Personality Disorders in Children and Adolescents

300 Pages·2000·0.98 MB·English

by  Paulina Kernberg

PERSONALITY DISORDERS IN
CHILDREN AND ADOLESCENTS
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PERSONALITY
DISORDERS
IN CHILDREN AND
ADOLESCENTS
PAULINA F. KERNBERG, M.D.
ALAN S. WEINER, P H . D.
KAREN K. BARDENSTEIN, P H .D
BASIC
BOOKS
Copyright © 2000 by Basic Books
Published by Basic Books, A Member or the Perseus Books Group
All rights reserved. Printed in the United States of America. No part of this book may be repro
duced in any manner whatsoever without written permission except in the case of brief quota
tions embodied in critical articles and reviews. For information, address Basic Books, 387 Park
Avenue South, New York, NY 10016-8810.
Library of Congress Cataloging-in-Publicarion Data
Kernberg, Paulina F.
Personality disorders in children and adolescents / Paulina F. Kernberg,
Alan S. Werner, Karen K. Bardenstein.
p. cm.
Includes bibliographical references and index.
ISBN 0-465-09562 3
1. Personality disorders in children. 2. Personality disorders in adolescence.
3. Child psychiatry. I. Weiner, Alan S. II. Bardenstein, Karen K. TIL Title.
[DNLM: 1. Personality Disorders—Adolescence. 2. Personality Disorders—
Child. WS 350.8.P3 K39p 1999]
RJ506.P32 K47 1999
618.92'89—dc21 99-046470
CIP
EBC 03 04 05 (36 15 14 13 12 11 10 9 8 7 6 5
To my father,
Isaac S. Fischer
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Contents
Preface ix
PART I:
DEVELOPMENTAL PERSPECTIVE
1.1 Personality Disorders in Children and Adolescents:
An Overview 3
1.2 Components of Personality 15
PART II:
ASSESSMENT OF PERSONALITY DISORDERS
IN CHILDREN AND ADOLESCENTS
II.l Assessment of Personality Disorders in
Children and Adolescents 33
PART III:
THE NEUROTIC PERSONALITY ORGANIZATION
111.1 Introduction 83
111.2 Hysterical (and Histrionic) Personality Disorders 85
111.3 Avoidant Personality Disorder 109
111.4 Obsessive-Compulsive Personality Disorder 119
viii Contents
PART IV:
THE BORDERLINE PERSONALITY ORGANIZATION
IV.l Introduction 131
IV.2 Borderline Personality Disorder 133
IV.3 Narcissistic Personality Disorder 179
IV.4 Antisocial Personality Disorder 193
PART V:
THE PSYCHOTIC PERSONALITY ORGANIZATION
V.l Introduction 225
V.2 Schizotypal, Paranoid, and Schizoid Personality Disorders 227
PART VI:
SPECIAL ISSUES AND RESEARCH IMPLICATIONS
VI. 1 Special Issues and Research Implications 247
References 259
Index 281
Preface
Personality disorders (PDs) in adulthood have been recognized as having a
profound and prolonged impact on the individual, on the family, and on so
ciety (Ruegg and Frances 1995). Epidemiological research indicates a high
prevalence of PDs between the ages of 9 and 19 as well (Bernstein et al.
1993); however, the development of PDs in young people has not received
the attention it merits.
Our purpose is to present the mounting and compelling evidence for the
presence of PDs in children and adolescents so that they will be more readily
recognized and treated. In this population, they are associated with increased
suicidality, delinquency, academic failure, social dysfunction, and substance
abuse. They also worsen the prognosis for patients suffering from such other
disturbances as anxiety disorders, affective disorders, and eating disorders.
All clinical and research findings about adult PDs emphasize their early
developmental precursors. Yet the very existence of PDs in children and
adolescents has been questioned. Practically, PDs often require more ex
tended and therefore more costly treatment than that covered by third-party
payers. Conceptually, there persists an imderstandable reluctance to believe
that a developing child can have a disorder of such magnitude that it inter
feres with his relationship to his environment and to himself.
Because of the ongoing debate (P. Kernberg 1990, Shapiro 1990), we think
it is timely to focus more systematically on this issue. It is our intention to
highlight the usefulness of a developmental perspective for identifying the
features of PDs arid related pathological personality traits at different devel
opmental phases. We will provide clinical and research evidence to support
the reliable identification of PDs in children and adolescents.
The first section begins by introducing the developmental perspective on
personality and personality disorders: It reports epidemiological findings
and examines the DSM nosology, including its influence on research and
ix