Theories of Personality Disorders: Evolutionary and Neurobiological 209

Evolutionary Theories of Personality Disorders 209

Basic Concepts of Evolutionary Theory 210 Application to Antisocial, Histrionic, Narcissistic, Dependent, and Avoidant Personality Disorders 212 Application to Borderline Personality Disorder 216 Application to Paranoid Personality Disorder 218 Application to Schizoid, Schizotypal, and Avoidant Personality Disorders 219

Neurobiological Theories of Personality Disorders 220

Conclusions 226

Chapter 9-

Assessment 229

Chart/Records Review 232

The Clinical Interview of the Patient 234

Interview with Informants 239

Self-Report Objective Personality Instruments 240

Millon Clinical Multiaxial Inventory-III 242

Personality Diagnostic Questionnaire-Fourth Edition Plus 244

Coolidge Axis II Inventory 245

Minnesota Multiphasic Personality Inventory-2 247

NEO Personality Inventory-Revised 249

Application of Personality Inventories with Older Adults 250

Semi-Structured Clinical Interviews 251

Structured Interview for DSM-IV Personality 252 International Personality Disorder Examination 254

Structured Clinical Interview for DSM-IV Axis II

Personality Disorders 256 Personality Disorder Interview-IV 258

Diagnostic Interview for DSM-IV

Personality Disorders 259

Application of Semi-Structured Interviews with Older Adults 260

Conclusions 262

Chapter 10

Treatment: General Issues and Models 265

Core Features of Personality Disorder Affecting Treatment 266

Reliance on Primitive Defenses 266

Rigidity of Character Structure and Limited Repertoire 267 Effect on Others 267 Course of Personality Disorders 268

Routes into Treatment 268

Function of Buffering 269 Function of Bolstering 270 Function of Binding 270 An Essential Caveat 271

Goals of Treatment 272

Invisibility of Personality Disorders 275

What (Little) Is Known 275

Comorbidity of Axis I and Axis II Disorders 276

Understanding the Comorbidity 277 Treatments and Therapies 278

Somatic Treatments 278 Psychological Treatments 281 Countertransference 284

Guideposts for Treatment Planning and Goal Setting 287

Understanding the Phenomenology of Personality Disorders and Helping Guide Treatment 288

Patterns of Attachment 288 Inside and Outside Feeders 289 Rules of Personality Disorders 290

Illusion of Uniqueness 290

Chapter 11

The "Goodness of Fit" Model and Its Implications for Treatment 293

"Goodness of Fit" Model 296

Trait Template 297 Utility of a Personality Trait Model 301 Implications of the Goodness of Fit Model for Designing a Treatment Plan 302

References 307

Author Index 321

Subject Index

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