.

What is more useful when using the DSM to understand violence is to look at what types of character traits and behaviors people have – within the “bad” group (Cluster B) that increase their risk(s) of behaving violently etc. This means we don’t have to make an actual diagnosis that may see somebody who behaves in a risky manner fall short of the set of conditions that they may need to have in order to be labelled with such a disorder e.g., there are a lot of people who have many traits of Narcissism who wouldn’t have enough to be diagnosed as such, but who may cause harm to others due to those that they do have etc. In this article I want to look at some of the character traits and behaviors that are contained in Cluster B personality disorders that can lead to violent offending without having to make a diagnosis of what disorder a person may or may not have.

A common feature that both those with Anti-Social Personality Disorder (which includes Psychopathy) and those with Narcissistic Personality Disorder share, is a lack of empathy. Empathy is what allows us to see each other as people rather than as objects. Both disorders are seen as being “immature” disorders in that those who have been diagnosed with them, operate in an emotionally immature/unevolved way. If we take Maslow’s Hierarchy of needs as a tool to help explain and illustrate this, we can see that people with these disorders are only concerned with the basic needs, such as having their safety and physiological needs met, they are not interested in attaining “Self-Actualization” which would involve them developing a deeper understanding of who they are as an individual etc. They are unable to recognize that other people have needs too. Having empathy recognizes that other people have their own interests, and needs and that it is important that these are met. When individuals have low empathy they are focused exclusively on meeting their needs, regardless of how this affects others – a characteristic shared by Narcissists, who believe they are more important than anyone else, and psychopaths who are unable to make an emotional connection with others, and emotionally “read” other people’s needs. There are people who would not meet all the conditions to be diagnosed with either of these personality disorders who also lack empathy, and because of this are more likely to respond violently to an incident or situation than somebody who is highly empathetic i.e., thinks about how their actions and behaviors affect others.         

A lack or inability to regulate emotional responses is a characteristic/trait that is something that is common with those who have ASPD (Anti-Social Personality Disorder) and those who have Borderline Personality Disorder (BPD). Both personality types (especially when looking at psychopathy more specifically), suffer to varying degrees from alexithymia i.e., the individual’s inability to recognize and describe their own emotional state. This means that they may not be sure of how somebody else’s actions and behaviors may be emotionally affecting them (those with BPD will talk of an emotional “emptiness”), which may lead to a degree of uncertainty about how they should respond. When we consider that we judge threats and danger largely from interpreting our emotional state, we can see that those with alexithymia lack the ability to do so, they can only understand these things cognitively, which means there is the potential for misinterpreting benign situations as dangerous ones, and vice versa etc., however it is perhaps more likely that such individuals have learnt, or have a tendency to err on the side of caution, and to respond aggressively when a safe situation includes certain components of a dangerous one etc. If we think of emotions as being short cuts that allow us to recognize and interpret an event without having to analyze all of the components in it, we can quickly see that individuals who lack the ability to interpret their emotional state are at a distinct disadvantage when trying to make sense of their experiences, and are likely to misinterpret what is happening to them – it simply isn’t feasible to make sense of all of the components of an incident cognitively in the time that a response to that event is needed.

It is important that not everyone who would be clinically diagnosed with Psychopathy, Anti-Social Personality Disorder, Narcissistic Personality Disorder, and/or Borderline Personality Disorder have, or will, be violent offenders – in the case of BPD, they are much more likely to self-harm than harm others etc. However, there are certain common traits and characteristics that these disorders contain that do pose a risk of violent behavior, and it is better to focus specifically on these when looking at violence prediction than looking at the disorder as a whole.