Major Theories of Personality Disorder

People with personality disorders share an uneasiness in their own skin. There are no birds here with deployed plumage flying toward the silvery tree (1), only women and men "each unhappy...in [his or her] own way" (2). They may feel aimless or ashamed, disgraced or doubtful, empty or envious, fearful of others or insatiably needing them. They may forever search for figures to admire while also being unable to commit to life-long goals, nurturing relationships, intimacy, and the pursuit of meanings. They may try to divine what life holds for them through magical signs from far-away planets and galaxies. They may be hesitant or impulsive, or unstable, needing constant admiring recognition, or they may entirely lack feelings for others and become social outcasts. Their lack of ease thus interferes with their human relationships and their creative, productive activities. Indeed, they may well feel like Huraki Murakami's Frog: "What you see with your eyes is not necessarily real. My enemy is, among other things, the me inside me. Inside me is the un-me" (3).

Ultimately, theories of disordered personalities are hypotheses—working models—of the pathogenic sources and developmental evolution of these persons' affects, behavior, perception of self or others, of their anguish, as well as of potential ways to relieve their inordinate malaise and enable them to alter their unsuccessful adaptation to life.

In this second edition of Major Theories of Personality Disorder, the editors, Dr. Mark Lenzenweger and Dr. John Clarkin, two distinguished authorities in personality disorder research, have assembled a group of recognized leaders in their respective fields to present a rich collection of different perspectives on these disturbances. The current edition has two new points of view added to those represented in the earlier version. The senior authors of the other chapters are the same as in the 1996 edition. References are complete through 2003, with occasional 2004 citations.

In the introductory chapter, The Personality Disorders, the editors confront the following significant issues: 1) the controversial nature of categorical versus dimensional conceptualizations of personality disorder diagnostic features; 2) the high degree of overlap among currently defined axis II personality disorders; 3) the absence of published data derived from a large sample of carefully assessed cases in which individual criterion items confirm our current DSM-IV-TR disorder structure; 4) the lack of long-term stability in actual patients of the current criteria of personality disorders; and, finally, 5) the lack of a "gold standard" of validity against which personality disorder diagnoses could be measured.

This introduction is followed by in-depth discussions of seven major theories of personality disorders.

"A Cognitive Theory of Personality Disorders" is presented by Dr. James L. Pretzer and Dr. Aaron T. Beck. The discussion of goals, principles, process, assessment instrumentation, and treatment, including a three-page section on Future Directions, is unchanged from that in the first edition of this volume. New material is only in the seven pages covering validity and effectiveness. Among the 106 references cited, only seven date since 1996. A difference between cognitive therapy and dialectical behavior therapy is alluded to but not discussed.