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Social Sci LibreTexts

8.17: Borderline Personality Disorder

  • Page ID
    23210
  • Name: Mad Hatter

    Source: Alice in Wonderland (movies, 1951 & 2010)

    Background Information

    In the 1951 film

    Mad Hatter appears to be Caucasian male is in his late thirties, although his age is never disclosed. He is a fictional character in Alice’s dream. In the movie there are not any known physical or mental illness to be associated with the Mad Hatter, although there are visible traits to be noted for. He appears to be eccentric in his behavior and also in his appearance. He is dressed in a olive green blazer, with a green vest, aqua bow tie, beige button down shirt in which the collar is up, green pants and a large green top hat where on the side there is a 10/6 paper. He has white hair sticking out from the hat, and is rather pink in complexation throughout the movie. Prior to Alice stumbling upon them, the Mad Hatter and the Hare can be seen having a party celebrating non-birthdays (a celebration of all the other days in the year that are not one’s birthday). Currently the Mad Hatter lives in the forest that is a figmentation of Alice’s dream. It is unknown if the Mad Hatter has any family, although he can be seen quite often with the Hare and a little mouse. The Hare can be seen has having similar traits as the Mad Hatter; not being able to sit in one spot, interrupting others, speaking rather fast, constantly moving and appears to break teacups.

    In the 2010 version

    The Mad Hatter appears to be living in a forest that is part of Alice’s dream, in which he lives with Mally and the Hare. He appears to be in his mid-thirties, although his age is never disclosed. He is Caucasian and dresses vibrant. He has on a rather large top hat on, which has random objects stick out of it. Under the hat can be seen his is orange hair that is rather wild. His face is painted, in which his eyes are painted an array of colors; such as blue on, orange, and brown on one eye and the other pink and orange and purple on the other eye. His whole face is painted white. He can be seen wearing a brown tattered suit that is randomly put together, in which it matches his personality perfectly. Throughout the movie, his parents and other family members are never disclosed. Although he is rather fond of the White Queen and he remains loyal to her. The Mad Hatter lost his enjoyment and became “crazy” due to the Queen of Hearts overtaking the White Queen. This happened when the Jabberwocky came and destroyed the White Queen’s area and caused massive damage to her property. After that the Mad Hatter was never the same, he was no longer happy.

    Description of the Problem

    In the 1951 film

    The Mad Hatter can be seen singing and dancing with the Hare. They are drinking tea and while dancing they continue to pour each other tea. Once they discover Alice has been watching them, they stop their dancing and signing. They run to Alice to tell her ” it’s veryvery rude to sit down without being invited”, but quickly overcome this once she compliments them on their singing. While the Mad Hatter is talking to Alice, he has his elbow in a cup of tea, and at one point he even pours tea from the kettle down his shirt and makes the tea go into a cup. They ask Alice where she came from but never give her a chance to answer, because they become distracted by clean cups they stubble upon. While dancing with the Hare to teach Alice about what non-birthday celebration is, the Mad Hatter makes a cake appear in place of where his top hat was. At one point he dips his plate into his tea and takes a bite out of the plate. He never stays with one thing, while talking to Alice about birthdays, he insists that she drinks some tea, but as she starts to drink her tea he starts to sing “clean cup clean cup!!” Before Alice can even take a sip of her tea he has dragged her off to the other end of the table and proceeds to ask her if she would like more tea. He can hardly sit still, every few minutes; he is compelled to move down the table and has Alice and the Hare to move down with him. It is clear that the character has difficulty focusing their attention to one aspect and also has difficulty remaining in one spot. The Hatter asks her “Why is a raven like a writing desk?” but never gives Alice the chance to answer. He quickly becomes angry when she attempts to answer the question, but his attention is diverted when the White Rabbit comes exclaiming he is late. The Mad Hatter tells the White Rabbit that his watch his two days old and proceeds to destroy the White Rabbit’s watch by dipping it in tea and adding an assortment of food to the watch. After placing all the food into the watch the Hare smashes the watch with his sledgehammer and the Mad Hatter and he kick out the White Rabbit.
    When called to Alice’s trial as a witness, it he decides to throw the Queen of Hearts a unbirthday party, but this makes the Queen happy and does not last long due to Alice seeing Chester the Cat on top of the Queen’s head and the Mad Hatter running on top of the Queen to obtain Chester the Cat.

    In the 2010 film

    Upon seeing Alice approach him, he climbs on the table and walks across it, as he breaks plates and teacups along the way. Mally tells him that it is the wrong Alice, the Mad Hatter is positive that it is not the wrong Alice, and this is the correct one. While Alice is having tea with the Mad Hatter, the Hare and Dormouse, Chester the cat appears. While Chester is having tea, he brings up a topic that is sore for the Mad Hatter, who instantly becomes enraged in which Dormouse has to remind the Mad Hatter he needs to calm down. He is rather protective of Alice; when the guards of the Queen of Hearts come he hides her in a tea kettle. Upon making sure that Alice is safe, Mad Hatter puts her on his hat, after he had shrunk her, and takes her for a walk. While walking he starts to talk about the Jabberwocky and becomes enraged when Alice tells him that she will not slay the Jabberwocky. Talking to Alice about why she needs to slay the Jabberwocky, Mad Hatter becomes emotional, and tells Alice she has changed. He continues to go to lengths to protect Alice; he throws his hat with her on it across the field, so the Queen of Heart’s guards do not capture her, instead they capture him. He lies to the Queen and tells he has not seen Alice; when she is clearly sitting next to the Queen. Instead of answering the Queen’s question, he tells her that he is thinking of things that start with M: moron, mutiny, murder and malice. He decides to charm the Queen, by tell her that he wants to make her a hat for her rather large head. Once the White Queen regained her land again, the Mad Hatter is happy. To show his happiness he does The Futterwacken Dance, which he was not able to do when the White Queen was not in power.

    Diagnosis

    The diagnosis the Mad Hatter seems to fit best is Borderline Personality Disorder (301.83).

    1. Borderline Personality disorder is consider a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. This is indicated by having 5 or more of the following characteristics:
    2. Being frantic to avoid abandonment, either real or imagined
    3. A pattern of intense, unstable interpersonal relationships characterized by alternating between extreme variances of idealization and devaluation
      • He displays this among Mally and the Hare. He is constantly changing his mood and one minute is harsh to them, and the next minute he thinks they have the greatest idea ever. Also, he instantly he is drawn to Alice once he sees her. He goes out of his way to protect Alice from the Queen of Hearts.
    4. Identity disturbance: markedly and persistently unstable self-image or sense of self
      • Although he knows he is the Mad Hatter, he does not seem like he knows this all the time. In the 2010 version the Mad Hatter saw himself as being with the White Queen, but after the Queen of Heart took over, he no longer knew who he was. He was one minute was having tea with Mally and the Hare, the next minute protecting Alice from the Queen of Hearts, and also he was someone that made hats.
    5. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
      • The Mad Hatter in the 2010 version fits this better, in that he is willing to himself at risk constantly for Alice. He takes on the Queen of Hearts’ guards, he repeatedly insults them and challenges them. Although it is never disclosed, he displays a several symptoms of someone that may have substance abuse, he is quick to change his behavior, his moods are hardly stable; they vary greatly from sadness, happiness, and anger, his behavior is eccentric; he talks in riddles and is constantly moving.
    6. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
    7. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
      • He displays this GREATLY. He varies through multiple emotions, one minute he is happy then the next minute he is angry. Upon seeing Alice he drops what he is doing and decides to walk across the table to get to her. He is happy to see her because she is the right Alice and is the one that can slay the Jabberwocky. While Chester pops in for tea and brings up the topic of the Queen of Hearts taking over, Mad Hatter becomes angry instantly and cannot control his anger until Mally reminds of where he is. He displays symptoms of Attention Deficit Hyperactivity Disorder, one minute he is talking about something and his attention becomes drifted to something else. The Mad Hatter in the 1951 could qualify of Attention Deficit Hyperactivity Disorder due to his lack of being able to focus on one thing. One minute he is telling Alice to have tea but then makes everyone move down because he saw a clean cup. He is constantly over talking the Hare and Alice. His emotions are unstable; he can easy become angry but can be pacified quickly. Both of the Mad Hatters are impulsive in the sense they do something without thinking about it. For instance in the 2010 version, the Mad Hatter is quick to insult the Queen of Hearts, but is quickly able to get himself out of being killed by telling the Queen he wants to make her a hat for her big head. In the 1951 version, the Mad Hatter throws the Queen of Hearts a unbirthday party when he is on trial for Alice.
    8. Chronic feelings of emptiness
      • Personally I feel like he has these feelings, and hides them by being eccentric. Reasoning for why he would have feelings of emptiness is that when the Queen of Hearts took over, he could no longer do what he loved; being with the White Queen. He is now living in a forest and displays multitudes of emotions rather rapidly. You can sense he is hiding his true feelings; depression of the White Queen no longer in charge.
    9. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
      • He becomes angry instantly when Chester brings up the day of when the Queen of Hearts took over. Mally has to remind him of where he is and to control his anger.
    10. Transient, stress-related paranoid ideation or severe dissociative symptoms

    Accuracy of Portrayal

    In a sense both Mad Hatters portray this disorder but the 2010 version does a better job of doing so. The 2010 version shows more emotion and you can see what caused him to become eccentric. His mood varies rapidly; he is quick to be impulsive and has a short attention span. He displays having other mental illness, such as depression and attention deficit hyperactivity disorder. His attention is constantly shifted between topics and is always moving. He has a hard time sitting still; he is never in one spot. The depression would be due to the Queen of Heart coming to power. She destroyed the property that he lived on, it was the end of the world that he knew. Even though the White Queen lost her power, he still remained loyal to her. In losing the property that he lived on, and the White Queen no longer being in power, caused the Mad Hatter to be even more eccentric, psychotic.

    Treatment

    To treat the Mad Hatter a Diagnostic Interview for Borderline Patients would first be given. The interview looks at areas of functioning that are associated with borderline personality disorder. The four areas of functioning include Affect (chronic/major depression, helplessness, hopelessness, worthlessness, guilt, anger, anxiety, loneliness, boredom, emptiness), Cognition (odd thinking, unusual perceptions, nondelusional paranoia, quasipsychosis), Impulse action patterns (substance abuse/dependence, sexual deviance, manipulative suicide gestures, other impulsive behaviors), and Interpersonal relationships (intolerance of aloneness, abandonment, engulfment, annihilation fears, counterdependency, stormy relationships, manipulativeness, dependency, devaluation, masochism/sadism, demandingness, entitlement). The best treatment for Borderline Personality Disorder is dialectical behavior therapy; this treatment focuses on the patient building a life that balances changes and handle situations that occur in their life. Patients with Borderline Personality Disorder respond best to psychotherapy. Establishing trust between the patient and therapist is difficult to create and also maintain once established. Types of psychotherapy that can be used are cognitive-behavioral therapy, transference-focused therapy, dialectical- behavioral therapy, schema-focused therapy, and metallization-based therapy. Also it would best to place the Mad Hatter in a stable environment, and around people that have stable moods.

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    A YouTube element has been excluded from this version of the text. You can view it online here: http://pb.libretexts.org/temp/?p=939


    Name: Ernie “Chip” Douglas “Aka” Larry Tate/Ricky Ricardo/ the Cable Guy.

    Source: Cable Guy (Movie, 1996)

    Background Information

    From his reminisces, Chip grew up in a neglected home. His father was out of the picture, and his mother seemed to be some sort of cocktail waitress, or prostitute which is concluded from Chip watching a family scene on the television and saying to his mom” When am I going to get a brother to play with?,” while his mother replies,” Honey, that’s why mommy is going to happy hour,” as she leaves the house. Now in his early thirties, Chip works an eccentric cable guy who has a distinct lisp. The scene opens as Steven Kovacs waits on Chip to arrive to install his cable. It appears that Steven has waited all day on Chip. Finally, when Steven is in the shower, Chip arrives and starts banging on the door saying, “Cable guy,” multiple times, and with each time getting louder and more annoyed. Finally, Steven comes to the door, upset that he was late, and Chip also becomes upset and states that he will just leave instead. After Steven asks Chip to come inside, Chip starts looking around the living room for a spot to put the cable wires. He starts talking to the walls in a sexual manner, and even displaying gestures to the walls that makes Steven uncomfortable.

    Once Chip installs the cable, Steven asks him for free cable since his friend told him all he had to do was slip the cable guy a fifty-dollar bill. Chip then asks Steven to hang out with him later on yet Steven was “busy” so Chip asked again, “Well, what are you doing tomorrow?” Steven agreed and Chip exited saying “See you tomorrow pal.” While hanging out, Chip takes Steven to the large satellite receiver where Chip becomes overly emotional about how people’s satellite usage will expand and how you will one-day play video games with your friends in Vietnam. Afterwards, Steven asked what his name was, and Chip becomes highly emotional and explains with a dramatic monologue how it amazes him at the thought that Steven wanted to know his name, and goes on to say that his name is Ernie Douglas, but everyone calls him Chip.

    After Chip incentivizes his friendship with Steven by giving gifts such as a new home theater system while having no regard for personal space or privacy, although Steven asks Chip to return it, Chip becomes upset and says that he has given him friendship and that is greater than that stuff. Chip insists on awkward social activities, including dinner at Medieval Times where Chip becomes overwhelmingly aggression by competing in jousting, and sword fighting with Steven. The next day, Chip ignorantly stumbles upon Steven and his friends playing basketball, invited himself to join them, and ruined the game by breaking the goal. The next day, Chip leaves Steven thirteen messages on his machine, and undoes his cable, so that Steven will call him. Chip arrives furious that he only calls when he needs something.

    To make Steven feel better about his girlfriend problems, Chip hosts a karaoke party with all the equipment he gave to Steven and without his knowledge, hires Steven a prostitute whom he slept with that night. Outraged, Steven throws Chip out, and Chip promises he will fix it. By fixing it, Chip goes stalks Steven’s girlfriend Robin with her date, and waits for him incognito in the bathroom and severely assaults her date then shows up at Robin’s house and installs her free cable. After Steven tells Chip he does not want to be friends anymore, Chip calls Robin to make her paranoid about how Steven is supposedly acting and then informs the police that Steven has stolen property. Once Steven is out on bail, Chip invites himself over to Steven’s parents where he instigates a game of porno password and insinuating that he slept with Robin. Infuriated, Steven punches Chip and Chip leaves. The next day, Chip kidnaps Robin, takes her to the huge satellite dish, and holds her hostage with a staple gun. Steven chases Chip and Robin up to the very top of the satellite. When the helicopter shines a light on Chip, he hallucinates that it is his mother telling him to jump. So, right as the world is waiting to hear the verdict on a huge case, Chip jumps and lands on the receiver, which knocks out the city’s cable. However, Chip survives the fall and makes a mends with Steven and Robin, and as the helicopter pilot airlifts Chip away, he calls Chip pal, which starts the whole cycle over again.

    Description of the Problem

    Chip shows instability with personal relationships such as friendships. He becomes frantic if he believes if his friend(s) are abandoning him. He has no job, He had been fired from several cable companies in which he used different television names as his own such as Larry Tate, which is known from “I dream of Jeannie.” Chip has feelings of abandonment, which stems from his neglectful childhood, where the television raised him instead of his parents. Chip has intense emotional problems such as erratic acts of aggression, violence, revenge, and dramatic emotions in terms of sobbing. Within moments, Chip can show signs that he absolutely loves his friends and then despise or hate the same friends. Chip shows signs of self-harming impulsivity such as reckless behavior including frequent trips to the large satellite dish, drinking, and hiring prostitutes. His risk of suicide behavior increased when he assumed he no longer had any friends and attempted, but failed at a suicide attempt.

    Diagnosis

    301.83 Borderline Personality Disorder

    DSM-IV-TR criteria:

    A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts. This is indicated by having 5 or more of the following characteristics:

    1. Being frantic to avoid abandonment, either real or imagined
      • Chip shows this throughout the entire movie at his multiple attempts to keep Steven as his friend, and then included Robin into the mix, and lastly the helicopter pilot.
    2. A pattern of intense, unstable interpersonal relationships characterized by alternating between extreme variances of idealization and devaluation
      • Chip exhibits extreme highs and lows on how he feels about himself as a good and bad friend to Steven. Chip does this when he cooks Steven breakfast after a party the next morning (high) then feels incredibly bad at the fact that he hired a prostitute that Steven slept during the night (low). To fix the friendship, Chip goes out to make things right with Steven and Robin (high).
    3. Identity disturbance: markedly and persistently unstable self-image or sense of self
      • Until Steven’s friend did a background check, it was unaware. However, Chip was terminated from multiple cable companies where he had different alias from television shows such as Ricky Ricardo, and Larry Tate. Even though that Chip believes he is a great friend, he has broken into Steven’s house and disrupted his privacy by wiring cameras in Steven’s home and using them as blackmail.
    4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex, substance abuse, reckless driving, binge eating).
      • It is not real clear, however, there were scenes of him drinking alcohol and what seems to him being either drunk or drugged. In addition, by hiring the prostitute for Steven, Chip knows how to get women, whether it is through giving free cable or something else.
    5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior
      • Chip displays few suicidal behaviors. However, Chip did imply that he should end his life when the police shined the light on him, and then plunged to what he thought would be his death. Chip survived the fall.
    6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria, irritability, or anxiety usually lasting a few hours and only rarely more than a few days)
      • When Chip first met Steven to install his cable, he was very annoyed that Steven took a moment to answer the door, and then switched his mood to friendly when he asked Steven to hang out with him. Another instance occurred when Steven did not reply to Chip’s 13 messages on the machine, until Steven’s cable went out and then was upset at the fact that Steven only called when he needed something. Chip displayed signs of depression or dysphoria when he was telling Steven that no one ever asked his name until then.
    7. Chronic feelings of emptiness
      • Chip appears to feel empty from an early age as he lives in a neglectful home. There is no father present and a mother who goes out to happy hour in search of a man. In his adult age, Chip feels empty because no one takes the time to ask for his name let alone befriend him.
    8. Inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights)
      • Frequent temper outbursts and anger along with fights are seen throughout Chip’s behavior towards Steven. Chip has temper tantrums when Steven does not want to be his friend. Chip becomes angry and vengeful when Steven says he does not want to be his friend anymore. Chip shows erratic when he plays basketball with the guys and begins to name call and play “street ball” after someone runs into him. Chip has two physical fights, one with Steven at the Medieval Times where he comes at Steven with a sword, a joust, and a mace. The second occurrence is where he waits for Robin’s date in the bathroom and assaults him until he has to be rushed to the hospital.
    9. Transient, stress-related paranoid ideation or severe dissociative symptoms

    Accuracy of Portrayal

    I believe that Chip matches most of the criteria of this disorder unquestionably if not perfectly. His uncontrollable anger issues, feelings of emptiness, unstable interpersonal relationships, and his abandonment issues seem to make him fit the criterion of this disorder. Some things that need to be addressed is the few instances of self-mutilation to himself, including impulsivity, and suicide behaviors. More examples of suicidal tendencies needed to be seen in order to accurately diagnose him with Borderline Personality Disorder. In the movie, Chip only has the one instance of self-harm, which was the attempted suicide, and although Chip portrays himself to know the prostitute, he never mentions that he himself has had personal encounter with her, nor does it ever show that Chip was sexual impulsive. With some of the criteria still uncertain, Chip does fit eight out of the nine characteristics.

    Treatment

    To accurately diagnose Chip with BPD, He would be given the Diagnostic Interview for Borderline Patients Test, the Structured Clinical Interview (SCID-II) and the Personality Disorder Beliefs Questionnaire (PDBQ). For treatment, the best thing available is the Dialectical behavior therapy. In this therapy, it is broken down into three focuses, which would help Chip survive and build a meaningful life by helping him to balance change and accepting his life’s situations. First, life-threatening or harmful situations are addressed in Chip’s life. This would include self- harm from self-mutilation or attempted suicide; each instance would be dealt with accordingly. Then, Chip would be gently pushed to experience emotions that are painful for him. Pushing Chip to experience intense emotions head-on is a type of exposure with response prevention therapy. As Chip faces his toughest emotional outbreaks with different situations, Chip’s anxiety levels will eventually decrease. The decreased anxiety will allow Chip to experience those situations again only without the emotional outbreaks and anxiety. Lastly, Part three addresses living problems. Although it is unclear in the movie of Chip’s living conditions, this portion of the DBT will help Chip feel complete as a person. By feeling complete, Chip would be able to deal with the feelings of “emptiness” and the imagined fears of being abandoned. Once Chip is able to cope with these feelings, he will be able to identify when these feelings are beginning and be able to recognize that they are not real. By being able to identify these feelings, Chip will be able to control his outbursts of anger and mood swings.

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    A YouTube element has been excluded from this version of the text. You can view it online here: http://pb.libretexts.org/temp/?p=939

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