With May being National Mental Health Awareness Month, the conversation around mental health is intensified. In many ways, the awareness aspect of Mental Health Month is positive and facilitates conversation around the stigma associated with mental health. Even though 1 in 5 US adults experienced mental illness in 2020, the stigma tied to mental illness contributes to the daily challenges associated with living with a mental illness on top of symptoms and manifestations of the disease (Substance Abuse and Mental Health Services Administration, 2021 & Corrigan & Watson, 2002). The misconceptions about mental illness threaten the progress made in strengthening the societal support system for mental illness and dissuades individuals from seeking the help they need. While awareness efforts like Mental Health Awareness Month strive to negate this stigma, pop culture tends to perpetuate the negative generalizations on mental illness. 

If you own an iPhone or even minorly keep up with national news, I’m sure you’ve heard of the intensely publicized Amber Heard and Johnny Depp defamation case. Although this trial is technically about a newspaper article – with Depp suing Heard over an article she wrote insinuating Depp abused her – the focus on domestic abuse is further magnified through each of their testimonies asserting that the other abused them. Since Heard claims she suffers from PTSD as a result of his abuse, Depp’s lawyers requested that a psychiatric evaluation was completed to determine the accuracy of her testimony. Dr. Shannon Curry, a licensed psychologist, testified in court that based on her direct psychological assessments of Heard, she determined that Heard displays symptoms of both Borderline Personality Disorder (BPD) and Histrionic Personality Disorder (HPD). 

Both of these personality disorders initially exhibit symptoms typically in early adulthood like reactive emotions, strong expression of emotion, and impulsivity as a result of the illness (American Psychiatric Association). Although they are distinct disorders, when comparing the features of each disorder, there is substantial symptom overlap. The American Psychiatric Association’s DSM-5, the established source for diagnostic material, contends that an individual’s demonstration of  5 out of the 9 symptoms below warrants a potential BPD diagnosis: 

• Efforts to avoid abandonment 
• Emotional instability 
• Feelings of emptiness 
• Identity disturbances 
• Impulsive behaviors 
• Inappropriate, intense anger 
• Unstable interpersonal relationships 
• Suicidal or self-harming behaviors 
• Transient paranoid or dissociative symptoms

On the other hand, the American Psychiatric Association’s DSM-5 maintains that at least 5 of the traits below must be present for a well founded diagnosis of Histrionic Personality Disorder: 

• A compulsion to be the center of attention that results in discomfort if unmet 
• Inappropriate sexual, seductive, or proactive behavior when interacting with others 
• Shallow, repeatedly shifting emotions 
• The use of physical appearance to draw others’ attention 
• Dramatic, impressionistic speech that lacks detail 
• Exaggerated, theatrical emotional expression 
• Easily influenced by others or situations 
• Assumes relationships are more intimate than they are  

After stating that her evaluation of Heard supports diagnoses of both BPD and HPD, she elaborates on her findings by discussing the complexities of each personality disorder. While on the stand, Dr. Curry states that a BPD diagnosis “seems to be a predictive factor for women who implement violence against their partner”; she claims that individuals with BPD can react to their intense fear of abandonment by being “abusive to their partners” often by  “physically prevent[ing] their partner from trying to leave”. When Dr. Curry was questioned about the traits associated with HPD, she reinforced that patients with HPD yearn to be the center of attention and will go to extreme lengths, like “taking on a victim or princess role” or manipulating others through being “inappropriately flattering”, to receive attention. 

Consequently, due to the public nature of the case, social media was flooded with insults directed towards Heard and personality disorders in general after Dr. Curry’s testimony. This is unfortunate because it seems that this stigmatizing narrative around personality disorders creates dangerous misconceptions about the disorders. Something to keep in mind is that no BPD or HPD diagnosis is identical due to the heterogeneous make-up behind both of these disorders (for example, possessing any combination of 5 out of the 9 traits associated with BPD justifies a diagnosis). As a result, every individual with BPD or HPD experiences their disorder differently and the influence and magnitude of symptoms will vary for every individual. It is important to emphasize that in no way is Heard’s diagnosis justifying or excusing any alleged abuse and does not minimize the consequences of her alleged abuse. In fact, it’s unfair to imply BPD is synonymous with abuse, especially since the development of BPD and HPD is associated with trauma. Therefore, the multitude of traumatic experiences that could catalyze the onset of BPD or HPD accounts for the unique combination of symptoms in each individual. BPD and HPD are both lesser known personality disorders, demonstrating how any awareness of BPD and HPD influences how the general public perceives these disorders. Even though Heard displayed symptoms of these personality disorders, it’s crucial to acknowledge how individuals with personality disorders – about 9% of US citizens have at least one personality disorder – cannot be placed into boxes with stereotypical generalizations (Lenzenweger et al., 2007). Regardless of the outcome of the case, presenting a BPD / HPD diagnosis as evidence to corroborate alleged domestic abuse further stigmatizes the diagnoses and the individuals who cope with these disorders every day. The portrayal of mental health in society matters; demonizing an entire community because of an illness they did not choose to develop only undermines everything National Mental Health Awareness Month stands for. 

References 

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington D.C.: 2013.

Corrigan, P. W., & Watson, A. C. (2002). Understanding the impact of stigma on people with mental illness. World psychiatry : official journal of the World Psychiatric Association (WPA), 1(1), 16–20. 

Lenzenweger MF, Lane MC, Loranger AW, Kessler RC. 2007. DSM-IV personality disorders in the National Comorbidity Survey Replication. Biological Psychiatry, 62(6), 553-564.

 Substance Abuse and Mental Health Services Administration. (2021). Key substance use and mental health indicators in the United States: Results from the 2020 National Survey on Drug Use and Health (HHS Publication No. PEP21-07-01-003, NSDUH Series H-56). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/