Personality, Childhood Disorders – Dr. Mascolo
Personality Disorders
DSM hates this section! – most ill-fitting in a medical nosology
Anachronistic – current scientific Personality Theory has moved from Types to Traits
 DSM – Types -- categorical – mutually exclusive (nonoverlapping)
 Personality Theory – Traits -- Big Five
1. Neuroticism
2. Openness
3. Conscientiousness
4. Extraversion,
5. Agreeableness
Personality Disorders –


Wide-ranging (emotional, interpersonal, cognitive, work, familial), develop early, generally permanent.
Lack of insight – ego-syntonic symptoms
DSM-5 Personality Disorders Organized Around 3 Clusters
Cluster A Odd & Eccentric
Schizoid
aloof, distant
Paranoid
untrusting, suspicious; Life is a
“Zero Sum Game” – “What you
win I have lost”
Schizotypal
magical thinking
Cluster B Dramatic & Erratic
Histrionic
Seeks attention, “disdain for dry
weights & measures of the world”
Narcissistic
Seeks adoration; insouciant,
charming; “Narcissistic Rage”
Cluster C Anxious
Avoidant
Differential Dx: Social Anxiety,
Generalized
Dependent
original “co-dependent”
Borderline
c/o emptiness, Self-destructive
rage, Fear of abandonment,
Emotional Dysregulation,
splitting/projection
Psychopathic (ASPD
conscienceless; autonomic
hypoarousal
Obsessive-Compulsive
perfectionistic, rigid
Not the same as OCD!
Personality, Childhood Disorders – Dr. Mascolo
Childhood Disorders
Work with kids, work with their families
 Harbor negative countertransferential feelings of parents – may lose the patient.
 Issues of law:– e.g., the holder of the privilege (confidentiality), consent to tx.
 Confidentiality – technically, parents have a right to know the content of the sessions.
Nature of SXs –
 Not inherently pathological – instead developmentally inappropriate
 Need to know developmental milestones
 Not always a delay.
 Focus on function, rather than topography of the behavior.
Verbal Skills/Insight – weak; Candor -- strong
Dx – consequences of a false positive -- but also -- a false negative
 “Sensitivity” it may be subtle, but the clinician makes the diagnosis
 “Specificity”– it may seem obvious, but the clinician does not make the diagnosis
ADHD -- maybe is an example of a trait, not a type
 3 subtypes – primarily inattentive, primarily hyperactive, combined
 Inattention – kid playing video games for hours?
Autism – Neurodevelopmental Disorder – like Schizophrenia
 “spectrum disorder” – acknowledges huge variation in severity and symptoms
 Typical sx’s include social isolation, stereotypic interests & behaviors, language problems
Oppositional Defiant Disorder – ODD
 All kids are sometimes noncompliant (disobedient)
 ODD is extreme – for example not just noncompliant -- actually defiant
 ODD may “graduate” to Conduct Disorder (CD), which may graduate to Antisocial Personality Disorder
(ASPD)
Conduct Disorder
 worse than just noncompliant – or even defiant – actually violate the rights of others
 prelude to ASPD?