If you are a regular reader of this site, you know that in an earlier rather lengthy article we analyzed the popular public diagnoses of Jodi Arias. I posted this article well before Dr. DeMarte stated her diagnosis during testimony.
I have had many of my regular readers ask me how I felt about Dr. DeMarte’s diagnosis of borderline personality disorder (BPD), in light of the fact that my earlier article had chosen antisocial personality disorder (ASPD) over BPD.
The fact that we disagree does not come as a surprise to me. Studies show that professional agreement of particular diagnoses is surprisingly low (Aboraya, 2007).
A look at research done in this area shows something of note. Studies that were done to look specifically at diagnoses, across professionals, show the following results. When licensed practicing clinicians, as a whole, were divided into three groups: 1) those who had recently graduated; 2) those who were more distant from having graduated; and 3) those who were the most distant from having graduated, a most interesting relationship was found (kappa score). The highest agreement of diagnoses was in the group of professionals who had most recently graduated or group one.
Group two, those who were more distant from their date of graduation were less likely to agree upon diagnoses and group three, who were the most distant from their time in graduate school, had the least agreement of diagnoses.
Let me state that another way. Those who had the least experience, agreed the most. Those who had the most experience, agreed the least. There does appear to be a correlation between experience and agreement of diagnoses.
Logically, two explanations are possible. It could be that the most experienced group, agreed the least, because they just forgot how to do a diagnosis since they had been out of school so long. I don’t think this is very likely.
The second explanation, is the one that I choose and believe to be true. With experience you come to see the uniqueness of each client, their problems and their situations. As a clinician, if you’ve had 100 borderline clients, you’ve had 100 different clients. No two were the same.
Experience makes it harder and harder, to neatly fit a unique individual into a category contained within a book. We should not come to believe too strongly in a particular category. Why? Because with certainty, we know that category and the diagnostic criteria to fit someone into that category, will most definitely change.
The DSM-5 will be out very shortly. The diagnostic criteria for antisocial PD has changed (Paris, Chenard-Poirier, & Biskin, 2013). Before, or should I say currently, to diagnose someone with antisocial PD, conduct disorder must be present before the age of 15.
In the DSM-5, this is no longer true. Today, there are many individuals who would qualify and do qualify for a diagnosis of antisocial PD, except there is no evidence of conduct disorder before the age of 15. Two months from now, they will qualify.
This is not a complaint about the DSM but is instead a realization of the limitations of labeling and categorizing human beings. I wrote much about this in the previous article “Diagnosing Jodi Arias.” I would encourage you to read that article for more of an explanation, as I do not plan to repeat that information in this article.
Now back to Dr. DeMarte and her diagnosis of borderline PD. It’s not too bad. I still believe wholeheartedly, that the antisocial PD diagnosis is most appropriate.
In her testimony Dr. DeMarte stated why she believed a diagnosis of borderline fit Jodi Arias. She did not discuss why a diagnosis of antisocial was not her choice. I can’t speak for Dr. DeMarte but I don’t think that she would’ve argued too much against a diagnosis of antisocial PD.
It’s a best fit situation, not a perfect fit. All the personality disorders are axis II diagnoses. We have to choose one. What we need for Jodi, is a new category, that encompasses antisocial, borderline, narcissistic and histrionic. She shows traits of each of these categories.
I’ve also received emails from individuals who have been diagnosed with borderline personality disorder. Because of Jodi’s diagnosis, they are worried that they too could become a horrendous murderer or that their friends or family members will come to see them that way. That’s the problem with labeling.
For those of you that have written in, diagnosed with borderline personality disorder, worried that you too are like Jodi Arias, stop worrying. You are very different. First of all, Jodi Arias would never have written in, worried about being a murderer or being perceived as one.
You care and you worry because you do have a conscience and have morality. From all I’ve seen and read, Jodi Arias does not. If Jodi Arias is found innocent and moves into the house next door to mine, I will move out. That’s how dangerous I believe Jodi Arias to be and how dangerous I believe anyone could be with antisocial personality disorder.
If someone with borderline personality disorder, moved into the house next door, I would have no worries. Anyone can be dangerous, with or without a personality disorder, and each individual is different, each situation different. I am speaking generally and saying that there is a major difference between someone with borderline PD and someone with antisocial PD. One is very dangerous, and the other potentially dangerous but no more so than any other stranger. The antisocial is dangerous to others. The borderline PD, is far more dangerous to themselves than to others.
Now back to the Dr. Randle – Dr. DeMarte debate. No I don’t agree that borderline is a better diagnosis than antisocial. There is an elephant in the room that nobody wants to talk about, and that’s Jodi’s lying. Lying and deception, are not characteristic of borderline personality disorder. With Jodi Arias, we are talking about immense lies and grand attempts to deceive. If you haven’t followed this case too closely, then her lying may not be so apparent to you. If you just heard, on the news, that first she lied about being there and then she lied about two ninjas having committed the murder, then you really don’t know about Jodi Arias the liar.
To see Jodi in action, you need to see her Academy award winning performances in her 48 Hour interviews and her police interrogation. You really need to see those interviews.
After watching those interviews, you might say “my God, who could lie like that?” If God doesn’t choose to respond to your question, I will (he loves you but he is very busy).
Who could? An antisocial could. They could. They can and they do. If for no other reason, this makes Jodi Arias someone with antisocial PD.
I would like to include just one more reason why Jodi Arias better fits antisocial than borderline. The lack of emotion. Have you seen her show any real remorse in the courtroom? When she talks about killing Travis, she shows no remorse. After arriving back home at Yreka, having just finished days earlier killing Travis, she acted perfectly normally. Her father said so. Her mother said so. People at work said so.
Where is the emotion? Where is the terror? Where is the guilt? I could give you many, many examples but if you’ve watched this trial, you already know them well enough.
Someone with borderline PD, is filled with emotion. They have trouble dealing with that emotion. They have trouble containing that emotion. Not just a little trouble but more like the trouble you’d have trying to put a cork in an erupting volcano. They are filled with swirling intense emotions.
Do you see, have you seen, anything like that in Jodi Arias?
In the debate between a diagnosis of borderline and antisocial, there is one last thing of tremendous importance. Premeditation. The prosecution contends that this murder was premeditated. A .25 caliber pistol, was stolen from the home in which Jodi was living, just one week before Jodi shot Travis Alexander in the head with a .25 caliber pistol.
Jodi borrowed and bought, gas cans, that would conveniently eliminate the need for gas receipts and records as she diverted her trip to Salt Lake City, to include a trip to Mesa to kill Travis. She also shut off her cell phone, so that there would be no cell phone records to go along with no gas receipts, so that there would be no evidence of her trip to Mesa.
There are many more things, much more evidence, that proves Jodi Arias premeditated this murder.
Premeditated murder requires planning, scheming and deception. These are all characteristic of antisocial personality disorder. This premeditation shows a desire to kill that goes back at least a week or more. That means the urge to kill, the emotion necessary to kill, has been sustained for at least a week or more.
Though someone with borderline personality disorder may feel the urge to kill in a fit of rage, this emotional state will pass quickly, usually within minutes or hours. Rarely will this last as long as a day. If Jodi Arias did indeed premeditate this murder, it almost completely eliminates the possibility of her primary diagnosis being borderline personality disorder.
Dr. DeMarte testified as to the reasons why Jodi Arias fit a diagnosis of borderline personality disorder. She did not focus on the reasons why Jodi Arias does not fit a diagnosis of borderline PD. She likewise, did not testify as to why a diagnosis of antisocial PD would be incorrect. I am not at all blaming her, after all she could only answer the questions that were asked of her.
I can live with the diagnosis of borderline personality disorder. It however, does not fit as well as does the diagnosis of antisocial personality disorder.
Aboraya A. (2007) Clinicians’ opinions on the reliability of psychiatric diagnoses in clinical settings. Psychiatry (Edgmont), 4, 31-33.
Paris, J., Chenard-Poirier, M., & Biskin, R. (2013). Antisocial and borderline personality disorders revisited. Comprehensive Psychiatry, 54, 321-325.