AP: Gunman Believed To Suffer From Personality Disorder
Source: TPM
IGOR BOBIC 6:36 PM EST, FRIDAY DECEMBER 14, 2012
Adam Lanza, the suspected shooter of an elementary school in Newtown, Conn. is believed to have suffered from a personality disorder, the Associated Press reports:
Police shed no light on the motive for the attack. The gunman was believed to suffer from a personality disorder and lived with his mother in Connecticut, said a law enforcement official who was briefed on the investigation but was not authorized to publicly discuss it.
Ryan Lanza, the brother of the suspected shooter, cooperated with police and had reportedly not been in contact with Adam Lanza since 2010:
The law enforcement official who said Adam Lanza had a possible personality disorder said Ryan Lanza had been extremely cooperative, was not believed to have any involvement in the rampage and was not under arrest or in custody, but investigators were still searching his computers and phone records. Ryan Lanza told law enforcement he had not been in touch with his brother since about 2010.
-30-
Read more: http://livewire.talkingpointsmemo.com/entry/ap-gunman-believed-to-suffer-from-personality-disorder
undeterred
(34,658 posts)And being a narcissist or having an antisocial personality doesn't stop you from purchasing a gun.
deafskeptic
(463 posts)undeterred
(34,658 posts)And use them to express your anger.
amuse bouche
(3,657 posts)and be a paranoid mofo.
undeterred
(34,658 posts)paulkienitz
(1,296 posts)"personality disorders" are pretty routine common things, like depression or anxiety. We can't put too much on that if we're looking for a reason for this guy to go that far off the deep end.
mopinko
(70,134 posts)depression is a mental illness, treatable with medication.
a personality disorder is sorta the opposite. like being a psychopath. permanent, untreatable.
Democracyinkind
(4,015 posts)Intersting. If so, I'll have to amend my usage of the term "personality disorder". I never used it for exclusively pathalogical cases... good to know. Are you a professional ? (I'd like to know if that's how professionals use the term..?)
mopinko
(70,134 posts)NMDemDist2
(49,313 posts)WTF???
something is fishy here.....
Bonhomme Richard
(9,000 posts)kestrel91316
(51,666 posts)southerncrone
(5,506 posts)--the name of the shooter?
--what the mother's job really is? Kindergarten teacher, substitute teacher, former Kindergarten teacher
--why she would have 4 guns to which he had access, especially if he had problems?
--was the mother killed at school or home?
--where are his girlfriend & other missing friend?
--where is dad?
--why has brother not had any contact w/younger brother in over 2 yrs?
--why the community hasn't bee forthcoming w/info, especially if it is such a tight-knit community? They seem in the dark?
--WHY THIS HAPPENED?
I read that dad was a VP w/GE. Protecting of reputation of one of the powerful? That's my guess.
Mc Mike
(9,114 posts)Tons of coverage that doesn't answer the most basic questions. Statements of 'fact' that contradict other 'factual' statements, or common sense.
valerief
(53,235 posts)Myrina
(12,296 posts)n/t
marshall
(6,665 posts)If so, she needed to keep them more secure.
Response to DonViejo (Original post)
DCBob This message was self-deleted by its author.
greiner3
(5,214 posts)I think you have posted a hateful post.
I am on several 'psychiatric' drugs. I am not violent.
I suggest to you that the ones who ARE violent are the ones who NEED are NOT taking these drugs.
So much for open mindedness on DU!
Cetacea
(7,367 posts)Also, when SSRIs first came out there was a spike in violence that gave birth to the so-called "prozac defense". Some drugs meant to help various forms of mental illness do not go well with everyone's particular biochemistry. Thanks to the war on drugs, many gold standard and inexpensive medications are forsaken for more profitable drugs that often make matters worse. And that is one reason why there is such a miserable rate of success with medications. Another is that doctors do not have the time or resources to track every person's reaction to a given drug over the course of a month or so. And then there is the mater of GPs handing out SSRIs and even anti-psychotics (Abilify) to children and and working adults who have no idea how powerful and mind-altering these drugs are.
Not dissing medications or the biochemical model for mental illness. I'm just informing you that some psych drugs can make symptoms worse in some/many people.
A bigger issue to me is the discriminatory way people conflate mental illness with violence, and how that is used in place of "Guns don't kill people. People kill people" as a defense for mass weapon possession in this country. "Guns don't kill people. Only the mentally ill do".
lbrtbell
(2,389 posts)That kind of stigma is one reason people are afraid to seek help.
I'm on "psychiatric" drugs for my fibromyalgia, and I can assure the world that I'm not violent, nor do I own a gun.
Iggy
(1,418 posts)The point is-- and I'm not stating or even implying you are mentally ill-- the point is mentally ill people have no business being allowed to purchase guns/ammo..
If the mother allowed her mentally ill son in this case access to deadly weapons, then I'm sorry to say she's a moron that may have just enabled this slaughter.
tiny elvis
(979 posts)would any other such allowances also be moronic?
Iggy
(1,418 posts)Are you implying mentally ill people should have access to guns??
The state of VA disagrees with you. they immediately passed laws blocking sales of guns to mentally ill people-- after the VA Tech slaughter a few years ago.
I deleted my post although there was nothing hateful about it. I was just stating my opinion, maybe dumb and insensitive but not hateful. I think many of us are looking for reasons and explanations and something to blame. Sorry.
marble falls
(57,112 posts)think its the guns, its the abysmal and almost nonexistent treatment we give the mentally ill because of tax dodging "Conservatives" and teabillies, and health insurance has very low limits on mental health benefits. Most of the really mentally ill get no notice and minimal treatment until drugged into passiveness after they get jailed.
There is no way folks like you or me will get a chance to discuss this rationally and quietly until weeks from now.
DCBob
(24,689 posts)unfortunately.
Sivafae
(480 posts)stances.
Having lived in halfway house before, I have seen some shit that is just completely inhumane. Having been in San Francisco General Hospital's psychiatric emergency room a few times, I can tell you without a doubt, they just do not know how to handle people having the symptoms of their psychiatric disorders.
You add to the mix someone who is mentally ill having a reaction to the meds prescribed to them, and you'll find people tied to beds peeing on themselves. I know, it happened to me. There was no reason for what happened to me to ever to have happened. I called and called the person who prescribed the medication, Paxil for those that want to know, saying that something didn't feel right and that I didn't know what to do. PLEASE HELP ME. But she told me to give it a few days. Well the SFPD ended up giving me the help I needed because I had become out of control. I remember bits and pieces of that night. I have never heard nor seen myself ever behave that way. It was scary shit.
On the black box warnings for SSRI's, hostility is one of them. They are not talking about the "fuck you" level of hostility, they are talking about HOMICIDAL behaviour. Wording is everything.
And for the record, I have PTSD, and after years and years of work, I have reduced it to anxiety with some disassociation, or it is the other way around, not sure anymore. No, I do not have a mental illness that lends itself to believing that everything and/or everyone is out to get me, being delusional, or having hallucinations. I have a firm grasp on reality. That is why my reaction to the SSRI, which is commonly prescribed for Generalized Anxiety Disorder, is such a departure from even my most extreme behaviour. And to go a bit ad nauseum, at first I was not properly diagnosed and thus was given medication that actually exacerbated the symptoms.
Go Public Mental Health System!
marble falls
(57,112 posts)I worked as an intake interviewer at a state mental hospital in Ohio. My wife became paranoid schizophrenic and is now permanently hospitalized. I think one of the worst aspects of medication I saw was its overuse and the fact that patient feedback was totally undervalued/ignored or reported in case files as a 'symptom' or evidence of a diagnosis. My advice to anyone being treated for anything is to be the best advocate you can be for yourself regarding treatment. Particularly if psychotropics are being on the treatment regimen.
Thank you very much for your unique and pertinent perspective.
Bo
(1,080 posts)Sounds like Mom was a wack job....
regnaD kciN
(26,044 posts)I think it's safe to say that someone who kills their mother and then goes on to wipe out a classroom full of little kids has a "personality disorder."
tabasco
(22,974 posts)I was about to post the same thing.
"Brilliant deduction, Watson."
Berlin Expat
(950 posts)possibly a "serious personality disorder" at that.
azurnoir
(45,850 posts)arcane1
(38,613 posts)It certainly doesn't clarify anything.
arely staircase
(12,482 posts)eom
heaven05
(18,124 posts)ya think? I didn't need any report for that deduction, plus he had access to legal weapons. My god.
riqster
(13,986 posts)None of our existing gun control laws would have prevented this sickening tragedy.
There has to be a better way.
CreekDog
(46,192 posts)kestrel91316
(51,666 posts)adigal
(7,581 posts)Those with guns must have law enforcement inspect where they are stored every year, with just one person allowed access to the guns.
It seems this has shaken up any sane conservatives,who,are left. I think that is a great idea. We have car Inspections? Why not gun inspections?
And if you need a vision test to drive, you should need to have a doctors letter attesting you are sane, through the same psychological they give applicants to the police dept, before you get a gun.
brentspeak
(18,290 posts)For handgun permits, local and state police conduct personal, one-on-one interviews and background checks with applicants to determine if they are mentally fit and competent to own a handgun. This is in addition to any computer background check, which often don't provide important information.
If a household member of the permit seeker's residence is deemed to be dangerous/unstable/etc. and judged capable of accessing the handgun, the state police have the authority to decline the application.
We now know that the mother was an incompetent, irresponsible (legal) gun-owner who had in her household an unstable family member who had access to her weapons. I don't know how they do it in CT, but, given her son, Nancy Lanza likely would not have been able to obtain her weapons in NJ.
riqster
(13,986 posts)Nice that your state has something of its shit together.
Posteritatis
(18,807 posts)dkf
(37,305 posts)Posteritatis
(18,807 posts)lbrtbell
(2,389 posts)Instead of trying to help the mentally ill, we just scorn them. Then something like this happens, and everybody acts all surprised.
Untreated illnesses get worse. Period.
Cetacea
(7,367 posts)and a really disappointing failure of many fellow progressives to see how much they are discriminating against a group who are no more violent than the rest of us.
It's also really insulting to a lot of DUers, I'm sure.
kestrel91316
(51,666 posts)It doesn't give him a pass, unlike full-blown psychosis and delusions from organic brain disease like schizophrenia.
Diclotican
(5,095 posts)DonViejo
Most people who have personality disorder do not go on a rampage to murder children.. Very few of them decide that they want to go on a rampage to kill children who have their future ahead of them...
This is a horrible crime - and a very sad day for so many americans.. Maybe it is time to recognize your limits when it come to guns now?
Dilcotican
Ecumenist
(6,086 posts)of the high power guns. It's literally insane.
dkf
(37,305 posts)Who kill vs percent of gun owners who kill
dkf
I do not know - but I doubt to many with personality disorders is willing to have a gun in the house - for the sake of the security of their own and for the rest.. And if I'm not to wrong about it, if you have a documented issue mentally, it is rather difficult to get a license to have a gun at all.. If you are not willing to go on the black marked that is - or to as in this case it sees, take gun from others who had a legal license to have gun in the house..
This is regardless of what it all is, a tragedy, a horrible thing that should not have been at all.. This is on so many levels so terrible that I am not sure what to say - other than I feel verry sad for the whole thing..
Diclotican
dkf
(37,305 posts)Locally I would say its the majority of our mass shootings as I can think of several where mental health problems were involved.
I think there is something to this...
olddad56
(5,732 posts)Yo_Mama
(8,303 posts)I understood that Norway had pretty tough gun laws?
It's not that gun laws might not be good things and might not prevent some crimes, but I think we may be looking at a situation in which gun laws haven't traditionally worked.
This seems like revenge, to be honest. Gun laws, to the extent that they truly limit access (questionable in many parts of the US), prevent violence only to the extent that they change criminal behavior or impulsive behavior.
If a person truly has an intent to commit mass murder, there are many ways other than guns. Bombs, for one. Like McVeigh.
We're all grappling with a sense of crushing failure, because one of the most basic duties of a society is to protect little kids, most especially little kids congregated in public places where by law they must go. It's so basic a duty that we don't even think of it as duty.
And today, we failed. Massively.
He stole these from someone (his mother) whom he killed. I suppose you could confiscate all weapons except for cops, but then I suspect he would have committed the same crime in a different way.
Diclotican
(5,095 posts)Yo_Mama
No it doesn't worked to well in Norway either - and we have a strict gun law, where you have to have a rather decent rap sheet if you want to be able to have a gun at all... And you also need to be member of a gun club to be able to buy a gun at all.. (At least 6 mounts in a gun club) but I do believe it have been more strict after Breivik did what he did...
Some people, would be able to do this crimes regardless of how strict, or how laps the laws are about guns in a country - even in country's where you in precise have no allowance for personal weapons you can get weapons - and go on a rampage - it all goes down to how you know, and the money you are willing to use to get a weapon.. That be a assault rifle, or a 9 mm gun...
And to be honest - what happened in Norway that peacefully Freeday afternoon more than a year ago - was never expected by the public, or by the government itself.. Even though the security systems had been beefed somewhat up since 11 sept 2001, it was not up to the task, and many have later one admitted that they failed miserably to protect Norway from lone killers like Breivik... And even today, 1,5 year after the fact - many have problems coming to the grasp about the whole things - as it was unheard about in Norway before 22 july 2011...
I feel so sorry about what happened over there in the US today - it is just horrible what happened - so many totally Innocent children murdered, and we do not really know why he did it.. It is so horrible what happened - and I can not express my deepest sadness for what happened... So many parents, so many family members would go into the Christmas crying about the wounded and murderers ones, who they cared for, and loved.. THis is HORRIBLE... Plain and simple..
Diclotican
Yo_Mama
(8,303 posts)But I am very serious - how do civilizations protect themselves against berserkers like this?
There are also bombs and planes and sabotage of energy delivery systems - like gas lines, which could produce even higher casualties. One thing that so disturbs me about the Norwegian massacre and this one - aside from the fact that the young were targeted in each instance - is that the perps were relatively mentally competent. Most of the people who do this sort of thing are dumbasses, whether because they have organic insanity or they are just dumb. But these two perps were SMART. So they did incredible damage.
Of course Norway did not anticipate what happened. How could Norway? Two years from now we in the US will still be staggering around contemplating the frightening reality that someone could even conceive of massacring school children, for what most people cannot understand as any reason at all. The normal mind cannot grasp these types.
We don't understand what they do because we do not understand how they think or why they want to do what they do. And we will not.
Diclotican
(5,095 posts)Yo_Mama
I do remember your kindness and your love, when it all happened in Oslo.. It was good to know, that many cared for us, on the other side of the world to.. It was horrible to watch it all - and the news was all over it.. But as you might now, I think we reacted in a way I do not suspect so many others to do, to this horrible act of devastation. I was surprised myself, by the lack of anger - it was more like sorrow, sadness - and the willingness to care for each other, in this horrible act...
I have not the answer to that - how we protect our selfs against berserker's like this (Nice tutch of words there, as Berserker's is a nordic word, who once was meant to point to a person who under the influence of some form of drugs, would go nuts against the enemy. It was often the strongest, biggest and meanest ones who could do horrible damage when they was under the influence)
Many "evil" persons is smart - maybe they also is able to slip under the radar - in most cases when people is sick on the mind, they act out in a way, got attention, and get help.. But people like our Breivik, was seen as mental capable of great things - he even was from what in Norway goes for the higher upper class - he was known as a "dandy" who played the facade of a person with income -and a lifestyle thereafter.. But he was also known as a little wired person, who act out in a way - but not enough to get attention, and he was smart - he was able to "talk the talk, and walk the walk" even if he had to live in his mothers apartment - as he was not able to found his own home.. He was a drop out, he wanted to start business for himself- and when that kind of missed it targets - and he was not able to be rich fast I suspect it somehow broke down for him... But very few who have this kind of experiences, goes on a rampage to blow up government offices, and murder more than 70 young people , who wat at a youth camp....
They did horrible damage - because they was smart enough to do it in a way they was sure to make much damage.. And I would say, if Breivik had blown up our government offices not in the middle of our holidays - but in a ordinary "business day" the damage and carnage to Oslo, would have been much worse.. The traffic is high in the area in ordinary hours - and it is a lot of business going on in the area - it would have been many ten of thousands out there doing their business, and be caught in the carnage if Breivik had blown up the buildings in say May or September.... July and August tend to be at the slow end of the summer in Oslo....
It is one big difference between Norway and the US, specially when it come to weapons. We have not at all the same gun culture in Norway - even if it exist more than 1.6 million weapons, in homes - at a population of little more than 5 million, it is a whole different culture around the use of weapons.. In Norway the weapons who is in home is strictly used to hunt animals, like our Arctic Elke, or other type of big games - whose hunt also is strictly organized, to a couple of mounts every year.. Outside of that, every responsible hunter hide their weapons as best as they can for others.. Some of my family was/is hunters - but outside of hunting seasons, you NEVER was seeing any gun in the open.. IN most cases it was locked up in a room, where no one had the business to be... And you must have specially permits to have a gun at all.. And for hunting purposes, you also need to go true "basic" training" where it comes to the use of a weapon or to hunt animal properly.. And you can not just walk in and get a weapon from the stores - you must more or less admit to a probe of your character to get a weapon in Norway.....
In the US it looks like you can buy almost what you want to buy - with less than a background check for the authorities - and it looks also like the use of weapons is far more commonplace in the US, than in many, if not most Europeans nations.. I might be an ignorant about it , but why need americans all that variety of weapons?.. In most cases no one need a military grade weapons to hunt an elk - and many of the weapons the american population have a free movement to buy IS military grade weapons, who can do as much damage as the real ones in the army, navy or air force (not to say the US marines), they might put some limits on it, like semi-automatic or other things - but in reality, the weapons is able to do as much damage as the military counterparts out there..
No one can know who the other person think, and want to do - but at least we all can, if we choose to do it, safeguard our youngest ones - by maybe, lets say control the guns properly - by having laws that restrict the use and ownership of weapons to people who are not a danger to them selfs, or to others?.. The US might have to rethink the whole idea bout your 2 amendments, even though I believe that to be a tough one... And it is maybe time for the government, both local, on state level and the federal level, to think about making it less easy to buy weapons - for everyone on a more permanent bases than before?.. I'm not sure, but to be, it sounds crazy to let everyone buy as much weapons you can possible buy - for as long as you need it, just because "some" is scared about the federal government - or in many cases doesn't even accept the authority over the level of the local Sheriff departement... And who look at the UN or the FBI as the great evil who try to steal their birth right away...
I saw some of the pictures of the young ones who was gunned down a couple of days ago - and I was just sitting down and crying - it was so sad to look at the children, who was so innocent - gunned down by a person who was absolutely nuts..
Diclotican
u4ic
(17,101 posts)in Norway vs a pattern that is becoming scarily commonplace in the U.S. Big difference.
Yo_Mama
(8,303 posts)There are less than 5 million people living in Norway. There are about 313 million in the US. Based on populations alone, one would expect about 62 times more such incidents in the US than in Norway. In other words, if you had one in 10 years in Norway you would expect 62 incidents in the US during that time frame.
I don't, of course, expect one such incident in Norway every 10 years. Probably more like one or two a century, which is still too much. But Norway did have laws, and they did not protect Norway. It may just be that Breivik was smart and determined enough to circumvent them, but I don't know because I don't live there and I haven't seen an analysis of what went wrong.
You would expect 3-4 times more such incidents in China than in the US due to relative populations, and that sounds about right to me based on the news.
It may just be that the human race has a certain small incidence of berserkers, and that we can only take precautions against them but not eliminate the berserkers themselves.
nolabear
(41,987 posts)Don't assume someone who commits such a horrible act has one. It's a diagnostic term and has many facets, and a wide range of severity. Quick primer:
Psychiatric diagnoses include several categories, called Axes. Whe we diagnose, we use all of them. Someone can have diagnoses on one or more axes at the same time.
Axis I: Things laypersons might categorize as "mental illness" such as bipolar disorder, the schizophrenias, Major Depressive Disorder, Generalized Anxiety Disorder, OCD, etc. They also have a wide range of severities and manifestations. There's a ton of brain chemistry in the origin of the problem.
Axis II: Personality Disorders. This is a lifelong, but acquired problem that involves distortions in the formation of personality. Personality disorders evolve as a maladaptive mechanism for dealing with unregulated emotion. Healthy personalities look to other people for succor and trust others. They aren't without problems by any means but those with personality disorders face extreme emotional dysregulation that is so horrifically unbearable they will do almost anything to feel better, more stable, more worthwhile, more real. There is a spectrum here from the somewhat typical neurotic to the deeply delusional. "Borderline" means on the border between neurotic and psychotic. Again, there are many ways this can play out. There's brain chemistry here too but it's not the original problem. Cortisol as a result of abuse is still cortisol, though. Also, and oddly, includes developmental disorders.
Axis III: Neurological issues or medical issues.
Axis IV: Psychosocial stressors such as divorce, loss, and so forth.
Axis V: Global Assessment of Functioning. I.e., how are you doing in school, work, sexually, socially, and in all areas of life.
I suppose I'm just doing this because it's easy to dismissively remark on the concept "mental illness" and it is a true Gordian Knot of things. We try hard, but the science is inexact. I have known people with multiple diagnoses that are just wonderful, and people I find unbearable or frightening. It really does depend. I think it's wise to wait and see. I don't know why the AP put that info out without detail but it was irresponsible imo.
Blasphemer
(3,261 posts)Many terms get thrown out there when "mentally ill" is applied to a person in a high profile case such as this one and there is simply not enough information available right now for us to know this young man's psychiatric history. I agree that it was irresponsible for this information to be reported so quickly. As he was legally an adult, it is quite possible that this secondhand information is coming from people who have no idea what the status of his illness, if indeed he was ill, was since he became an adult.
llmart
(15,540 posts)Take someone with a borderline personality disorder, especially someone who does not recognize that he has it and won't seek help, add a psychosocial stressor and bingo! This could happen.
How do we screen for that when allowing someone to purchase guns or when handing out concealed weapons permits like they're candy? It's the old adage of "there's a first time for everything". He may be the guy at work who just seems quiet and shy; doesn't socialize much with others, is able to keep his anger under control (repressed) when he has to, but it only takes one thing to set him off and if he has a gun or access to guns, it's a disaster waiting to happen.
Oftentimes, these are the kind of guys who are drawn to guns because it makes them feel powerful or like they have more control. Add a society that encourages this kind of image and you end up in the place we're at right now.
happyslug
(14,779 posts)12.08 Personality disorders: A personality disorder exists when personality traits are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress. Characteristic features are typical of the individual's long-term functioning and are not limited to discrete episodes of illness.
The required level of severity for these disorders is met when the requirements in both A and B are satisfied.
A. Deeply ingrained, maladaptive patterns of behavior associated with one of the following:
1. Seclusiveness or autistic thinking; or
2. Pathologically inappropriate suspiciousness or hostility; or
3. Oddities of thought, perception, speech and behavior; or
4. Persistent disturbances of mood or affect; or
5. Pathological dependence, passivity, or aggressivity; or
6. Intense and unstable interpersonal relationships and impulsive and damaging behavior;
AND
B. Resulting in at least two of the following:
1. Marked restriction of activities of daily living; or
2. Marked difficulties in maintaining social functioning; or
3. Marked difficulties in maintaining concentration, persistence, or pace; or
4. Repeated episodes of decompensation, each of extended duration.
http://www.ssa.gov/disability/professionals/bluebook/12.00-MentalDisorders-Adult.htm#12_08
slackmaster
(60,567 posts)happyslug
(14,779 posts)To further understand the regulations you have to read the headnote for the listing, it goes into details of HOW to apply the terms of each listing. Here is the headnote for Mental Impairments. Please note these regulations are for determining if someone is so disabled that person gets Social Security due to the fact he or she can not "do work in jobs that exist in subtanial numbers in the national economy".
12.00 Mental Disorders
A. Introduction: The evaluation of disability on the basis of mental disorders requires documentation of a medically determinable impairment(s), consideration of the degree of limitation such impairment(s) may impose on the individual's ability to work, and consideration of whether these limitations have lasted or are expected to last for a continuous period of at least 12 months. The listings for mental disorders are arranged in nine diagnostic categories: Organic mental disorders (12.02); schizophrenic, paranoid and other psychotic disorders (12.03); affective disorders (12.04); mental retardation (12.05); anxiety-related disorders (12.06); somatoform disorders (12.07); personality disorders (12.08); substance addiction disorders (12.09); and autistic disorder and other pervasive developmental disorders (12.10). Each listing, except 12.05 and 12.09, consists of a statement describing the disorder(s) addressed by the listing, paragraph A criteria (a set of medical findings), and paragraph B criteria (a set of impairment-related functional limitations). There are additional functional criteria (paragraph C criteria) in 12.02, 12.03, 12.04, and 12.06, discussed herein. We will assess the paragraph B criteria before we apply the paragraph C criteria. We will assess the paragraph C criteria only if we find that the paragraph B criteria are not satisfied. We will find that you have a listed impairment if the diagnostic description in the introductory paragraph and the criteria of both paragraphs A and B (or A and C, when appropriate) of the listed impairment are satisfied.
The criteria in paragraph A substantiate medically the presence of a particular mental disorder. Specific symptoms, signs, and laboratory findings in the paragraph A criteria of any of the listings in this section cannot be considered in isolation from the description of the mental disorder contained at the beginning of each listing category. Impairments should be analyzed or reviewed under the mental category(ies) indicated by the medical findings. However, we may also consider mental impairments under physical body system listings, using the concept of medical equivalence, when the mental disorder results in physical dysfunction. (See, for instance, 12.00D12 regarding the evaluation of anorexia nervosa and other eating disorders.)
The criteria in paragraphs B and C describe impairment-related functional limitations that are incompatible with the ability to do any gainful activity. The functional limitations in paragraphs B and C must be the result of the mental disorder described in the diagnostic description, that is manifested by the medical findings in paragraph A.
The structure of the listing for mental retardation (12.05) is different from that of the other mental disorders listings. Listing 12.05 contains an introductory paragraph with the diagnostic description for mental retardation. It also contains four sets of criteria (paragraphs A through D). If your impairment satisfies the diagnostic description in the introductory paragraph and any one of the four sets of criteria, we will find that your impairment meets the listing. Paragraphs A and B contain criteria that describe disorders we consider severe enough to prevent your doing any gainful activity without any additional assessment of functional limitations. For paragraph C, we will assess the degree of functional limitation the additional impairment(s) imposes to determine if it significantly limits your physical or mental ability to do basic work activities, i.e., is a "severe" impairment(s), as defined in �� 404.1520(c) and 416.920(c). If the additional impairment(s) does not cause limitations that are "severe" as defined in �� 404.1520(c) and 416.920(c), we will not find that the additional impairment(s) imposes "an additional and significant work-related limitation of function," even if you are unable to do your past work because of the unique features of that work. Paragraph D contains the same functional criteria that are required under paragraph B of the other mental disorders listings.
The structure of the listing for substance addiction disorders, 12.09, is also different from that for the other mental disorder listings. Listing 12.09 is structured as a reference listing; that is, it will only serve to indicate which of the other listed mental or physical impairments must be used to evaluate the behavioral or physical changes resulting from regular use of addictive substances.
The listings are so constructed that an individual with an impairment(s) that meets or is equivalent in severity to the criteria of a listing could not reasonably be expected to do any gainful activity. These listings are only examples of common mental disorders that are considered severe enough to prevent an individual from doing any gainful activity. When you have a medically determinable severe mental impairment that does not satisfy the diagnostic description or the requirements of the paragraph A criteria of the relevant listing, the assessment of the paragraph B and C criteria is critical to a determination of equivalence.
If your impairment(s) does not meet or is not equivalent in severity to the criteria of any listing, you may or may not have the residual functional capacity (RFC) to do substantial gainful activity (SGA). The determination of mental RFC is crucial to the evaluation of your capacity to do SGA when your impairment(s) does not meet or equal the criteria of the listings, but is nevertheless severe.
RFC is a multidimensional description of the work-related abilities you retain in spite of your medical impairments. An assessment of your RFC complements the functional evaluation necessary for paragraphs B and C of the listings by requiring consideration of an expanded list of work-related capacities that may be affected by mental disorders when your impairment(s) is severe but neither meets nor is equivalent in severity to a listed mental disorder.
B. Need for medical evidence: We must establish the existence of a medically determinable impairment(s) of the required duration by medical evidence consisting of symptoms, signs, and laboratory findings (including psychological test findings). Symptoms are your own description of your physical or mental impairment(s). Psychiatric signs are medically demonstrable phenomena that indicate specific psychological abnormalities, e.g., abnormalities of behavior, mood, thought, memory, orientation, development, or perception, as described by an appropriate medical source. Symptoms and signs generally cluster together to constitute recognizable mental disorders described in the listings. The symptoms and signs may be intermittent or continuous depending on the nature of the disorder.
C. Assessment of severity: We measure severity according to the functional limitations imposed by your medically determinable mental impairment(s). We assess functional limitations using the four criteria in paragraph B of the listings: Activities of daily living; social functioning; concentration, persistence, or pace; and episodes of decompensation.
Where we use "marked" as a standard for measuring the degree of limitation, it means more than moderate but less than extreme. A marked limitation may arise when several activities or functions are impaired, or even when only one is impaired, as long as the degree of limitation is such as to interfere seriously with your ability to function independently, appropriately, effectively, and on a sustained basis. See �� 404.1520a and 416.920a.
1. Activities of daily living include adaptive activities such as cleaning, shopping, cooking, taking public transportation, paying bills, maintaining a residence, caring appropriately for your grooming and hygiene, using telephones and directories, and using a post office. In the context of your overall situation, we assess the quality of these activities by their independence, appropriateness, effectiveness, and sustainability. We will determine the extent to which you are capable of initiating and participating in activities independent of supervision or direction.
We do not define "marked" by a specific number of activities of daily living in which functioning is impaired, but by the nature and overall degree of interference with function. For example, if you do a wide range of activities of daily living, we may still find that you have a marked limitation in your daily activities if you have serious difficulty performing them without direct supervision, or in a suitable manner, or on a consistent, useful, routine basis, or without undue interruptions or distractions.
2. Social functioning refers to your capacity to interact independently, appropriately, effectively, and on a sustained basis with other individuals. Social functioning includes the ability to get along with others, such as family members, friends, neighbors, grocery clerks, landlords, or bus drivers. You may demonstrate impaired social functioning by, for example, a history of altercations, evictions, firings, fear of strangers, avoidance of interpersonal relationships, or social isolation. You may exhibit strength in social functioning by such things as your ability to initiate social contacts with others, communicate clearly with others, or interact and actively participate in group activities. We also need to consider cooperative behaviors, consideration for others, awareness of others' feelings, and social maturity. Social functioning in work situations may involve interactions with the public, responding appropriately to persons in authority (e.g., supervisors), or cooperative behaviors involving coworkers.
We do not define "marked" by a specific number of different behaviors in which social functioning is impaired, but by the nature and overall degree of interference with function. For example, if you are highly antagonistic, uncooperative, or hostile but are tolerated by local storekeepers, we may nevertheless find that you have a marked limitation in social functioning because that behavior is not acceptable in other social contexts.
Back to Top
3. Concentration, persistence or pace refers to the ability to sustain focused attention and concentration sufficiently long to permit the timely and appropriate completion of tasks commonly found in work settings. Limitations in concentration, persistence, or pace are best observed in work settings, but may also be reflected by limitations in other settings. In addition, major limitations in this area can often be assessed through clinical examination or psychological testing. Wherever possible, however, a mental status examination or psychological test data should be supplemented by other available evidence.
On mental status examinations, concentration is assessed by tasks such as having you subtract serial sevens or serial threes from 100. In psychological tests of intelligence or memory, concentration is assessed through tasks requiring short-term memory or through tasks that must be completed within established time limits.
In work evaluations, concentration, persistence, or pace is assessed by testing your ability to sustain work using appropriate production standards, in either real or simulated work tasks (e.g., filing index cards, locating telephone numbers, or disassembling and reassembling objects). Strengths and weaknesses in areas of concentration and attention can be discussed in terms of your ability to work at a consistent pace for acceptable periods of time and until a task is completed, and your ability to repeat sequences of action to achieve a goal or an objective.
We must exercise great care in reaching conclusions about your ability or inability to complete tasks under the stresses of employment during a normal workday or workweek based on a time-limited mental status examination or psychological testing by a clinician, or based on your ability to complete tasks in other settings that are less demanding, highly structured, or more supportive. We must assess your ability to complete tasks by evaluating all the evidence, with an emphasis on how independently, appropriately, and effectively you are able to complete tasks on a sustained basis.
We do not define "marked" by a specific number of tasks that you are unable to complete, but by the nature and overall degree of interference with function. You may be able to sustain attention and persist at simple tasks but may still have difficulty with complicated tasks.
Deficiencies that are apparent only in performing complex procedures or tasks would not satisfy the intent of this paragraph B criterion. However, if you can complete many simple tasks, we may nevertheless find that you have a marked limitation in concentration, persistence, or pace if you cannot complete these tasks without extra supervision or assistance, or in accordance with quality and accuracy standards, or at a consistent pace without an unreasonable number and length of rest periods, or without undue interruptions or distractions.
4. Episodes of decompensation are exacerbations or temporary increases in symptoms or signs accompanied by a loss of adaptive functioning, as manifested by difficulties in performing activities of daily living, maintaining social relationships, or maintaining concentration, persistence, or pace. Episodes of decompensation may be demonstrated by an exacerbation in symptoms or signs that would ordinarily require increased treatment or a less stressful situation (or a combination of the two). Episodes of decompensation may be inferred from medical records showing significant alteration in medication; or documentation of the need for a more structured psychological support system (e.g., hospitalizations, placement in a halfway house, or a highly structured and directing household); or other relevant information in the record about the existence, severity, and duration of the episode.
The term repeated episodes of decompensation, each of extended duration in these listings means three episodes within 1 year, or an average of once every 4 months, each lasting for at least 2 weeks. If you have experienced more frequent episodes of shorter duration or less frequent episodes of longer duration, we must use judgment to determine if the duration and functional effects of the episodes are of equal severity and may be used to substitute for the listed finding in a determination of equivalence.
D. Documentation: The evaluation of disability on the basis of a mental disorder requires sufficient evidence to (1) establish the presence of a medically determinable mental impairment(s), (2) assess the degree of functional limitation the impairment(s) imposes, and (3) project the probable duration of the impairment(s). See �� 404.1512 and 416.912 for a discussion of what we mean by "evidence" and how we will assist you in developing your claim. Medical evidence must be sufficiently complete and detailed as to symptoms, signs, and laboratory findings to permit an independent determination. In addition, we will consider information from other sources when we determine how the established impairment(s) affects your ability to function. We will consider all relevant evidence in your case record.
Back to Top
1. Sources of evidence.
a. Medical evidence. There must be evidence from an acceptable medical source showing that you have a medically determinable mental impairment. See �� 404.1508, 404.1513, 416.908, and 416.913. We will make every reasonable effort to obtain all relevant and available medical evidence about your mental impairment(s), including its history, and any records of mental status examination, psychological testing, and hospitalizations and treatment. Whenever possible, and appropriate, medical source evidence should reflect the medical source's considerations of information from you and other concerned persons who are aware of your activities of daily living; social functioning; concentration, persistence, or pace; or episodes of decompensation.
Also, in accordance with standard clinical practice, any medical source assessment of your mental functioning should take into account any sensory, motor, or communication abnormalities, as well as your cultural and ethnic background.
b. Information from the individual. Individuals with mental impairments can often provide accurate descriptions of their limitations. The presence of a mental impairment does not automatically rule you out as a reliable source of information about your own functional limitations. When you have a mental impairment and are willing and able to describe your limitations, we will try to obtain such information from you. However, you may not be willing or able to fully or accurately describe the limitations resulting from your impairment(s). Thus, we will carefully examine the statements you provide to determine if they are consistent with the information about, or general pattern of, the impairment as described by the medical and other evidence, and to determine whether additional information about your functioning is needed from you or other sources.
c. Other information. Other professional health care providers (e.g., psychiatric nurse, psychiatric social worker) can normally provide valuable functional information, which should be obtained when available and needed. If necessary, information should also be obtained from nonmedical sources, such as family members and others who know you, to supplement the record of your functioning in order to establish the consistency of the medical evidence and longitudinality of impairment severity, as discussed in 12.00D2. Other sources of information about functioning include, but are not limited to, records from work evaluations and rehabilitation progress notes.
2. Need for longitudinal evidence. Your level of functioning may vary considerably over time. The level of your functioning at a specific time may seem relatively adequate or, conversely, rather poor. Proper evaluation of your impairment(s) must take into account any variations in the level of your functioning in arriving at a determination of severity over time. Thus, it is vital to obtain evidence from relevant sources over a sufficiently long period prior to the date of adjudication to establish your impairment severity.
3. Work attempts. You may have attempted to work or may actually have worked during the period of time pertinent to the determination of disability. This may have been an independent attempt at work or it may have been in conjunction with a community mental health or sheltered program, and it may have been of either short or long duration. Information concerning your behavior during any attempt to work and the circumstances surrounding termination of your work effort are particularly useful in determining your ability or inability to function in a work setting. In addition, we should also examine the degree to which you require special supports (such as those provided through supported employment or transitional employment programs) in order to work.
4. Mental status examination. The mental status examination is performed in the course of a clinical interview and is often partly assessed while the history is being obtained. A comprehensive mental status examination generally includes a narrative description of your appearance, behavior, and speech; thought process (e.g., loosening of associations); thought content (e.g., delusions); perceptual abnormalities (e.g., hallucinations); mood and affect (e.g., depression, mania); sensorium and cognition (e.g., orientation, recall, memory, concentration, fund of information, and intelligence); and judgment and insight. The individual case facts determine the specific areas of mental status that need to be emphasized during the examination.
5. Psychological testing.
a. Reference to a "standardized psychological test" indicates the use of a psychological test measure that has appropriate validity, reliability, and norms, and is individually administered by a qualified specialist. By "qualified," we mean the specialist must be currently licensed or certified in the State to administer, score, and interpret psychological tests and have the training and experience to perform the test.
b. Psychological tests are best considered as standardized sets of tasks or questions designed to elicit a range of responses. Psychological testing can also provide other useful data, such as the specialist's observations regarding your ability to sustain attention and concentration, relate appropriately to the specialist, and perform tasks independently (without prompts or reminders). Therefore, a report of test results should include both the objective data and any clinical observations.
c. The salient characteristics of a good test are: (1) Validity, i.e., the test measures what it is supposed to measure; (2) reliability, i.e., the consistency of results obtained over time with the same test and the same individual; (3) appropriate normative data, i.e., individual test scores can be compared to test data from other individuals or groups of a similar nature, representative of that population; and (4) wide scope of measurement, i.e., the test should measure a broad range of facets/aspects of the domain being assessed. In considering the validity of a test result, we should note and resolve any discrepancies between formal test results and the individual's customary behavior and daily activities.
6. Intelligence tests.
a. The results of standardized intelligence tests may provide data that help verify the presence of mental retardation or organic mental disorder, as well as the extent of any compromise in cognitive functioning. However, since the results of intelligence tests are only part of the overall assessment, the narrative report that accompanies the test results should comment on whether the IQ scores are considered valid and consistent with the developmental history and the degree of functional limitation.
b. Standardized intelligence test results are essential to the adjudication of all cases of mental retardation that are not covered under the provisions of 12.05A. Listing 12.05A may be the basis for adjudicating cases where the results of standardized intelligence tests are unavailable, e.g., where your condition precludes formal standardized testing.
c. Due to such factors as differing means and standard deviations, identical IQ scores obtained from different tests do not always reflect a similar degree of intellectual functioning. The IQ scores in 12.05 reflect values from tests of general intelligence that have a mean of 100 and a standard deviation of 15; e.g., the Wechsler series. IQs obtained from standardized tests that deviate from a mean of 100 and a standard deviation of 15 require conversion to a percentile rank so that we can determine the actual degree of limitation reflected by the IQ scores. In cases where more than one IQ is customarily derived from the test administered, e.g., where verbal, performance, and full scale IQs are provided in the Wechsler series, we use the lowest of these in conjunction with 12.05.
d. Generally, it is preferable to use IQ measures that are wide in scope and include items that test both verbal and performance abilities. However, in special circumstances, such as the assessment of individuals with sensory, motor, or communication abnormalities, or those whose culture and background are not principally English-speaking, measures such as the Test of Nonverbal Intelligence, Third Edition (TONI-3), Leiter International Performance Scale-Revised (Leiter-R), or Peabody Picture Vocabulary Test-Third Edition (PPVT-III) may be used.
e. We may consider exceptions to formal standardized psychological testing when an individual qualified by training and experience to perform such an evaluation is not available, or in cases where appropriate standardized measures for your social, linguistic, and cultural background are not available. In these cases, the best indicator of severity is often the level of adaptive functioning and how you perform activities of daily living and social functioning.
Back to Top
7. Personality measures and projective testing techniques. Results from standardized personality measures, such as the Minnesota Multiphasic Personality Inventory-Revised (MMPI-II), or from projective types of techniques, such as the Rorschach and the Thematic Apperception Test (TAT), may provide useful data for evaluating several types of mental disorders. Such test results may be useful for disability evaluation when corroborated by other evidence, including results from other psychological tests and information obtained in the course of the clinical evaluation, from treating and other medical sources, other professional health care providers, and nonmedical sources. Any inconsistency between test results and clinical history and observation should be explained in the narrative description.
8. Neuropsychological assessments. Comprehensive neuropsychological examinations may be used to establish the existence and extent of compromise of brain function, particularly in cases involving organic mental disorders. Normally, these examinations include assessment of cerebral dominance, basic sensation and perception, motor speed and coordination, attention and concentration, visual-motor function, memory across verbal and visual modalities, receptive and expressive speech, higher-order linguistic operations, problem-solving, abstraction ability, and general intelligence.
In addition, there should be a clinical interview geared toward evaluating pathological features known to occur frequently in neurological disease and trauma; e.g., emotional lability, abnormality of mood, impaired impulse control, passivity and apathy, or inappropriate social behavior. The specialist performing the examination may administer one of the commercially available comprehensive neuropsychological batteries, such as the Luria-Nebraska or the Halstead-Reitan, or a battery of tests selected as relevant to the suspected brain dysfunction. The specialist performing the examination must be properly trained in this area of neuroscience.
9. Screening tests. In conjunction with clinical examinations, sources may report the results of screening tests; i.e., tests used for gross determination of level of functioning. Screening instruments may be useful in uncovering potentially serious impairments, but often must be supplemented by other data. However, in some cases the results of screening tests may show such obvious abnormalities that further testing will clearly be unnecessary.
10. Traumatic brain injury (TBI). In cases involving TBI, follow the documentation and evaluation guidelines in 11.00F.
11. Anxiety disorders. In cases involving agoraphobia and other phobic disorders, panic disorders, and posttraumatic stress disorders, documentation of the anxiety reaction is essential. At least one detailed description of your typical reaction is required. The description should include the nature, frequency, and duration of any panic attacks or other reactions, the precipitating and exacerbating factors, and the functional effects.
If the description is provided by a medical source, the reporting physician or psychologist should indicate the extent to which the description reflects his or her own observations and the source of any ancillary information. Statements of other persons who have observed you may be used for this description if professional observation is not available.
12. Eating disorders. In cases involving anorexia nervosa and other eating disorders, the primary manifestations may be mental or physical, depending upon the nature and extent of the disorder. When the primary functional limitation is physical; e.g., when severe weight loss and associated clinical findings are the chief cause of inability to work, we may evaluate the impairment under the appropriate physical body system listing. Of course, we must also consider any mental aspects of the impairment, unless we can make a fully favorable determination or decision based on the physical impairment(s) alone.
Back to Top
E. Chronic mental impairments. Particular problems are often involved in evaluating mental impairments in individuals who have long histories of repeated hospitalizations or prolonged outpatient care with supportive therapy and medication. For instance, if you have chronic organic, psychotic, and affective disorders, you may commonly have your life structured in such a way as to minimize your stress and reduce your symptoms and signs. In such a case, you may be much more impaired for work than your symptoms and signs would indicate. The results of a single examination may not adequately describe your sustained ability to function. It is, therefore, vital that we review all pertinent information relative to your condition, especially at times of increased stress. We will attempt to obtain adequate descriptive information from all sources that have treated you in the time period relevant to the determination or decision.
F. Effects of structured settings. Particularly in cases involving chronic mental disorders, overt symptomatology may be controlled or attenuated by psychosocial factors such as placement in a hospital, halfway house, board and care facility, or other environment that provides similar structure. Highly structured and supportive settings may also be found in your home. Such settings may greatly reduce the mental demands placed on you. With lowered mental demands, overt symptoms and signs of the underlying mental disorder may be minimized.
At the same time, however, your ability to function outside of such a structured or supportive setting may not have changed. If your symptomatology is controlled or attenuated by psychosocial factors, we must consider your ability to function outside of such highly structured settings. For these reasons, identical paragraph C criteria are included in 12.02, 12.03, and 12.04. The paragraph C criterion of 12.06 reflects the uniqueness of agoraphobia, an anxiety disorder manifested by an overwhelming fear of leaving the home.
G. Effects of medication. We must give attention to the effects of medication on your symptoms, signs, and ability to function. While drugs used to modify psychological functions and mental states may control certain primary manifestations of a mental disorder, e.g., hallucinations, impaired attention, restlessness, or hyperactivity, such treatment may not affect all functional limitations imposed by the mental disorder.
In cases where overt symptomatology is attenuated by the use of such drugs, particular attention must be focused on the functional limitations that may persist. We will consider these functional limitations in assessing impairment severity. See the paragraph C criteria in 12.02, 12.03, 12.04, and 12.06. Drugs used in the treatment of some mental illnesses may cause drowsiness, blunted affect, or other side effects involving other body systems. We will consider such side effects when we evaluate the overall severity of your impairment. Where adverse effects of medications contribute to the impairment severity and the impairment(s) neither meets nor is equivalent in severity to any listing but is nonetheless severe, we will consider such adverse effects in the RFC assessment.
H. Effects of treatment. With adequate treatment some individuals with chronic mental disorders not only have their symptoms and signs ameliorated, but they also return to a level of function close to the level of function they had before they developed symptoms or signs of their mental disorders. Treatment may or may not assist in the achievement of a level of adaptation adequate to perform sustained SGA. See the paragraph C criteria in 12.02, 12.03, 12.04, and 12.06.
I. Technique for reviewing evidence in mental disorders claims to determine the level of impairment severity. We have developed a special technique to ensure that we obtain, consider, and properly evaluate all the evidence we need to evaluate impairment severity in claims involving mental impairment(s). We explain this technique in �� 404.1520a and 416.920a.
olddad56
(5,732 posts)or, perhaps it is the citizens that suffer from their disorders.
freshwest
(53,661 posts)easttexaslefty
(1,554 posts)BainsBane
(53,035 posts)So that it Is no longer considered a personality disorder, since its treatable?
At any rate the article linked says nothing.
People don't want to face the obvious-- guns kill-- so they are going to blame mental illness. DUers are ecstatic that Michael Savage suggested anyone taking antidepressants be forbidden from owning guns. Because the problem is not 300 million guns; its people who seek treatment for depression.
mysuzuki2
(3,521 posts)olddad56
(5,732 posts)I'm would not take a news media's diagnosis to seriously. Wait until you find out more about the killers childhood, the answers to what makes a person tick can very often be found in their early childhood.
southerncrone
(5,506 posts)BainsBane
(53,035 posts)Which is not a personality disorder but a symptom of thought disorders.
aquart
(69,014 posts)I don't give a flying fuck. WE SOLD HIM GUNS!!!
The personality disorder belongs to anyone who takes money for guns without giving a damn whose hands they're in.
We arrest saloon keepers for selling liquor to minors or drunks. We arrest drug dealers. BUT WE PROTECT SICK, SOULLESS GUN SELLERS?
Nuh uh.
MADem
(135,425 posts)He swiped 'em and killed her, and then went on his rampage...
It's all for profit, just like the banking industry. No worries of repercussions...
Iggy
(1,418 posts)I've been off line all day.
doesn't sound like the perp used the rampage killer's weapon of choice? Glock pistol?
it appears he fits the profile made all too evident by The Joker in Aurora just a few months ago-- and Jared Loughner prior to that: young white male, mental problem(s), probably on meds...
Apparently we're NEVER going to learn.
Response to Iggy (Reply #42)
Post removed
mainer
(12,022 posts)We cannot predict which ones will become mass murderers. We cannot lock up 20 percent of our young people.
What we can do is take away the means by which they can slaughter large numbers of people at a time.
Iggy
(1,418 posts)mass murderers".
It's about monitoring/tracking the ones with a mental problem (like "The Joker" in Aurora, and Mr. Loughner in Tucson) who take several next steps needed to become a rampage killer. in the case of The Joker, he used his credit card over what? four months to purchase guns, ammo, tear gas, gas masks and other gear and have it all delivered to his apartment. This is NOT trackable behavior??
gimme a break, please. stop the baloney. this is totally trackable behavior.
Paladin
(28,265 posts)Is this a great country, or what?
(Sarcasm alert, for those perpetually in need of it.)
Odin2005
(53,521 posts)zellie
(437 posts)nt
lovuian
(19,362 posts)I'm just wondering who is their source?