Sunday, September 16, 2007

Personality Disorder?: Chloe O'Brian from "24"

If you have watched the Fox show, 24, you know Chloe O'Brian, CTU's best analyst. Dinah and I were talking and it seems she thinks Chloe's character (played superbly by Mary Lynn Rajskub) has Schizoid Personality Disorder, while I think she has Borderline Personality Disorder. What are your thoughts?

A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:
1. neither desires nor enjoys close relationships, including being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having sexual experiences with another person
4. takes pleasure in few, if any, activities
5. lacks close friends or confidants other than first-degree relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affectivity

[I don't think she meets 5, 6, 7. Not sure about the rest, though the fact that she has been married reduces the strength of this formulation.]

A pervasive pattern of instability of interpersonal relationships, self-image and affects, as well as marked impulsivity, beginning by early adulthood and present in a variety of contexts, with many of the following features:
1. Frantic efforts to avoid real or imagined abandonment such as lying, stealing, temper tantrums, etc.. [Not including suicidal or self-mutilating behavior covered in Criterion 5]
2. A pattern of unstable and intense interpersonal relationships characterized by alternating between extremes of idealization and devaluation.
3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., promiscuous sex, eating disorders, substance abuse, reckless driving, overspending, stealing, binge eating). [Again, not including suicidal or self-mutilating behavior covered in Criterion 5]
5. Recurrent suicidal behavior, gestures, threats, or self-mutilating behavior.
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).
7. Chronic feelings of emptiness, worthlessness.
8. Inappropriate anger or difficulty controlling anger (e.g., frequent displays of temper, constant anger, recurrent physical fights, getting mad over something small).
9. Transient, stress-related paranoid ideation or severe dissociative symptoms.

[2, 6, & 8 are the characteristics that made me think of BPD.]

I'd say she has a mix of the two. In Blogs4Bauer, Bob noted: "a vote for Chloe is a vote for a knocked-up Asperger's case with borderline anti-social personality disorder with strong leaning to OCD."

In reading Guntrip's criteria in the Schizoid wikipedia article, I am tempted to agree with Dinah (but only tempted).

Dinah's Input: I decided to join in as a front page-commenter, I hope that's okay, but talk about Meaningful topics, especially now that The Sopranos are gone. Please, commenters, no spoilers--Roy is at the beginning of Season 4, I am nearing the end. I was afraid to check out the Blogs4Bauer blog. Just what I need, anyway, a new blog in my life.

Does Chloe have Asperger's : definitely.
And since Roy likes to list diagnostic criteria:

Diagnostic Criteria For 299.80 Asperger's Disorder

A. Qualitative impairment in social interaction, as manifested by at least two of the following:
  1. marked impairments in the use of multiple nonverbal behaviors such as eye-to-eye gaze, facial expression, body postures, and gestures to regulate social interaction
  2. failure to develop peer relationships appropriate to developmental level
  3. a lack of spontaneous seeking to share enjoyment, interests, or achievements with other people (e.g. by a lack of showing, bringing, or pointing out objects of interest to other people)
  4. lack of social or emotional reciprocity
B. Restricted repetitive and stereotyped patterns of behavior, interests, and activities, as manifested by at least one of the following:
  1. encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus
  2. apparently inflexible adherence to specific, nonfunctional routines or rituals
  3. stereotyped and repetitive motor mannerisms (e.g., hand or finger flapping or twisting, or complex whole-body movements)
  4. persistent preoccupation with parts of objects
C. The disturbance causes clinically significant impairment in social, occupational, or other important areas of functioning

D. There is no clinically significant general delay in language (e.g., single words used by age 2 years, communicative phrases used by age 3 years)

E. There is no clinically significant delay in cognitive development or in the development of age-appropriate self-help skills, adaptive behavior (other than social interaction), and curiosity about the environment in childhood

F. Criteria are not met for another specific Pervasive Developmental Disorder or Schizophrenia

So Chloe has 1-4 in the A list and 1 &2 in the B list. I haven't seen her flap and if she's preoccupied with parts of objects, I haven't gotten that far. If you ask me, schizoid and Asperger's have a fair amount of overlap and I haven't found Schizoid Personality Disorder to be a particularly useful diagnostic entity.

In terms of the criteria above for Schizoid Personality Disorder-- you don't have to have them ALL! Few people fit into Chinese Menu descriptions-- I would contend that she's mostly Schizoid. Okay, so she get ruffled and makes funny faces when she's criticized, but she scowls and moves on, Chloe doesn't break down in tears or ruminate when criticized, and many non-schizoid people would. She's a little impervious. Chloe's been married? Unfortunately trying to look this up led me to plot information about Season 5, but it seems Roy is right. I've actually assumed that a lot of the quibbling and tension between Chloe and Edgar results from their inability to address the sexual tension between them-- just my theory. Okay, so Jack's her "friend" and Chase is her "friend" but really, I think they just use her--maybe some vague fondness, but trust me, at the end of the day Jack isn't texting Chloe "Hey want to get a bite to eat." You'll note that when she gets fired in Season 4, she goes home alone, not off to a friend's. And affective flattening? Well, affective something--you aren't going to tell me, Roy, that Chloe is affectively normal.

Chloe as having borderline personality? I don't see it. I'll let our readers chime in. So she gets miffed. I don't think her relationships are all that intense or unstable. And she's chronically irritable, is that affective instability? No signs of euphoria or depression. You'll tell me if I'm wrong. And even if she does have a mild degree of one of two these features, that doesn't give you the diagnosis. OCD-type rigidity? Yup-- kind of goes with the Asperger's Diagnosis. And I also don't see the Anti-social Jack, in the name of the greater good he can execute his own boss and a tear or two later he's back in the saddle......

I hope it's okay that I jumped on Roy's post... great pic, great topic, great show.

Roy here. So we're gonna have all our comments within the post, huh? Okay. I agree that the affective instability is more driven by irritation with others' perceived incompetence (hmm, perhaps a touch of OCPD or NPD). [you all know, we're just having a bit of fun here; not taking the show too seriously, so please no "it's just a TV show!!" comments. tx]

But she does NOT meet criteria B1 and B2. B1 says "encompassing preoccupation with one or more stereotyped and restricted patterns of interest that is abnormal either in intensity or focus." She is at work, so of course she has a preoccupation. There is nothing abnormal about her intensity or focus... it's her job! Lives are at stake.

B2 says "apparently inflexible adherence to specific, nonfunctional routines or rituals." Again, this is a work requirement. Her type of work requires such adherence to routines. However, she is not really so inflexible, as evidenced by her bypassing usual protocols when Jack asks her to, despite the fact that it could get her fired or in jail. She sees the bigger picture, and so tries to do "the right thing", not the correct thing.

So, I don't see any of the B criteria. And, if you look at the OCPD link above, you'd think that these criteria fit her to a T. But, it is important to remember that many of these characteristics are necessary for her work. And we really only see her in work settings, so it is hard to assess these. I think she has nearly none of the OCPD criteria. And, the only piece of Narcissistic PD criteria she meets is that of lacking empathy.

[You all can see why many of us don't focus too much on personality disorder classification. Too subjective.]