Broken Structures Severe Personality Disorders and Their Treatment

by Akhtar, Salman

• ISBN13: 9780876685389
• ISBN10: 0876685386
• Format: Hardcover
• Copyright: 1992-10-01
• Publisher: Jason Aronson, Inc.

Summary

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

Table of Contents

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