Mental health question: what would this person be diagnosed with?

Factual Questions
1
  1. This is for a story and involves no actual people
  2. I realize that there’s a lot of fuzzy lines in mental health stuff, and welcome multiple possible diagnoses.
  3. I may ask about some other characters later, but I’m working on WR’s story right now.

I have a character who has some serious mental problems (actually there’s several of them, but…). We’ll call him WR. I’m leaning towards anti-social personality disorder as the most likely diagnosis, but, obviously, I’m no expert in anyway.

He can be very charming although he gets annoyed and angry easily. He doesn’t really care about anything and is very vain (he got pissed because his wife glibly told their lawyer that he, the lawyer, was the best). He’ll go into rages and break shit over seemingly minor things.

He does care about his friends, all two or three of them, and tries to keep them from getting hurt. He desperately loves his wife and would never ever hurt her, something he repeats loudly whenever anyone suggests otherwise. Anyone who even slightly threatens her is likely to die, unless she says otherwise. (She’s pretty much the conscious he doesn’t have - he’ll do anything he finds amusing - although she’s not exactly a paragon of law-abidingness either)

He likes to fight and cheat at cards. He loves causing explosions and other excitement, without regard to the consequences. He’s quite sure the world revolves around him, and if it doesn’t, it revolves around his wife. He hates being bored and doesn’t deal with it well.

He can be very forgetful. He’ll blank out about stuff, even things he liked, and not remember them until reminded.

He has no tolerance for idiots (and bigots which he considers giant idiots) and doesn’t respect anyone he doesn’t like.

If it makes a difference, his parents were kinda giant assholes - his dad beat him with a belt at least weekly, they told him he was worthless and that they never wanted him, and they locked him his room, which was an unfinished basement with a cot and a set of cheap drawers. He actually ended up killing them when he was seventeen, although he was never connected to it (they think it was a wandering serial killer or something. It’s not a very nice city).

He ends up spending a lot of time in prison and the psychiatric hospital next to the prison (again, it’s that kind of city).

So what would he likely be diagnosed as and what sort of therapy / treatment would they give? I’m not looking for ‘cures’, just what the doctors would do to try to get him, um, socially acceptable, I guess.

2

if you’re just looking for a likely diagnosis for a fictional character, sounds like Mixed Personality Disorder NOS with Antisocial and Borderline features fits just fine. I would say Antisocial Personality Disorder with Psychopathy, except that he genuinely cares about his wife and friends.

3

Thanks.

What kind of therapies or treatments would the doctors put him through?

4

To elaborate slightly: the propensity for criminal behavior and violence he exhibits are clearly antisocial, but his dramatic interpersonal relationships with his wife and friends and his extreme black and white thinking regarding them suggests borderline features as well.

5

The most common treatment is a lenghty prison sentence (he said jokingly ;)).

Seriously, personality disorders are among the hardest to treat, although I understand cognitive behavioral therapies are somewhat promising, particularly group therapy approaches in criminal populations.

6

I think he protects his friends because he finds them amusing and useful. On the other hand, they’ve managed to convince him not to do things he enjoys - like driving. They may have exchanged sexual favors for that (he insists he’s a good driver since he’s never hit anything he didn’t mean to. His passengers think otherwise, as do the cars avoiding him)

And he can’t let himself even think about hurting his wife, because he’s afraid he will. (He’s hit her exactly once, and he was mind controlled at the time. It’s… that kind of series. And he completely freaked out about. They both deny it ever happened)

I’m not sure if he actually ‘feels’ love about his wife, or just acts it - not in the sense of faking it, but doing the things that show you love someone, if that makes any sense - but at a certain point it’s basically the same.

… I’m probably over thinking it.

:smiley: Oh, he gets those a lot. He just also breaks out a lot.

7

bumping for second opinions

8

Personality disorder- somewhere in cluster B (dramatic).

You’ve picked a few antisocial traits, some narcissistic, some borderline- if your character was real he’d probably have had several different diagnoses from several different psychiatrists, depending on what he chose to focus on as his main issue at that time.
Dialectical behavioral therapy is the big thing in EUPD/Borderline PD at the moment. Otherwise it is all group therapy and behaviour modification.

That isn’t to say your character won’t have tried antipsychotics (Seroquel), tranquilisers (Valium) and mood stabilisers (Lithium) in the past- they won’t have worked, but someone might have thought it was worth a try.

9

Oh group therapy could be fun… <evil grin> How wide of a range of disorders can I realistically put in the group?

Have there been big changes in the treatment since the mid-80s? I think that’s about the earliest he’s going to be treated, until I mess with the timeline some more.

10

Definitely Cluster B traits (Antisocial, Narcissistic, Borderline, Histrionic), perhaps with a Personality Disorder NOS ultimate diagnosis.

There have been some major changes in therapy since the 80s, most particularly with the use of Dialectical Behavior Therapy in the treatment of personality disorders (specifically Borderline PD), but in general, the feeling in the mental health community is still that the vast majority of personality disorders cannot be successfully treated.

And he’ll have not sought out that treatment on his own - someone will have forced him into it (loved one, court system). In any of the Cluster B disorders, the person in question will not feel that there is anything wrong with them at all. Instead, the problem will be everyone else - people who don’t recognize his specialness, his uniqueness, his importance.

11

Thanks. The way I’m writing him right now, the only thing that manages to control him in any way is his wife, who has some mental problems herself (they’re a little more complicated and very strictly in the fantasy category).

Thanks for your help everybody.

12

The other issue you’ll probably have to consider is his motivation for treatment. Personality disorders don’t usually voluntarily present for treatment - they aren’t motivated by emotional distress. Their significant others, OTOH, are frequently miserable and present for tx. So tx is probably involuntary for this character, and unlikely to make any headway.

13

Without reading the other posts, I’m going to go with sociopathic murderer. No effective cure or treatment available other than removal from society, aka prison.

14

He doesn’t seek treatment - he’s in prison and they send him over the mental part of it. Several of the stories are set there and I’ll probably want to about more than him cheating at cards and breaking out. :smiley:

15

I am pretty sure that if he was recaptured after breaking out of prison the first time, that they would put a 24 hour guard on him and tape him in his cell. I know it’s fiction and all, but being able to break out of prison multiple times is not a credible plot. Unless there are super-powers involved or something.

16

It’s somewhat a mix of X-men and Batman. Cardboard Prison is assumed.

17

Multiple prison escapes are very unlikely, but not unheard of. In Texas Steven Jay Russell has managed it multiple times, gaining international fame for himself in the process. My favorite escape:

“In 1996, while in Harris County Jail (Texas), Russell impersonated a judge and ordered his own bond decreased from $900,000 to $45,000, which he paid, securing his own release. He was arrested ten days later in Florida, and was subsequently transported back to Texas. That same year he began participating in art classes provided by the prison. Each time he attended a session, he stole a green Magic Marker and hid it under his bed. Eventually, he had enough markers to dye his white prison uniform green. Since all the medical professionals in the prison wore green uniforms, Russell was able to walk out of the prison disguised as a doctor.”

The Wikipedia article leaves the best part out: after he walked out of the prison, he called a cab and sweet talked the driver into driving him to the medical center in Houston. Since he was a big time doctor in his scrubs, he needed a lift to an important appointment, where he would have his administrator run out with the fare plus a $100 tip.

18

He’s an alcoholic or a child of an alcoholic.

19

What would he be diagnosed with? I’d say Every Guy Syndrome, to be most damning.

Most of what you describe is just regular people-type stuff, certainly not indicative of a mental illness. However, you offer up “Anyone who even slightly threatens her is likely to die, unless she says otherwise”… If that’s meant to be literal, then you are dealing with a horror story and not a mental illness.

20

He killed both his parents. Murder does not an everyman make.