Despite the title of this book, personality disorders are not disorders at all in the medical sense. Rather, personality disorders are theoretical constructs employed to represent varied styles or patterns in which the personality system functions maladaptively in relation to its environment. When the alternative strategies employed to achieve goals, relate to others, and cope with stress are few in number and rigidly practiced (adaptive inflexibility); when habitual perceptions, needs, and behaviors perpetuate and intensify preexisting difficulties (vicious circles); and when the person tends to lack resilience under conditions of stress (tenuous stability), we speak of a clinically maladaptive personality pattern.
For pedagogical purposes, a maladaptive personality system can be heuristically decomposed into various clinical domains. While these facilitate clinical investigation and experimental research, no such division exists in reality. Personality development represents the complex interplay of elements within and across each of these domains. Not only is there an interaction between person and environment, but also there are interactions and complex feedback loops operating within the person at levels of organization both biological and psychological.
Because all scientific theories are to some extent simplifications of reality—the map rather than the territory—all theories involve trade-offs between scope and precision. Most modern developmental theories are organismic and contextual in character. By embracing a multidomain organismic-contextual model, we aspire to completely explain personality disorder development as a totality. However, we must simultaneously accept the impossibility of any such explanation. Despite our aspirations, a certain amount of imprecision is built into the guiding metaphor. It posits the existence or reality of experimental error, that is, that the interaction of personality variables is often synergistic, combinatorial, and nonlinear rather than simply additive.
Certain conceptual gimmicks could be used to recover this imprecision or to present an illusion of precision. We might give an exposition of personality disorder development from a single-domain perspective, whether cognitive, psychodynamic, or behavioral. Such explanations might increase precision, but this feat would be accomplished only by denying essential aspects of the whole person. Such reductionism with respect to content is incommensurate with the guiding metaphor, that of the total organism. Thus, while any one personologic domain could be abstracted from the whole to give an exposition of personality disorder development from a particular and narrow perspective, this would not do justice to a "pathology" that "pervades" the entire fabric of the person.
Accordingly, interaction and continuity are the major themes of this chapter. The discussion stresses the fact that numerous biogenic and psychogenic determinants covary to shape personality disorders, the relative weights of each varying as a function of time and circumstance. Further, this interaction of influences persists over time. The course of later characteristics is related intrinsically to earlier events; an individual's personal history is itself a constraint on future development. Personality disorder development must be viewed, therefore, as a process in which organismic and environmental forces display not only a mutuality and circularity of influence, but also an orderly and sequential continuity throughout the life of the individual.
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