Major Theories of Personality Disorder, Second Edition / Edition 2

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Overview

This landmark work brings together in one volume the most important current perspectives on personality pathology. Chapters from leading experts have been extensively rewritten to reflect a decade's worth of significant theoretical, empirical, and clinical developments, and two entirely new chapters have been added. Coverage encompasses psychodynamic, interpersonal, attachment, ecological, psychometric, and neurobiological models, all presented in a consistent format to facilitate ready reference and comparison. The volume also explores similarities and differences among the various theories, identifies potential avenues of integration, and discusses key implications for research and clinical care.
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Editorial Reviews

From the Publisher

"This superb volume offers an up-to-date presentation of the major theoretical approaches to disorders of personality. Aside from including more recent neurobiological thinking, this edition benefits from the ability of such major theorists as Otto Kernberg and Aaron T. Beck to continue to revise their theories in the light of new data, and to present their theories concisely and with clarity."--Drew Westen, PhD, Department of Psychology and Department of Psychiatry and Behavioral Sciences, Emory University

"This second edition continues to challenge received wisdom as to what the major theories of personality are, treating both personality theory and its uses in the service of informing the practices of psychotherapy as open concepts. Psychopathologists and clinicians will find plenty to expand their horizons, and personologists will be alerted to the dynamic changes from evidence-based research in their own territory."--Irving I. Gottesman, PhD, Hon FRCPsych, Department of Psychology, University of Minnesota

"This second edition represents a major revision of the original, and, more importantly, it continues to distinguish this work as the authoritative reference on the topic. Lenzenweger and Clarkin have assembled many of the world’s leading authorities on personality pathology to present a superb array of theories. The contributors cover the waterfront, with models ranging from neurobiological to interpersonal. The volume remains peerless and will surely engage readers at all levels of expertise."--Dante Cicchetti, PhD, Mt. Hope Family Center, Rochester, New York

"Lenzenweger and Clarkin have produced a book that provides outstandingly useful information for researchers and students of personality theory and psychopathology, as well as for the clinician dealing with the personality disorders in a practical setting. They have assembled comprehensive chapters by experts in the theories concerned, together with thoughtful discussion about the directions in which future research might progress. This combination of theory, practice, and research is of critical value. It belongs on the desk of every serious student of psychopathology and personality."--Brendan A. Maher, PhD, DrPhil, Department of Psychology, Harvard University

Bulletin of the Menninger Clinic

"Tightly packed with information about the leading theories of personality disorder....Researchers in the study of personality disorders and therapists of all descriptions will find this edition a useful and substantial resource for the informed understanding of the complexities of personality function and dysfunction, as well as a comprehensive reference source."--Bulletin of the Menninger Clinic
Journal of Social and Clinical Psychology

"The volume will appeal to a wide audience. Newcomers to the field will benefit from comprehensive introductions to major theoretical approaches to etiology, classification and treatment of personality disorder. Established researchers will find discussions of current research, framed in theoretical context. Clinicians will value the practical implications of each of the major theoretical models....The eight chapters provide a theoretically sophisticated and empirically informed grand tour of Personality Disorder. Researchers and practitioners alike will find their current thinking challenged in an intellectually stimulating way by the diverse theoretical formulations and empirical support offered by the authors. The book would also provide an outstanding backdrop for a graduate course on Personality Disorder that aims to integrate the science of personality disorder with assessment and treatment."--Journal of Social and Clinical Psychology
Psychiatry

"This is an impressive group of researchers, and the depth of the thinking and analysis of the current problems in theory and technique make this an important contribution to the literature. Importantly, the authors address the primary problem today in personality disorder research: how to develop a coherent and comprehensive theory of causation and treatment of personality disorders....This book articulates the key issues and questions we need to answer. It outlines the essential elements which any comprehensive multidimensional theory of personality disorders must now include."--Psychiatry
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Product Details

  • ISBN-13: 9781593851088
  • Publisher: Guilford Publications, Inc.
  • Publication date: 11/19/2004
  • Edition description: Second Edition
  • Edition number: 2
  • Pages: 464
  • Sales rank: 1,243,723
  • Product dimensions: 8.90 (w) x 5.90 (h) x 1.40 (d)

Meet the Author


Mark F. Lenzenweger, PhD, is Professor of Clinical Science, Cognitive Psychology, and Behavioral Neuroscience in the Department of Psychology at the State University of New York (SUNY) at Binghamton and Adjunct Professor of Psychology in Psychiatry at the Weill Medical College of Cornell University, New York City. He also directs the Laboratory of Experimental Psychopathology at SUNY/n-/Binghamton, where he conducts research and teaches on personality disorders, schizophrenia, schizotypy, and statistical methods.

John F. Clarkin, PhD, is Professor of Clinical Psychology in Psychiatry at the Weill Medical College of Cornell University and Director of Psychology and Co-Director of the Personality Disorders Institute at New York/n-/Presbyterian Hospital. His academic writing and research have focused on the phenomenology of the personality disorders and the treatment of patients with borderline personality disorder.

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Read an Excerpt

Major Theories of Personality Disorder


The Guilford Press

Copyright © 2005 The Guilford Press
All right reserved.

ISBN: 1-59385-108-1


Chapter One

The Personality Disorders History, Classification, and Research Issues

Mark F. Lenzenweger John F. Clarkin

In the dialogue between theory and experience, theory always has the first word. It determines the form of the question and thus sets limits to the answer. -François Jacob (1982, p. 15)

Theory without data runs the risk of ungrounded philosophizing, but data without theory lead to confusion and incomprehension. The definition of the personality disorders in DSM-III (and its successors, DSM-III-R, DSMIV, and DSM-IV-TR) as well as their separation from other clinical syndromes (Axis I disorders) greatly enhanced the legitimacy of this class of psychopathology as an area for research and personality disorder research has shown unprecedented and exciting expansion over the past 25 years. It was the thesis of first edition this volume (in the spirit of the quote from François Jacob) that the time had come to articulate contrasting and competing (at times, partially overlapping) theories of personality disorder in order to stimulate some intellectual clarity within the growing body of empirical data on the personality disorders. We remain convinced that personality disorder research will only move forward appreciably when guided by rich and sophisticated models. With thesecond edition of this volume, it remains our hope that the models and theories of personality pathology presented here will continue to serve not only as an organizing function but, perhaps more important, as useful heuristics for continuing empirical research on the personality disorders.

A BRIEF HISTORICAL OVERVIEW OF PERSONALITY DISORDER THEORIES

One can trace the conceptualization and articulation of personality and related personality pathology in the history of psychiatry and clinical psychology, and in the development of personality theory and research in the tradition of academic psychology. Whereas there has traditionally been considerable interaction between psychiatry and clinical psychology, the writings and research generated by the field of academic psychology have been focused mainly on normal personality and had little relationship to the clinical traditions. This separation was promoted not only by the physical locale of many clinicians (i.e., hospitals and medical centers vs. university departments of psychology) as well as the reasonable aims of both groups (clinicians diagnose and treat the impaired and dysfunctional, whereas academic personality psychologists view normative functioning and normal personality organization as the object of study). Our goal here is not to review the history of personality theory and related personality disorder theory. Rather, our major focus here is to briefly summarize the conceptualizations of those personality theorists who have ventured into the area of personality disorders or the relationship of personality to pathology. Our overview is, therefore, necessarily selective and makes no claim to be exhaustive; we provide references which the interested reader can pursue.

Vaillant and Perry (1985) trace the articulation in the history of clinical psychiatry of the notion that personality itself can be disordered back to work in the 19th century on "moral insanity." By 1907, Kraepelin had described four types of psychopathic personalities. The psychoanalytic study of character pathology began in 1908 with Freud's Character and Anal Erotism (1980/1959) followed by Franz Alexander's (1930) distinction between neurotic character and symptom neuroses and by Reich's (1945) psychoanalytic treatment of personality disorders.

Clinical Psychology and the Assessment of Personality Pathology

The most unique contribution of clinical psychology to the history of personality and personality pathology was the development and application of psychological testing instruments for the assessment of personality pathology in clinical settings. The flowering of the traditional "full battery" approach to personality assessment in clinical settings is exemplified in the writings of Rappaport, Gill, and Schafer (1968). According to these authors, diagnostic testing of personality and ideational content was concerned with "different types of organizations of the subject's spontaneous thought processes, and attempts to infer from their course and characteristics the nature of his personality and maladjustment" (p. 222). The focus of this traditional approach was shaped by the environment of the day-that is, by the psychiatric diagnostic system in vogue (officially and unofficially) and the predominantly psychodynamic treatment approaches.

In contrast to the full-battery traditional approach, the Minnesota Multiphasic Personality Inventory (MMPI), the well-known self-report inventory, was first published in 1943 by Starke Hathaway, PhD, and J. Charnley McKinley, MD (Hathaway & McKinley, 1943/1983), with scales measuring salient clinical syndromes of the day such as depression, hypochondrias, schizophrenia, and others. The fact that the MMPI was called a personality test is itself a manifestation of the intertwining of concepts of clinical syndromes and personality/personality pathology. Interestingly, however, only two (Scale 4: Psychopathic deviate and Scale 5: Masculinity/ Femininity) of the original nine clinical scales actually assessed constructs akin to personality traits or attributes; Scale 0, developed later, was designed to assess social introversion.

In more recent times, there has been less emphasis in clinical assessment in psychiatric settings on projective tests used to assess personality defined in a global sense (owing to concerns about validity, see Lilienfeld, Wood, & Garb, 2000), and more focus on the development of successors to the MMPI that have used advances in psychometric development and are more closely tied to a diagnostic system that makes a distinction between Axis I syndromes and Axis II personality pathology. Illustrative of these instruments are the Millon Clinical Multiaxial Inventory (MCMI; and its successors, the MCMI-II and MCMI-III) and the Personality Assessment Inventory (PAI; Morey, 1991). Given the historical role and importance attached to the clinical interview procedure in psychiatry as well as the advances achieved in the design of structured interviews for the major mood disorders and psychoses (e.g., the Present State Examination [PSE] and Schedule for Affective Disorders and Schizophrenia [SADS]) through the 1970s, it was a natural development to see the careful development of semistructured interviews (e.g., the Structured Clinical Interview for DSMIII-R [SCID-II; Spitzer, Williams, & Gibbon, 1987] and the PDE [Loranger, 1988]) that reliably assess personality disorders as described in the DSM system. Today the standard and most well-accepted approach to the diagnosis of personality disorders remains the structured interview approach with a number of excellent interviews to choose from (International Personality Disorders Examination [IPDE; Loranger, 1999]; Structured Interview for DSM-IV Personality [SIDP-IV; Pfohl, Blum, & Zimmerman, 1997]; Structured Clinical Interview for DSM-IV Axis II Personality Disorders [SCID-II; First, Spitzer, gibbon, & Williams, 1997]). It is worth noting that unlike its peers, the IPDE is configured to assess both DSM-IV and ICD-10 diagnostic criteria for personality disorders (Loranger et al., 1994). Axis II structured interviews still remain primarily used in research settings, their integration into training program curricula has increased, and their application in clinical work is encouraged. The interested reader is referred to Zimmerman (1994) for an excellent review of the many critical issues that surround the diagnosis of personality disorders (see also Livesley, 2003; Loranger, 1991a; Loranger, 2000).

Other self-report personality questionnaires have been developed to capture the dimensions thought to be related to the diagnostic criteria on Axis II. This would include the work of Livesely and colleagues (e.g., Schroeder, Wormworth, & Livesley, 1994, 2002) and Clark (1993). Some would speculate that the personality disorders involve maladaptive and inflexible expressions of the basic dimensions of personality as captured in the popular five-factor model of personality (see Costa & McCrae, 1990; John, 1990) or the interpersonal circumplex model of personality (e.g., Wiggins & Pincus, 1989, 2002). Energetic efforts have been made to describe the personality disorders on Axis II in terms of the five-factor model from a conceptual point of view (Costa & Widiger, 2002; Morey, Gunderson, Quigley, & Lyons, 2000), with some measure of consistent empirical support (Saulsman & Page, 2004; Schroeder et al., 1994, 2002) (see below). An alternative dimensional model that is firmly rooted in underlying neurobehavioral systems conceptualizations (e.g., Depue & Lenzenweger, 2001, and Chapter 8, this volume) is also now available as an alternative to the nonbiological lexically based five-factor approach. Finally, a comprehensive self-report instrument, developed within a clinical setting, now exists that is designed to capture both the putative dimensions underlying normal personality as well as those domains relevant to the assessment of DSM-IV-defined Axis II disorders (i.e., the OMNI Personality Inventory and OMNI-IV Personality Disorder Inventory, Loranger [2002]).

Academic Psychology

The field of personality within the larger academic world of psychology has been a time-honored tradition that has suffered its ups and downs (see Hogan, Johnson, & Briggs, 1997; Pervin & John, 1999). An examination of the reviews of the field of personality in the Annual Review of Psychology provides an historical sense of the academic debates in the field and the issues that were passionately fought over in the past (e.g., do traits exist?) (e.g., Funder, 2001). In 1990, Pervin, a senior observer of the field, enumerated the recurrent issues in personality research and theory, some of which are relevant to and may be rethought (and fought) in the field of personality disorders: (1) definition of personality; (2) relation of personality theory to psychology and other subdisciplines, including clinical psychology; (3) view of science; (4) views of the person; (5) the idiographic-nomothetic issue; (6) the internal-external issue; (7) the nature-nurture issue; (8) the developmental dimension; (9) persistence and change in personality; and (10) emphasis on conscious versus unconscious processes.

Traditionally, academic personality psychologists studied nonclinical populations, they were more interested in the "normal" personality and consequently gave little attention in their theories to abnormal personality or personality pathology. For example, Gordon Allport (1937) one of the early leaders of normative personality theory, criticized Freud for suggesting a continuum of personality pathology; instead he postulated a division in personality processes between the normal personality and the neurotic personality. The tendency on the part of academic personologists to theorize about and research normative personality most probably reflects not only their substantive area of interest (i.e., normalcy) but also their training (i.e., absence of training in clinical methods and lack of exposure to psychopathological populations) and place of work (the university psychology department as opposed to the clinic and/or psychopathology laboratory). Until relatively recently, there were few academic personologists who extended their theorizing or empirical work to the pathological personality realm, exceptions such as Henry Murray (1938) and Timothy Leary (1957) are well known. This is a theme that will reverberate through the second edition of this volume: In what setting does the theoretician of personality disorders work, and how does that affect the resulting theory?

THE NEO-KRAEPELINIAN REVOLUTION, DSM-III, AND THE BIRTH OF AXIS II

Just as the academic personologists have focused on the normative personality and its structure and development, those in the clinical area (clinical psychologists, psychopathologists, psychiatrists, psychoanalysts) focused their attention and efforts on the pathological variations seen in human personality functioning. To begin, DSM-I (American Psychiatric Association, 1952) provided four categories of psychiatric disorder: (1) disturbances of pattern; (2) disturbances of traits; (3) disturbances of drive, control, and relationships; and (4) sociopathic disturbances. These and subsequent categories of personality disorder in DSM-II (American Psychiatric Association, 1968) were used only when the patient did not fit comfortably in other categories. The personality disorders defined on a separate axis, whether or not a symptomatic disorder was present, first appeared in DSM-III in 1980. The interested reader is referred to Millon (1995) for one of the best historical reviews of both the process of DSM-III's construction and its formulation of personality disorders as well as a more general prior history of personality disorders.

The advent of DSM-III and its successors (DSM-III-R, DSM-IV, DSMIV-TR), which use a multiaxial diagnostic system that makes a distinction between clinical syndromes (Axis I) and personality disorders (Axis II), both brought into sharp focus and encapsulated the controversy concerning the nature and role of personalty/personality pathology in the history of psychiatry and the history of modern personality research. The introduction of a distinction between clinical syndromes and personality disorders as well as explicit description of personality pathology within DSM-III by no means brought about unanimity and intellectual peace. In many ways, the introduction of the formal Axis II classification scheme in 1980 ushered in what would begin an exceedingly active initial phase of personality disorder research-namely, clarification and validation of the personality disorder constructs and beginning efforts at illumination of the relations between personality and personality disorder (see section "Normal Personality and Personality Disorder").

Numerous examples can be cited of active productive discussion resulting from the introduction of DSM-III and subsequent DSM nomenclatures. Some workers have argued from accumulated clinical experience that the particular disorders defined in Axis II do not adequately match clinical reality.

Continues...


Excerpted from Major Theories of Personality Disorder Copyright © 2005 by The Guilford Press. Excerpted by permission.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents


Contents
1. The Personality Disorders: History, Classification, and Research Issues, Mark F. Lenzenweger and John F. Clarkin
2. A Cognitive Theory of Personality Disorders, James L. Pretzer and Aaron T. Beck
3. A Psychoanalytic Theory of Personality Disorders, Otto F. Kernberg and Eve Caligor
4. Interpersonal Theory of Personality Disorders: The Structural Analysis of Social Behavior and Interpersonal Reconstructive Therapy, Lorna Smith Benjamin
5. An Attachment Model of Personality Disorders, Björn Meyer and Paul A. Pilkonis
6. A Contemporary Integrative Interpersonal Theory of Personality Disorders, Aaron L. Pincus
7. Personology: A Theory Based on Evolutionary Concepts, Theodore Millon and Seth D. Grossman
8. A Neurobehavioral Dimensional Model of Personality Disturbance, Richard A. Depue and Mark F. Lenzenweger
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Sort by: Showing all of 2 Customer Reviews
  • Posted August 28, 2009

    Plenty of Meat on the Bone Here

    While Strack's Handbook of Personology and Psychopathology is more current and extensive, it'll also set you back about $80.00 at this time. The "flooring" here is '90s vintage, but it's pretty solid both theoretically and empirically. The nine contributors hereto were all among the top people in personality theory at the time, with Aaron Beck, Lorna Benjamin, Otto Kernberg and Teddy Millon ranking at the very top of the heap.

    Of necessity in a book this size, Major Theories... is a tree-topper much of the way, but three of the five conceptualizations are plenty deep for beginning (or even intermediate-level) readers. Kernberg, Benjamin and Millon (with sometime co-author Roger Davis) go long, and though the sledding can get pretty soggy here and there (Millon can be a trial for anyone), full attention is well rewarded.

    Kernberg (arguably The Man on borderline personality) gives one of the most coherent presentations of his career here. Moreover, he brings a very modern perspective to the psychoanalytic theory that (at least for me) used to make Kernberg's extremely important work pretty verbally opaque. One can see it all quite clearly here.

    Benjamin summarizes her work in Interpersonal Reconstructive Therapy (1993) in detail, then clarifies how it relates to personality in crystal clarity. Her explanation of the "important person and their internalized representation" is one of the most literate descriptions of psychodynamic theory I've ever come across.

    Millon and Davis make you work for it, but as has been the case every time I've gone down the road with Teddy, the meat is all there on the bone (and, perhaps unfortunately, then some; some of the material here seems irrelevant). For those who have read Millon's epic Personality Guided Therapy (1999), here, at least, is the "how" and "why" of his remarkable illuminations.

    Beck makes a convincing case for personality as the behavioral result of core beliefs, ideals, values, assumptions, convictions and attitudes driving current appraisals, evaluations, interpretations, judgments, analyses and/or attributions of meaning. The depth here is not what it is in Beck's and Freeman's Cognitive Theory of Personality Disorders (1990; strongly recommended), but it is adequate to establish a grasp of what is currently the most accessible and widely utilized theory in current psychotherapeutic practice.

    Because I come from extensive study of personality theory, behaviorism, object relations theory (and psychodynamic psychology in general), and cognitivism, I was personally most impressed with the foregoing sections of Major Theories... But my schooling in millennial-era "neuropsychology" met with disappointment in Depue's article on the ostensible biology of personality. Frankly, I saw more relevance in Millon's notions about the bipolar nature of personality-disordered behavior and how they might fit into both essentially manic and essentially depressive, as well as truly Axis I "bipolar" schemes.

    I would have looked more deeply into the "condition" of the bits and pieces of the limbic system's "brake lining," into dendritic growth or decay in affective memory centers, into excitotoxicity (a major issue in the paranoid, schizotypal and borderline PDs), and into the autonomic nervous system in general and post-traumatic stress disorder in particular. (The data was available in the mid-'90s.)

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    Posted March 1, 2010

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