Histrionic Personality Disorder Might Not Be a Real Thing

I’m starting to wonder if Jerry Sandusky’s defense team has decided to sabotage him. They recently announced they’ll introduce evidence that Sandusky has Histrionic Personality Disorder (HPD), which they say will explain the letters he sent to the young boys. The idea is that, if he has HPD, the letters were just an inappropriately dramatic expression of his innocent love for the kids rather than “grooming letters” from a predator.

This suggestion of HPD is completely idiotic. It’s idiotic from a mental health perspective and idiotic from a legal perspective. It’s so idiotic, in fact, it seems deliberate.

If you want to know how the media is describing HPD is, go here for a good start. But it doesn’t really matter, and here’s why: Soon HPD may not even exist. The Diagnostic and Statistical Manual of Mental Disorders (DSM)—known as the “bible” of mental illness—is undergoing one of its revisions. This book determines which illnesses are official and which are not, which are covered by insurance and which are not, which are credible in the legal context and which are not. And one of the revisions is the elimination of HPD.

The current DSM includes 10 personality disorders, but the proposal is to eliminate five of those, including HPD. The rationale for the revision reads:

In fact, most patients diagnosed with personality disorders meet criteria for more than one. In addition, all of the personality disorder categories have arbitrary diagnostic thresholds, i.e., the number of criteria necessary for a diagnosis. PD diagnoses have been shown in longitudinal follow-along studies to be significantly less stable over time than their definition in DSM-IV implies (e.g., Grilo et al., 2004).

The rationale goes on to suggest that HPD diagnoses have become, essentially, invalid.

Sandusky’s attorneys are obviously out of touch with the current thinking on the disorder they’re using to explain their client’s behavior. That’s not good representation. Because of that, their claim could be handily discredited with a savvy rebuttal by a DSM heavy hitter, many of whom practice in this area. So if you’re going to say he did it because he was crazy, you better come up with a better crazy.

But that’s another issue: The justice system has a high threshold when it comes to using mental disorders as a defense. It works best when a person has committed a single horrific act during which they were out of touch with reality. Think of Andrea Yates, the Texas woman diagnosed with schizophrenia who drowned her children in the bathtub. At the time of that act, she was, according to the justice system, unable to distinguish right from wrong or that what she was doing was wrong because she was in a psychotic state. A consistent pattern of sexually inappropriate behavior over a period of many years during which the defendant was otherwise functional and even thriving does not typically bode well, which Sandusky’s lawyers must know.

Or maybe they don’t? Maybe they’re just incompetent? After reading the alleged victims’ testimony this week, I’m comfortable either way.