ABSTRACT
H A V I N G MAN AGE D, like Ulysses, to avoid Scylla and to circum-vent Charybdis, and therefore having obtained the necessary clinical evidence for a diagnosis, we now move on to the next obstacle, akin to Circe-the difficulties in differential diagnosis once the evidence has been collected. These differential difficulties arose at two levels in our study. First, when the diagnosis of personality disorder itself was definite in twelve cases, decision as to the specific subtype was difficult in nine of these, the choice usually lying between a passive-aggressive and one of the other subtypes, most often the sociopathic (six cases). Second, when the diagnosis of personality disorder was in doubt (twenty-nine cases) we had trouble differentiating the disorder from a character neurosis (eighteen cases), from a schizophrenia (six cases), and from epilepsy (five cases). Thus, by far the major theme of diagnostic difficulty (43 per cent, or eighteen cases) is the differentiation of a personality disorder from a character neurosis. Closer study of this problem revealed that it could be more exactly stated as follows: The difficulties are in perceiving the personality disorder that underlies and is masked by a dramatic fa~ade of psychoneurotic symptoms. Incidentally, Beck [8] reports this decision to be equally troublesome in adults.
