Dr. Gintner, an associate professor and program leader of the counseling program at Louisiana State University, is a past president of the American Mental Health Counselors Association. He chairs its DSM-5 Task Force.

Dr. Gintner:

Here is a list of my psychiatric symptoms. Do I constitute a new and distinct psychiatric diagnosis?

1. I was the scapegoat in a dysfunctional, disturbed family that featured emotional and physical abuse.

2. I tend to be the scapegoat in groups. I become the target of warded off aggressive and libidinal impulses of the group.

3. I have a high level of subjective psychological distress. I ruminate obsessively on my past.

4. I have low hedonic capacity. I do not experience pleasure.

5. I have a lifelong history of social withdrawal and isolation. I show schizoid detachment, consistent with have had a cold, emotionally unresponsive mother.

6. I dismiss the value of relationships, consistent with avoidant disorder. Avoidant disorder is associated with having had a rejecting mother.

7. I show a tendency toward intense, primitive idealization. According to Salman Akhtar (Jefferson University) omnipotence, denial, and idealization are the three constituents of manic defense. Winnicott noted that the use of manic defense is typical of individuals who dread sadness and are unable to mourn.

8. I live in a fantasy world. I seem to prefer fantasy to reality.

9. Psychological testing disclosed serious, if not severe, character pathology. The test results confirmed the experience of scapegoating and abuse (i.e., elevations on the Family Discord and Social Alienation Scale for Schizophrenia on the MMPI).

Notwithstanding my character pathology, clinical examination shows a competent, mature, emotionally regulated presentation, consistent with “disguised presentation.” Disguised presentation is found typically in trauma survivors.

10. I have a lifelong history of dysthymia (characterological depression) and anxiety.

11. I struggle with intense feelings of alienation. I feel as if I am like no one else in the world. This is the flip side of my idealization. I idealize those few people who mirror me.

12. I have high executive functioning. I had a perfect score on the Wisconsin Card Sorting Test.

13. I am an intellectually gifted person with an overall IQ in the top 2%. My verbal IQ is in the top 1%.

What does all this add up to? Where do you find people with this cluster of psychological problems? Any thoughts?

Gary Freedman
Washington, DC

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