There has been considerable controversy regarding the level of criminal responsibility in people diagnosed with Borderline Personality Disorder (BPD), with positions ranging from their having full responsibility to little or none. This paper defends the notion that BPD patients are morally---and legally responsible for any criminal acts they commit. Following Louis Charland and Carl Elliot, I argue that BPD is primarily a defect of character rather than a disease per se although “disease” cannot be totally eliminated as a factor for understanding the disorder. As such, the BPD person, all else being equal, knows right from wrong and has free choice regarding criminal behavior, and should therefore be held responsible for such behavior.

1. Borderline Personality Disorder:
Implications for Moral and Criminal
Responsibility*
*Opinions expressed in this presentation are those of the author alone and do not necessarily reflect the views of Methodist
University’s faculty, staff, students, or administration.
Michael Potts, Ph.D.
Professor of Philosophy
5400 Ramsey Street
Fayetteville, North Carolina 28311
mpotts@methodist.edu

2. Presentation Outline
 Definition and characteristic of BPD (DSM-V) and
correlations between BPD and crime
 Discussion of the controversy concerning moral and
criminal responsibility and Cluster B Personality
Disorders, focusing on BPD in particular
 Discussion of the nature of addiction and its similarities
to BPD
 Conclusion

3. Characteristics of BPD I
A person with BPD has problems with:
(1) a sense of having no stable identity
along with “chronic feelings of emptiness”
and “dissociative states under stress.” This
also includes “instability in goals,
aspirations, values, or career plans.”

4. Characteristics of BPD II
(2) A lack of empathy and an inability to form
intimate relationships due to “mistrust,
neediness” and feelings of being abandoned by
loved ones as well as splitting, a tendency to
either consider a person as being near-perfect to
viewing the same person, sometimes within a
short period of time, in the opposite light as
someone totally bad.

5. Characteristics of BPD III
(3) Rapid mood changes and emotions “out of
proportion to events and circumstances,” constant
anxiety, fear of separation from or rejection by
“significant others,” and constant feelings of low
self-esteem and depression.

6. Characteristics of BPD IV
(4) Acting on impulse often in an
irresponsible way, self-harming, risk-
taking, and persistent feelings of anger,
including extreme reactions “to minor
slights and insults” (American
Psychiatric Association, 2012).

7. Overlap of Some Symptoms with
Axis I Disorders (Paris, 2007, 458)
Prominent mood swings
Suicidality
A wide range of impulsive behaviors
Micropsychotic episodes (extreme
dissociation, fugue states)

8. Selected Physiological Markers of BPD
Abnormal function of the amygdala
Lower levels of serotonin (related to
“trait impulsivity,” (Paris, 2007; Soloff,
et al., 2008)
Frontal lobe deficits associated with
executive function (Paris, 2007)
Multiple causative factors

9. Known Co-Morbidities of Borderline Personality
Disorder (Newhill, Vaughn, and DeLisi, 2010; Black,
et al., 2007)
Antisocial personality disorder
Psychopathy
Mood disorders
Anxiety
Psychosis
Eating disorders
Attention Deficit Hyperactivity Disorder

10. Four Classes of BPD (Newhill, Vaughn, and DeLisi,
2010)
Impulsive/antisocial subgroup
Low psychopathic subgroup
Interpersonally exploitative/narcissistic
subgroup
High psychopathic/antisocial subgroup

11. Correlation between BPD and Criminal Behavior:
Percentage of Inmates with BPD
In the total population—1-2%; in prisons, 12-
30% (Kraus and Reynolds, 2001)
In one jail population, 29.5%; 93% had at least
one BPD trait (Black, et al., 2007)
13% of male inmates; 23% of female inmates
(Tretsman, et al, 2007)
31.7% of inmates (Conn, et al, 2010)
Cluster Bs and BPD associated with crime; the
latter more with violent crime (Arola, et al.,
2016).

12. BPD and Criminal Responsibility I
BPD may mitigate moral or criminal
responsibility (Kincherff, 2010)
Personality disorders cannot be
distinguished from other conditions
successfully used in insanity defenses.
Fugue states can mitigate responsibility.
Co-morbidities that lead to psychotic
episodes may also limit responsibility.

13. BPD and Criminal Responsibility II
BPD almost always does not mitigate moral or
criminal responsibility (Bray, 2003)
Bray focuses on the process of moral decision
making being rational rather than knowledge of
right from wrong.
Knowing the facts
Ability to find rational causal links between
mental representations
Her case is weakened (in my judgment) by her
denial of agent causality and support of
compatibilism.

14. BPD and Criminal Responsibility II:
Types of Dissociative States in BPD (Bray, 2003)
Memory disturbance
Depersonalization
Discontinuity of personal experience
Hallucinatory phenomena
Sometimes accompanied by paranoid
delusions
Bray believes that mitigation of personal
responsibility occurs only in the most severe
cases of dissociation

15. BPD and Criminal Responsibility III:
Bray argues we are ignorant of processes that occur
even in the most severe forms of dissociation; it goes
beyond the evidence to deny moral responsibility in
most cases
The appeal to “irresistible impulses” in BPD is no
defense since this view reifies “impulses” (and, I
argue, commits the fallacy of “misplaced
concreteness”)
Bonnie (2010) argues that the logic of BPD defenses
in insanity cases would evacuate every person of
moral and criminal responsibility.

16. BPD and Criminal Responsibility IV:
Separation of blame from responsibility (Lacey
and Pickard, 2012)
They define “blame” strictly in noncognitivist
terms, as a set of “negative emotions.”
However, I would argue that blame is not only
negative emotion, but a cognitive judgement that
person P committed act A and
A is morally wrong
Thus moral blame accrues to A

17. BPD and Criminal Responsibility V:
 BPD is a moral, not a medical condition, or at least is
predominately a moral condition (Charland, 2006, 2010)
He argued that most of the DSM-IV characteristics of BPD
are character flaws and thus issues of morality requiring
“moral counseling”
But what about DSM-V, which tried to downplay any
moral dimension to BPD?

18. BPD and Criminal Responsibility VI:
 BPD is a moral, not a medical condition, or at least is
predominately a moral condition (Charland, 2006, 2010)
He argued that most of the DSM-IV characteristics of BPD
are character flaws and thus issues of morality requiring
“moral counseling”
But what about DSM-V, which tried to downplay any
moral dimension to BPD?
Moral implications are present: “lack of empathy,”
“hypersensitivity,” “mistrust,” “hostility”.

19. BPD and Criminal Responsibility VII:
 Carl Elliot (1999) holds a strong moral conception of
BPD, arguing that it does not mitigate criminal
responsibility
BPD patients should not be held to a different standard
regarding character influences than the rest of us.
Many psychologists disagree, but I argue this is due to
philosophical assumptions:
Determinism
Scientism
Reductionism
Flawed application of primum non nocere, assuming moral
evaluation harms patients.

20. Addiction, Responsibility, and BPD I
 Addiction is not simply a physical illness, but a mental, moral, and
spiritual illness (Valliant, 1983; Seeburger, 1993).
 Physiological reductionism runs into the “chicken-egg” problem as
well as the possibility of changed behavior rewiring the brain.
 The holistic approach of Alcoholics Anonymous to alcohol
addiction:
1. Admission of powerlessness over alcohol [physical, mental]
2. Belief that a Higher Power can restore the alcoholic “to sanity” [spiritual]
3. Decision to turn the will and life to God as the alcoholic understands God.
[spiritual]

21. Addiction, Responsibility, and BPD II
Alcoholics Anonymous 12 Steps, continued
4. A “searching and fearless moral inventory” of the self [moral]
5. “Admitted to God, to ourselves, and to another human being the exact nature of our
wrongs.” [moral, spiritual]
6. Readiness “to have God remove all these defects of character” [moral, spiritual]
7. Humbly ask God to remove the alcoholic’s shortcomings [moral, spiritual]
8. Make a list of all persons harmed and willingness to make amends. [moral]
9. Make “direct amends…except when to do so would injure them or others.” [moral]
10. Continued personal inventory and admission of wrongdoing. [moral]
11. “Prayer and meditation to improve…contact with God…praying…for knowledge of His
will…and the power to carry that out. [spiritual]
12. Practicing the other steps and carrying the message to others. [all components]

22. The Four Stages of Dialectical Behavior Therapy
(from Dimeff and Linehan, 2001):
1. Decreasing negative behaviors such as self-harm,
refusing to come to treatment, and behaviors that reduce a
patient’s quality of life. [de facto moral]
2. Focus on controlling emotions, especially reducing
traumatic emotional experiences. [de facto moral]
3. To “achieve ordinary happiness and unhappiness” (2).
[mental]
4. “[T]o resolve a sense of incompleteness and achieve
joy” (2). [spiritual]

23. CONCLUSIONS
 BPD is not a psychosis, although in extreme fugue states it
may approach such.
 In general, BPD does not abrogate or weaken moral and
criminal responsibility; the BPD person not only knows right
from wrong, but can engage in a rational moral decision
making process.
 BPD can be called a “disease,” since it causes suffering in
those who have it, but it is a complex moral, spiritual, and
mental illness with concomitant physiological changes in brain
structure and function.
 Severe fugue states and psychotic co-morbidities may, in some
cases, mitigate or perhaps eliminate criminal responsibility.

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