Personality Disorders in Modern Life E-Book

Theodore Millon

• Herausgeber: John Wiley & Sons
• Kategorie: Fachliteratur
• Sprache: Englisch

Seitenzahl: 1445

Veröffentlichungsjahr: 2004

Beschreibung

A revision of the leading textbook on personality disorders by renowned expert Theodore Millon "Personalities are like impressionistic paintings. At a distance, each person is 'all of a piece'; up close, each is a bewildering complexity of moods, cognitions, and motives." -Theodore Millon Exploring the continuum from normal personality traits to the diagnosis and treatment of severe cases of personality disorders, Personality Disorders in Modern Life, Second Edition is unique in its coverage of both important historical figures and contemporary theorists in the field. Its content spans all the major disorders-Antisocial, Avoidant, Depressive, Compulsive, Histrionic, Narcissistic, Paranoid, Schizoid, and Borderline-as well as their many subtypes. Attention to detail and in-depth discussion of the subtleties involved in these debilitating personality disorders make this book an ideal companion to the DSM-IV(TM). Fully updated with the latest research and theory, this important text features: * Discussion of the distinctive clinical features and developmental roots of personality disorders * Balanced coverage of the major theoretical perspectives-biological, psychodynamic, interpersonal, cognitive, and evolutionary * Individual chapters on all DSM-IV(TM) personality disorders and their several subtypes and mixtures * Case studies throughout the text that bring to life the many faces of these disorders Including a new assessment section that singles out behavioral indicators considered to have positive predictive power for the disorders, this Second Edition also includes a special focus on developmental, gender, and cultural issues specific to each disorder. A comprehensive reference suitable for today's practitioners, Personality Disorders in Modern Life, Second Edition features a clear style that also makes it a valuable resource for advanced undergraduate and graduate students. The most thorough book of its kind, this Second Edition is a powerful, practical resource for all trainees and professionals in key mental health fields, such as psychology, social work, and nursing.

Leseprobe

Contents

Foreword

Preface

Chapter 1: Personality Disorders: Classical Foundations

Abnormal Behavior and Personality

Early Perspectives on the Personality Disorders

Summary

Chapter 2: Personality Disorders: Contemporary Perspectives

The Interpersonal Perspective

The Cognitive Perspective

Trait and Factorial Perspectives

The Evolutionary-Neurodevelopmental Perspective

Summary

Chapter 3: Development of Personality Disorders

On the Interactive Nature of Developmental Pathogenesis

Pathogenic Biological Factors

Pathogenic Experiential History

Sources of Pathogenic Learning

Continuity of Early Learnings

Sociocultural Influences

Summary

Chapter 4: Assessment and Therapy of the Personality Disorders

The Assessment of Personality

Psychotherapy of the Personality Disorders

Summary

Chapter 5: The Antisocial Personality

From Normality to Abnormality

Variations of the Antisocial Personality

Early Historical Forerunners

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 6: The Avoidant Personality

From Normality to Abnormality

Variations of the Avoidant Personality

Early Historical Forerunners

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 7: The Obsessive-Compulsive Personality

From Normality to Abnormality

Variations of the Compulsive Personality

Early Historical Forerunners

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 8: The Dependent Personality

From Normality to Abnormality

Variations of the Dependent Personality

Early Historical Forerunners

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 9: The Histrionic Personality

From Normality to Abnormality

Variations of the Histrionic Personality

Early Historical Forerunners

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 10: The Narcissistic Personality

From Normality to Abnormality

Variations of the Narcissistic Personality

Early Historical Forerunners

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 11: The Schizoid Personality

From Normality to Abnormality

Variations of the Schizoid Personality

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 12: The Schizotypal Personality

From Normality to Abnormality

Variations of the Schizotypal Personality

Early Historical Forerunners

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 13: The Paranoid Personality

From Normality to Abnormality

Variations of the Paranoid Personality

Early Historical Forerunners

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 14: The Borderline Personality

From Normality to Abnormality

Variations of the Borderline Personality

The Biological Perspective

The Psychodynamic Perspective

The Interpersonal Perspective

The Cognitive Perspective

The Evolutionary-Neurodevelopmental Perspective

Therapy

Summary

Chapter 15: Personality Disorders from the Appendices of DSM-III-R and DSM-IV

The Self-Defeating (Masochistic) Personality

The Sadistic Personality

The Depressive Personality

The Negativistic (Passive-Aggressive) Personality

Summary

References

Author Index

Subject Index

Copyright © 2000, 2004 by John Wiley & Sons, Inc. All rights reserved.

Published by John Wiley & Sons, Inc., Hoboken, New Jersey.

Published simultaneously in Canada.

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Library of Congress Cataloging-in-Publication Data:

Personality disorders in modern life.—2nd ed. / Theodore Millon . . . [et al.].

p. cm.

Rev. ed. of: Personality disorders in modern life / Theodore Millon and Roger D. Davis. c2000.

Includes bibliographical references (p. ).

ISBN 0-471-23734-5

1. Personality disorders. I. Millon, Theodore. II. Millon, Theodore. Personality disorders in modern life.

RC554.M537 2004

616.85’81—dc22

2004043374

Foreword

It is a pleasure to introduce the reader to the second edition of this highly acclaimed volume, Personality Disorders in Modern Life. The first edition, which I had the honor to review for Contemporary Psychology: APA Review of Books, was excellent, and the second edition by Theodore Millon and his team of coauthors—Seth Grossman, Carrie Millon, Sarah Meagher, and Rowena Ramnath—expands and updates the first. The senior author of this volume has reached the status of icon in the psychological sciences and has inspired a generation of workers in the field of personality theory, assessment, psychotherapy, and nosology. He is almost single-handedly responsible for the resurgence of a nearly moribund area in psychology—personology, the study of the human personality system, of interest to humankind since the dawn of consciousness—and the concomitant development of language, cognition, and culture—only a recent development. Personality theory nearly became extinct during the latter half of the past century, dismissed as a useless artifact of “prescientific psychology.” However, the advances of clinical sciences, such as diagnosis, classification, and psychotherapy, spear-headed by Millon, beckoned leaders in the field to prevent this clinically and socially useful area of discourse and science from going the way of other prescientific precursors of our field, such as phrenology—the study of the contours of the head and their relationships to various neuropsychological functions.

As I described in my review of the original edition, published at the turn of the century, this volume represented significant advances over the first 100 years of modern psychology. Advances in the fields of psychotherapy, psychopathology, and personality theory have been substantial. Over a century ago, William James (1890) published his two-volume work, Principles of Psychology, which many consider a landmark in psychology and which ushered in the birth of modern psychology. Certainly, there were other groundbreaking works that had similar impact on the clinical sciences, such as Freud’s (1900) Interpretation of Dreams, which during the same time span, gave birth to psychoanalysis and what many consider to be the beginning of modern psychotherapy. Over the course of the first century of modern psychology, many have attempted to elaborate the realm of the personality system; but few have been as comprehensive in this endeavor as Millon. This volume represents the accumulated wisdom and theoretical, clinical, and empirical findings over the past century. It affords us the opportunity to be introduced or reawakened by one of the most interesting subjects of our time: personality and its disorders. The insight offered in this volume allows all of us to understand the complexities of the plethora of converging forces that leads to alterations in personality and how they are represented, conceptualized, and treated.

The audience for this text is advanced undergraduate and graduate students, but it will serve as an introduction to all interested readers and excite even the most hesitant reader. Its broad coverage introduces undergraduate students to the fascinating world of clinical sciences with easy-to-follow case illustrations through the eyes of a student struggling to understand how these constructs and theories apply to clinical reality. For advanced students, this text serves as a consolidation of Millon’s other works and introduces his conceptual system, which, for many, will lead to the reading of his other groundbreaking volumes on the topic. As a practicing clinician and personality theorist, I share Millon’s view that personality is the main organizing system of humankind, and any understanding or attempt at altering the suffering encountered in clinical practice requires a deep appreciation of the domains of human personality.

For those pursuing careers in the social or clinical sciences, this volume is one for your library of reference books. I guarantee that you will refer to it often. The systematic theoretical modeling and self-other awareness that this volume engenders will enrich those students who are attracted to other disciplines. All of us at one time will encounter individuals similar to those described in this volume. It is important that we not use personality labels pejoratively or stigmatize those who suffer from personality dysfunction but, rather, that we develop a deeper appreciation for the variety of personality types profiled in this volume. This appreciation will enable those in various careers to be more effective when assigned a narcissistic boss or when reading about a psychopathic individual who preys on society, such as some of the infamous figures presented in this text. Those in the medical professions will gain a keener appreciation for their patients and for how their psychological immune system, as Millon has termed it, functions and dysfunctions under stressful conditions.

Millon and his team have carefully laid the groundwork for you to build a working model of human personality functioning and dysfunction. The framework is based on the dominant psychiatric model of diagnosing personality disorders but provides an even richer, more textured system, pioneered by Millon and based on evolutionary principles and clearly articulated domains of functioning. You will begin to acquire an appreciation for how clinical syndromes such as anxiety, depression, and eating disorders emanate from the unique configuration of the personality system, which will allow you to embark on an incomparable journey of self- and other understanding. You will be challenged with many of the constructs and terminology, but familiarization with Millon’s system has both clinical utility and value in understanding the unique and shared characteristics of the human race. Dr. Millon is one of the most prominent personality theorists of contemporary times; his work will inspire successive generations, just as William James and Sigmund Freud did more than 100 years ago. Enjoy the journey!

Jeffrey J. Magnavita, PHD, ABPP

Fellow, American Psychological Association

Adjunct Professor in Clinical Psychology, University of Hartford

Director, Connecticut Center for Short-Term Dynamic Psychotherapy

References

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 “sDSM-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]

Chapter 1

Personality Disorders: Classical Foundations

Objectives

What is

personality?

Distinguish among personality, character, and temperament.

What makes a personality disordered?

What is the

DSM?

Make a list of terms important in the study of personality and its disorders.

Explain the

DSM

’s multiaxial model. What are the reasons for having a multiaxial classification system?

Why is personality analogous to the body’s immune system?

What are the three criteria that distinguish normal from abnormal functioning?

Why is eclecticism perforce a scientific norm in the social sciences?

Explain how ideas progress in the social sciences.

What are the different components of the biological perspective?

Describe Freud’s topographical and structural models of the mind.

What is the function of defense mechanisms? How do they work?

Describe the stages of psychosexual development.

What are

character disorders?

Explain the significance of object relations theory.

Explain Kernberg’s use of the term

structural organization.

What sort of a person are you? What do you see as distinctive about your personality? How well do you know yourself? Are there aspects of your personality of which you are unaware? Do others know you as you know yourself? What are the best and worst things about your personality? Questions such as these are easy to ask, but are often difficult to answer. Yet, they go directly to the essence of what we are as human beings. Personality is that which makes us what we are and that which makes us different from others. People who are especially different, for example, are said to have “personality” or be “quite a character.” Other people have “no personality at all.” Depending on how someone affects us, he or she may be viewed as having a “good personality” or a “bad personality.”

In the past several decades, the study of personality and its disorders has become central to the study of abnormal psychology. In the course of clinical work, we encounter subjects with vastly different pathologies. Some are in the midst of a depressive episode, and some must cope with the lasting effects of traumas far beyond the range of normal human experience. Some are grossly out of contact with reality, and some have only minor problems in living rather than clinical disorders. Although the problems of patients vary, everyone has a personality. Personality disorders occupy a place of diagnostic prominence today and constitute a special area of scientific study. The issues involved are complex, certainly much more sophisticated than the everyday understanding of personality described in the previous questions. This chapter introduces the emergence of this new discipline by analyzing personality and personality disorders by comparing and contrasting the basic assumptions that underlie different approaches to these ideas and by presenting the fundamentals of the classical perspectives on personality, which are essential to the understanding of the clinical chapters that follow. The questions are: What is personality? How does our definition of personality inform our understanding of personality disorders? Do the assumptions underlying the concept of personality support the use of the term disorder? How can the content of different personality disorders best be described?

One way to investigate the definition of a term is to examine how its meanings and usage have evolved over time. The word personality is derived from the Latin term persona, originally representing the theatrical mask used by ancient dramatic players. As a mask assumed by an actor, persona suggests a pretense of appearance, that is, the possession of traits other than those that actually characterize the individual behind the mask. In time, the term persona lost its connotation of pretense and illusion and began to represent not the mask, but the real person’s observable or explicit features. The third and final meaning personality has acquired delves beneath surface impression to turn the spotlight on the inner, less often revealed, and hidden psychological qualities of the individual. Thus, through history, the meaning of the term has shifted from external illusion to surface reality and finally to opaque or veiled inner traits. This last meaning comes closest to contemporary use. Today, personality is seen as a complex pattern of deeply embedded psychological characteristics that are expressed automatically in almost every area of psychological functioning. That is, personality is viewed as the patterning of characteristics across the entire matrix of the person.

Personality is often confused with two related terms, character and temperament. Although all three words have similar meanings in casual usage, character refers to characteristics acquired during our upbringing and connotes a degree of conformity to virtuous social standards. Temperament, in contrast, refers not to the forces of socialization, but to a basic biological disposition toward certain behaviors. One person may be said to be of “good character,” whereas another person may have an “irritable temperament.” Character thus represents the crystallized influence of nurture, and temperament represents the physically coded influence of nature.