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Man Found Competent to Stand Trial - Schizotypal Personality Disorder Discussed

Posted Feb 03 2009 12:47am

Here’s an article summarizing the finding that a man accused of killing his wife is competent to stand trial. Opposing experts testified before the judge, with the defense expert stating the defendant’s diagnosis, Schizotypal Personality Disorder (in addition to either Narcissistic Personality Disorder or narcissistic features) was impairing his ability to aid in his defense. The prosecutor’s expert, in contrast, stated the defendant is capable of both understanding the proceedings, and aiding in his defense; he is simply choosing not to do so. In a previous post, I discussed the standards with respect to competency to stand trial here, if any readers are more interested.

More interestingly, I find the effort to argue an individual to be incompetent to stand trial on the basis of a personality disorder to be interesting, simply because personality disorders are generally not considered to be a “severe mental disease or defect,” often a requirement for a finding of incompetence. However, if there is going to be a personality disorder that one might make an argument on, Schizotypal PD is certainly one of the better personality disorders to go with.

According to the DSM-IV-TR, personality traits are enduring patterns of perceiving, relating to, and thinking about the environment and oneself that are exhibited in a wide range of social and personal contexts. Only when personality traits are inflexible and maladaptive and cause significant functional impairment or subjective distress do they constitute Personality Disorders. The essential feature of a Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual' s culture and is manifested in at least two of the following areas: cognition, affectivity, interpersonal functioning, or impulse control. This enduring pattern is inflexible and pervasive across a broad range of personal and social situations and leads to clinically significant distress or impairment in social, occupational, or other important areas of functioning. The pattern is stable and of long duration, and its onset can be traced back at least to adolescence or early adulthood.

More specifically, Schizotypal Personality Disorder is considered to be a pervasive pattern of social and interpersonal deficits marked by acute discomfort with, and reduced capacity for, close relationships. In addition, there is a presence of cognitive or perceptual distortions and eccentricities of behavior. These patterns are usually first observed by early childhood, and are present in a variety of contexts.

More casually, many consider Schizotypal PD to be “mild schizophrenia,” in that they have difficulty in relationships, odd/eccentric behavior, and peculiar beliefs about others and the world. They tend to interpret events and statements in a different manner than the typical person, and often have associated depression and/or anxiety due to their difficulty of “fitting in.” However, they generally do not exhibit symptoms that rise to the level of psychosis (i.e. a “break with reality”). Wracking my brain for examples in pop culture, I think Johnny Depp’s character in Benny and Joon might qualify, though it’s been a long time since I’ve seen that film, and he may have been schizophrenic. Another possible example would be Robert De Niro’s Travis Bickle in Taxi Driver, prior to his decompensation. He definitely had severe suspiciousness (if not paranoia), but their was an odd interpersonal style as well; for example, his complete inability to understand that taking a woman to a porn film on a first date may not be the best way to make a good first impression.

In the context of competency issues, I think any personality disorder is a tough sell for a cause of incompetency, even Schizotypal PD. While the DSM-IV description sounds severe (and often the poor judgment exhibited by individuals with personality disorders is quite severe), there is no underlying disconnect with reality - individuals with personality disorders are aware of their actions, and the potential consequences. Generally speaking, personality disorders are not even raised as a possible diagnositc reason for competency - they are simply not considered to meet the criteria of “severe mental disease or defect,” in the legal sense of that phrase.

What can happen, however, is that the difficulties in functioning as a result of an individual’s personality issues can become so significant that other issues also appear. The other possibility is that the symptom presentation that meets critieria for the personality disorder eventually manifests into a more severe mental health problem over time.  In the example of Taxi Driver above, Travis Bickle’s personality traits lead to a series of increasingly poor decisions and interpretations, that be the end of the film he has developed a significant psychotic disorder. Or, in another way of interpreting it, the Schizotypal PD was a prodromal presentation of a more severe psychotic diorder.  Enough information is not contained in the article to be able to say whether that has occurred in this particular case, though I think that would have been argued by the defense if that were in fact the case. Once again, the threshold for a finding of competence is very low - it takes a truly significant degree of impairment to be found incompetent. In the case of personality disorders, their lack of cooperation with the trial process, no matter how stupid (to be blunt), is a decision made with a sufficient knowledge of the consequences.

The other interesting comment from the article (to me) was this statement:

In such cases a person is often considered odd or bizarre and does interact well with others.
Obolsky said Pender was also extremely narcissistic and boasted of dating 3,000 women. He also does not respect boundaries and cannot prioritize information to determine what is important, Obolsky said.

"He can' t process what he' s told. It just doesn' t register," he said.

It also can' t be faked, Obolsky noted. "It' s an actual unhinging of the mind."

This is simply an incredibly odd statement to make; anything can be faked. Some disorders are easier to fake than others, and some people are better than others at faking. However, if a person reads the relevant information, and particularly if they receive coaching, some people are actually not bad at it. It is usually caught, but the idea that someone “can’t fake” certain diagnoses sounds strange to me. I wonder if there is something lost in the translation here, such as the defense attorney stating that the defendant was not faking, based on observations, etc. I simply can’t imagine anyone saying a mental health diagnosis can’t be faked.

Anyway, I thought this blurb would provide a good opportunity to discuss competency and how it works in the real world. I’ll continue to seek out other examples and offer observations as they become available.

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