What may be less familiar is a mental illness his lawyers are connecting with him: Histrionic personality disorder. The defense attorneys say they intend to offer expert testimony from a psychologist who "will explain that the words, tones, requests and statements made in the letters are consistent with a person who suffers from a Histrionic Personality Disorder," according to documents.
Histrionic personality disorder is part of a class of conditions called dramatic personality disorders, which are marked by unstable emotions and distorted self-images, according to the Cleveland Clinic.
For these people, self-esteem doesn't come from true feelings of self worth, but rather from the approval from other people, and those suffering from this disorder will often engage in dramatic or inappropriate behaviors to call attention to themselves.
"People develop this disorder because they have a need to be appreciated and to feel valued and worthwhile and special," said Nadine Kaslow, psychologist at Emory University School of Medicine, who has not treated Sandusky.
About 2% to 3% of the general population is thought to have histrionic personality disorder, she said. "We all have traits that resemble this, but it becomes a problem when all of the symptoms are combined in a way that makes functioning difficult."
Inflicting sexual abuse is not a commonly recognized trait of this condition, but sexually-provocative behavior is, she adds.
People with this personality disorder may also change emotions rapidly, overly dwell on physical appearance, and take criticism or disapproval sensitively. They are easily influenced by others and make rash decisions, according to the Cleveland Clinic. Rarely showing concern for others, they often find it challenging to maintain relationships. People with histrionic personality disorder may even threaten or attempt suicide for the sake of getting attention.
No one knows what causes this disorder, but experts say it's probably a combination of nature and nurture. The personality disorder can run in families, suggesting a genetic connection, but children may also be influenced by their parents in ways that would lead kids to crave attention or be confused about how to get parents' approval.
The standard treatment for this disorder is a type of counseling called psychotherapy, in which a mental health professional helps the person delve into what's causing their thoughts and behaviors, and figure out how to create more positive relationships. Depression and anxiety may be issues for some patients, and may be treated with medications. But generally this personality disorder has not received a lot of attention in terms of evidence-based treatments, Kaslow said.
It's important to seek help if you believe you have symptoms of histrionic personality disorder, especially if it's causing trouble in your romantic or professional life.