By Sakuni Weerasinghe
The Johnny Depp versus Amber Heard defamation trial had many of us glued to our screens over the past few weeks. Among the many twists and turns this highly publicised trial has taken, one of the most pronounced moments came with a clinical and forensic psychologist from Depp’s legal team diagnosing Amber Heard with two personality disorders: Borderline Personality Disorder (BPD) and Histrionic Personality Disorder (HPD). These diagnoses were allegedly arrived at after the psychologist had engaged in 12 hours of direct testing in addition to reviewing case and medical documents. This testing had involved the Minnesota Multiphasic Personality Instrument (MMPI) which is a standardised assessment commonly used to assess adult personality and psychopathology. As per the psychologist’s testimony, Amber’s scores on this evaluation had been consistent with other people who had displayed traits specific to BPD and HPD.
No sooner had these diagnoses been revealed, the internet was filled with stigmatising conversations about personality disorders. For many, it was the first time they had heard of a personality disorder. Others considered abuse to be synonymous with having a personality disorder. Some started diagnosing people they have been acquainted with who displayed similar characteristics as Amber. The result? Extremely harmful notions about what it means to have a personality disorder.
According to a revision of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) study by Trull and Colleagues (2010), out of all personality disorders, those of Cluster B which include BPD and HPD, are the most prevalent totaling 5.5% of the U.S. population. Along with this study, surveys have consistently shown high prevalence rates (2.7%), especially for BPD. It has also emerged to be one of the most stigmatised of all personality disorders. Cluster B personality disorders are often labelled, “dramatic”, “manipulative”, and “emotionally unstable”. For example, people with BPD on hospital admission during a crisis were reported to commonly face discrimination, with suicide attempts being viewed as “attention-seeking” as opposed to a symptom of a disorder. Further studies have also found that people with BPD were assigned more negative traits than those with depression or anxiety. The stereotype that people with personality disorders are troublesome has also led authorities to take more stern action or provide services that are not suited to the unique needs of these individuals.
The stigma related to BPD unfortunately is present within the mental health community itself. It has been established in literature (such as in Mark Zimmerman’s article in 2015) that stigma also plays a role in diagnosis and assessment, with insufficient diagnostic tools being available to accurately assess the BPD population. This has often led to the misdiagnosis of these individuals as having mood disorders such as bipolar disorder. Since interventions rely on accurate diagnosis, these individuals would then not receive the care required.
While the signs of BPD and HPD may be talked about at length, especially during highly publicised cases like this, their respective etiologies are rarely brought into the spotlight. Individuals with these diagnoses are those that have undergone significant abuse or trauma or even neglect as young children. Their experiences of mistreatment and abandonment are what bring up “fears of abandonment” in their relationships as adults. As a response to these fears, they may engage in behaviours such as a push and pull dynamic, that can be damaging to relationships and perceived as being done out of spite. Despite being viewed this way, their intention would be to get their loved ones to stay. The strategies that had worked in their past would still be the strategies they would use to meet their needs as adults, which is an alternate explanation as to why their behaviours appear manipulative. Difficulties in emotion regulation can also result from being brought up in an environment where emotions were invalidated or their expression considered unacceptable by parents/parental figures. This may result in experiences of mood swings and coping with intense emotions in harmful ways. This may present as self-harm (internalised) or aggression/violence (externalised) among other maladaptive coping mechanisms. Due to the trial being centred around alleged violence, people have been quick to assume that everyone with BPD is violent which is extremely stigmatising. Psychologists have long posited that there are many combinations of symptoms when it comes to personality disorders which would make the case for them to exist on a spectrum. Therefore, symptoms of BPD or HPD may appear frequently and in higher intensities in some individuals in comparison to others.
Abuse is never okay, never in any circumstance. At the same time, we must refrain from judging an entire community of individuals already battling stigma and discrimination, based on our perceptions of one case.
Author description:
Sakuni Weerasinghe is an Applied Psychologist and Lecturer with an MSc from the UK, and a BSc in Psych Counselling from Sri Lanka.
Twitter: @sakuniamanda
Instagram: @breathe.lk
Facebook: breathe.lk
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Amber Heard’s diagnosis : The stigma of personality disorders
15 May 2022
Amber Heard’s diagnosis : The stigma of personality disorders
15 May 2022