Luke Bouchard

CLPS 0640 Developmental Psychopathology

Child Disorder
07/28/2016

Joffrey Baratheon
HBO has a hit series that has made it cool to obsess over fantasy writing
Game of Thrones. The series is based off George R.R. Martins A Song of Ice and Fire
anthology. Martin has described the show as medieval, very loosely based on
western Europe in the 14th or 15th century. The show, which just wrapped up its sixth
season, featured a character many described as the most hated in television history
throughout its first four seasons. We are introduced to then-Prince Joffrey Baratheon,
the apparent oldest son and heir of King Robert Baratheon and Queen Cersei
Lannister. In reality, he is the product of an incestual relationship between Queen
Cersei and her brother Jamie. It is never explicitly stated but he is around fourteen or
fifteen in season 1. He ascends to the seat of Iron Throne after Robert dies and
becomes king at the end of the season. He remains king until season 4, when he is
assassinated. Although he died, I will diagnose him and propose the treatment plan I
would have recommended were he still alive.
From the first time we see him, Joffrey displays violent, aggressive behavior
and shows a lack of sympathy and empathy. He has many, many examples but I will
show some major ones. According to the books, when he was younger, he cut open a
pregnant cat to see the kittens inside. In the first episode of the show, Bran Stark, a
boy just younger than Joffrey, is pushed out of a window by Jamie and paralyzed.
Although it was not his fault, Joffrey shows no empathy or sympathy whatsoever for
Bran. Later, after Arya Stark, a little girl, disarms and embarrasses Joffrey in front of

Sansa Stark, who Joffrey is betrothed to, Joffrey has Sansas direwolf killed and also
has his bodyguard kill a boy named Mycah, whom Arya was friends with. Although he
did not kill Mycah himself, he had someone else carry out his task and exhibited a
need for revenge and a passion for violence. Joffrey shows off his deceitful,
manipulative side by acting nice to Sansa to win her back. After Joffrey becomes King,
despite pleas from his High Council and his wife-to-be Sansa, he has another
bodyguard execute Eddard Stark. He does this in front of Sansa, forces Sansa to look
at her fathers decapitated head, and tells her he will do the same to her brother. This
goes back to the problem of a love of violence, even though he himself did not commit
the act. He goes on to rule very cruelly, maiming anyone who dares speak out against
him. Still betrothed to Sansa, he has yet another bodyguard strip and beat Sansa
(after threatening to kill her with a crossbow himself) in front of a crowd when her
brother is doing well in battle against Lannister forces. When his uncle gives him two
prostitutes for the night as a possible stress outlet, he forces one of the prostitutes to
beat the other unconscious, while threatening them both with a crossbow. A pattern
has emerged- Joffrey seems to enjoy and get pleasure out of making other people
suffer. He hates to be disrespected and has a very high need for revenge against
anyone who he thinks wronged him. When he finds out that one of the prostitutes
mentioned above was spying on him, he brings her into his bedroom and brutally
murders her with a crossbow. This marks a turning point for Joffrey. Up until now, all of
the beatings and violence were via his orders, but never him personally. This was the
first outburst where he used his own hands, and he savagely murdered a woman by
shooting her many times. After he marries someone other than Sansa, he arranges for

Sansa to be married to his uncle Tyrion. Tyrion is a midget and at his and Sansas
wedding, Joffrey relentlessly harasses Tyrion, including taking away his stepstool so
he cannot kiss Sansa. Joffrey then tells Sansa he will have sex with her on the night
she is married to someone else. After his armies have defeated Robb Stark, he wants
to bring Robbs head to Sansa. He further humiliates Tyrion in public at a ceremony
before being poisoned.
Joffrey has never had much of a relationship with either of the father figures in
his life, Robert or Jamie. However, he did know that Robert and Cersei were in an
abusive relationship. The marriage was not of love, but of political purposes. There are
hints that Robert might have known Cersei was cheating on him, and he beat her
frequently. Exposed to this from a young age, Joffrey might have identified Robert as
the winner in the relationship and learned that violence is acceptable if you win.
Studies indicate that 50%+ of variability in antisocial behavior is attributable to
heredity. If I had to quickly diagnose both his (biological) parents, Id say Cersei has
borderline personality disorder and Jamie is a narcissist. The incestual relationship (his
parents were siblings and his grandparents were first cousins) might have played a
role. It is no surprise, therefore, that Joffrey displayed antisocial behavior. His
upbringing featured several risk factors: poor disciplinary practices, lack of parental
supervision, lack of affection, marital conflict and violence as discussed above, and
relative isolation in the castle. Cersei, with whom Joffrey had a closer relationship,
turned a blind eye to and implicitly enabled Joffreys behavior as a child. In her hunt for
power, she very much might have seen Joffrey displaying symptoms of oppositional
defiant disorder in his younger years (age 6-10, for example) and, rather than putting a

stop to it, encouraged him to be fierce and ruthless. When he became King and his
actions grew worse, no one dared correct him or otherwise attempt to censure him, for
fear of his wrath. He has no accountability. When you look at his genes as well as the
environment he grew up, combined with Cersei likely encouraging his behavior from a
young age and the ability as King to do whatever he pleases, it is easy to see how
Joffreys problem started out and continued to get worse over time.
I would diagnose Joffrey as a child with severe Conduct Disorder. In truth, I
believe his symptoms fall much more toward Antisocial Personality Disorder (APD).
However, since he was murdered right around the age of 18, he was not old enough to
officially receive that diagnosis. Assuming he survived, I would have classified him as a
child with CD with a strong likelihood of developing APD in his future, as he currently
displays many of the traits for APD. He easily meets all of the criteria that the DSM-5
lays out for CD. It is a little tricky, since we must be careful to diagnose him with an eye
towards his culture and what was normal back then. Mortality and death were
definitely more common in Westerosi society than they are today. However, Joffrey
goes above and beyond what was normal and is regarded as extreme by the people
he was around. The pleasure that Joffrey obtains from the pain and suffering of others
is not normal, even for the time. DSM-5 defines CD as a repetitive and persistent
pattern of severely aggressive and antisocial acts that involve inflicting pain on others
or interfering with the rights of others through physical and verbal aggression, stealing,
or vandalism. The DSM-5 groups symptoms of CD into four dimensions, and Joffrey
fits into the aggression to people and animals dimension. Focusing on that dimension,
DSM-5 lists 7 criteria, three of which must have been met in the past 12 months and 1

in the past 6 months. Joffrey fits 6 of the 7 criteria, easily passing the diagnosis
threshold. He threatens/intimidates others (threatening a jester to either break his
hand or cut his tongue out), initiates fights (with Arya and Mycah, among others), has
used a weapon that causes serious physical harm to others (is fascinated by the
crossbow and has killed with it), been physically cruel to people (kills and beats people
regularly), been physically cruel to animals (killed at least one cat when he was a
child), and has forced someone into sexual activity (threatens to rape Sansa and has
bedded prostitutes on threat of harm). Since the show started with Joffrey around 14
years old and doesnt delve much into his past, and I havent read most of the books, I
cannot definitively say whether it was childhood-onset or adolescent-onset, and will
therefore say it was unspecified onset. My gut feeling is that it was childhood-onset,
since adolescent-onset tends to be less severe and children suffering from adolescentonset have a higher chance of growing out of it, and Joffrey showed no signs of
stopping entering young adulthood. He also easily meets the criteria of limited
prosocial emotions, or callous and unemotional (CU) interpersonal style. He has
shown symptoms of all four criteria, when only two are needed: lack of remorse/guilt
(when he orders someone killed or does it himself, he shows no guilt), lack of empathy
(shows no empathy for Bran when he is paralyzed), unconcerned about performance
(he is one of the most widely hated kings in Westeros history but it does not faze him),
and deficient affect (he has no friends and is only somewhat close with one person, his
mother). With so many criteria being checked off, I think Joffrey easily qualifies as a
severe case of conduct disorder, with a big red flag for APD. The criteria for APD is a
pervasive pattern of disregard for, and violation of, the rights of others. Example of

criteria include repeated physical fights/assaults, reckless disregard for the safety of
others, and a lack of remorse. Joffrey displays all of these, time and time again. I
would go so far as to say he also looks to be on track for psychopathic features,
defined as pattern of callous, manipulative, deceitful, and remorseless behavior.
Joffrey might not need to be deceitful anymore (after his initial encounter and betrothal
to Sansa), since he is the King and therefore not held accountable, but he is callous
and remorseless. In conflict situations, his goals involve revenge (such as with Arya
and Mycah), dominance (forcing Ros to savagely beat the other prostitute), and forced
respect (he desperately wants his council and soldiers to respect him).
Joffrey suffers from severe CD but I would still try to help him rather than
institutionalizing him. As an adolescent, I would recommend Multisystemic Therapy
(MST), an intensive, ongoing intervention involving several different dimensions.
Cersei would have to engage n Parent Management Training, as she is the only one
close enough to and with enough sway over Joffrey to perhaps alter his behavior. She
would have to stop turning a blind eye to his behavior. In addition to this, she would
have to learn new skills, including when to reward and when to punish. The when to
punish aspect dovetails with the stopping of overlooking behavior. It would be difficult
to stand up to the king, but as his mother, she would have to try. Encouraging good
behavior would involve rewarding Joffrey whenever he handles a situation with
diplomacy and tact rather than violence and aggression. Additionally, I would
recommend Joffrey step down as King of Westeros and let Cersei rule in his place until
he becomes more stable. The reason I would do this is because he is most likely very
ingrained in his ways and his environment has an effect on his CD. A change of

scenery could do him well, as well as having to have some accountability rather than
being allowed to do as he please as the King. Problem solving skills training (PSST), a
more individual approach, would also probably be necessary in order to teach him new
ways of dealing with problems, rather than violence and aggression. I would focus on
cognitive therapy here, teaching him more ways to deal with the situation than calling
for someone to be beaten. If the above fails, I would resort to medication, and if that
fails, I think there would be no choice but to put him in a psychiatric hospital or
institution. In an ideal world, I would have been able to intervene at a much earlier age,
as prevention is always better than treatment, but you have to play the hand youre
dealt.
Despite my best efforts, I do not think Joffrey would respond very well to the
treatment I have proposed. This is partly because I do not think that Cersei would take
well to my recommendations either. Without her support, my whole plan would fall
apart, as Cersei is the one person close enough to Joffrey to get him to change. Even
with her extremely strong desire for power, and the position of Regent Queen that
would come with the plan, I believe the Lannisters as an entire family are extremely
arrogant and believe themselves to be above retribution and the opinions of
commoners such as myself. Without Cerseis assistance with parent management
training, I would have to rely on the other facet of my plan, the problem-solving skills
training. Relying just on this without the PMT is risky. Even with gradual reinforcement,
I do think Joffrey would be easily angered and with his power it could be dangerous.
With a very negative response from both mother and child, my remaining option would
be medication or institutionalization.