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

·  Best bet for overhaul in DSM-5 – but passed over!

·  Medical (DSM) – Types -- Categorical – Discrete (nonoverlapping)

·  Scientific (Personality Theory) – Traits – Continuous (spectrum)

·  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

Personality, Childhood Disorders – Dr. Mascolo

·  10 types divided into 3 “Clusters”

Personality Disorders
Cluster A / Cluster B / Cluster C
Odd & Eccentric / Dramatic &Erratic / Anxious
Schizoid – detached, distant, indifferent, flat / Histrionic -- Seeks attention; impressionistic: “Disdain for dry weights & measures of the world”; immature sexuality / Avoidant – socially inadequate, inhibited, fears criticism, responsibility, new/challenging situations or relationships
Paranoid –suspicious, competitive, bears grudges / Narcissistic – entitled, self-important, preoccupied with success & status, demands adoration/hostile to criticism (“narcissistic rage”); superficial insouciance & charm, exploits relationships, unempathic / Dependent -- excessive need to be under the care of another; fear of being alone – urgent, clinging, submissive
Schizotypal - magical thinking; ideas (not delusions) of reference; genetically related to Schizophrenia / Borderline – “frantic efforts to avoid real or imagined abandonment”, intense, unstable relationships, unstable identity, chronic emptiness, self-destructive, “emotional dysregulation” (e.g., intense, inappropriate rage); suicidal threats, gestures, behaviors; primitive defenses: Splitting/Projection / Obsessive-Compulsive – rigid, perfectionistic; (not the same as Obsessive-Compulsive Disorder)
Antisocial – “psychopath” –irresponsible, reckless, deceitful, lack of conscience & remorse, social nonconformity, autonomic hypoarousal (“Thrill Seeking”)

Personality, Childhood Disorders – Dr. Mascolo

Childhood Disorders

Want to work with kids?, Have to work with families!

·  Harbor negative countertransferential feelings of parents – may lose the patient.

·  Legal issues– e.g.,

·  the holder of the privilege (confidentiality) legally, parents have a right to know session details

·  Consent to tx.

· 

Symptoms

·  Not inherently pathological – instead developmentally inappropriate

·  Need to know developmental milestones

·  Not always a delay.

·  Focus on function, rather than topography.

·  Verbal Skills/Insight – weak; Candor -- strong

Diagnosis

/ /

Reality

/
Disorder Absent / Disorder Present
Clinician
Decision / DX Yes / False Positive / Sensitivity
DX No / Specificity / False Negative

·  Concerns:

·  False Positive – “Stickiness” (e.g., Disruptive Mood Dysregulation Disorder)

·  False Negative – Fail to take advantage of early intervention

Attention Deficit Hypersensitivity Disorder (ADHD)

·  Inattentive, careless, disorganized – (kid playing video games for hours?)

·  Fidgety, impulsive, impatient

·  Specifiers:

·  Primarily Inattentive Presentation

·  Primarily Hyperactive/Impulsive Presentation

·  Combined Presentation

Autism Spectrum Disorder (a Neurodevelopmental Disorder)

·  “Spectrum” = large variation in symptom severity

·  Deficits in social reciprocity, understanding nonverbal communication

·  Restricted, stereotypic interests & behaviors

·  Overreliance on consistency (“sameness”)

·  Hyper- or Hyposensitivity to sensory stimuli

Oppositional Defiant Disorder – ODD

·  Extreme noncompliance -- defiance

·  Can “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

·  “ASPD” in waiting?