1. A personality disorder is a “pervasive, enduring and inflexible pattern of inner experience and behavior that deviates markedly from the expectations of the individual’s culture” (DSM IV, 1994).  Each disorder contains Cognitive, Affective, Interpersonal and Behavioral components. The following is a narrative description using a popular character from either a fairy tale or fictional story, that describes each of the following personality disorders:  -Paranoid; -Schizoid; -Schizotypal; -Antisocial; -Borderline; -Histrionic, -Narcissistic; -Avoidant; -Dependent; -Obsessive-Compulsive

The characters in the Peanuts cartoon strip are rich in a variety of personality types. Charlie Brown clearly meets several possible personality disorders. His continual trips to the mailbox to check on Valentines or love letters from the ‘little red haired girl’, might fit the criteria for Obsessive Compulsive Behaviors. To elaborate some on his general presentation in the cartoon strip, Charlie thinks of his ‘little red haired girl’ as an unobtainable desire that haunts his dreams and his awake time as well. Most of his day dreams are wrapped around finding a letter in the mailbox. He checks on it several times a day, even when he knows the mail has already come. He believes that he should keep checking, ‘just in case’.  He thinks that it might magically appear if he is faithful in checking.  He has a heightened level of anxiety as his compulsion permeates his thinking throughout the day. His attitude reflects that he assumes that life should be perfect; that there should be a ‘red haired girl’ for every boy who does what is right and is properly expectant. 
Charlie also meets the Dependent personality description as his view of himself is tied closely to his performance on the baseball field, kicking the ball Lucy holds for him, and keeping the kite out of the kite-eating tree. He has wrapped his sense of self-esteem around success in these areas.  His thinking process is consistently tied to how others are viewing him. He keeps trying over and over again to successfully meet the expectations he believes others hold for him. He looks to the recognition of Lucy, the baseball fans and team members and even the kite eating tree for self-affirmation and never receives this.
Lucy best fits the Narcissistic personality. Every event is measured against how it affects her. She has no empathy toward others. Her relationship with and treatment of her Linus, her brother, Charlie Brown and Schroeder, the pianist, all point to how these three meet or fail to meet her needs. Her thoughts are centered about how the world treats her. She views herself as a victim or at the mercy of fate or circumstance when under duress. She sees others are to blame for her unhappiness. When she is thwarted in her goals she is angry and becomes pessimistic and depressed. She exaggerates her abilities and her worth to others. Her penchant for setting up a psychiatric advice booth to sell advice for five cents is a good reflection of her “I know what is good for you, so you should listen to me,” personality.
Pepperment Patty may possibly meet the paranoid personality disorder criteria depending on how seriously she takes the idea that the teachers are always out to get her. Her thoughts are focused on where the next criticism is coming from and how she is going to respond. She focuses on how she is never able to meet anyone’s expectations because they are expecting entirely too much work and attention from her. She blames this on the teacher’s mistaken view that Patty is lazy. Her behavior is reactive. She is fearful that she will be caught and accused of being lazy or of making mistakes, even when she is not doing either. She strongly mistrusts her world. She feels she is not lazy, only misunderstood, and that each of her teachers simply have a bias toward her. This bias leads them to mistreat her and ridicule her in class.
Schizoid personality might describe the character Pig-Pen, though not as much is presented in the strip on him. His automatic attraction to dirt seems to set him off from the rest of the group. This being set apart or being alone does not seem to affect him in anyway. He seems perfectly content in his own dirt-filled world. With this personality trait he would avoid others most of the time, show little concern with the lives of others, have few friends, and seem to have little or no need for acceptance.  His thoughts are his own and he does not feel a need to share them with others. He is generally content when alone and isolated.
Histrionic personality might best describe Sally, Charlie Brown’s sister from the Peanut’s cartoon strip. She enters every relationship or life event as if it were a life changing or life or death situation. She screams at Linus when he declines the opportunity to be her boyfriend.  She is furious at being duped by Linus when the Great Pumpkin refuses to show up at the pumpkin patch.  She is upset at her teacher for assigning ‘undoable’ homework.  She is angry at the world for being too complex and too changing because she has to learn more history. She is always dramatic in her presentation of information and evidences a sense of being the main character in a dramatic play, which is how she views each of the events that happen to her. Her thoughts are self-centered and she is generally ego centric.
Schizotypal is more descriptive of Eeyore, the burro from the Winnie the Pooh books. His odd eccentricities, such as worrying about unlikely catastrophic events, avoidance of friends for fear of eventual rejection or loss, and the great sense of loneliness he exhibits might fit this disorder.  His personification of things such a pinecones having a grudge against him is an example of his muddled thinking, sensing a force or presence that is out to get him in the routine objects that surround him. His discussions with Piglet, befuddle Piglet, due to Eeyore’s vague points and loose associations he makes, referring to the problems with snow being too white or water being too wet and soft.  Eeyore is actually a favorite character of many, in that he exhibits a more extreme level of a depressive approach to life that is often seen in others and one that is the antithesis of what is healthy or happy. People feel happier in their only slightly depressive state when they compare themselves with Eeyore. 
Avoidant personality could also describe Eeyore, the burro from the Winnie the Pooh story. He is unwilling to see himself as part of the group. He chooses to be alone and appears fearful or unwilling to engage in a close personal relationship, possibly due to fear of rejection or future loss. He acts as if his opinions do not matter, so he never offers them and if asked he is so reluctant to offer an opinion that is it entertaining to experience. He is confident that he could never be right, be accepted for who he is, or be of any value to others.
Antisocial behavior might best describe Captain Hook from the story of Peter Pan. He is at his happiest when others suffer. His day is spent scheming up ways of hurting his nemesis, his men, the crocodile, or Tinkerbell. His thinking is related to ‘what is in this for me’, with little or no thoughts about how his behavior might affect others or how others may feel. He is self-centered and lacks the ability to empathize. He sees no connection between the suffering of others and any obligation on his part. In fact he draws some pleasure from creating or being the source of such suffering.
Borderline personality might best describe Tinkerbell. Though even under a good deal of stress with legitimate justification for her personal safety, her jealousy over Peter Pan’s relationship with Wendy, led her to behave in ways that put Peter’s life in jeopardy and put herself in an alliance with Captain Hook. She was remorseful later, yet even then, she vacillated in her thinking and would develop an uncontrollable jealousy when she would think about Wendy and Peter. Even after all was resolved, she still remained erratic in thinking and in her behaviors about her relationship with Wendy, the lost boys, and Peter.
2.	The following illustrates the differential diagnosis of Dementia vs. Dissociative Amnesia vs. Dissociative Fugue. Dissociative Identity Disorder is described, specified, and illustrated through a case example, including the three kinds of relationships amongst the subpersonalities, including the 3 subtypes.  

Dementia is characterized by the development of multiple cognitive deficits that are due to direct physiological effects of a general medical condition, to the persisting effects of a substance, or to multiple etiologies. This includes memory impairment. The person’s general forgetfulness and impaired thought processes are associated with an underlying physical condition or the effects of drugs. It is a affect of what has happened physically to the person.
Dissociative Amnesia is the inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by normal forgetfulness. The disturbance is not due to the direct physiological effects of a substance or a neurological or other general medical condition. The disturbance is not exclusive to Dissociateve Identity Disorder or Fugue, posttraumatic stress disorder, acute stress disorder, or somatization disorder. The symptoms cause significant distress or impairment.  The underlying cause is more related to the affect of an emotionally charged event in the life of the person or the person’s emotional reaction to a stressful event that causes specific information to be unavailable, often temporarily to the individual for recall.
Dissociative Fugue describes sudden travel away from home or usual place of activity and the inability to recall some or all of one’s past, with confusion of identity. It is not connected with the physiological effects of a substance or a general medical condition. This is also forgetfulness, but it is generalized as opposed to forgetting specific events or information. One’s entire identity and past may be forgotten. As with Amnesia, it is not related to a specific physical condition or reaction to medication, more likely related to an underlying emotional reaction.
All three cause general impairment or distress in important areas of functioning. Dementia is associated with effects of underlying medical conditions or the effects of substance abuse impairment. Dissociative Amnesia is related usually to stressful or traumatic information and it is not related to a specific physiological or substance use related condition, and it is related to the inability to recall specific important information. Dissociative Fugue is a general inability to recall one’s past and identity. The person is out of place and out of normal thoughts.
Example:
Mary presents in therapy a description of at least three distinct identities. Her history, as presented by herself and her husband describes a definite distinction between the Mary who is a wilting, wall flower, never offering any input into conversations, is fearful, and reluctant to leave the house or insist on her way and the dominant, aggressive Mary, who is highly verbal, energetic, forceful, demanding of her own way, and spends time at bars and clubs, often staying out all night. Also, she has a third personality that is related solely to her part time job. Her husband says that when she is at work she is the consummate professional, very efficient in her role as legal secretary and considered by her boss and peers as effective, entertaining, warm and friendly.  He says that this happy, efficient and warm person is the girl he married, but beginning about six months ago the two other personalities appeared following her return from her father and mother’s funeral, which were killed in a car wreck. She states that she rarely is able to recall what she does during these altered times when she is at bars or when she is ‘curled into a shell’ as she describes her more subdued altered personality.  Her husband states that when he confronts her when she is in her ‘bar girl’ persona, that she is not able to focus on or recall much about the quiet life she has been sharing with him and only recently has he finally convinced her of the existence of her other two persona. Mary said that if her sister had not confirmed his descriptions of her three personalities, she would not have agreed to therapy. A physical exam by her personal physician reveals no medical explanation for her behaviors and she has stated that she is on no medication other than an occasional asprin or antihistimine. She may exhibit a Dissociative Identity Disorder by evidencing two or more distinct identities or personality states that control her behavior. She is unable to recall important personal information from one state to the next, which is reflective of mutually amnesic relationships between the three distinct personalities. Were she consciously aware of her behaviors and thinking in each state while in another state, she would have evidenced a mutually cognizant patterned relationship between the relationships. Had she only been aware of the other two during her ‘club’ personality, but totally unaware of the club personality from either of her other two, the quiet personality or the business personality, this would have been a one-way amnesic relationship. She does not have any underlying medical conditions nor any substance related affects that explain her condition. She alternates between a very aggressive and haughty affect and a very subdued, diminutive affective personality.  
3.  Some of the most common diagnoses that children are given are amongst the Disruptive Behavior Disorders. It is often difficult to differentiate Opposition Defiant Disorder from Conduct Disorder from Attention-Deficit Hyperactivity Disorder, as the symptoms often overlap. Discuss the steps you would take and the questions you would ask the child, parents and teachers in the following scenario, to clarify the diagnostic picture:
	Johnny, a ten year old Hispanic boy, is dragged in by his parents to see you upon the insistence of his school principal. Mom tells you that he “lies, steals and throws tantrums”. Dad tells you that his son is “just a typical boy with a lot of energy”. Johnny is laughing as his parents speak.

Oppositional Defiant Disorder children argue repeatedly with adults, lose their tempers, and feel great anger and resentment. They deliberately annoy other people and blame other for their own mistakes and problems. The opposition to authority or exerting their will over others is a critical piece in understanding this disorder.
Children with Conduct Disorders are aggressive and often cruel in their behaviors, which are often repetitive. These children will go out of their way to be cruel. Though some of their behaviors may be defiant, their aggression is more generalized, often reflected in general violence or cruelty across a wider range of relationships than with just adult caregivers.
Children who suffer from Attention-Deficit Hyperactivity Disorder have great difficulty in attending to tasks, are impulsive in their behaviors, or both.  The symptoms build on one another, the higher activity levels making it more difficult to focus or maintain attention to tasks.  They may be disobedient, but the causes behind the acts are more related to lack of impulse control, simple forgetting, inattention, or inability to remain still vs. a willful act of disobedience. 
The related behaviors to each of these conditions are similar in that they appear to be out of control of at least the adult caregivers’ wishes for the child. The Oppositional Defiant Disorder children are out of control from the perspective of the child’s willful reactivity to external instruction. The child with conduct disorder is out of control due to tendencies to behave in a generally anti-social fashion across a number of settings.  The child who has an Attention-Deficit Hyperactivity Disorder has behaviors equally out of control, but the behaviors are out of his conscious control as well. With little or no impulse control and highly active behaviors maintaining any sort of internal structure for the child’s own behavior is severely limited.
Depending on mutual schedules I would pursue setting up a time to observe the child in a neutral setting, such as a playroom, or making a visit to his classroom. Or, in the alternative, I would ask for a report on his general behaviors in class from his teacher.  I would look for acts of cruelty vs. simple acts of disobedience, and I would watch for general activity levels and impulsiveness to differentiate between the first two and Attention-Deficit Hyperactivity Disorder.
Sample Dialogue:
T-Therapist; C-Child; M-Mother; F-Father
Reflecting Attention-Deficit Hyperactivity Disorder- In an interview with only the parents:
T-Does Johnny ever bully other children or be the first to hit in a fight?
M-No he is almost always having too much fun.
F-Yes, his main problem is that he is just too much of a boy, he just likes to jump and run, just like his dad.  
M-But he keeps getting in trouble and does not listen when I scold him.
F-He’ll listen when I scold him!
M-Yes but you just scare him for a very short time and then he is back to his old behaviors. I can’t get him to finish anything unless I stay right on him and it is wearing me out. His teachers say the same thing, “Does not follow instructions.” But they say he is likeable, despite his classroom disruptiveness.

Reflecting Conduct Disorder- In an interview with the child only:
T-Why are you here today?
C-My teacher told on me for socking John in the nose. 
T-Tell me what happened.
C-John is a jerk so I had to hit him to teach him a lesson.
T-What had John done to make you want to hit him?
C-He just a sissy and had it coming.
T-How were you feeling when you hit him?
C-Like he needed it and I was teaching him a lesson. 
T-Did it make you feel powerful or strong?
C-Yeh!
Reflecting Oppositional Defiant Disorder- Interview with the parents and Johnny:
T-Does Johnny have a favorite teacher?
F-Yes.
C-Yes, it is Mr. George my PE coach.
T-Do you find it difficult to obey instructions given you by the coach?
C-No, he is cool and I know he will beat my butt if I don’t.
F-Why can’t you mind your other teachers then?
C-They are jerks and always getting in my way. They don’t know how to teach and are stupid.
T-Coach George is different. 
C-Yes, he listens to me and doesn’t make me do things I don’t want to do, like write and read and stuff.
T-You were in a fight today with another student. What happened?
C-It was his fault; he pushed me first. I showed him he could not push me around.
T-Do you find that your friends are usually bigger or smaller than you. 
C-I have both, but I like the ones smaller than me because they don’t try to tell me what to do.