Pathometry Newsletter, July 6-2013


A service of The Institute for Relational Harm Reduction

Pathometry, noun, The measure of suffering; The distinction of suffering into different types; The perception, recognition, or diagnosing of different types of suffering (as we apply it to Pathological Love Relationships); The determination of the proportionate number of individuals affected with a certain disorder at any given time, and the conditions leading to an increase or decrease in this number.

The Pathometry Newsletter is designed for better understanding the Cluster B continuum range including sociopathy and psychopathy; for the correlation to other co-morbid conditions especially those with inconsistent treatment outcomes; to address the effects of these disorders on relational harm; and to see the impact on sociological systems.


Pathological Love Relationships: Systemic Impact and Its Relevancy for Professionals

Copyrighted© Sandra L. Brown, MA 2013

Issue 2

Background Info on The Institute

The Institute for Relational Harm Reduction and Public Pathology Education has been an early pioneer in the research and treatment approaches for Pathological Love Relationships (referred to as PLRs). For close to 25 years we have been involved in developing model- of- care approaches for survivor treatment. Additionally, we have been promoting public pathology education for prevention and intervention for survivors, awareness for the general public, and as advanced education for victim service providers.

In those 25 years, we have:

* Created and run our own Trauma Disorder Program

* Provided consultations for other programs

* Trained victim service providers in our model-of-care

* Treated hundreds and hundreds of survivors

* Spoken to thousands in the general public

* Reached millions with the message of “inevitable harm” related to Pathological Love Relationships (PLRs), through television and radio, print publications, our extensive product line of books, articles, e-books, CDs, DVDs and guest blogging on websites such as Psychology Today.

Our mission for the new Pathometry Lab Newsletter is simple:

   ~In order to help more survivors, we need to train more professionals.~

The mental health professionals that have been intricately trained by The Institute have lamented that graduate school, face-to-face counseling, and reading about Pathological Love Relationships (PLRs) did not prepare them for the treatment challenges of the survivor of a PLR or +the understanding of the disorders of the partner. Professionals have indicated that by far the most frustrating type of counseling cases have been the Pathological Love Relationship couple, the wounded partner of one of these relationships, and the “identified” problem pathological partner. To help professionals maneuver the challenging “obstacle course” of PLRs, we have dedicated a newsletter solely for you.

Systemic Impact

In our previous newsletter we introduced the concept of Pathological Love Relationships and the clinical relevancy for mental health professionals. We also touched on the issues that make specialized treatment approaches necessary. Over the course of the next 12 months, the newsletter will be talking about the specifics of our model- of-care and approaches that can be used by therapists with their clients.

(A Pathological Love Relationship (PLR) is a relationship in which at least one of the

partners has serious psychopathology which is likely to negatively affect his or her mate. The Institute specializes in the partners who are/were in relationships with those who have pathology of Cluster B Personality Disorders, which include: Borderline Personality Disorder, Narcissistic Personality Disorder, Anti-Social Personality Disorder, and the additional disorders of Sociopathy and Psychopathy . We will focus on these Cluster B Disorders this year in our newsletter, and in the following years we will discuss other disorders that can impact relational harm.)

In this edition of the newsletter, we are going to discuss the impact of PLRs on the major systems within our society and its psychosocial relevancy for professionals in various disciplines. In the upcoming newsletters we will discuss our theoretical framework for our work and our approaches. Today, let’s discuss the high impact of PLRs on all of us.

Our desire to make inroads in PLRs is related to the global necessity to relieve the effects of pathology which is crippling our mental health, criminal justice, social services, and health care systems. In fact, one of the most expensive impacts on our society is pathology and what it costs our national systems.

We have calculated that 60 million people in the U.S. alone are negatively impacted by someone else’s pathology costing billions of dollars a year through our societal systems.

“I consider one of the biggest public health concerns we face is that of pathology,

or more specifically, unidentified pathology.” —–
(Howard D., former Psychiatrist)

Dr. Kent Kiehl of the Mind Research Network (expert in MRIs of psychopaths’ brains indicated in a recent interview that, “Psychopathy costs us 10 times what depression costs; in other words, it costs $460 BILLION a year to deal with psychopathy.” Let’s look at some of the systemic impact of not only psychopathy, but other forms of pathology as well.

Criminal Justice and Family Law Systems

How do we see pathology affecting the criminal justice and family law systems? Most assuredly, criminal courts are barraged with the undiagnosed and often unmonitored anti-socials. Jail, Prison, Probation, Court Monitoring systems, according to research, have an inordinately high number of Narcissistic Personality Disorders (NPDs) and Anti-Social Personality Disorders (ASPDs) in their populations. The more violent the crime, and/or the more times in criminal court, the greater the likelihood of the diagnosis of Cluster B is likely to be applicable. With the low treatment outcomes known for NPD and ASPD, we find a revolving door of pathologicals that keeps coming in and out of jail/prison/court programs.

“The results of the current study suggest that those individuals exhibiting high levels of both anti-social and narcissistic personalities are the best predictors of who will commit the majority of offenses. Based on this and other studies, these are the individuals most often incarcerated for violent crimes (Warren et al., 2002; Mamak, 1998). It is also suggested by the data that narcissism is the best overall predictor of crime.”

The domestic violence, batterer intervention, anger management, divorce court, and family court systems which all flow into each other, are clogged systems of new and repeat offenders, often of the Cluster B variety cloaked in the term of “high-conflict cases.” High conflict cases are often undiagnosed pathology trying to be “cookie-cutter retrofitted” to existing court programs.

High-conflict cases, as they are referred to, are recognized as “court cloggers”; however, rarely are there actual “diagnoses” connected with the terminology of “high conflict.” What are common aspects of high-conflict/PLR cases that are affecting our Criminal Justice (CJ) and Family Courts?

* Parental alienation

* Failed mediation

* 60+ appearances (on average) in Family Court, with custody battles raging for years

* Abductions

* Hundreds of thousands of dollars spent in court cases

* Abuse of partners and children

* Stalking

* Violation of protective orders

* Hidden lives

* Forensic accountants

* Private investigators

All of these are common issues for PLRs in court and relationally. Some of these are the actual behaviors, which helps courts identify them as “high-conflict cases” (but unfortunately, without the diagnosis).

But long before the identification of a “high-conflict case” was the reality of a PLR. And herein lays the “pathology-in-the-courtroom” problem: When the criminal justice system does not recognize the PLR dynamics or the disorders often associated with PLRs, we get profoundly pathological people included in legal or intervention approaches that are not designed to work for them. Not only do they fail, but they put the other partner/victim at risk and clog systems because the approaches are not working.

High-conflict cases, without the diagnosis, are being referred to what is called “Diversion Programs,” which is another legal “program-ese” for a type of case management within the legal system. Diversion programs are trying various psychological approaches with the “high-conflict population,” again, without recognizing the pathology and assessing whether that even works with these types of disorders. As clinicians we recognize “we can’t treat what we don’t identify.” But that is not always true in the CJ system.

In mental health disciplines, we recognize the need for treatment to be disorder-specific, that is, what we are offering as resources fit the disorder, thus the need. The CJ field is not that specific and tends to offer broader, more generalized, approaches to Family Court problems. These approaches may fit well for non-PLRs but do nothing but frustrate the courts when applied to PLRs. This is why we are seeing the rise of grassroots organizations that are made up of survivors who are now demanding Family Court reform because the approaches not only don’t work, but enflame the pathological.

These cases that are unrecognized for their pathology go nowhere as they are shuffled from one program to the next, one referral to the next, who passes them along because they are sick of the “go-nowhere-ness” of the cases. And each case bounces from one docket to the next as the judge hopes a program/any program will help, while yet another PLR clogs the system for years.

These are the couples that are sent everywhere—to mediation (failed), to co-parenting (failed), then parallel parenting, to court psychologists (what the heck is wrong with them?), to child evaluators (what is this doing to the child?), to anger management, to batterer intervention (if applicable), to divorce approach to a complex case then passes it on to the next program, while years tick off the calendar.

If we asked ourselves clinically, “Who does that?” and if we dropped these kinds of specific behaviors into an imaginary “DSM-IV analyzer,” while they clinked and clunked, aligning behaviors with possible disorders, it would produce a diagnosis often dealing with a Cluster B disorder in the mix, which means for the therapist:
* The client has a Pathological Love Relationship

* The end of the relationship is going to be full of risk and drama (stalking, 50B violations, repeat offending, custody problems, unending court and divorce court, higher risk of physical injury and intimate partner homicide)

* Our client has a pathological court case

* We have the nightmare of watching our client try to parallel parent or co-parent with a pathological

* The programs that are being referred for the pathological partner to attend and that normally work well for non-pathologicals, are not likely to work well with PLRs

* For treatment and support we will need a different approach when dealing with PLR survivors

Mental Health and Domestic Violence Systems

What about mental health systems and DV-oriented programs? How are they affected by PLRs? Donald Dutton, a Domestic Violence Researcher, indicates that the highest percentage of repeat abusers fall into the Cluster B disorders. According to Dutton, the more times they repeat as DV offenders, the more likely they are Cluster B. He indicates that as many as 85% of repeat offenders fall into Cluster B.

With this high a percentage, this IS who is likely to be the face of the repeat offender of DV, indicating that most repeat DV cases actually involve PLRs. Thus, we should expect to see PLR survivors in DV-based services whether public or private mental health services.

What about the victims? Survivors spend time in DV agencies, private counselors, support groups and online forums, never getting close to understanding the relational dynamics they have experienced with a pathological partner whose disorder is never accounted for, but whose behaviors are often labeled generically, as “abusive.”

Many survivors of pathological relationships skip the treatment altogether and suffer silently instead of trying to withstand explanations and one-size-fits-all ideologies about their experiences and the behaviors associated with the pathological perpetrator. Survivors of PLRs do not find the Power and Control Wheel comprehensive or specific enough for what they experienced with Cluster Bs. And if their partner has had repeat violence and are Cluster B, they are not likely to have gotten specific information about PLRs from shelter care, group or individual therapy. They are no further ahead in understanding the low treatment outcome likelihood of their partner.

Having seen the profound ‘failures’ of DV treatment which often end up in intimate partner homicides there aren’t any of us who would ever advise a client that their violent partner was conclusively ‘treated’ for their problems. And yet, unidentified Cluster Bs similar to OJ or Mike Tyson fly through Batterer Intervention Programs unrecognized repeatedly. Many partners will go back after ‘treatment’ has ended believing that what was wrong with them was corrected through ‘psycho education.’

What about the offenders? Perpetrators are referred to Batterer Intervention or Anger Management programs which do not always pre-assess for pathological disorders, especially since these services are court-mandated and the offender has no choice in the decision to attend. All perps are approached with the same material that was largely designed for perps without pathology. Much of the material that is used in Batterer Intervention (BI) is designed for those who have a propensity for the ability to sustain positive and consistent change, a known deficiency within the Cluster B population. Additional chronic risk factors of low impulse control, reduced empathy, and neurological abnormalities that impact aggression, are not considered when deciding who will be most successful with the mandated treatment offered.

Instead, pathologically disordered perps are those most likely to repeat offend or repeat in other chronic ways, thus ending up back in these same programs or other programs, clogging the systems they are funneled through, undiagnosed. The low treatment outcomes for batterers then become risk factors for victims as they believe the batterers were “treated” because they attended a program (albeit, one that was not designed for their unique disorder).

A factor that is not always known about Anger Management (and sometimes BI) programs is that they are not necessarily run by mental health professionals. In a recent workshop given for CJ personnel by us, Anger Management facilitators discussed their backgrounds for performing these high pathologically- oriented community services. Many were simply 501c3s who wrote a grant and went to a few weeks of training, but had no mental health training, assessment training or tools. Many were survivors of PLRs (contributing to this writer’s concern about transference of over- and under-identification of offender status, during group facilitation).

Considering that some of the most dangerous people in the DSM-IV are likely to be attending these community mental health programs, shouldn’t the community expect that a mental health professional would be pre-assessing for whether inclusion is recommended and post-assessing for low treatment, thus a continuing risk for the victim?

Health Care Systems

It is now well understood the impact of mental health on physical health. Survivors of PLRs have a significant history of stress-related health problems, including prolific autoimmune disorders. Given the survivor’s often long history of unrelenting stress with the emotionally dys-regulated Cluster B, it is not a far stretch that these survivors have unusually high numbers of health related problems. A high percentage of untreated PLR survivors are so impacted by both poor mental and physical health that they are removed from their jobs, take voluntary time off, are hospitalized, put on Disability, or are negatively affected for years, causing them to lapse into not only the health care system, but also the social service system once their health is impacted. When Dr. Kent Kiehl quoted psychopathy costing our systems $460 BILLION, it most assuredly reflected the impact on our health care system.

Social Service Systems

The survivors of PLRs often emerge with C-PTSD (even without experiencing physical violence—the reason for this will be discussed over the course of the ongoing Pathometry Newsletter), removing them from functional life and plunging them into the social service systems. Even the survivors who were formally white collar workers and previously economically stable (not the usual service user of social services) are significantly impacted, introducing their entrance into social service support. We have had female attorneys, doctors, CPAs, CEOs, judges, all reduced to disability following a PLR.

The children are of course impacted as well, often requiring assistance and services for their own recovery. Family Courts that do not recognize the impact of pathology on children will often mandate shared custody, causing untold damage to children filtering them into child social service systems. (See our chapter on the impact of pathology on children in our book Women Who Love Psychopaths). PLRs’ impact on our social service system is incalculable.

Helping Our Society Understand and Recover From Pathological Impact

This has been a simplified overview of a complex issue of the systemic impact that pathology makes on our world. To fully discuss it would require a book regarding something like, “The Sociological Impact of Pathology on Societal Resources.” The far reaching effects of pathology are impacting our country in many of ours societal systems.

Of course, the most impact is felt on the personal, or relational, levels where individuals are most harmed. It is in the close proximity to pathology where others are so gravely impacted by another’s lack of empathy, poor impulse control, and lack of insight. Those wounded by pathology are then driven into our systems—into our social services, health care, mental health and criminal justice systems seeking restitution, recuperation, or restoration from pathology.

We believe this is where we can be of most help in our society by bringing our level of understanding to your workplace, whether it is as a school counselor, private practitioner, forensic psychologist, jail counselor, pastoral counselor, marriage and family therapist, DV agency worker, addictions counselor or legal advocate. The newsletter exists to bring specialized awareness and training to those dealing with survivors of pathological love relationships. The impact of pathology has left its thumbprint in our minds, lives, and world, requiring knowledge of PLRs to help others recover.

During our next newsletter we will look at the variety of systemic language regarding pathology and why it has hindered our ability in multi-disciplinary fields to get on ‘the same page’ with ‘Who Does That?’ Following a few introductory newsletters about the issues of pathology, we will begin discussing our research findings about the survivors, and our Model-of-Care approach. We hope you will stay tuned.

Please take a moment to check out the related research and resources regarding pathology and PLRs for your practice listed below.

To read earlier Pathometry Lab articles click HERE

Interested In This Topic?

Our Therapist Training for Treating the Aftermath of Pathological Love Relationships Model of Care Approach (next training November 2013) includes further elaboration on items related to this topic:

  •  Relationship Dynamics of Pathological Love Relationships
  •  Bonding and Attachment Differentials
  •  Drama and Communication Triangle
  •  Event Cycles of PLRS
  •  What Doesn’t Work in PLR’s
  •  The Institute’s Model of Care Approach

    Next Newsletter

    Join us for our next newsletter when we will discuss more pathocentric ideas related to PLRs.

    Do Your Part

    Public pathology education is everyone’s issue, and if you are learning about pathology, please do your part and teach others what you know.  One way is to share our survivor support-oriented newsletters with your clients. They can sign up on the front page of the main magazine site–there is no cost and it comes out every week.

    You can also further public pathology education by sending your colleagues and others who might be working with PLRs to our monthly newsletter. They too can sign up on the front page of the main magazine site and it is complimentary.

    Here’s how we can help professionals…

    How The Pathometry Lab Can Help You

    This program is designed for professionals who are most likely to encounter the survivors, or the Cluster B partners, in your line of work.  Our Pathometry Lab will offer you:

  •  Articles on issues of clinical relevancy regarding treating the aftermath of Pathological Love Relationships (no charge)
  •  Information on pathology and personality disorders as it relates to survivor’s recovery, marital counseling, addictions perspectives, pastoral views, and other mental health disciplines (no charge)
  •  Recommended reading on pathology (no charge)
  •  Handouts and other pathocentric tools (no charge)
  •  Personalized Institute services for your survivor clients (fee for services)
  •  Products for Professionals related to Pathology (fee for products)
  •  Case Consultations (fee)
  •  Yearly Training Conference (fee)
  •  Tele-Events (fee)
  •  Personalized services for Professionals Wounded by Pathology (fee for services).

    Our goal is to better equip you to be able to spot, intervene, and help the recovery of survivors of PLRs. We hope you will join us monthly for our Pathometry Lab Newsletter.  Most of all let us know if we provide support or education to you in the field of Pathological Love Relationships.

    Next Institute Event

    Treating the Aftermath of Pathological Love Relationships November 2013 Hilton Head Island, SC.

    Relational Harm Reduction Radio

    Every Thursday at 8:30 pm starting March 7, 2013

    Call in questions taken.

    RHR University: Coming soon Online Training for Professionals


    Patho-Lingo  Word of the Month:

    Pathognomonic–distinctive characteristics in a disorder

    Narcissus Gazing?


    Sandra L. Brown, M.A.

    The Institute for Relational Harm Reduction & Public Pathology Education

    Director of Advanced Professional Education Services

    Cathy Backlund

    Pathometry Lab Newsletter Coordinator

    Nancy Bathe

    Technical Editor



Clinically Relevant Articles

Personality Disorders in Relationships

The Burden of Personality Disorders

Barriers to Effective Management

Neuropsychopharmacology for Cluster Bs

Reading Suggestions

Love Relations–Normality and Pathology, Otto Kernberg, M.D.

Psychopathy: Antisocial, Criminal & Violent Behavior by Millon, Simonsen, Davis & Birket-Smith

The Everything Guide to Narcissistic Personality by Elsa F. Ronningstan

Character Disturbance: The Phenomenon of Our Age by George K. Simon, Ph.D.

Evil Genes by Barbara Oakley

Women Who Love Psychopaths: Inside the Relationships of Inevitable Harm with Psychopaths, Sociopaths & Narcissists by Sandra L. Brown, M.A.

Pathocentric Tools

Wise Counsel Interview Transcript: An Interview with Otto Kernberg M.D. on Transference Focused Therapy (The Dangerous And Severe Personality Disorders–Cluster B)

Partner Related Assessment and His Cluster B Traits Checklist (Survivor Oriented)

30- Minute Lesson: Personality Disorders (Overview of All PDs)

Pathocentric Videos

Narcissistic Personality Disorder Video (Relational)

Video on Borderline Personality Disorder

Video on Anti-Social Personality Disorder


For Anxiety (Survivor Oriented)

Hamilton Anxiety Scale (Survivor Oriented)

Assessment and Medical Case Management in Personality Disorders (Pathological Oriented)

Partner Related Assessment and His Cluster B Traits Checklist (Survivor Oriented)


Safe Relationships Magazine (The Institute for Relational Harm Reduction & Public Pathology Education) :

Dr. George Simon :

Psychology Tools :

Dr. Don Dutton :

Professional Journals


Journal of Forensic Psychology

Psychological Trauma: Theory, Research, Practice & Policy Journal

Survivor Centered Help Aides

The Institute’s Partner Related Assessment and His Cluster B Traits Checklist

Intrusive Thoughts

Stress Management for Survivors

The Institute’s Resources

Pathological Love Relationships Archive of Articles

DVD Training Set on Cluster B and PLRs 

1. Understanding Destructive and Pathological Relationships

2.  Healing the Aftermath of Pathological Love Relationships: Help for Wounded Women

3.  Treating the Aftermath of Pathological Love Relationship: Understanding Pathology and Its Effects on Relational Harm

How to Spot a Dangerous Man Book

How to Spot a Dangerous Man Workbook

Women Who Love Psychopaths

Counseling Victims of Violence 

Maintaining Mindfulness in the Midst of Obsession 2CDs

Healing the Aftermath Relaxation CD


Treating the Aftermath of Pathological Love Relationships: TBA, Hilton Head Island, SC

Contact us for more information

Help For Wounded Healers

Therapist Care

Are you a professional whose own personal Pathological Love Relationship is impacting your ability to help your clientele, function, or work? Do you need discrete and effective support? Long called ‘the therapist’s therapist’ The Institute provides our same Model-of-Care approach to wounded healers. Let us help you recover and come back stronger so you too can bring Pathological Love Relationship assistance to your own clientele.


GENDER DISCLAIMER: The issues The Institute writes about are mental health issues. They are not gender issues. Both females and males have the types of Cluster B disorders we refer to in our articles. Both male and female can be either the disordered, the partner of the disordered, or both. Our clients, readership and user of our services are approximately 90% female therefore we write for those most likely to seek out our materials or services.  Cluster B Education is a mental health issue applicable to both genders. Our wording merely reflects our market.

COPYRIGHT INFRINGEMENT: Please be advised The Institute utilizes Intellectual Property Management Services that tracks, detects, and prosecutes the misuse of our copyrighted materials and property.