Rob Kall: OK. What about related diagnoses? I noted that in your book you mention that a
lot of women who might not be diagnosed as anti-social might be diagnosed as
"borderline."
Donald Black: Yes.
Rob Kall: You also
mentioned in your book that there is a lot of co-morbidity for anti-social
personalities with depression and alcoholism.
Donald Black: Yeah,
that's true.
Rob Kall: So I'm
curious about, particularly, borderline disorder and narcissism. Where do they tie in with this?
Donald Black: That's an
excellent question. It gets at the
larger question of what you mentioned as "co-morbidity." Listeners may not know that term; it just
means, "other conditions or disorders that a person has in addition to the
anti-social personality disorder." Now,
as a psychologist I can tell you: most people I see because of one disorder -
let's say obsessive compulsive disorder - also meets criteria for other disorders
as well. Maybe substance abuse, or
depression, or a gambling problem; and this is true with anti-socials.
They often have a whole host of problems, and I
know speaking as a Psychiatrist, they don't come to our clinic specifically for
the anti-social personality disorder.
They don't come in and say, "Doc, I've got ASPD, I've got
Sociopathy. I need help for this." They don't come in for that reason. They'll say, "I'm depressed," or "I'm
suicidal," or "I'm drug-addicted, and I need help for that." And then as we evaluate them we see what
their personality pattern has been long-term, and then we make that other
diagnosis. But anti-socials as a group
have a high level of co-morbidity with substance use disorders, alcoholism,
drug addiction, they're often addicted to gambling, they often suffer
depression or other anxiety disorders; so those are all fairly common.
Now there's a group of them that also seem to have
this Borderline Personality Disorder, which is a disorder that tends to be more
common in women. Basically, in a
nutshell, for those who are not familiar with it, it's a disorder of emotional
intensity. People get overly emotional
reactions when things happen to them, and what that produces is rapidly
shifting moods, difficult relationships, suicidal behaviors, self-harm by
cutting or burning or other methods. I
think one way you could look at it is, these women (because it's mostly women)
are in distress, and they're taking it out on themselves, where[as] the men
with anti-social personality disorder, they're kind of taking it out on the
world around them. So they're
externalizing their problem; the women are internalizing their problem.
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