ENTERTAINMENT
10/03/2014 08:12 am ET Updated Oct 03, 2014

A Psychiatrist Weighs In On Amy & Nick In 'Gone Girl'

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"Gone Girl" is out in theaters now, meaning book readers are ready to cycle through the twists and turns of Gillian Flynn's narrative yet again. As we prepare to relive the embittered marriage of Nick and Amy Dunne (Ben Affleck and Rosamund Pike), HuffPost Entertainment spoke with Dr. Paul Puri, a psychiatrist who specializes in personality disorders, to discuss how he might hypothetically diagnose Amy (and a bit about Nick as a "boiled frog" as well). Major spoilers ahead.

So, what's Amy's diagnosis?
For her, antisocial personality disorder is the Diagnostic and Statistical Manual of Mental Disorders diagnosis. That covers people who have a personality structure that goes against societal norms. People who have no conscience and do things to abuse or hurt other people to a high degree of psychopathy, where they will hurt other people for their own enjoyment. Requirements will include things like conduct disorder, where, even as a child, they will hurt animals or do things to test out this cruelty aspect. They're believed to have difficulty getting excited by other things, things other than cruelty or taking advantage of it.

How common are those more extreme levels of antisocial personality disorder?
In the real world, psychopathy is diagnosed really uncommonly in women. The one we diagnose more frequently in women is borderline personality disorder.

Is there a biological basis to differentiation between disorders in the genders? Or is it more a cultural expectation of the way gender is performed that leads to the difference?
It's believed to be a cultural expectation, including a bias by mental health practitioners, maybe combined with gender roles/expectations of how each gender behaves.

Does Amy have borderline personality disorder as well?
Well, the DSM has a whole set of clusters. One is cluster B, in which borderline personality disorder and antisocial personality disorder are right next to each other, meaning you don't have to fit exactly one or the other, you can have aspects of both. It seems like Amy has definite aspects of that in terms of her conscience.

And what does the borderline personality disorder part of that cluster entail? The idea of "putting on" personas seems like it would be a fit there.
The difficulty with personality disorder is that they have a real difficulty with a core identity or feeling of self. Their core self feels very unstable, so they'll do things to kind of help them feel more stable, and that will often be things like pulling people in to take care of them or in behaviors such as cutting themselves or parasuicidal behaviors like cutting or burning or getting hospitalized for the purpose of being taken care of. The other aspects of it are emotional mood swings in very brief periods, so they overreact to things that otherwise they might not react to.

Pulling from this combination of personality disorders, can you speak to what Amy's motivation might be? It's all a bit too extreme for just "revenge."
Someone with antisocial personality disorder usually executes their action for primarily one or two thing: some ulterior motive like money or for the cruelty or aspect of hurting other people. Amy's behavior really kind of tracks with the lack of perspective on what she's doing compared to society norms. We can see from what she's doing that this is so over the top. Within her world and her narrative for herself, she's the hero, and she has to paint a picture for herself that we all do of how these kind of circumstances could make her the hero. In her case, she's really playing the victim, so she's creating a really dramatic victim role, so that she can be the hero.

She's willing to harm herself pretty severely -- with the wine bottle at Desi's house, for example -- in order to position herself as the victim. How does that align with antisocial and borderline personality disorders?
The aspect of antisocial that fits for that is that they have no particular conscience and they will do what they need to do to get what they want. The moral aspect of it just kind of doesn't pop up in their head. More commonly, that self-harm fits with borderline personality disorder. They might cut themselves or do things to that severity. In order to fit that picture, they will kind of escalate things above and beyond what anybody would consider reasonable.

Amy has a history of accusing people of abuse. Are you familiar with any cases of that?
There's something called factitious disorder. The most common version of that is Munchausen syndrome. In the medical world, you see these people pop into hospitals for the purpose of getting taken care of. The textbook one is a nurse or a nurse assistant who injects herself with insulin and comes in with mysteriously low blood sugar. In the real world, people will do this to the degree that they get fake surgeries. I've also seen people lying about the death of loved ones for the purpose of getting attention. So, for Amy, she might be trying to construct this picture where people look up to her and feel sorry for her or whatever the goal is with that. It really fits with that picture.

How about Nick? What could explain him being so detached that he is willing to stay with Amy despite her monstrous behavior?
There's a couple possibilities. People can end up very desensitized. It's sort of the creeping boundaries or the boiling frog analogy. If you drop a frog in boiling water, he'll jump right out. If you drop a frog in cold water and turn up the heat, he'll slowly boil to death, because he just doesn't realize enough to sense the big jump. So, there might have been small things that slowly progressed, and he made a reason for it, and before you know it things are so out of control that he doesn't even see how far that's departed from normal. That's one possible explanation: that he has become desensitized to a lot of her behavior that way. The other thing is the nature of the way people repeat patterns in their lives. They often try to reset or correct a bad experience, but often they just keep on repeating it. So, if he is drawn to her, many times people are drawn to things that repeat from similar drama earlier in their life and they're trying to, unconsciously, have a corrective emotional experience where things go better this time.

Dr. Puri is a psychiatrist and writer on the faculty of the UCLA Department of Psychiatry. He specializes in psychotherapy treatment of complex psychiatric conditions including personality disorders. You can find his website here.

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