Certain mental disorders are frequently encountered in the criminal justice system, but they are distinct from the psychotic and mood disorders discussed in the previous section for a few reasons. First, the previously discussed disorders may, in some cases, provide a defense to criminal conduct, an issue discussed in later chapters of this text. However, most states (including Oregon) specifically exclude as a criminal defense the influence of a mental disorder that is manifested only by repeated antisocial conduct (for example, pedophilia, a paraphilic disorder that can be the driver for a person to abuse children) or a personality disorder (Or. Rev. Stat. §161.295) Additionally, 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, 2022).

2.4.1 Personality Disorders

A personality disorder is a mental disorder where a person’s atypical thinking and functioning cause them to have trouble understanding and relating to others – often causing them to have problems in many areas of life, including work and social relationships. A personality disorder is based on long-standing patterns that comprise a person’s personality – and generally are not changeable. A person with a personality disorder may be unaware of their problematic approaches (Mayo Clinic, 2016).

There are ten different personality disorders listed in the DSM-V-TR. Discussed here are three that are more commonly seen in the criminal justice field, including in correctional settings, forensic hospitals, and mandated treatment settings – sometimes in conjunction with other mental disorders.

2.4.1.1 Antisocial Personality Disorder

Antisocial personality disorder (APD) describes someone who is continuously violating the rights of others. This may include lying, fighting, and engaging in impulsive, reckless behavior. People with APD can be deceitful for personal gain. People with this disorder often struggle abiding by the law and have limited empathy towards others. Someone diagnosed with antisocial personality disorder may end up in the criminal justice system due to a greatly increased likelihood of engaging in illegal activities. Diagnosis of antisocial personality disorder requires that a person be at least 18 years old and have a childhood history of behavioral and emotional problems.

Antisocial personality disorder (figure 2.11) 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 percent – of incarcerated men have antisocial personality disorder, compared to just about 5 percent or less of the general population (Schnittker, Larimore, & Lee, 2020). Although maladaptive behaviors can be addressed in treatment, it is difficult to change long-standing thought patterns that support an antisocial lifestyle.

Figure 2.11 shows several of the signs or symptoms of antisocial personality disorder.

2.4.1.2 Narcissistic Personality Disorder

A person with narcissistic personality disorder (figure 2.12) displays grandiosity (a sense that they are unique, extra-special and important), a constant need for admiration, and a lack of empathy towards others. Together, these characteristics may lead to exploitation of others due to a sense of entitlement.

Figure 2.12 shows several of the signs or symptoms of narcissistic personality disorder.

People with narcissistic personality disorder are more likely to have additional diagnoses of mood disorder and substance use disorders, as well. Like antisocial personality disorder, this disorder is relatively rare – impacting less than 5 percent of the general population (Psychology Today, 2022). However, rates of narcissistic personality disorder among people formally convicted is thought to be much higher – especially among sexual offenders (Arbanas, 2022).

2.4.1.3 Borderline Personality Disorder

Borderline personality disorder (figure 2.13 is another chronic condition that is characterized by unstable and intense relationships, intense mood changes, and high rates of self-harm (Psychology Today, 2021). A person with borderline personality disorder (BPD) experiences what is commonly called all-or-nothing thinking. For instance, a person with this disorder is hindered in connecting with others as they can vacillate frequently on whether the other person is “good” or “bad,” which they will see in black-and-white terms. The person with BPD may experience extreme fear of abandonment and separation, either real or imagined. A romantic partner may be idealized early in a relationship, but then later vilified at the slightest sign of perceived disinterest. For people with BPD, thoughts of suicide are common, as are self-harming behaviors such as cutting.

Figure 2.13 shows several of the signs or symptoms of borderline personality disorder.

People with BPD are often survivors of trauma, including abuse or abandonment. BPD is more common in women than men. This disorder is often identified in emergency rooms after suicidal gestures, in correctional settings, or in treatment facilities (Psychology Today, 2021). Later in this textbook, we will discuss certain treatment options for people with BPD. Significant progress has been made to treat those struggling with this diagnosis.

2.4.2 Paraphilic Disorders

Paraphilic disorders are conditions where a person’s sexual arousal is dependent upon specific, atypical and sometimes extreme behaviors that cause distress or harm. Examples would be arousal involving animals, or behaviors such as causing pain or exposing oneself. The disorder is distinguished from mere unusual interests by the fact that it hurts or impairs the affected person or someone else. There are a number of paraphilias, including exhibitionism, fetishism, and sexual sadism (Psychology Today, 2022).

Pedophilia is the most well-known of the paraphilic disorders, and one of the more common ones. Pedophilic disorder involves ongoing sexual attraction – intense fantasies, urges, or behaviors – involving prepubescent children, of any gender, generally aged 13 or younger. Males are more likely to have this disorder. 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, 2022).

Acting on urges may lead a person to commit criminal behaviors, and paraphilias are often identified in the criminal justice system after someone has already committed a sexual crime. Once someone has sexually victimized a person and has had legal action taken against them, they are often mandated to sex offense specific treatment either during the legal process, while incarcerated, or post-conviction while on supervised release (i.e. probation). When someone has been diagnosed with a paraphilic disorder, sexual preference will be identified while in sex offense specific treatment to best categorize the person’s sexual interest and target treatment modalities accordingly.

2.4.3 Licenses and Attributions

“Personality Disorders and Paraphilic Disorders” by Kendra Harding is licensed under CC BY 4.0.

Modification: Copied some paragraphs verbatim and reworded others from U.S. Department of Justice

Figure 2.11. Signs of Antisocial Personality Disorder by MissLunaRose12 is licensed under CC BY-SA 4.0

Figure 2.12. Signs of Narcissistic Personality Disorder by MissLunaRose12, is licensed under CC BY-SA 4.0

Figure 2.13. Signs of Borderline Personality Disorder by MissLunaRose12, is licensed under CC BY-SA 4.0