Cinematic masterpieces based on mental disorders: cruel intentions' characters display antisocial personality disorder

ASPD in Cruel Intentions

Introduction

The movie Cruel Intentions is centered on two upper class step-siblings and a bet they make. The brother, a prolific womanizer named Sebastian, and his step-sister, Kathryn, agree that if Sebastian can successfully seduce the new headmaster’s daughter they will have sex, but if he fails Kathryn will get his classic car. Due to complications and various manipulations by Kathryn the bet ends with Sebastian’s death (Moritz, 1999). While both Sebastian and Kathryn display traits associated with Antisocial Personality Disorder (ASPD), Kathryn’s behavior in particular fits the criteria.

Diagnosis

In the movie Kathryn was never formally diagnosed with any mental disorder, but her behavior throughout is strong evidence that she would be diagnosed with ASPD. The current DSM-V criteria for ASPD is divided into six parts (American Psychological Association, 2013). The first part deals with “ significant impairments in personality functioning.” Kathryn fulfills the self-functioning part of this criteria in how she defines her identity. In the movie she spends most of her time engaged in self-serving behavior that only serves to enhance her power or her personal pleasure. In fact, at one point she complains about having to keep her sexual exploits private to maintain her high social position. Everything she does is focused solely on her wants and when her duplicitousness is finally revealed her reaction show how she has built her identity around her power (Moritz, 1999). Kathryn also demonstrates impaired interpersonal functioning with her lack of empathy. Notably, she is unmoved after her actions directly lead to the death of her step-brother (Moritz, 1999).

Kathryn also fulfills the second part of the DSM-V criteria with her display of pathological personality traits. She displays personality traits both in the domain of antagonism and disinhibition. In the antagonism domain her actions show her to be manipulative, she befriends a girl just to get back at ex-boyfriend, deceitful, she lies about being abused by her step-brother to one of her lovers, callous, as referenced before at no time does she express remorse for causing her step-brother’s death, and hostile, she throws a glass at her step-brother when he refuses to have sex with her. In the disinhibition domain Kathryn displays the traits of irresponsibility, she immediately breaks a promise to keep a friend’s secrets, and she is a risk-taker, engaging in frequent casual sex and also harboring a cocaine addiction. Thus, Kathryn meets the second part of the criteria of ASPD with all four of the traits in the first domain and two out of three in the second.

The other parts of the DSM-V criteria for ASPD are much simpler. The third part stipulates that the personality traits must remain constant across time. While this is hard to assess because the movie only covers a period of about three weeks, from Sebastian’s interactions with Kathryn it is implied that she regularly manipulates and lies to people. The fourth part of the criteria is that the aforementioned personality traits are not normal for the developmental stage or socio-cultural environment. Kathryn’s behavior is in no way normal for an upper class apparently developmentally normal girl. The fifth part of the criteria is similar requiring that the personality traits are not the resultant of substance abuse or a general medical condition. Although Kathryn is shown to have a cocaine addiction, none of her behavior can be directly attributed to it and she has no general medical conditions. Finally the DSM-V states that the individual must be at least 18 years old. Kathryn’s age isn’t mentioned in the movie, but she appears to be around 18 years old.

Etiology & Development

Like many mental disorders ASPD is thought to have both genetic and environmental influences (Kring and Johnson, 2013). Research has indicated that those with ASPD tend to have impairments in Unfortunately, both

Demographics

There are varying estimates of the prevalence of ASPD in the population. One North American study found a prevalence rate of 4. 5% in men and . 8% in women (Robins et. al, 1991) while another found the prevalence rate to be 6. 8% in men and . 8% in women (Swanson et. al, 1994). For both studies it is obvious that ASPD is diagnosed more in men than in women, making Kathryn a somewhat atypical ASPD sufferer. On the other hand Kathryn does appear to have a cocaine addiction which is consistent with research that indicates that women with ASPD are especially likely to abuse substances than those without (Compton et. al, 2005).

Impact

Treatment

Kathryn did not receive any treatment at any time in the movie and it is highly unlikely that she would have voluntarily would have even if she was diagnosed. Research has shown that those with ASPD tend to reject treatments, mostly because they do not believe they need to change (Tyrer et. al, 2003). However even if she had been forced into treatment, there is no established treatment for ASPD that has been supported with controlled random trials (Duggan et. al, 2007). Instead there is some evidence for the effectiveness of a variety of techniques that are mostly focused on reducing anti-social behavior of those with ASPD. A 2002 meta-analysis of 42 treatment studies found that both psycho-analytic and cognitive behavioral approaches had a fairly high rate of success (Salekin). Unfortunately, the same study notes that treatment is hard to assess because those with ASPD can merely fake good and have a high incentive to do so (Salekin, 2002). Therefore it would make the most sense to enroll Kathryn in cognitive-behavioral therapy, but closely monitor her for any signs of deception or use of therapy as another way to manipulate others.

Outcome

In the movie Kathryn did not show any improvement or recovery from ASPD. This is due to her lack of treatment and likely refusal to recognize that her behavior is destructive. Even if she had showed signs of improvement, as mentioned in the treatment section it is hard to accurately assess whether a patient is truly cured of ASPD or simply has become more adept in hiding their symptoms. Psychologists, therefore have taken mixed approaches in follow-up studies. One study of imprisoned male felons found that 87% still displayed anti-social behavior after three years and 72% after nine years (Guze, 1976). Another study focused on substance abusers with ASPD and determined that after treatment, during a six month follow up, that those with ASPD had worse substance abuse problems but did not have worse psychiatric outcomes than those without ASPD (Galen et. al, 2000). Yet another study, this time focused on female criminals, found that only 33% of women were still committing crimes after three years and only 18% at six years (Martin et. al, 1982). Unfortunately, those with ASPD are usually uncooperative and hard to find, resulting in no large-scale studies about recovery from ASPD in the general population.

Regardless, of the exact rate of recovery ASPD as a personality order is stable rather than episodic ()We

Impressions

The way Kathryn was presented in the movie was not very sympathetic at all, and as a result I was mostly ambivalent toward her. Her behavior was despicable and the movie did not provide much insight into her background. Part of this was caused by how the movie was structured around the plot, rather than a particular person like an autobiography would be. As a static character and arguably the antagonist, Kathryn does not change at all and accordingly my feelings towards did not either.

Stigma

I do not think I would recommend Cruel Intentions to those who want to understand ASPD. The movie falls in an interesting place because while the way it portrays ASPD is fairly accurate, it is also one-sided. The movie’s treatment of Kathryn is linked to a larger problem with the perception of ASPD. Unlike other mental disorders that have a stigma against them, many of those diagnosed with ASPD are dangerous, not surprising given the wide range of anti-social tendencies needed to be diagnosed. This leads the general population to think about those with ASPD, which is associated with the now defunct words “ psychopath” and “ sociopath,” as simply evil. The movie does nothing to dispel this notion, Kathryn is a rather flat character with almost all of her behavior an expression of ASPD, behavior we consider evil. This encourages the audience simply to characterize her as evil, which is especially problematic because it taps into the femme fatale stereotype of a beautiful women using her guile to manipulate men. While Cruel Intentions makes for good entertainment it simply does not have the depth to give an accurate understanding of ASPD. In fact, it is debatable if any movie can portray ASPD in a sufficient way due to the limits of the format. It is simply too hard to represent ASPD in a three-dimensional way on screen when by-definition most of their actions will be anti-social. Any movie that seeks to depict ASPD correctly must focus on the inner state of the character, a difficult task on the big screen.