Description of Borderline Personality Disorder and  accompanying traits that make it difficult for the person living with Borderline Personality Disorder.

• Watch the video on Borderline Personality Disorder

The fact that the Borderline personality disorder is often found among women makes it a controversial mental health diagnosis. Some scholars say that it is a culture-bound pseudo-syndrome invented by men to serve a patriarchal and misogynistic society. Others point to the fact the lives of patients diagnosed with the disorder are chaotic and that the relationships they form are stormy, short-lived, and unstable. Moreover, not unlike compensatory narcissists, people with the Borderline Personality Disorder often display labile (wildly fluctuating) sense of self-worth, self-image and affect (expressed emotions).

Like both narcissists and psychopaths, borderlines are impulsive and reckless. Like histrionics, their sexual conduct is promiscuous, driven, and unsafe. Many borderlines binge eat, gamble, drive, and shop carelessly, and are substance abusers. Lack of impulse control is joined with self-destructive and self-defeating behaviors, such as suicidal ideation, suicide attempts, gestures, or threats, and self-mutilation or self-injury.

The main dynamic in the Borderline Personality Disorder is abandonment anxiety. Like codependents, borderlines attempt to preempt or prevent abandonment (both real and imagined) by their nearest and dearest. They cling frantically and counterproductively to their partners, mates, spouses, friends, children, or even neighbors. This fierce attachment is coupled with idealization and then swift and merciless devaluation of the borderline's target.

Exactly like the narcissist, the borderline patient elicits constant narcissistic supply (attention, affirmation, adulation, approval) to regulate her gyrating sense of self-worth and her chaotic self-image, to shore up serious, marked, persistent, and ubiquitous deficits in self-esteem and Ego functions, and to counter the gnawing emptiness at her core.

The Borderline Personality Disorder is often co-diagnosed (is comorbid) with mood and affect disorders. But all borderlines suffer from mood reactivity.

From an entry I wrote for the Open Site Encyclopedia:

"(Borderlines) shift dizzyingly between dysphoria (sadness or depression) and euphoria, manic self-confidence and paralyzing anxiety, irritability and indifference. This is reminiscent of the mood swings of Bipolar Disorder patients. But Borderlines are much angrier and more violent. They usually get into physical fights, throw temper tantrums, and have frightening rage attacks.

When stressed, many Borderlines become psychotic, though only briefly (psychotic micro-episodes), or develop transient paranoid ideation and ideas of reference (the erroneous conviction that one is the focus of derision and malicious gossip). Dissociative symptoms are not uncommon ("losing" stretches of time, or objects, and forgetting events or facts with emotional content)."

Hence the term "borderline" (first coined by Otto F. Kernberg). The Borderline Personality Disorder is on the thin (border) line separating neurosis from psychosis.

Read Notes from the therapy of a Borderline Patient

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Schizoid Personality Disorder

Read therapy session notes from patient diagnosed with Avoidant Personality Disorder. See what it's like living with Avoidant Personality Disorder.

Notes of first therapy session with Gladys, female, 26, diagnosed with Avoidant Personality Disorder

"I would like to be normal" - says Gladys and blushes purple. In which sense is she abnormal? She prefers reading books and watching movies with her elderly mother to going out with her colleagues to the occasional office party. Maybe she doesn't feel close to them? How long has she been working with these people? Eight years in the same firm and "not one raise in salary" - she blurts out, evidently hurt. Her boss bullies her publicly and the searing shame of it all prevents her from socializing with peers, suppliers, and clients.

Does she have a boyfriend? I must be mocking her. Who would date an ugly duckling, plain secretary like her? I disagree wholeheartedly and in details with her self-assessment. I think that she is very intelligent. She half rises from her seat then thinks better of it: "Please, doctor, there no need to lie to me just in order to make me feel better. I know my good sides and they don't amount to much. If we disagree on this crucial point, perhaps I should start looking for another therapist."

A glass of water and mounds of tissue paper later, we are back on track. She dreads the idea of group therapy. "I am a social cripple. I can't work with other people. I declined a promotion to avoid working in a team." Her boss thought highly of her until she turned his offer down, so in effect it's all her fault and she has earned the abuse she is being subjected to on a daily basis. And, anyhow, he overestimated her capabilities and skills.

Why can't she interact with her co-workers? "Well, that's precisely what we are supposed to find out, isn't it?" - she retorts. Everyone is too critical and opinionated and she can't stand it. She accepts people as they are, unconditionally - why can't they treat her the same way? She fantasizes about getting married one day to a soulmate, someone who would love and cherish her regardless of her blemishes.

I ask her to describe how she thinks she is being perceived by others. "Shy, timid, lonely, isolated, invisible, quiet, reticent, unfriendly, tense, risk-averse, resistant to change, reluctant, restricted, hysterical, and inhibited." That's quite a list, I comment, now how does she view herself? The same, she largely agrees with people's perceptions of her "but it doesn't give them the right to ridicule or torment her just because she is different."

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: The Histrionic Patient ~ back to: Case Studies: Table of Contents

How do you cope with a stalker, an abuser who doesn't understand that the relationship is over? Learn about the psychological makeup of the stalker.

Abuse by proxy continues long after the relationship is officially over (at least as far as you are concerned). The majority of abusers get the message, however belatedly and reluctantly. Others - more vindictive and obsessed - continue to haunt their ex-spouses for years to come. These are the stalkers.

Most stalkers are what Zona (1993) and Geberth (1992) call "Simple Obsessional" or, as Mullen and Pathe put it (1999) - "Rejected". They stalk their prey as a way of maintaining the dissolved relationship (at least in their diseased minds). They seek to "punish" their quarry for refusing to collaborate in the charade and for resisting their unwanted and ominous attentions.

Such stalkers come from all walks of life and cut across social, racial, gender, and cultural barriers. They usually suffer from one or more (comorbid) personality disorders. They may have anger management or emotional problems and they usually abuse drugs or alcohol. Stalkers are typically lonely, violent, and intermittently unemployed - but they are rarely full fledged criminals.

Contrary to myths perpetrated by the mass media, studies show that most stalkers are men, have high IQ's, advanced degrees, and are middle aged (Meloy and Gothard, 1995; and Morrison, 2001).

Rejected stalkers are intrusive and inordinately persistent. They recognize no boundaries - personal or legal. They honor to "contracts" and they pursue their target for years. They interpret rejection as a sign of the victim's continued interest and obsession with them. They are, therefore, impossible to get rid of. Many of them are narcissists and, thus, lack empathy, feel omnipotent and immune to the consequences of their actions.

Even so, some stalkers are possessed of an uncanny ability to psychologically penetrate others. Often, this gift is abused and put at the service of their control freakery and sadism. Stalking - and the ability to "mete out justice" makes them feel powerful and vindicated. When arrested, they often act the victim and attribute their actions to self-defence and "righting wrongs".

Stalkers are emotionally labile and present with rigid and infantile (primitive) defense mechanisms: splitting, projection, projective identification, denial, intellectualization, and narcissism. They devalue and dehumanize their victims and thus "justify" the harassment or diminish it. From here, it is only one step to violent conduct.

This is the topic of our next article.

Additional Reading

• Coping with Four Types of Stalkers - Click HERE!
• Zona M.A., Sharma K.K., and Lane J.: A Comparative Study of Erotomanic and Obsessional Subjects in a Forensic Sample, Journal of Forensic Sciences, July 1993, 38(4):894-903.
• Vernon Geberth: Stalkers, Law and Order, October 1992, 40: 138-140
• Mullen P.E., Pathé M., Purcell R., and Stuart G.W.: Study of Stalkers, American Journal of Psychiatry, August 1999, 156(8):1244-
• Meloy J.R., Gothard S.: Demographic and Clinical Comparison of Obsessional Followers and Offenders with Mental Disorders, American Journal of Psychiatry, February 1995, 152(2):258-63.
• Morrison K.A.: Predicting Violent Behavior in Stalkers - A Preliminary Investigation of Canadian Cases in Criminal Harassment, Journal of Forensic Sciences, November 2001, 46(6):1403-10.

next: Statistics of Abuse and Stalking

Learn about signs, symptoms of Histrionic Personality Disorder and what it's like living with Histrionic Personality Disorder.

Most patients with the Histrionic Personality Disorder are women. This immediately raises the question: Is this a real mental health disorder or a culture-bound syndrome which reflects the values of a patriarchal and misogynistic society? A man with similar traits is bound to be admired as a "macho" or, at worst, labeled a "womanizer".

Histrionics resemble narcissists - both seek attention compulsively and are markedly dysphoric and uncomfortable when not at the center of attention. They have to be the life of the party. If they fail in achieving this pivotal role, they act out, create hysterical scenes, or confabulate.

Like the somatic narcissist, the histrionic is preoccupied with physical appearance, sexual conquests, her health, and her body. The typical histrionic spends huge dollops of money and expend inordinate amounts of time on grooming. Histrionics fish for compliments and are upset when confronted with criticism or proof that they are not as glamorous or alluring as they thought they are.

Unlike narcissists, though, histrionics are genuinely enthusiastic, open, emotional, warm, and empathic, up to the point of being maudlin and sentimental. They also strive to "fit in", mingle, blend, and "become a part of" groups, collectives, and social institutions.

Histrionics sexualize everyone and every situation. They constantly act flirtatious, provocative, and seductive, even when such behavior is not warranted by circumstances or, worse still, is proscribed and highly inappropriate (for instance in professional and occupational settings).

Such conduct is often ill-received. People usually find this unabashed directness and undisguised hunger for approval annoying, or outright repulsive. Consequently, histrionics are sometimes subject to social censure and ostracism.

The histrionic leverages this libidinous excess and overt emotionality to gain the attention she craves. But the histrionics' intensity and unpredictability are exhausting. The histrionic's nearest and dearest are often embarrassed by her unbridled display of emotions: hugging casual acquaintances, uncontrollable sobbing in public, or having temper tantrums. The histrionic's behavior is so off-color that she is typically accused of being a fake.

I wrote this about the histrionic in the Open Site Encyclopedia:

"As the histrionic depletes one source of narcissistic supply after another, she glides from one relationship to the next, experiencing a range of shallow feelings and commitments in the process. This shallowness is reflected in the histrionic's speech which is impressionistic, disjointed, and generalized. Concerned only with the latest conquest, the histrionic uses her physical appearance and attire as a kind of conscious bait. It is ironic that histrionics often mistake the depth, durability, and intimacy of their relationships and are devastated by their inevitable premature termination.

Histrionics are the quintessential drama queens. They are theatrical, their emotions exaggerated to the point of a caricature, their gestures sweeping, disproportional, and inappropriate. The histrionic is easily suggestible and responds instantly and fully to the slightest change in circumstances and to the most meaningless communication or behavior by others." Histrionics are early adopters and closely adhere to the latest fads and fashions.

Read Notes from the therapy of a Histrionic Patient

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Borderline Personality Disorder

Vivid description of what it's like living with Histrionic Personality Disorder. Read therapy notes from woman diagnosed with Histrionic Personality Disorder.

Notes of first therapy session with Marsha, female, 56, diagnosed with Histrionic Personality Disorder

Marsha visibly resents the fact that I have had to pay attention to another patient (an emergency) "at her expense" as she puts it. She pouts and bats suspiciously long eyelashes at me: "Has any of your female patients fallen in love with you?" - she suddenly changes tack. I explain to her what is transference and countertransference in therapy. She laughs throatily and shakes loose an acid blond mane: "You may call it what you want, doctor, but the simple truth is that you are irresistibly cute."

I steer away from these treacherous waters by asking her about her marriage. She sighs and her face contort, on the verge of tears: "I hate what's been happening to Doug and me. He has had such a stretch of bad luck - my heart goes out to him. I really love him you know. I miss what we used to be. But his rage attacks and jealousy are driving me away. I feel that I am suffocating."

Is he a possessive paranoid? She shifts uneasily in her seat: "I like to flirt. A little flirting never hurt nobody is what I say." Does Doug share her insouciance? He accuses her of being too provocative and seductive. Well, is she? "A woman can never be too much of either" - she protests mockingly.

Has she ever cheated on her husband? Never. So, why his jealous tantrums? Because she has been pretty direct with men she fancied, told them what she would do with them and to them if circumstances were different. Was this a wise thing to do in public? Maybe not the wisest, but it sure was fun, she laughs.

How did men react to her advances? "Usually, with an enormous erection." - she chuckles - "How did you react, doctor?" I was embarrassed, I admit, even annoyed. She doesn't believe me, she says. No red-blooded male has ever been put off by the lure of an attractive female and "from where I sit, you sure look as red-blooded as they come."

Doug has been her fourth serious relationship this year. How can such a short-lived liaison be meaningful? "Depth and intimacy can be created overnight" - she assures me, they are not a function of the length of acquaintance. But surely they depend on the amount of time spent together? "Is this your wife?' - she points at a silver-framed picture on my desk - "I bet you are hitting it off in the sack!" Actually, I tell her, that's my daughter. She shrugs off her faux-pas and sprawls across my duvet, long legs exposed to the hip and crossed at the ankles.

She sighs theatrically and shields her eyes with her hand: "I wish it was all over." Does she mean her relationship with Doug? "No, silly", she was referring to her tumultuous life and its vagaries. Does she really mean it? Of course not. She rolls to one side, leaning on her elbow, face supported by an open palm: "I just wish people were more lighthearted, you know? I wish they knew how to enjoy life to the maximum, give and take with joy. Isn't this what psychotherapy is all about? Aren't these the skills you, as a psychiatrist, are trying to instil in your patients?"

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: The Schizoid Patient ~ back to: Case Studies: Table of Contents

• Watch the video on What is a Domestic Violence Shelter?

This article is meant to be a general guide to seeking and finding help in shelters. It does not contain addresses, contacts, and phone numbers. It is not specific to one state or country. Rather, it describes options and institutions which are common the world over. You should be the one to "fill in the blanks" and locate the relevant shelters and agencies in your domicile.

Read this article on other options and getting help!

Shelters are run, funded, and managed either by governments or by volunteer non-government organisations. According to a 1999 report published by the National Coalition Against Domestic Violence, there are well over 2000 groups involved in sheltering abused women and their off-spring.

Before you opt for moving with your children into a sheltered home or apartment, go through this check list.

1. 1. It is important to make sure that the philosophy of the organisers of the shelters accords with your own. Some shelters, for instance, are run by feminist movements and strongly emphasise self-organisation, co-operation, and empowerment through decision-making. Other shelters are supervised by the Church or other religious organisations and demand adherence to a religious agenda. Yet others cater to the needs of specific ethnic minorities or neighbourhoods.
   2. Can you abide by the house rules? Are you a smoker? Some shelters are for non-smokers. What about boyfriends? Most shelters won't allow men on the premises. Do you require a special diet due to medical reasons? Is the shelter's kitchen equipped to deal with your needs?
   3. Gather intelligence and be informed before you make your move. Talk to battered women who spent time in the shelter, to your social worker, to the organisers of the shelter. Check the local newspaper archive and visit the shelter at least twice: in daytime and at night.

1. 1. How secure is the shelter? Does it allow visitation or any contact with your abusive spouse? Does the shelter have its own security personnel? How well is the shelter acquainted with domestic violence laws and how closely is it collaborating with courts, evaluators, and law enforcement agencies? Is recidivism among abusers tracked and discouraged? Does the shelter have a good reputation among them? You wouldn't want to live in a shelter that is shunned by the police and the judicial system.
   2. How does the shelter tackle the needs of infants, young children, and adolescents? What are the services and amenities it provides? What things should you bring with you when you make your exit - and what can you count on the shelter to make available? What should you pay for and what is free of charge? How well-staffed is the shelter? Is the shelter well-organised? Are the intake forms anonymous?
   3. How accessible is the shelter to public transport, schooling, and to other community services?
   4. Does the shelter have a batterer intervention program or workshop and a women's support group? In other words, does it provide counselling for abusers as well as ongoing succour for their victims? Are the programs run only by volunteers (laymen peers)? Are professionals involved in any of the activities and, if so, in what capacity (consultative, supervisory)?

Additionally, does the shelter provide counselling for children, group and individual treatment modalities, education and play-therapy services, along with case management services?

Is the shelter associated with outpatient services such vocational counselling and job training, outreach to high schools and the community, court advocacy, and mental health services or referrals?

1. Most important: don't forget that shelters are a temporary solution. These are transit areas and you are fully expected to move on. Not everyone is accepted. You are likely to be interviewed at length and screened for both your personal needs and compatibility with the shelter's guidelines. Is it really a crisis situation, are your life or health at risk - or are you merely looking to "get away from it all"? Even then, expect to be placed on a waiting list. Shelters are not vacation spots. They are in the serious business of defending the vulnerable.

When you move into a shelter, you must know in advance what your final destination is. Imagine and plan your life after the shelter. Do you intend to relocate? If so, would you need financial assistance? What about the children's education and friends? Can you find a job? Have everything sorted out. Only then, pack your things and leave your abuser.

How to plan and execute your getaway - in the next article.

Visit the HealthyPlace.com Support Network area for abuse and personality disorders support groups.

next: Coping with Stalking and Stalkers - Planning and Executing Your Getaway

How big is the problem of domestic violence and intimate partner abuse? Here are the chilling statistics.

• Watch the video on Domestic Violence 

Before we proceed to outline the psychological profile of the stalker, it is important to try and gauge the extent of the problem by quantifying its different manifestations. More plainly, studying the available statistics is both enlightening and useful.

Contrary to common opinion, there has been a marked decline in domestic violence in the last decade. Moreover, rates of domestic violence and intimate partner abuse in various societies and cultures - vary widely. It is, therefore, safe to conclude that abusive conduct is not inevitable and is only loosely connected to the prevalence of mental illness (which is stable across ethnic, social, cultural, national, and economic barriers).

There is no denying that the mental problems of some offenders do play a part - but it is smaller than we intuit. Cultural, social, and even historical factors are the decisive determinants of spousal abuse and domestic violence.

The United States

The National Crime Victimization Survey (NCVS) reported 691,710 nonfatal violent victimizations committed by current or former spouses, boyfriends, or girlfriends of the victims during 2001. About 588,490, or 85% of intimate partner violence incidents, involved women. The offender in one fifth of the totality of crimes committed against women was an intimate partner - compared to only 3% of crimes committed against men.

Still, this type of offenses against women declined by half between 1993 (1.1 million nonfatal cases) and 2001 (588,490) - from 9.8 to 5 per thousand women. Intimate partner violence against men also declined from 162,870 (1993) to 103,220 (2001) - from 1.6 to 0.9 per 1000 males. Overall, the incidence of such crimes dropped from 5.8 to 3.0 per thousand.

Even so, the price in lost lives was and remains high.

In the year 2000, 1247 women and 440 men were murdered by an intimate partner in the United States - compared to 1357 men and 1600 women in 1976 and around 1300 women in 1993.

This reveals an interesting and worrying trend:

The number overall intimate partner offences against women declined sharply - but not so the number of fatal incidents. These remained more or less the same since 1993!

The cumulative figures are even more chilling:

One in four to one in three women have been assaulted or raped at a given point in her lifetime (Commonwealth Fund survey, 1998).

The Mental Health Journal says:

"The precise incidence of domestic violence in America is difficult to determine for several reasons: it often goes unreported, even on surveys; there is no nationwide organisation that gathers information from local police departments about the number of substantiated reports and calls; and there is disagreement about what should be included in the definition of domestic violence."

Using a different methodology (counting separately multiple incidents perpetrated on the same woman), a report titled "Extent, Nature and Consequences of Intimate Partner Violence: Findings from the National Violence Against Women Survey", compiled by Patricia Tjaden and Nancy Thoennes for the National Institute of Justice and the Centres for Disease Control and published in 1998, came up with a figure of 5.9 million physical assaults against 1.5 million targets in the USA annually.

According to the Washington State Domestic Violence Fatality Review Project, and Neil Websdale, Understanding Domestic Homicide, Northeastern University Press, 1999 - women in the process of separation or divorce were the targets of half of all intimate partner violent crimes. In Florida the figure is even higher (60%).

Hospital staff are ill-equipped and ill-trained to deal with this pandemic. Only 4% of hospital emergency room admissions of women in the United States were put down to domestic violence. The true figure, according to the FBI, is more like 50%.

Michael R. Rand in "Violence-related Injuries Treated in Hospital Emergency Departments", published by the U.S. Department of Justice, Bureau of Justice Statistics, August 1997 pegs the real number at 37%. Spouses and ex-husbands were responsible for one in three murdered women in the USA.

Two million spouses (mostly women) are threatened with a deadly weapon annually, according to the US Department of Justice. One half of all American homes are affected by domestic violence at least once a year.

And the violence spills over.

One half of wife-batterers also regularly assault and abuse their children, according to M. Straus, R. Gelles, and C. Smith, "Physical Violence in American Families: Risk Factors and Adaptations to Violence in 8,145 Families, 1990" and U.S. Advisory Board on Child Abuse and Neglect, A Nation's Shame: Fatal child abuse and neglect in the United States: Fifth report, Department of Health and Human Services, Administration for Children and Families, 1995.

"Black females experienced domestic violence at a rate 35% higher than that of white females, and about 22 times the rate of women of other races. Black males experienced domestic violence at a rate about 62% higher than that of white males and about 22 times the rate of men of other races."

[Rennison, M. and W. Welchans. Intimate Partner Violence. U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics. May 2000, NCJ 178247, Revised 7/14/00]

The young, the poor, minorities, divorced, separated, and singles were most likely to experience domestic violence and abuse.

next: The Stalker as Antisocial Bully

• Watch the video on Schizoid Patients

Not only symptoms of Schizoid Personality Disorder, but traits that characterize person diagnosed with Schizoid Personality Disorder.

Notes of first therapy session with Mark, male, 36, diagnosed with Schizoid Personality Disorder

Mark sits where instructed, erect but listless. When I ask him how he feels about attending therapy, he shrugs and mumbles "OK, I guess". He rarely twitches or flexes his muscles or in any way deviates from the posture he has assumed early on. He reacts with invariable, almost robotic equanimity to the most intrusive queries on my part. He shows no feelings when we discuss his uneventful childhood, his parents ("of course I love them"), and sad and happy moments he recollects at my request. No Iframes

Mark veers between being bored with our encounter and being annoyed by it. How would he describe his relationships with other people? He has none that he can think of. In whom does he confide? He eyes me quizzically: "confide?" Who are his friends? Does he have a girlfriend? No. He shares pressing problems with his mother and sister, he finally remembers. When was the last time he spoke to them? More than two years ago, he thinks.

He doesn't seem to feel uneasy when I probe into his sex life. He smiles: no, he is not a virgin. He has had sex once with a much older woman who lived across the hall in his apartment block. That was the only time, he found it boring. He prefers to compile computer programs and he makes nice money doing it. Is he a member of a team? He involuntarily recoils: no way! He is his own boss and likes to work alone. He needs his solitude to think and be creative.

That's precisely why he is here: his only client now insists that he collaborates with the IT department and he feels threatened by the new situation. Why? He ponders my question at length and then: "I have my working habits and my long-established routines. My productivity depends on strict adherence to these rules." Has he ever tried to work outside his self-made box? No, he hasn't and has no intention of even trying it: "If it works don't fix it and never argue with success."

If he is such a roaring success what is he doing on my proverbial couch? He acts indifferent to my barb but subtly counterattacks: "Thought I'd give it a try. Some people go to one type of witch doctor, I go to another."

Does he have any hobbies? Yes, he collects old sci-fi magazines and comics. What gives him pleasure? Work does, he is a workaholic. What about his collections? "They are distractions". But do they make him happy, does he look forward to the time he spends with them? He glowers at me, baffled: " I collect old magazines." - he explains patiently - "How are old magazines supposed to make me happy?".

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: The Borderline Patient ~ back to: Case Studies: Table of Contents

Take a  look at the intricate workings, traits of the person with Antisocial Personality Disorder - sometimes referred to a psychopath or sociopath.

• Watch the video on Antisocial Personality Disorder 

Roots of the Disorder

Are the psychopath, sociopath, and someone with the Antisocial Personality Disorder one and the same? The DSM says "yes". Scholars such as Robert Hare and Theodore Millon beg to differ. The psychopath has antisocial traits for sure but they are coupled with and enhanced by callousness, ruthlessness, extreme lack of empathy, deficient impulse control, deceitfulness, and sadism.

Like other personality disorders, psychopathy becomes evident in early adolescence and is considered to be chronic. But unlike most other personality disorders, it is frequently ameliorated with age and tends to disappear altogether by the fourth or fifth decade of life. This is because criminal behavior and substance abuse are both determinants of the disorders and behaviors more typical of young adults.

Psychopathy may be hereditary. The psychopath's immediate family usually suffer from a variety of personality disorders.

Cultural and Social Considerations

The Antisocial Personality Disorder is a controversial mental health diagnoses. The psychopath refuses to conform to social norms and obey the law. He often inflicts pain and damage on his victims. But does that make this pattern of conduct a mental illness? The psychopath has no conscience or empathy. But is this necessarily pathological? Culture-bound diagnoses are often abused as tools of social control. They allow the establishment, ruling elites, and groups with vested interests to label and restrain dissidents and troublemakers. Such diagnoses are frequently employed by totalitarian states to harness or even eliminate eccentrics, criminals, and deviants.

Characteristics and Traits

Like narcissists, psychopaths lack empathy and regard other people as mere instruments of gratification and utility or as objects to be manipulated. Psychopaths and narcissists have no problem to grasp ideas and to formulate choices, needs, preferences, courses of action, and priorities. But they are shocked when other people do the very same.

Most people accept that others have rights and obligations. The psychopath rejects this quid pro quo. As far as he is concerned, only might is right. People have no rights and he, the psychopath, has no obligations that derive from the "social contract". The psychopath holds himself to be above conventional morality and the law. The psychopath cannot delay gratification. He wants everything and wants it now. His whims, urges, catering to his needs, and the satisfaction of his drives take precedence over the needs, preferences, and emotions of even his nearest and dearest.

Consequently, psychopaths feel no remorse when they hurt or defraud others. They don't possess even the most rudimentary conscience. They rationalize their (often criminal) behavior and intellectualize it. Psychopaths fall prey to their own primitive defense mechanisms (such as narcissism, splitting, and projection). The psychopath firmly believes that the world is a hostile, merciless place, prone to the survival of the fittest and that people are either "all good" or "all evil". The psychopath projects his own vulnerabilities, weaknesses, and shortcomings unto others and forces them to behave the way he expects them to (this defense mechanism is known as "projective identification"). Like narcissists, psychopaths are abusively exploitative and incapable of true love or intimacy.

Narcissistic psychopath are particularly ill-suited to participate in the give and take of civilized society. Many of them are misfits or criminals. White collar psychopaths are likely to be deceitful and engage in rampant identity theft, the use of aliases, constant lying, fraud, and con-artistry for gain or pleasure.

Psychopaths are irresponsible and unreliable. They do not honor contracts, undertakings, and obligations. They are unstable and unpredictable and rarely hold a job for long, repay their debts, or maintain long-term intimate relationships.

Psychopaths are vindictive and hold grudges. They never regret or forget a thing. They are driven, and dangerous.

I wrote this in the Open Site Encyclopedia:

"Always in conflict with authority and frequently on the run, psychopaths possess a limited time horizon and seldom make medium or long term plans. They are impulsive and reckless, aggressive, violent, irritable, and, sometimes, the captives of magical thinking, believing themselves to be immune to the consequences of their own actions.

Thus, psychopaths often end up in jail, having repeatedly flouted social norms and codified laws. Partly to avoid this fate and evade the law and partly to extract material benefits from unsuspecting victims, psychopaths habitually lie, steal others' identities, deceive, use aliases, and con for "personal profit or pleasure" as the Diagnostic and Statistical Manual puts it."

The Anxious Psychopath

Psychopaths are said to be fearless and sang-froid. Their pain tolerance is very high. Still, contrary to popular perceptions and psychiatric orthodoxy, some psychopaths are actually anxious and fearful. Their psychopathy is a defense against an underlying and all-pervasive anxiety, either hereditary, or brought on by early childhood abuse.

Read Notes from the therapy of a Psychopathic Patient

Read Narcissist vs. Psychopath

This article appears in my book, "Malignant Self Love - Narcissism Revisited"

next: Histrionic Personality Disorder

If you're a victim of abuse, domestic violence, or stalking, here's where to turn for help.

• Watch the video on Get Help Against a Stalker 

This article is meant to be a general guide to seeking and finding help. It does not contain addresses, contacts, and phone numbers. It is not specific to one state or country. Rather, it describes options and institutions which are common the world over. You should be the one to "fill in the blanks" and locate the relevant groups and agencies in your domicile.

Your first "fallback" option is your family. They are, in many cases (though by no means always) your natural allies. They can provide you with shelter, money, emotional support, and advice. Don't hesitate to call on them in times of need.

Your friends and, to a lesser extent, your colleagues and neighbors will usually lend you a sympathetic ear and will provide you with useful tips. Merely talking to them can not only ease the burden - but protect you from future abuse. Stalkers and paranoids thrive on secrecy and abhor public exposure.

Regrettably, resorting to the legal system - your next logical step - is bound to be a disappointing, disempowering, and invalidating experience. I wrote about it extensively in the essay "Pathologizing the Victim".

A 1997 Review Paper titled "Stalking (Part II) Victims' Problems With the Legal System and Therapeutic Considerations", Karen M. Abrams, MD, FRCPC1, Gail Erlick Robinson, MD, DPsych, FRCPC2 note:

"Law-enforcement insensitivity toward domestic violence has already been well documented. Police often feel that, as opposed to serious crimes such as murder, domestic issues are not an appropriate police responsibility; 'private' misconduct should not be subject to public intervention, and, because few cases result in successful prosecution, pursuing domestic violence complaints is ultimately futile... This sense of futility, reinforced by the media and the courts, may be transmitted to the victim.

In cases involving ex-lovers, the police may have equal difficulty in being sympathetic to the issues involved. As in the case of Ms A, society often views stalking as a normal infatuation that will eventually resolve itself or as the actions of a rejected lover or lovesick individual, more to be empathised with than censured (2). Victims often report feeling that the police and society blame them for provoking harassment or making poor choices in relationships. Authorities may have particular difficulty understanding the woman who continues to have ambivalent feelings toward the offender...

In terms of the laws themselves, there is a history of ineffectiveness in dealing with crimes of stalking (1,5). The nature of the offences themselves makes investigations and prosecution difficult, because surveillance and phone calls often have no witnesses. Barriers to victims using civil actions against stalkers include dangerous time delays and financial requirements. Temporary restraining orders or peace bonds have been used most commonly and are generally ineffective, partly because law-enforcement agencies have limited resources to enforce such measures. Even if caught, violators receive, at most, minimal jail time or minor monetary penalties. Sometimes the offender just waits out the short duration of the order. Persistent, obsessed stalkers are usually not deterred."

Still, it is crucial that you document the abuse and stalking and duly report them to the police and to your building security. If your stalker is in jail, you should report him to the wardens and to his parole officer. It is important to resort to the courts in order to obtain restraining or cease and desist orders. Keep law enforcement officers and agencies fully posted. Don't hesitate to call upon them as often as you need to. It is their job. Hire a security expert if the threat is credible or imminent.

You are well advised to rely on professional advice throughout your prolonged and arduous disentanglement from your paranoid and stalking ex. Use attorneys, accountants, private detectives, and therapists to communicate with him. Consult your lawyer (or, if you can't afford one, apply for a pro bono lawyer provided by a civic association, or your state's legal aid). Ask him or her what are your rights, what kinds of legal redress you have, what safety precautions you should adopt - and what are the do's and don't do's of your situation.

Especially important is to choose the right therapist for you and for your children. Check whether he or she has any experience with victims of stalking and with the emotional effects of constant threat and surveillance (fear, humiliation, ambivalence, helplessness, paranoid ideation). Stalking is a traumatic process and you may need intervention to ameliorate the post traumatic stress effects it wreaks.

Join online and offline groups and organizations for victims of abuse and stalking. Peer support is critical. Helping others and sharing experiences and fears with other victims is a validating and empowering as well as a useful experience. Realising that you are not alone, that you are not crazy, and that the whole situation is not your fault helps to restore your shattered self-esteem and puts things in perspective.

The social services in your area are geared to deal with battering and stalking. They likely run shelters for victims of domestic violence and abuse, for instance.

The ins and outs of shelters for victims of domestic violence (battering) - that is the subject of the next article.

next: Coping with Stalking and Stalkers - Domestic Violence Shelters