A Case Study of Ted Bundy Psychology 313 Courtney M. Guinn

A Case Study of Ted Bundy
Psychology 313
Courtney M. Guinn
Due Date: June 22, 2013
A Case Study of Ted Bundy
Clinician: Courtney M. Guinn
Patient: Theodore Robert Cowell ("Ted Bundy")
Date: January 23, 1989
Reason for referral:
Ted Bundy is accused of killing 30 women across the Pacific West Coast. He was referred to by
the defense attorneys and judge of his trial to determine what mental disorders he might be
suffering from, the causes of those disorders and a possible treatment for those disorders. He
admits to having bad mood swings, but does not refer to his down times as a depression. He
understands that what he did was wrong, and has been trying to give a reasonable background
but lack of evidence to claim himself innocent and not responsible. Knowing there is a possible
history of mental illness in his family and the brutality of his crimes, an analysis of his mental
status is required. He says that after he escaped from jail twice and during other events, he felt as
if he was on top of the world, but that those feelings would subside and he would return to his
average affect again. He describes these patterns as "simple changes". His psychotic kidnapping,
raping, murdering and assault before killing his victims holds room for the possibility of
biological, psychological, and/or social factors
Relevant history:
Patient's name is Theodore Robert Cowell, also known as "Ted Bundy". He is a 34 year old male
and was born in a home for unwed mothers in Vermont. As a child, he states that he admired his
grandfather when in fact his grandfather was abusive and inhumane, as was later revealed.
Previous evaluations of Bundy exposed that his grandfather frequently was seen conversing with
people who were not there and that his grandmother received ECT for depression. Both of these
findings point to a history of possible mental disorders that run in the family. Others have
suggested to him that his biological father could potentially be his grandfather; Regardless, he
does not know who his biological father is and claims that as a child he never wondered about
him or cared about who he was. In the beginning, while he was living with his grandparents, they
claimed him to be their son to avoid social scrutiny of his real mother having a baby out of
wedlock. He found out the truth after he found his certified birth certificate later in life and
claims that he will forever have extreme animosity towards his mother for not telling him the
truth as he grew up. Nevertheless, Bundy claims to have had two dedicated and loving parents
who gave him a warm and comforting household. Still at a young age, his mother moved from
Philadelphia to Washington and this is where he met the figure that would become his father,
bring him four siblings and give him the famous surname "Bundy".
He attributed his fast-thinking and academic excellence to his mother, but also holds the belief
that something happened to her in her life that prevented her from opening up to him and talking
about any personal matters. His stepfather was considered the head of the household but was,
according to Bundy, not smart like his mother and couldn't really support them. His parents met
at a church social and enrolled Bundy in Bible study throughout his life up until the end of his
high school career. He claims to remember, if anything, a very small amount of what he was
taught. His parents weren't very political, which was important to him when he brought up how
political he was. He grew up listening to the radio and explained that he did this a lot not because
he was interested in what they were saying, but just because they were talking in general. He was
very antisocial as a child.
In high school, he tried to get into sports, but failed. He began to think that there was something
wrong with him and he agonized over wanting to be better. He felt as though he did not socialize
the way he should have and that he missed out on vital developmental stages of his adolescence.
He acknowledged that in the classroom, he always spoke up and expressed his intelligence
because the way you are perceived in the classroom was vastly different than the way you are
perceived when in cliques of students in the hallway of his school. He would make up excuses
about why he wouldn’t try and conform with his surroundings and never thought about going to
a counselor because he never knew what was wrong, even though he knew that he was different.
He felt menial because his parents couldn't afford most things and parts of life that he secretly
wanted to be a part of. His only social activity was skiing and even then, he would steal
equipment and forge his way to the top. His career against the law began at a young age.
Later in life, during his senior year in high school, Bundy joined the political scene in a variety
of different aspects and began to socialize in fields of social status that he believed he would
have never been able to otherwise. He was enticed by the mysterious and promiscuous
atmosphere. He went to two different colleges in Washington before dropping out after three
years of attendance. He got into a relationship that lasted only about a year. She left him because
of his lack of maturity and sense of direction regarding his career and life in general. He became
very spiteful towards her. He went to another college in Colorado after she left him over these
issues. He got a second girlfriend, a former divorcee, soon after and stayed with her up until he
was put in jail. He got a job at the suicide hotline and reenrolled in his previous college in
Washington. He got back into the political scene after he graduated and got into law school. He
got back together with his first girlfriend and was dating both girls at once. He discussed
marriage with the first girlfriend, but then ended it suddenly stating that he just wanted to show
that he was capable of having someone to marry. He dropped out of law school and that was
when his first killings supposedly began.
Clinical Interview:
During the clinical interview, a series of specific questions will be asked to get important
background information and to allow the patients to answer questions regarding their symptoms
with a brief answer. This interview will help me to interpret and observe Bundy’s life history and
how he feels about it. To begin, I asked Bundy the date, his age and his date of birth to confirm
that he knows basic environmental facts and is not delirious about his current situation. After
asking about his marital status, he described his wife as loyal and devoted to him. His current
support network is his wife and all of his "followers" that believe he is innocent. He has one
child, a daughter who is 7 years old. He claimed that his childhood was not the cause of his
killings, that he was content with his adolescent past. He used to be able to hold jobs, but ever
since he has been on the run, it has been impossible for him to settle down like that. His job for
the past several years has been trying to determine who his victims should be. He felt pressure to
choose the right person. He had no time to relax, he had to choose the right person and figure out
how he was going to execute his plan. He doesn't really have any leisure activities, but he says
that he counts all of the police and people that are accusing him of these crimes as his "friends",
even though he shouldn't. He feels as if time with them is entertaining. He was arrested at least
two times when it came to the robberies and possible car theft he committed while at the ski
As for his substance abuse history, he admitted to drinking large amounts of alcohol and
searching neighborhoods where he could find women and girls taking off their clothes in the
comfort of their own homes. He has been labeled as an alcoholic and a drug addict. He professed
to smoking marijuana and being an avid smoker of it as well. The only other drugs that he
admitted to trying were prescription drugs like Valium. These drugs are not available to him
anymore as he is incarcerated. He would smoke marijuana to calm himself during times of
distress and when he was experiencing his low moments. It is noted that alcohol was used during
some of his attacks.
He explains that he doesn't really experience any type of severe depression or anxiety being in
jail. When he was in the outside world, he was not able to control those around him and he was
unaware of what was going to happen next. In jail, he is able to control, befriend or scare people.
He exclaims that he has become in contact with the most dangerous people on Death Row and
get along with them. The only way he would have any trouble with them is if he tried to have sex
with one of them. He has never had any thoughts about killing himself; but, as it is obvious, he
has constant thoughts about killing women and taking their bodies as part of his own. He reports
not being on any medication at the moment.
Mental Status Examination:
The Mental Status Exam (MSE) will be conducted during the entire interview. This exam will
cover a variety of components that will assess the condition of Bundy's mental state at the time
of the interview. Ted is well oriented. He is aware of his surroundings and his position in
reference to everything around him. His facial expressions are as the normal person's would be.
He is somewhat animated and shows no tearful or empathetic expressions. He makes good eye
contact and looks as if he wants you to believe everything he is telling you. His gait is steady and
relaxed. He seems very comfortable where he is. His attitude towards me is friendly, cooperative,
and alluring. He is able to answer my questions with responses that are accurate to the details
asked. He wants control over the situation. He shows very inappropriate affect as he is euphoric
when explaining how he escaped from jail twice and how one might conduct a murder. Along
with his affect being inappropriate, it is also exaggerated. He has a dramatic, theatrical tone to his
speech. His words show signs of a histrionic mind set. His thoughts are organized, his memory
regarding his life events seem in order and accurate. He does not seem to be making things up.
His goal when talking to me is to make sure that I fully understand his story and analyze it as
accurately as possible. Lastly, his thought content is unremarkable. The details that he is able to
recall is as if he has written it all down and is rehearsing the words back to me. He shows no
blame and has no preoccupations with guilt or sadness regarding his crimes.
Symptoms and Diagnosis
Pathological lying, manipulative behaviors, spontaneous, deceitful, lack of empathy, grandiose
thoughts of self, lack of future goals, ignorance of societal norms, anti-social, disregard of others,
violent, violates peoples rights, severely depressed at times, lethargic, lack of energy, lack of
motivation, narcissistic, lack of inhibition, erratic behavior, lack of remorse, caused the death of
30+ women, necrophilic acts, brutal attacks on women, irresponsibility, heightened excitation
During my initial analysis of Ted's symptoms, I believed him to be suffering from Bipolar I
disorder. His manic moods that consisted of heightened excitation, grandiose thoughts, and a
large amount of energy fulfilled the first stem requirement of a manic episode in the diagnosis of
Bipolar I Disorder. These symptoms did not meet the criteria for a Mixed Episode. These
symptoms have caused him to use unusual and violent actions against people in society and have
caused him to act psychotic, seen in the brutality and completion a number of vicious crimes.
On top of the diagnosis of Bipolar I disorder, Ted shows more than the minimal amount of
criteria to be identified as having Anti-social Personality Disorder. Since the age of 15, as noted
with his disregard for other people's privacy, deceitfulness to forge ski lift tickets, car theft,
irresponsibility with his college career, the brutal murders of more than 30 women, impulsivity
in his crimes, lack of remorse for these women and their families and other factors, he holds all
symptoms of this personality disorder. This diagnosis can be considered a comorbid disorder
because the former mentioned actions did not occur only during manic episodes. Also, the
actions of his childhood show evidence of Conduct Disorder with a childhood onset.
Axis I: 296.54 Bipolar I D/O, Severe with Psychotic Features
312.81 Conduct D/O, Childhood-Onset Type
Axis II: 301.7 Antisocial Personality D/O
Axis III: None
Axis IV: Problems with Primary Support Group: Girlfriend Broke Up Due to Lack of Ambition,
Unaware of Biological Father, Abusive Grandfather
Problems Related to the Social Environment: Difficulty with Acculturation
Educational Problems: Dropped out of College A Couple Times
Occupational Problems: Lack of Employment Due to Always Being On The
Housing Problems: No Settled Household
Economic Problems: Inadequate Finances
Problems Related to Interaction With The Legal System: Incarcerated and
Charged With The Murder Of 30+ Women
Axis V: GAF
(past): Social: 5
Occupational: 32
Symptoms: 23
(current): Social: 42
Occupational: 41
Symptoms: 55
Case Formulation:
The results of this assessment show that Ted Bundy's ability to communicate and live
responsively in his surroundings are working at a normal level. His health seems average, but
normal for being incarcerated. His memory of the events and his capability of being able to stay
focused on the question at hand is above average. This is related to his demeanor, intelligence
and deceptive ways. He has shown this behavior with other clinicians and his victims. Ted
Bundy's assessment concluded that his actions are common for and meet the requirements for the
diagnosis of Bipolar I Disorder, severe with psychotic features, Conduct Disorder with
childhood-onset and Anti-Social Personality Disorder.
Bundy expressed his former symptoms as being spontaneous, having grandiose thoughts,
increase energy and heightened excitation. These symptoms fulfill all of the diagnosis criteria for
a Manic Episode. On top of these symptoms, Ted Bundy is also manipulative, disregards the
safety and rights of others, has a lack of remorse , has murdered several women, is deceitful and
irresponsible, all of which define Anti-Social Personality Disorder. Ted Bundy is not currently
taking any medications, but is thriving in his jail environment. His control and relatedness to the
situation within the jail allows him to act out in his deceitful ways to the full extent.
Ted Bundy's cleanliness, sly demeanor and charming attitude are a sign of his inability to feel
remorse or any guilt towards his actions. He took pride in the actions that he give details about
and came off with an inappropriate affect in relation to the topics at hand. An approximate order
of his symptoms in the past could look like the following:
(1) Ted feels as if he cannot be a part of society and begins to isolate himself from every person
and every place;
(2) He drives around neighborhoods and public areas, possibly while intoxicated, and looks for
women or young girls that activate the part of his brain that have been conditioned to bring about
violent and immoral acts;
(3) He begins to seek that energy in his life and formulates a plan, as well as chooses a specific
victim for a specific reason;
(4) He commits the acts of violence (rape, murder, disembodiment, etc.) to the woman or
(5) A sense of euphoria from the completion of the act, the deceitfulness of his actions and the
fact that he got away with it pleases him;
(6) This heightened state of mind will last a few days to a week, during this time he will be
sociable, excited and have grandiose thoughts;
(7) After the deterioration of this state of mind, he will fall back into the beginning stage of his
depressive state;
Let it be noted that the pattern of these mental state of minds is not specifically only during his
Due to the fact that Ted Bundy is a very impulsive and uninhibited man, it is possible that there
are biological factors that contributed to his abnormal personality and behavior. His behavior
could be explained as being fueled by an over-excitatory behavioral neurotransmitter pathway.
Dopamine and serotonin, both associated with pleasure, could be the cause of the feelings he
thrived on. Bundy's levels of these neurotransmitters could be low and through his attacks on
women, those levels could have raised. Also, there are reward systems (pathways) in which the
completion of a goal and/or the lack of punishment from a bad action will condition a person to
continue that behavior. Ted's grandfather has been known to express some psychotic or manic
features and his grandmother received treatment for depression. A history of mental illness
allows the possibility of genetics playing a part in his personality. Facts regarding his father
remain unknown, therefore, we can leave space for a possible genetic heredibility of mental
disorder coming from his part as well.
There are a variety of psychological factors that are also contributing to Ted's mental disorders.
Ted experienced a dramatic uncovering of his true parents during the time of his first killings. He
found out that the woman he thought was his older sister was, in fact, his mother. His
grandparents, who raised him in the beginning, were unstable and his grandfather was very
abusive and malice. After his first girlfriend left him due to his in-ambition, his anger and
resentment towards her, along with that of his mother, built up and it was soon after that he
began, from the information we know, to attack women. Ted seems to be displacing his feelings
towards his mother and ex onto women in society (note: the women were apparently similar in
appearance to his ex-girlfriend). During his adolescence, he separated himself from others and
focused mainly on his school work. This, in turn, caused Ted to be unsure of where he belonged
and he began to develop a thought process in which he believed he had to put on an act to get
what he wants. This was the beginning of his deceitful and manipulative behavior. Also, Ted
always wanted to be able to be sociable and liked. After he would commit these crimes, or when
he would be in a manic episode, he would have the utmost confidence and he was the person that
he thought he was always meant to be.
When Ted was socializing normally in society, he was intertwined with the political scene which
he described to be promiscuous and mysterious. With the respect that he received while in these
positions, these two elements of the political world could have been bound together. Ted, when
thinking of reaching self-identity and power, also thought about how being with women
frequently would help him gain power. This, along with the violence that was already
conditioned with sexual relations, made his need for control over women unbearable. He would
resort to these crimes in order to fulfill that need and get his psychological reward. While
growing up, Ted was arrested on accusations of forgery and theft. These cases were expunged
from his record when he turned 18. Being able to have what he had done erased was the
beginning of his thrill to escape and get away with multiple murders. Due to the biological,
psychological and societal factors of Ted Bundy’s life, his thoughts of, his outlook on and his
emotionality towards the world became abnormal and extremely dangerous.
Cultural Formulation:
Ted grew up in a household in which going to church on a regular basis was highly important.
He does not recall retaining any lessons or facts that were associated with this church
background, but knows that his parents met at a church meeting and liked to go often. He admits
that sometimes after he attacked women, he would fall back and feel as if he was going against
God. His mother had him at a house for unwed mothers and society, at the time, looked down
upon a child been born illegitimately. He has a basic American cultural background. He is only
able to speak English, but he has a very eloquent way of speaking to make himself seem of high
stature to those around him. It could be said that during Ted's adolescence, he lacked the ability
to and did not conform to the typical cultural and societal norms of high school. He would say
that he "didn't like to drink" or that he "didn't have time with his studies to go out", but, in reality,
he feel incapable of blending with the crowd because he knew he was different. He secretly
wanted to be part of life that he so desperately wished for.
Currently, Ted views himself as different and higher in quality than that of the average person.
He used his knowledge and slyness to make it seem as if he somehow important in the culture.
This culture feeds on certain narcissistic personalities and wants to know more about them. Ted
has developed a band of followers who admired his dramatic and straight-forward explanations
for his behaviors and mindset. Being raised in the same culture, Ted's need for social attention
and cultural dominance is similar and familiar to many famous and known people that could be
used as an example. Throughout the assessment, Ted continued to remind me that he thinks all of
the publicity that he is getting is helping him to solidify who is he as a person. His need for
cultural dominance could make it difficult to bring him to reality and inform him of the
pathological being he is.
Treatment Plan:
Antisocial personality disorder is and has been a difficult disorder to treat. For the past few
decades, researchers have been trying to find a balance between possible medicine,
psychotherapy and cognitive behavioral changes that would be beneficial to those suffering from
the disorder. The patients usually believe that they do not need treatment or they know that they
do, but they choose to not take part in it specifically because they are being told they have to.
When the following possible treatments are being implemented, it is very important to have a
close relationship with the patient and follow-up with them on a regular basis. When working
with people who have Antisocial Personality Disorder, it is important to make them feel as if
they are active and in control of their treatment plan and that they are actively finding solutions
to their own problems.
Finding a way to help Ted reduce his risk of committing another crime is one of the key
problems to address first. A study conducted by Olver, Lewis and Wong (2013) assessed how
well risk-reduction treatment worked for high-risk psychopathic offenders. Their participants
were 152 males that were federally incarcerated, with eight of them having life sentences. After
many controls were contained and analyses of both risk recidivism and therapy change were
conducted, they reached the conclusion that the more at-risk the inmate was of committing
another crime, the less likely they were to gain positive outcomes after completing a riskreduction treatment. Those results imply that trying to get right at the act of Ted’s committed
crimes is not the best psychological path to decreasing his behavior. The effectiveness of general
psychotherapeutic treatments for all personality disorders, measured by Bateman (2002) is high,
although many psychiatrists have been criticized for lacking the ability to develop a treatment
plan that is more effective than not. They investigated what qualities a psychotherapeutic
treatment should have to be as effective as possible. They suggested that a plan should be
integrated along with other treatments, should be focused on patient compliance and should
undoubtably be a long-term program. Supporting this suggestion, a study conducted by Messina
and others (2002) found that when comparing those with APD with those without APD, there
was no difference in the success of a therapeutic community treatment. Along with this treatment
plan, the authors recommend aftercare in the community with support and applications of learned
behaviors. This treatment will also depend on Ted’s compliance throughout the entire
With the knowledge that risk-reduction programs are usually incapable of reducing another
future crime and that psychotherapeutic treatment only has some potential to help, Ted would be
best treated with a cognitive-behavioral approach that has been shown to be very effective over
many years in treating those with psychopathic personalities (Templeman & Wollersheim, 1979).
Different than the three treatments mentioned above, this type of approach focuses specifically
on how the psychopath sees himself and the world. A program of this kind would not focus on
modifying Ted’s behaviors and crimes, but more on how to teach Ted self-control when he has
thoughts of behaving in a violent manner. Ted needs to be treated as if he is a normal client and
the outcomes of the treatment need to be seen by Ted to be in his favor. When the outcomes are
believed to be in his best interest, he will have no choice but to continue treatment or ignore his
best interests. A positive outcome, for example, from this type of approach would be the roleplaying suggestions. During this part of the treatment, Ted, with the love of putting on an act to
manipulate and deceive those around him, will be asked to play specific pro-social positions in
society such as “the good guy”. This will turn Ted away from the negative roles while still
allowing him to use his rewarding behaviors to feel in control of the situation. It is not certain
that this type of psychotherapy is going to work in Ted’s situation, however, this is my
recommendation or an attempted therapy.
In reference to any medication that Ted should be put on, the medication should target his
Bipolar I disorder, his mood changes and his irrational emotions. The biological reasoning
behind using certain medications for this disorder is that there are abnormal neurotransmitter
reactions taking place in the brain. Rivas-Vazquez et al. (2002) explained the pathophysiology of
the brain and how it points to the limbic system and its involvement with the hypothalamicpituitary axis. This interaction between brain structures entails the neurotransmitters
norepinephrine, dopamine and serotonin, all of which are targeted by the medication designed for
or that subsequently help with Bipolar disorders. Some of the medications also target GABA and
glutamate, two of the inhibitory and excitatory neurotransmitters. The first choice medication for
treatment of Bipolar I disorder, and my recommendation of medication is Lithium carbonate.
Lithium targets all of the neurotransmitters listed above by increasing GABA, increasing the
reuptake of excitatory glutamate, decreasing the breakdown of dopamine, returning
norepinephrine to its baseline, and enhancing serotonin and acetylcholine. Lithium would control
Ted’s manic behaviors and, in return, hopefully reduce his risk of violent and illegal
Ted should be referred to a psychiatrist within the jail and his medication should begin
immediately, as the full effect of Lithium is seen after 7-14 days, during which the serum levels
are achieved. The cognitive-behavioral therapy should also begin right away. Ted will be hesitant
to comply, but with the recommendations I have for allowing Ted to control the beginning of the
evaluation and assessment will lower his chances of complete ignorance of the program. There is
a possibility that none of the recommended treatments for Ted will be successful. He is unlike
any patient I have seen and the magnitude of his crimes and behavior might be outside the realm
of treatment.
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