Defined by stable, long-term, subjective distress and/or social impairment, personality disorders affect up to 18% of the population. Social impairment and health care usage are far more prevalent among people with personality disorders than among people with major depressive disorders. Personality disorders are highly prevalent, variable, and notoriously difficult to treat, and they continue to challenge the therapeutic community and represent a formidable public health concern.
This volume ably addresses personality disorders as one of the top priorities of psychiatry for the new millennium, offering a thorough and updated review and analysis of empirical work to point up the issues central to developing a therapeutic model for treatment as well as current research challenges. A review of extant research yields the heartening conclusion that psychotherapy remains an effective treatment for people with personality disorders. An examination of psychodynamic treatment for borderline personality disorder speaks to its efficacy. An analysis of the rationale for combining psychotherapy and psychopharmacology emphasizes the importance of identifying temperament and target conditions. A well-documented and reasoned treatise on antisocial personality disorder makes the crucial point that clinicians must acquire a depth of understanding and skill sufficient to determine what the cut-off point is for treatable versus nontreatable gradations. With the caveat that evidence supporting the efficacy of cognitive treatments for personality disorders is slight and that such approaches require tailoring, a strong case is made for their validity.
This timely volume both answers and reframes many stubborn questions about the efficacy of psychotherapy for treating personality disorders.
Foreword. Empirical studies of psychotherapy for personality disorders. Psychodynamic psychotherapy for borderline personality disorder. Combining medication with psychotherapy in treatment of personality disorders. Gradations of antisociality and responsivity to psychosocial therapies. Cognitive therapy of personality disorders. Afterword. Index.
"This is a succinct, focused volume in which only a few topics are covered, but which are covered quite well. Given the continuous advances in our understanding of the human mind as well as the myriad ways in which it can become disordered, this volume is not merely justified, but overdue."—Doody’s Health Science Journal
"An amazing blend of empiricism, theory, practical medication advice and - thank Heaven!—psychodynamics. This timely compendium by two of our profession's leading theorist-practitioners is perfectly designed to help with the clinical problems we struggle with daily. This is an eminently ‘usable’ book for determining who is treatable and how."—Thomas Gutheil, M.D., Professor of Psychiatry, Harvard Medical School, Boston, Massachusetts
"Psychotherapy and Personality Disorders is a long overdue update of an important treatment approach to Axis II disorders. It offers a compendium of perspectives that satisfies both the investigative researcher and the practicing clinician. Perry and Bond provide a sophisticated review and meta-analysis of the now plentiful empirically informed studies of psychotherapeutic treatments. Their data driven conclusions are decidedly hopeful. Gunderson's review gives a sophisticated yet pragmatic treatise on the why and how of successful individual psychotherapeutic work with borderline patients. The contribution represents the condensed wisdom of the world's best psychotherapeutic practitioners presented with a clarity that puts it well within the operational reach of the good-enough clinician. Gabbard contributes a rarely attempted integration of medication strategy and psychotherapy and illustrates how the power of each can be augmented by the other and result in a combination that is literally neuro-dynamically informed. Stone relates with descriptive panache and chilling precision the character pathology that requires detention because therapeutic options cannot be managed, an important lesson for the neophyte clinician. Tyrer and Davidson finish with a critical look at the future of cognitive therapy for personality disorders. Overall, a superb collection from the psychotherapeutic discipline's best clinicians and researchers."—Thomas H. McGlashan, M.D., Professor of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
John G. Gunderson, M.D.,
is Director of Psychotherapy and Psychosocial Research and Chief of Ambulatory Personality Disorder Services at McLean Hospital in Belmont, Massachusetts. He is also Professor of Psychiatry at Harvard Medical School in Boston.
Glen O. Gabbard, M.D., is Professor and Director of the Baylor Psychiatry Clinic at the Baylor College of Medicine and Training and Supervising Analyst at the Houston-Galveston Psychoanalytic Institute in Houston, Texas. He was previously Director of the Menninger Hospital in Topeka, Kansas. Dr. Gabbard is the author or editor of sixteen books and currently is joint Editor-in-Chief and Editor for North America of the International Journal of Psychoanalysis. His numerous awards include the 2000 Mary Sigourney Award for outstanding contributions to psychoanalysis.