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Fatal Flaws

Navigating Destructive Relationships With People With Disorders of Personality and Character

Stuart C. Yudofsky, M.D.

  • ISBN 978-1-58562-214-6
  • Item #62214

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Featuring case vignettes from nearly 30 years of Dr. Yudofsky's clinical practice and incorporating the knowledge of gifted clinicians, educators, and research scientists with whom he has collaborated throughout that time, Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character uniquely captures the rapidly increasing body of clinical and research information about people with severe and persistent personality and character disorders.

Within these pages, the author brings to life the psychopathologies of personality and character disorders through vivid vignettes based on composites of his many patients and their most important relationships—while meticulously changing the identifying facts and relevant details to protect confidentiality.

Covering the clinical course, treatment, genetics, biology, psychology, and destructive consequences of hysterical (histrionic), narcissistic, antisocial, paranoid, obsessive-compulsive, addictive, borderline, and schizotypal personality disorders, Fatal Flaws stands out in the literature for these powerful reasons:

  • It is written for an unusually broad audience, from mental health students and trainees of all disciplines, to highly experienced clinicians, to patients who suffer from or are in destructive relationships with people with personality disorders.
  • It is a hybrid—part psychiatric textbook for clinicians and part self-help manual for patients and clients with personality and character disorders.
  • It is designed to supplement treatment by providing patients with practical, evidence-based information about personality disorders and character flaws.
  • It is particularly valuable to patients who are in psychotherapy, in part, because they are entangled in destructive relationships with people with disorders of personality and/or character.
  • It is written in the first person, with the author directly communicating with a patient who either has a personality or character disorder or is in an important relationship with a person who has such a disorder.
  • It is useful for people who are uncertain whether they or their loved ones have personality or character disorders, and who want to know more about these conditions and their treatments before making a decision about securing the help of a mental health professional.

Fatal Flaws: Navigating Destructive Relationships With People With Disorders of Personality and Character is a compelling volume that provides the essential information and a realistic sense of the clinical experience required to inform, orient, and support novice mental health professionals and seasoned practitioners alike as they face the ongoing challenges of treating patients or clients with personality or character disorders. It should also prove to be an invaluable resource for those who wish practical and effective help in understanding and changing their destructive relationships with people who have severe and persistent disorders of personality and/or character.


  • Acknowledgments
  • Introduction
  • Prologue
  • Chapter 1. What Are Fatal Flaws?
  • Chapter 2. Does This Person Have a Fatal Flaw?
  • Chapter 3. Nine Principles for Dealing With People With Fatal Flaws
  • Chapter 4. Hysterical (Histrionic) Personality Disorder
  • Chapter 5. Narcissistic Personality Disorder
  • Part I: Untreated Narcissism
  • Chapter 6. Narcissistic Personality Disorder
  • Chapter 7. Antisocial Personality Disorder
  • Chapter 8. Obsessive-Compulsive Personality Disorder
  • Chapter 9. Paranoid Personality Disorder
  • Chapter 10. Borderline Personality Disorder
  • Chapter 11. Schizotypal Personality Disorder
  • Chapter 12. Addictive Personality Disorder
  • Chapter 13. Getting Help
  • Index

About the Authors

Stuart C. Yudofsky, M.D., is D.C. and Irene Ellwood Professor and Chairman of the Menninger Department of Psychiatry and Behavioral Sciences at Baylor College of Medicine. He is Chief of Psychiatry Services at The Methodist Hospital and is also responsible for oversight of academic activities in psychiatry at The Menninger Clinic and Hospital, the Ben Taub General Hospital, the Houston Veterans Administration Medical Center, the St. Luke's Episcopal Hospital, and the Texas Children's Hospital. For the past seventeen years, Dr. Yudofsky has been Editor of the Journal of Neuropsychiatry and Clinical Neurosciences, the official journal of the American Neuropsychiatric Association.

Fatal Flaws is that rare crossover book that effectively speaks to both patients and psychiatrists. Case studies of novelistic intensity pull the reader into the dual perspectives of the patient and of the psychiatrist. The real-life depictions of what goes on in the therapy session turn out to be as engrossing as some classic 'therapy' movies such as Spellbound. My hunch is that therapists will refer this 'must-own' book to their patients and patients will refer it to their therapists.—Ethel S. Person, M.D., Professor of Clinical Psychiatry, College of Physicians & Surgeons, Columbia Univ; Training & Supervising Analyst, Columbia Univ Center for Psychoanalytic Training & Research

From the pen of a master educator and clinician, Fatal Flaws, by Stuart Yudofsky M.D., is a remarkable gift to mental health practitioners everywhere. Drawing on years of clinical experience, Dr. Yudofsky allows us into his consulting room and shares his views and strategies about how best to help patients who suffer from severe, complex, and disabling personality disorders. Most importantly, after careful 'de-identification' of each patient, he presents (from enviably detailed and preserved clinical records) selected dialogues between himself and his patients as well as between his patients ant heir friends, family members, employers, and others with whom they have interacted regularly.—The American Journal of Psychiatry, 4/1/2006

Fatal Flaws provides us with a user-friendly instrument to help us perceive personality flaws (fatal and otherwise) in ourselves and in others, and it quickly presents us with nine principles for safely interacting with people who have fatal flaws. . . . Each chapter leads with a captivating clinical vignette and then presents the available knowledge and wisdom on the subjract that at once is valuable to clinicians at all levels of experience and gives practical and effective help to the lay person in understanding and changing their destructive relationships with people who have severe and persistent personality disorders.—Psychiatric Services, 4/1/2006

From psychoanalysis to neurotransmitters, from underlying causes to practical applications, this unique volume will help the health care community and the public understand a group of mental disorders that inflict untold pain on those who suffer from them, untold frustration on their health care professionals, and untold damage on their families, friends, and business associates. Many books can enlighten; this engrossing work can also save families, careers, and lives.—Nada L Stotland, M.D., M.P.H., Professor of Psychiatry and Obstetrics/Gynecology, Rush Medical College, Chicago, Illinois

Fatal Flaws is wonderfully educational and well written. I have also convinced 4 others including Department Chairs, administrators, etc. to buy copies. I realize that it was probably not Dr. Yudofsky's intent to have the book read as an aid to administration, however often we have steered away from personal relationships with individuals with these types of problems, but cannot do so in the work place.—Niloo M. Edwards, M.D., Chairman of Cardiothoracic Surgery, University of Wisconsin, Madison, WI

I recommend Fatal Flaws to anyone attempting to understand some of the devastating experiences they have had in the past, or may be going through at present. It is certainly a wonderful starting point for a general study of personality disorders. I greatly appreciate Dr. Yudofsky's hard work and his effort to make it readable for the general public. Many of my psychology students have expressed an interest in moving on to a career that involves psychology or psychiatry. Much of this has to do with expert authors who help make the course better by providing people like me with the ammunition to better equip these young people.—Jim Rojas, El Rancho High School, Pico Rivera, California

Fatal Flaws was fascinating to read, especially the detailed and beautifully written portrait of Shelby Fairmont. Dr. Yudofsky enables the reader to be an unseen observer of the therapeutic process in the hands of a colorful patient and an extraordinarily gifted psychiatrist. He has given the best description I have seen of the anatomy of healing. The book should be of value and interest to a wide range of readers. It should certainly be must reading for anyone entering the field and for those whose lives are enmeshed in any of the destructive relationships Dr. Yudofsky describes and analyzes so superbly.—Rabbi Samuel Egal Karff, Congregation Beth Israel, Houston, Texas

Fatal Flaws is a well-written, accessible guide for understanding personality disorders. Its discussion of symptoms, diagnosis, and treatment is thorough enough to serve as guide for mental health practitioners in training, yet the case studies and guidelines are practical and useful for the layperson who is in a relationship with someone with a personality disorder.—PsycCRITIQUES

Using 30 years of experience as a successful therapist in the psychoanalytic tradition, the author provides rich information about personality disorders through cases that illustrate symptoms and treatment. The book is hard to put down, attesting to the author's achievement of his goal of providing information about persons with these disorders in a clear and interesting way. The style of the book lends itself well to the targeted audience of those who are beginning or are in training to proved therapy for persons with personality disorders as well as for patients themselves or their families who want a better understanding of these 'flaws'.—Doody's Book Review Service, 4/1/2006

[Fatal Flaws] is readable, thorough, and unique practical sharing of the author's and the mentors' wisdom regarding personality disorders of all types delineated in the DSM-IV.—Journal of Clinical Psychiatry, 4/1/2006

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