Broken Structures Severe Personality

This book integrates psychiatry and psychoanalysis to present deeper and sounder clinical profiles of the personality disorders than have been hitherto available.

Foreword

xiii

Otto F. Kernberg

Preface and Acknowledgments

xvii

PART I: IDENTITY

Identity and Its Origins

3

(22)

The Concept of Identity

Erikson

Lichtenstein

The Developmental Origins of Personal Identity

Freud

Fenichel

Greenacre

Mahler

Jacobson

Winnicott

Kernberg

Chasseguet-Smirgel

Blos

Conclusion

The Syndrome of Identity Diffusion

25

(20)

Clinical Features

Contradictory Character Traits

Temporal Discontinuity in the Self

Lack of Authenticity

Subtle Body Image Disturbances

Feelings of Emptiness

Gender Dysphoria

Inordinate Ethnic and Moral Relativism

Differential Diagnosis

Psychotic Disturbances of Identity

Multiple Personality

Adolescent Identity Crisis

Conclusion

PART II: THE PERSONALITY DISORDERS

Narcissistic Personality Disorder

45

(34)

Freud and the Early Analysts

Kernberg

Kohut

Other Contemporary American Analysts

Recent European Contributions

DSM-III and DSM-III-R

An Attempt at Synthesis

Distinction from Better Integrated Personality Disorders

Distinction from Other Severe Personality Disorders

Comment

Borderline Personality Disorder

79

(42)

Descriptive Studies

Psychoanalytic Views

DSM-III and DSM-III-R

An Attempt at Synthesis

Differential Diagnosis

Comment

Schizoid Personality Disorder

121

(28)

Descriptive Studies

Psychoanalytic Views

DSM-III and DSM-III-R

An Attempt at Synthesis

Differential Diagnosis

Comment

Paranoid Personality Disorder

149

(28)

Descriptive Studies

Psychoanalytic Views

DSM-III and DSM-III-R

An Attempt at Synthesis

Differential Diagnosis

Comment

Hypomanic Personality Disorder

177

(24)

Descriptive Studies

Psychoanalytic Views

An Attempt at Synthesis

Differential Diagnosis

Comment

Antisocial Personality Disorder

201

(46)

Descriptive Studies

Psychoanalytic Views

DSM-III and DSM-III-R

An Attempt at Synthesis

Differential Diagnosis

Comment

Histrionic and Schizotypal Personality Disorders

247

(28)

Histrionic Personality Disorder

Origins

DSM-III and DSM-III-R

Unresolved Issues

Schizotypal Personality Disorder

Origins

DSM-III and DSM-III-R

Unresolved Issues

Mixed Forms and Extrinsic Influences on Symptomatology

Mixed Forms

Level of Social Functioning

Sex-Related Differences

Changes in Symptomatology Over the Life Span

Cultural Factors

PART III: PSYCHOTHERAPY

Initial Evaluation and Early Treatment Decisions

275

(34)

The Technique of Initial Evaluation

Responding to the First Phone Call

Observing the Patient's Appearance, Behavior, and Manner of Arrival

Collecting the Core Information

Safeguarding the Therapeutic Framework

Assessing Psychological-Mindedness

Sharing Diagnostic Conclusions and Recommending Treatment

Frequent Questions at the End of Evaluation

Should the patient be treated at all?

Should the patient be treated as an outpatient or an inpatient?

Should the patient be put on medication?

Is the patient suitable for psychoanalysis?

What other psychotherapeutic strategies might be indicated?

Psychoanalytic Psychotherapy

309

(46)

Synthesizing Two Contrasting Approaches

The Skills, Attitude, and Personality of the Therapist

Beginning the Treatment

The Emergence of Transference and Its Handling

Needs versus Wishes

The Issue of Suicide

The Concept of Holding Environment and Its Technical Consequences

The Beginning of the End

Termination

PART IV: CODA

Summary, Conclusion, and Recommendations

355

(22)

Recapitulating the Important Points

A New Classification of Personality Disorders

The Parable of Two Flower Vases

References

377

(32)

Credits

409

(2)

Index

411

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Broken Structures Severe Personality Disorders and Their Treatment

Summary

Table of Contents

Supplemental Materials

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Broken Structures Severe Personality Disorders and Their Treatment

Summary

Table of Contents

Supplemental Materials

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