Major Theories of Personality Disorder Second Edition
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They may feel aimless or ashamed, disgraced or doubtful, empty or envious, fearful of others or insatiably needing them. They may forever search for figures to admire while also being unable to commit to life-long goals, nurturing relationships, intimacy, and the pursuit of meanings. They may try to divine what life holds for them through magical signs from far-away planets and galaxies. They may be hesitant or impulsive, or unstable, needing constant admiring recognition, or they may entirely lack feelings for others and become social outcasts. Their lack of ease thus interferes with their human relationships and their creative, productive activities. Indeed, they may well feel like Huraki Murakami s Frog: "What you see with your eyes is not necessarily real. My enemy is, among other things, the me inside me.
Ultimately, theories of disordered personalities are hypotheses working models of the pathogenic sources and developmental evolution of these persons affects, behavior, perception of self or others, of their anguish, as well as of potential ways to relieve their inordinate malaise and enable them to alter their unsuccessful adaptation to life.
In this second edition of Major Theories of Personality Disorder, the editors, Dr. Mark Lenzenweger and Dr. John Clarkin, two distinguished authorities in personality disorder research, have assembled a group of recognized leaders in their respective fields to present a rich collection of different perspectives on these disturbances. The current edition has two new points of view added to those represented in the earlier version. The senior authors of the other chapters are the same as in the 1996 edition. References are complete through 2003, with occasional 2004 citations.
In the introductory chapter, The Personality Disorders, the editors confront the following significant issues: 1) the controversial nature of categorical versus dimensional conceptualizations of personality disorder diagnostic features; 2) the high degree of overlap among currently defined axis II personality disorders; 3) the absence of published data derived from a large sample of carefully assessed cases in which individual criterion items confirm our current DSM-IV-TR disorder structure; 4) the lack of long-term stability in actual patients of the current criteria of personality disorders; and, finally, 5) the lack of a "gold standard" of validity against which personality disorder diagnoses could be measured.
This introduction is followed by in-depth discussions of seven major theories of personality disorders.
"A Cognitive Theory of Personality Disorders" is presented by Dr. James L. Pretzer and Dr. Aaron T. Beck. The discussion of goals, principles, process, assessment instrumentation, and treatment, including a three-page section on Future Directions, is unchanged from that in the first edition of this volume. New material is only in the seven pages covering validity and effectiveness. Among the 106 references cited, only seven date since 1996. A difference between cognitive therapy and dialectical behavior therapy is alluded to but not discussed.
The following chapter, "A Psychoanalytic Theory of Personality Disorders," by Dr. Otto Kernberg and Dr. Eve Caligor, is a creative, lucid, updated conceptualization and retelling of Dr. Kernberg s seminal and broadly based contributions to the field of personality organization and of personality disorders. Although Dr.
The authors integrate their theory with those of Margaret Mahler, on pre-oedipal separation-individuation and object constancy (p. 125), and of developmentalists like Daniel Stern, on inborn capacities for differentiation of self from non-self and the cross-modal transfer of sensorial experiences in early infancy to construct a model of self (p. 123).
The chapter on attachment-based Interpersonal Theory of Personality Disorders, using a structural analysis of social behavior (SASB) to undertake interpersonal reconstructive therapy (IRT), has been completely and very successfully re-written for this edition by Dr. Lorna Smith Benjamin. With such concepts as free associative path and internalized representations on the one hand, and learned interpersonal patterns and gifts of love on the other, it pays homage to both its psychoanalytic and cognitive behavioral therapeutic antecedents, but draws on optimally effective interventions from many schools of psychotherapy. According to Dr. Benjamin, most of the goals described in the 1996 version of this chapter have been achieved; a treatment manual and software have been published.
In a related chapter entitled "A Contemporary Integrative Interpersonal Theory of Personality Disorders," new to the current edition, Dr. Aaron Pincus describes "individual differences in personality disorder phenomenology through the structural models, operational definitions, and empirical methods of the interpersonal tradition" (p. 316). Analysis of social behavior on the Interpersonal Circle allows him, for instance, to distinguish valuably between two forms of narcissism: the grandiose and the hypersensitive, closet narcissist. Overall, a tremendous effort is expended on rather mechanical taxonomy: the accountancy, classification, and quantification of phenomenology, less on clinical interpretation or personal meaning of instantaneously observed behavior.
Missing at this juncture is, surprisingly, a chapter on Heinz Kohut s perspective on narcissistic personality disorders as resulting from a developmental arrest caused by early traumatization from chronically failing attitudes of early caregivers.
The chapter entitled "An Attachment Model of Personality Disorders," by Dr. Bj rn Meyer and Dr. Paul Pilkonis, is an important new addition to the current edition. They discuss Bowlby s work on the attachment behavioral system, Ainsworth and colleagues discovery of distinct infant attachment patterns secure, ambivalent, and avoidant as causal factors in the development of personality disturbances and the complex evidence for the role attachment disturbances can play in the etiology and maintenance of personality pathology. They conclude sensibly that insecure attachment should be viewed as a risk factor, but not as an absolute determinant of adult personality disturbances.
In the chapter "Personology: A Theory Based on Evolutionary Concepts," Dr. Theodore Millon and Dr. Seth D. Grossman describe their creation of a clinical taxonomy, linked to assessment instruments, and their synergistic model of psychotherapy as "a psychologically designed composite and progression among diverse techniques" (p. 385), e.g. behavior modification procedures, cognitive methods, followed by interpersonal techniques. They memorably consider each DSM disorder a " pure prototype ...an anchoring referent about which real patients vary" (p. 375).
The final daunting and provocative chapter of this volume, "A Neurobehavioral Dimensional Model of Personality Disturbances," by Dr. Richard A. Depue and Dr. Mark F. Lenzenweger, examines the neurobiology of anxiety, impulsivity, and aggression as they relate to higher-order neurobehavioral systems, personality traits, and personality disturbances. The authors "conceive of personality disturbance as emergent phenotypes arising from the interaction of...neurobehavioral systems underlying major personality traits" (p. 436). They have created a multidimensional visual model of personality disturbance, the three axes of which "are defined by neurobehavioral systems rather than traits" (p. 436): 1) behavioral approach on the vertical y-axis, 2) affiliative reward on the z-axis, and 3) neural constraint on the horizontal x-axis. Within this three-dimensional model "the phenotypical expression of personality disturbance represented by the... reaction surface in the figure...is continuous in nature, changing in character gradually but seamlessly across the surface in a manner that reflects the changing product of the multidimensional interactions... T he magnitude of disturbance at any point of the surface is variable, waxing and waning with fluctuations in environmental circumstances, stressors, and interpersonal disruptions...over time" (p. 437). I cannot even begin to do justice in this space to the authors uncanny articulation of the subject s complex, sophisticated details.
These cutting edge essays allow the post-postmodern psychiatrist to view personality disorders through various windows; to choose a paradigm; to decide what he or she needs to listen for, perceive, and comprehend; to use, whenever necessary, "impure interventions" culled from other modes of understanding; and, finally, to hone his or her own voice. Reading this illuminating volume, then consulting it again, will serve that purpose.
The collective psychological treatment-two of Zhongnan University Xiangya Hospital Associate Professor Liu Zhening Central South University in Xiangya Hospital Associate Professor Liu Zhening Group psychotherapy Group psychotherapy Central South University in Xiangya Hospital Professor Liu Zhening The collective psychological treatment characteristics Multiplier More Expand the vision The application of learning social skills and a good chance Clients initiative The collective psychological treatment history Bud Amorphous Development Group psychotherapy the implementation of the choice of participants The symptoms : anxiety, depression, somatization, work or study ineffective, unable to respond effectively to tension Emotion : difficult to control emotions, depression and stereotypes Interpersonal function; Intimate relations can not be established, in the collective uneasiness, interpersonal maladaptation Treatment options Collective Psychological Analysis : neurosis, youth psychological disorders, some personality disorder The collective cognitive behavioral therapy : neurosis (such as obsessive compulsive disorder, phobia), sexual dysfunction and certain behavioral disorder T group Rendezvous Group Efficacy of good targets Authoritative anxiety Projection denied or restrain submarine Eliminating the Empathy effect One child There is a driving force and has sufficient psychological maturity Effect of target poor Severe depression Acute Schizophrenia Paranoid Personality Extreme split personality Substance dependence Participants choose the specific implementation The first conversation : impressed and assignments Own problems Purpose A simple autobiography The second conversation : Panels Homogeneous groups : specific diseases or symptoms Heterogeneity Group : deepening self-awareness, improve interpersonal skills Group size : Six-10 were the most common and also the most appropriate Open team : Closed groups : Age, sex, background, etc. The number and duration of assembly : Analysis of the collective psychological therapy : 3-5 times a week, with a total course of 1-3 years Cognitive behavioral therapy group : 1-3 times a week, with a total treatment from March to June Every 1-2 hours of assembly time Group psychotherapy in the treatment of attention : The role of doctors Education reform? The mobilization initiative?
Related: Major Theories of Personality Disorder Second Edition
Additional information:
From ajp.psychiatryonline.org:
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