Alpf Medical Research Personality Disorders

Freud, S. (1900). The interpretation of dreams. In J. Strachey (Ed.), The standard edition of the complete psychological works of Sigmund Freud (Vols. 4 & 5, pp. 1-715). London: Hogarth Press. James, W. (1890). The principles of psychology (Vols. 1 & 2). New York: Henry Holt.

Magnavita, J. J. (2001). A century of the "scientific" study of personality: How far have we come? [Book Review: Personality disorders in modern life]. Contemporary Psychology: APA Review of Books, 46(5), 514-516.

Preface

The first edition of my Disorders of Personality text (1981) was widely regarded as the classic book in the field. Given its coordination with a theory of personality and psychopathology and with the then newly published DSM-III, it gained immediate acceptance among mental health professionals, the audience for which it was intended. As the years wore on, however, the readership of the book began to change. With the emergence of personality disorders as a distinct axis in the DSM, doctoral programs began to instruct their students on the role played by personality in creating and sustaining psychopathology. By the mid-1980s, my Disorders of Personality text gradually became required reading in most graduate programs, and even enjoyed some use at the undergraduate level.

With the publication of the DSM-IV in 1994, the Disorders text was ready for revision. Published in 1996, the second edition was greatly revised and expanded, its 800 pages of two-column text reflecting growing interest in personality disorders. Again, the book was an immediate success at the professional level. Unfortunately, with its increased length and complex writing style, the book was no longer appropriate for the limited background and experience of undergraduate students.

In mid-1998, a group at the Institute for Advanced Studies in Personology and Psychopathology began working in earnest on a revision for advanced undergraduate and beginning graduate students. About half of the material was simplified from the extensive Disorders of Personality, second edition, and about half the material was essentially new. This text was entitled Personality Disorders in Modern Life, published in 1999.

Students found the Modern Life text both informative and absorbing. Instructors found it well-organized and easy to teach. An optimal balance was struck between abstract concepts and concrete clinical case materials. Students appreciated the vivid examples that demonstrate personalities "in action." To that end, each of the clinical chapters began with a case vignette, which was then discussed in terms of the DSM-IV The result was a cross-fertilization that brought the rather dry diagnostic criteria to life for the student and provided a concrete anchoring point to which student and instructor could refer again and again as the discussion of the personality was elaborated. The psychodynamic, cognitive, interpersonal, and evolutionary sections referred back to the cases as a means of providing a clearer understanding of otherwise abstract and difficult to understand concepts. This was true even where the text discussed the development of a particular personality disorder, which was then linked back to the concrete life history of the particular case. Students thus saw not only how psychological theory informs the study of the individual, but also how the individual came to his or her particular station and diagnosis in life. Each chapter included two or three cases interwoven in the body of the text.

This new second edition of Modern Life has added two important elements to strengthen the text. First, we added a full chapter on personality development (Chapter 3) so that the origins and course of personality pathology could be more fully and clearly articulated. And second, with the growth of empirical research in the field, considerable reference is now made throughout the book to spell out supporting data for ideas contained in the text.

While case studies provide continuity between concrete clinical phenomena and abstract concepts and theories, other sections of each chapter address continuity in different ways. Since there is no sharp division between normality and pathology, an entire section of each clinical chapter is devoted to their comparison and contrast. The introductory case receives a detailed discussion here, and it is shown exactly why he or she falls more toward the pathological end of the spectrum. Such examples help students understand that diagnostic thresholds are not discrete discontinuities, but instead are largely social conventions, and that each personality disorder has its parallels in a personality style that lies within the normal range. Each chapter invites students to find characteristics of such normal styles within themselves, thus opening up their interest for the material that follows. The hope is that students will learn something about their own personalities, and what strengths and weaknesses issue therefrom. Continuity between normality and abnormality in personality gives the text a "personal growth agenda" that most books in psychopathology lack.

In addition, the text also focuses on the continuity between the personality pathology of Axis II and the Axis I disorders, such as anxiety and depression. As practitioners have recognized, depression in a narcissist is very different from depression in an avoidant. While some sources present only comorbidity statistics for Axis II and Axis I, our contention is that the next generation of clinical scientists will be best prepared if it is understood why certain personalities experience the disorders they do. When a dependent personality becomes depressed, for example, what are the usual causes, and how do they feel to the person concerned? Once students understand how the cognitive, interpersonal, and psychodynamic workings of each personality lead them repeatedly into the same problems again and again, they are ready for the last section of each chapter, focused on psychotherapy.

We are pleased to report that an excellent 240-minute videotape entitled "DSM-IV Personality Disorders: The Subtypes" has been produced and is distributed by Insight Media (800-233-9910, www.Insight-Media.com), psychology's premier publisher of videos and CD-Roms. It is available for purchase by instructors and students who wish to view over 60 case vignettes that illustrate all DSM-IV personality prototypes and subtypes, as interviewed by psychologists and discussed by the senior author of this book.

Thanks and credit for this second edition are owed to each member of the team of young associates at the Institute, all co-authors of this text. In addition, the Institute's executive director, Donna Meagher, provided an organizing force throughout, drawing the various pieces together into a coherent whole. We would also like to thank the many hundreds of instructors and thousands of students who have offered constructive suggestions that have made this second edition even more useful and attractive than the first.

Theodore Millon, PhD, DSc Institute for Advanced Studies in Personology and Psychopathology

Coral Gables, Florida [email protected]

Contents

Chapter 1 Personality Disorders: Classical Foundations 1

Abnormal Behavior and Personality 3

Early Perspectives on the Personality Disorders 14

The Biological Perspective 17

The Psychodynamic Perspective 22

Summary 35

Chapter 2 Personality Disorders: Contemporary Perspectives 38

The Interpersonal Perspective 39

The Cognitive Perspective 48

Trait and Factorial Perspectives 54

The Evolutionary-Neurodevelopmental Perspective 57

Summary 72

Chapter 3 Development of Personality Disorders 74

On the Interactive Nature of Developmental Pathogenesis 77

Pathogenic Biological Factors 78

Pathogenic Experiential History 88

Sources of Pathogenic Learning 90

Continuity of Early Learnings 101

Sociocultural Influences 112

Summary 116

Chapter 4 Assessment and Therapy of the Personality Disorders 117

The Assessment of Personality 118

Psychotherapy of the Personality Disorders 134

Summary 147

Chapter 5 The Antisocial Personality 150

From Normality to Abnormality 155

Variations of the Antisocial Personality 158

Early Historical Forerunners 161

The Biological Perspective 162

The Psychodynamic Perspective 166

The Interpersonal Perspective 168

The Cognitive Perspective 172

The Evolutionary-Neurodevelopmental Perspective 175

x

Contents

Therapy

182

Summary

184

Chapter 6

The Avoidant Personality

187

From Normality to Abnormality

191

Variations of the Avoidant Personality

193

Early Historical Forerunners

198

The Biological Perspective

198

The Psychodynamic Perspective

201

The Interpersonal Perspective

203

The Cognitive Perspective

206

The Evolutionary-Neurodevelopmental Perspective

210

Therapy

217

Summary

220

Chapter 7

The Obsessive-Compulsive Personality

223

From Normality to Abnormality

227

Variations of the Compulsive Personality

229

Early Historical Forerunners

235

The Psychodynamic Perspective

236

The Interpersonal Perspective

240

The Cognitive Perspective

244

The Evolutionary-Neurodevelopmental Perspective

247

Therapy

255

Summary

257

Chapter 8

The Dependent Personality

259

From Normality to Abnormality

263

Variations of the Dependent Personality

265

Early Historical Forerunners

268

The Psychodynamic Perspective

270

The Interpersonal Perspective

273

The Cognitive Perspective

275

The Evolutionary-Neurodevelopmental Perspective

278

Therapy

284

Summary

289

Chapter 9

The Histrionic Personality

292

From Normality to Abnormality

295

Variations of the Histrionic Personality

297

Early Historical Forerunners

301

The Biological Perspective

302

The Psychodynamic Perspective

304

The Interpersonal Perspective

311

The Cognitive Perspective 315

The Evolutionary-Neurodevelopmental Perspective 318

Therapy 324

Summary 327

Chapter 10 The Narcissistic Personality 330

From Normality to Abnormality 333

Variations of the Narcissistic Personality 337

Early Historical Forerunners 342

The Biological Perspective 343

The Psychodynamic Perspective 343

The Interpersonal Perspective 349

The Cognitive Perspective 355

The Evolutionary-Neurodevelopmental Perspective 358

Therapy 366

Summary 369

Chapter 11 The Schizoid Personality 371

From Normality to Abnormality 376

Variations of the Schizoid Personality 377

The Biological Perspective 380

The Psychodynamic Perspective 383

The Interpersonal Perspective 386

The Cognitive Perspective 390

The Evolutionary-Neurodevelopmental Perspective 392

Therapy 398

Summary 401

Chapter 12 The Schizotypal Personality 403

From Normality to Abnormality 408

Variations of the Schizotypal Personality 409

Early Historical Forerunners 412

The Biological Perspective 414

The Psychodynamic Perspective 416

The Interpersonal Perspective 419

The Cognitive Perspective 423

The Evolutionary-Neurodevelopmental Perspective 425

Therapy 430

Summary 433

Chapter 13 The Paranoid Personality 435

From Normality to Abnormality 439

Variations of the Paranoid Personality 442

Early Historical Forerunners 445

The Biological Perspective 448

The Psychodynamic Perspective 449

The Interpersonal Perspective 455

The Cognitive Perspective 458

The Evolutionary-Neurodevelopmental Perspective 463

Therapy 471

Summary 475

Chapter 14 The Borderline Personality 477

From Normality to Abnormality 481

Variations of the Borderline Personality 482

The Biological Perspective 488

The Psychodynamic Perspective 490

The Interpersonal Perspective 495

The Cognitive Perspective 502

The Evolutionary-Neurodevelopmental Perspective 505

Therapy 511

Summary 516

Chapter 15 Personality Disorders from the Appendices of

DSM-III-R and DSM-IV 519

The Self-Defeating (Masochistic) Personality 520

The Sadistic Personality 530

The Depressive Personality 539

The Negativistic (Passive-Aggressive) Personality 548

Summary 558

References 561

Author Index 583

Subject Index

Personality Disorders in Modern Life

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