Personality disorders and paraphilic disorders together have a few important characteristics that distinguish them, legally, from other groups of disorders in this chapter. First, neither of these sets of disorders provides a defense to someone who engages in criminal conduct due to the disorder. While some of the other disorders discussed in this chapter (e.g., psychotic and mood disorders) may, in some cases, excuse criminal conduct that is caused by the disorder, most state laws specify that criminal conduct driven by a personality disorder or paraphilic disorder will not be a basis for the insanity defense (discussed more in Chapter 6 of this text). Oregon, for example, excludes as a criminal defense any mental disorder that essentially consists of repeated antisocial conduct (for example, pedophilia, a paraphilic disorder that could cause a person to abuse children) and any personality disorder (Or. Rev. Stat. § 161.295). Another important distinction between these disorders and others is that, while therapy can be used to treat personality disorders or paraphilic disorders, these are patterns of behavior that are not considered treatable with medications in the same way psychotic or mood disorders may be (American Psychiatric Association, 2022b).

Personality Disorders

A person’s personality is their unique way of thinking, behaving, and feeling that makes them different from others. Personality is shaped by genetics and environment (American Psychiatric Association, 2022b). Ideally, a person’s personality is flexible and allows them to adapt to new situations, improve relationships, and build healthy coping skills (Mayo Clinic, 2023).

A personality disorder indicates that a person has personality traits that are less functional, causing them an array of problems in relating and responding to others. These problems, such as anger and impulsivity, may disrupt work and relationships, leading to social isolation and sometimes legal problems (Mayo Clinic, 2023).

There are 10 different personality disorders listed in the DSM-V-TR. Discussed here are three that are commonly seen in the criminal justice field.

Antisocial Personality Disorder

Antisocial personality disorder can be diagnosed when a person has a long-term pattern of manipulating, exploiting, or violating the rights of others. Genetic factors and environmental factors, such as child abuse, are believed to contribute to the development of this disorder. Intentional fire-setting and cruelty to animals during childhood are linked to the development of antisocial personality, but a person must be at least 18 years old to receive the diagnosis.

A person with antisocial personality may present as witty and charming, enabling them to manipulate others. However, the person is likely to disregard the safety of others and engage in acts such as stealing and fighting without guilt or remorse. Antisocial personality disorder (figure 2.15) is far more common in men than women, and it is vastly overrepresented in the criminal justice population. It is estimated that at least half—and maybe up to 75%—of incarcerated men have this disorder, compared to just about 5% or less of the general population (Schnittker, et al., 2020).

Antisocial personality disorder can be difficult to treat. Typically, individuals with this condition don’t seek treatment on their own. However, treatments that reward appropriate behavior and have negative consequences for negative behavior may work for some people.

Narcissistic Personality Disorder

A person with narcissistic personality disorder (figure 2.16) displays grandiosity (a sense that they are unique, extra-special, and important), a constant need for admiration, and a lack of empathy toward others. Together, these characteristics may lead to the person exploiting others due to a sense of entitlement (American Psychiatric Association, 2022b).

People with narcissistic personality disorder are more likely to have additional diagnoses of mood disorders and substance use disorders. Like antisocial personality disorder, this disorder is relatively rare, impacting less than 5% of the general population and appearing more frequently in men (Psychology Today, 2022a). However, rates of narcissistic personality disorder among people who have been convicted of crimes are thought to be much higher—especially among sexual offenders (Arbanas, 2022).

Borderline Personality Disorder

Borderline personality disorder (figure 2.17) is another personality disorder that is characterized by chaotic relationships, explosive emotions, and high rates of self-harm (Psychology Today, 2021a). People with borderline personality disorder are often uncertain about their identity. As a result, their interests and values can change rapidly. They tend to view things in terms of extremes: either all good or all bad. Their views of other people can change quickly, admiring a person one day and disdaining them the next. These suddenly shifting feelings often lead to intense and unstable relationships. Other symptoms include intense fear of abandonment, inability to tolerate being alone, engagement in risky behavior (e.g., substance use or gambling), and repeated crises or acts of self-harm. Borderline personality disorder carries a significant risk of suicidal behavior.

Genetics and social factors may play a role in the development of borderline personality disorder, as risk factors include childhood abandonment and abuse. Borderline personality disorder tends to occur more often in women than men.

Paraphilic Disorders

Paraphilic disorders are conditions where a person’s sexual arousal involves intense and atypical urges that cause distress or harm to the person or someone else. There are several paraphilias, including exhibitionistic disorder, pedophilic disorder, and sexual sadism disorder. Authors of the DSM added the term “disorder” to each of these diagnoses to clarify and emphasize that the experience of an unusual sexual interest (e.g., sadism) in itself does not amount to a disorder, and people engaging in consensual sexual conduct should not be improperly diagnosed with a disorder. Instead, atypical sexual urges are part of the diagnosis of a mental disorder only when the urges result in significant harm to that person or someone else (Psychology Today, 2022b; American Psychiatric Association, 2013).

Pedophilic disorder is the most well-known of the paraphilic disorders. Pedophilic disorder involves a continuing sexual attraction—signified by fantasies, urges, or behaviors—to prepubescent children, generally aged 13 or younger, of any gender. Diagnosis of pedophilic disorder requires more than simple experience of these sexual urges; the person must act on their urges or have serious distress or difficulty related to their urges (Psychology Today, 2022c).

Acting on urges related to a paraphilia may lead a person to engage in criminal behaviors (for example, the paraphilia of exhibitionism might cause a person to expose themself to an unsuspecting person on the bus). However, most sexual offenders with adult victims do not have paraphilic disorders; rather their behavior is driven by other factors and is often associated with other disorders such as antisocial personality disorder (Eher, et al., 2019).

Licenses and Attributions for Personality Disorders and Paraphilic Disorders

Open Content, Original

“Personality Disorders and Paraphilic Disorders” by Anne Nichol is licensed under CC BY 4.0.

Open Content, Shared Previously

“Antisocial Personality Disorder” is adapted from “Antisocial Personality Disorder” by Substance Abuse and Mental Health Services Administration (SAMHSA), which is in the Public Domain. Modifications by Anne Nichol, licensed CC BY 4.0, include adapting, condensing, and expanding the content.

“Borderline Personality Disorder” is adapted from “Borderline Personality Disorder” by Substance Abuse and Mental Health Services Administration (SAMHSA), which is in the Public Domain. Modifications by Anne Nichol, licensed CC BY 4.0, include revising and condensing, and expanding the content.

Figure 2.15. Signs of Antisocial Personality Disorder by MissLunaRose12 is licensed under CC BY-SA 4.0.

Figure 2.16. Signs of Narcissistic Personality Disorder by MissLunaRose12 is licensed under CC BY-SA 4.0.

Figure 2.17. Signs of Borderline Personality Disorder by MissLunaRose12 is licensed under CC BY-SA 4.0.