Agree with the comments on here that it was her mental illness (or, more correctly ‘illnesses’) that was the cause, and not the effect.
I would say that she suffers from more than one personality disorder.
Many personality disorders are extremely difficult to treat, even with the best of care, and they are called 'personality' disorders for a reason -- one doesn't change one's 'personality'; the traits are fairly fixed.
Personality disorders can't be 'cured', and are at best ‘managed’.
As portrayed in the film, Caroline seemed to suffer a form of body dysmorphia (which is all about one's perception of oneself; a person with this disorder can be extremely attractive, but still perceive themselves as somehow ugly or malformed); borderline disorder (the real Caroline did engage in self-mutilation when initially jailed – many folks with borderline disorder are ‘cutters’); anti-social disorder (and probably conduct disordered as a child – for example, the real Caroline admitted to her attorney that she frequently stole as a child, but didn’t know why she did), and paranoid.
Also as portrayed in the film, she exhibited extreme rapid cycling of moods, ranging from screaming me-me's to almost manic euphoria, sometimes within minutes.
I don't know if any of us know much about her parents, but parents aren't perfect, and trying to raise a child suffering from a basket of personality disorders like these could be daunting. One poster asked why didn’t they put her away – well, I don’t know about Australia, but you just can’t go around committing children in the USA. Then, as an adult, the real Caroline was known to function well at work and was able to live on her own, so her parents probably thought that she had grown out of the worst of it, at least enough to function reasonably well on her own.
Also, you may be able to alleviate some of the anxiety/depression that can accompany a personality disorder, but you can't 'med away' a personality disorder. You also can't 'talk a person out of the kind of obsessive beliefs she seemed to possess – research has shown that there is little to no benefit for many personality disorders from the jewel of ‘talk’ therapy -- cognitive behavior therapy.
Caroline undoubtedly was in the throes of puberty when she started obsessing about Rachel (the judge thought she had started at least as far back as around 15 years old – the same age Rachel was when she killed her), and it also was around this age when she reportedly was at the height of her difficulties at school.
All of this is not to minimize the horrible effects of prejudiced lookism, which can be devastating even to the most emotionally healthy individual. And, calling someone ‘fat’ seems to be one of those lingering discriminatory terms that society just can’t shake, despite the fact that we are born with different body types which has nothing to do with willpower or laziness or any of those other pejoratives that some folks like to toss around, and research is showing that some folks who are naturally ‘obese’ (I use the term ‘obese’ very liberally, as the definition for what constitutes ‘obese’ keeps shifting) can be just as healthy, some healthier, than their more slim counterparts.
Bullying a child/teen can certainly take a toll.
However, we don’t know how much abuse Caroline suffered from peers because of her ‘odd’ behavior and lack of social skills (again, this is not to excuse abuse or bullying, but we also have to remember that most kids who engage in that behavior are immature children themselves), which further alienated her and helped to reinforce a distorted perception she already had of herself.
And, even given that she was abused/bullied and had an extremely low opinion of herself, whether perceived or real, without the forms of mental illness she apparently suffered (and, IMHO, will continue to suffer for the rest of her life), there would not have been this calculated, cold, envy-driven murder against such an innocent young victim.
I think Caroline’s constellation of mental illnesses is more the exception than the rule – a rarity that her parents, her schoolmates, Rachel and her family, and society at large could not be equipped to handle or could foretell what would eventually result from it.
Unfortunately, it was one of those perfect storms in whose path Rachel unwittingly found herself.
And, I believe that Caroline will continue to be dangerous without very strict monitoring.
11/16/12: The day the Twinkie died :(
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