Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?

doi:10.1017/CBO9780511544439.002

1 - Treatability in severe personality disorders: how far do the science and art of psychotherapy carry us?

Published online by Cambridge University Press: 14 August 2009

Edited by

Salman Akhtar and

Michael H. Stone: Affiliation:
Professor of Clinical Psychiatry Columbia College of Physicians and Surgeons, New York City; Attending in Psychiatry and former Research Director, Mid-Hudson Forensic Psychiatric Center, retired New Hampton, NY, USA
Bert van Luyn: Affiliation:
Symfora Group, The Netherlands
Salman Akhtar: Affiliation:
Thomas Jefferson University, Philadelphia
W. John Livesley: Affiliation:
University of British Columbia, Vancouver

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Summary

Personality disorders, severe and otherwise, constitute what one might call afuzzy set, after the theory developed by Lotfi Zadeh (1987), and expanded by Bart Kosko (1993). An analogous concept is that of “warmth” as applied to the ambient temperature: there are numbers below which almost no one would consider the temperature “warm,” and other readings, say – above 122 °F/50 °C – that would almost universally be experienced astoo warm. As the temperature approached 50 °C, gradually increasing percentages of people would conclude it was “too hot.” This gradual change, which would speed up as one got very near to 50 °C, is the fuzzy set. As Kosko points out, the termlife is itself fuzzy (p. 242). When it begins (when the sperm meets the egg? at the blastula stage? later?) is a matter of shading; a matter of degree and debate. Questions concerning fuzzy sets are decided often by expert opinion, not precise scientific measurement. In the domain of medical diagnosis, models that use cluster analysis may begin with performing a clustering algorithm on a set of patients – “by examining (a) the similarity of the presence and (b) the severity of symptom patterns exhibited by each” (Klir and Folger, 1988, p. 252). The authors mention that the similarity measure is usually computed between the symptoms of the patient in question and the symptoms of a patient possessing (by experts' agreement) the prototypical symptom pattern for each possible disease or condition.

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Type: Chapter
Information: Severe Personality Disorders , pp. 1 - 29

DOI: https://doi.org/10.1017/CBO9780511544439.002 [Opens in a new window]

Publisher: Cambridge University Press

Print publication year: 2007

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References

Baron-Cohen, S. (2003).The Essential Difference: The Truth about the Male & Female Brain.New York:Basic Books.

Bateman, A. andFonagy, P. (2004a).Psychotherapy for Borderline Personality Disorder: Mentalization-Based Treatment.New York:Oxford University Press.

Bateman, A. andFonagy, P. (2004b).Mentalization-based treatment of BPD.J Personal Disord 18:36–51.Google Scholar

Beck, A. T. andFreeman, A. (1990).Cognitive Therapy of Personality Disorders.New York:Guilford Press.

Black, D. W. (1999).Bad Boys, Bad Men: Confronting Antisocial Personality Disorder.New York:Oxford University Press.

Buss, D. M. (2005).The Murderer Next Door: Why the Mind is Designed to Kill.New York:Penguin Press.

Chiesa, M. andFonagy, P. (2003).Psychosocial treatment for severe personality disorders. A 36-month follow-up.Br J Psychiatry 183:356–362.Google Scholar

Clarkin, J. F.,Foelsch, P. A.,Levy, K. N.,Hull, J. W.,Delaney, J. C. andKernberg, O. F. (2001).The development of a psychodynamic treatment for patients with borderline personality disorder: a preliminary study of behavioral change.J Personal Disord 15:487–495.Google Scholar

Cloninger, C. R. (2005). Antisocial personality disorder: a review. InMaj, M,Akiskal, H. S.,Mezzich, J. E. andOkasha, A. (eds.)Personality Disorders (WPA Series).Chichester, England:John Wiley & Sons Ltd, pp. 125–169.

Cloninger, C. R.,Svrakiċ, D. M. andPrzybeck, T. R. (1993).A psychobiological model of temperament and character.Arch Gen Psychiat 50:975–990.Google Scholar

Cooke, D. J. andMichie, C. (2001).Refining the concept of psychopathy: toward a hierarchical model.Psychological assessment. J Consult Clin Psychol 13:171–188.Google Scholar

Diagnostic and Statistical Manual of Mental Disorders, 4th edn. (DSM-IV). (1994).Washington DC:American Psychiatric Press.

D'Silva, K.,Duggan, C. andMcCarthy, L. (2004). Does treatment really make psychopaths worse? A review of the evidence. J Personal Disord 18: 163–177.Google Scholar

Eley, T. C., Lichtenstein, P. and Moffitt, T. E. (2003). A longitudinal behavioral genetic analysis of the etiology of aggressive and nonaggressive antisocial behavior. Dev Psychopathol 15: 383–402.Google Scholar

Emmons, N. (1986). Manson in His Own Words. New York: Grove Press.

Freud, S. (1904). On psychotherapy. In J. Strachey (ed.) (1953). Standard Edition of the Complete Psychological Works of Sigmund Freud, Vol 7. Translated by Strachey, J. London: Hogarth Press, pp. 257–268.

Gacono, C. B. (2005). Understanding the antisocial personality disorder and psychopathy professional literature [commentary on Cloninger 2005]. In Maj, M., Akiskal, H. S., Mezzich, J. E and Okasha, A (eds.) Personality Disorders (WPA Series). Chichester, England: John Wiley & Sons Ltd, pp. 170–175.

Ge, X., Donnellan, M. B. and Wenk, E. (2003). Differences in personality and patterns of recidivism between early starters and other serious male offenders. J Am Acad Psychiatry Law 31: 68–77.Google Scholar

Goodman, G., Hull, J. W., Clarkin, J. F. and Yeomans, F. E. (1999). Childhood antisocial behaviors as predictors of psychotic symptoms and DSM-III-R borderline criteria among inpatients with borderline personality disorder. J Personal Disord 13: 35–46.Google Scholar

Greeven, P. G. and Ruiter, C. (2004). Personality disorders in a Dutch forensic psychiatric sample: changes with treatment. Crim Behav Mental Health 14: 280–290.Google Scholar

Gretton, H. M., Hare, R. D. and Catchpole, R. E. (2004). Psychopathy and offending from adolescence to adulthood: a 10-year follow-up. J Consult Clin Psychol 72: 636–645.Google Scholar

Grilo, C. M., Sanislow, C. A., Gunderson, J. G., Pagano, M. E., Yen, S., Zanarini, M. C., Shea, M. T., Skodol, A. E., Stout, R. L., Morey, L. C. and McGlashan, T. H. (2004). Two-year stability of schizotypal, borderline, avoidant, and obsessive-compulsive personality disorders. J Consult Clin Psychol 72: 767–775.Google Scholar

Ha, K. S., Kim, S. J., Yune, S. K., Kim, J. H., Hwang, J. W., Lee, N. Y., Sung, Y. H., Abrams, K. Y. and Lyoo, I. K. (2004). Three year follow-up of women with and without borderline personality disorder: development of Cloninger's character in adolescence. Psychiatry Clin Neurosci 58: 42–47.Google Scholar

Hare, R. D. (1993). Without Conscience: The Disturbing World of the Psychopaths Among Us. New York: Pocket Books.

Hare, R. D., Harpur, T. J., Hakstian, A. R. et al. (1990). The Revised Psychopathy Checklist: reliability and factor structure. Psychological asessment. J Consult Clin Psychol 2: 238–241.Google Scholar

Hazelwood, R. and Michaud, S. G. (2001). Dark Dreams: Sexual Violence, Homicide, and the Criminal Mind. New York: St Martin's Press.

Hemphill, J. F., Templeman, R., Wong, S. and Hare, R. D. (1998). Psychopathy and crime: recidivism and criminal careers. In Cooke, D. J, Forth, A. E and Hare, R. D. (eds.) Psychopathy: Theory, Research & Implications for Society. Dordrecht, The Netherlands: Kluwer Academic Publishers.

Judd, P. H. and McGlashan, T. H. (2003). A Developmental Model of Borderline Personality Disorder: Understanding Variations in Course and Outcome. Washington, DC: American Psychiatric Press.

Kernberg, O. F. (1967). Borderline personality organization. J Am Psychoanal Assoc 15: 641–685.Google Scholar

Kernberg, O. F. (1992). Aggression in Personality Disorders and Perversions. New Haven: Yale University Press.

Klir, G. J. and Folger, T. A. (1988). Fuzzy Sets, Uncertainty and Information. Englewood Cliffs, New Jersey: Prentice Hall.

Kosko, B. (1993). Fuzzy Thinking: The New Science of Fuzzy Logic. New York: Hyperion.

Leichsenring, F. and Leibing, E. (2003). The effectiveness of psychodynamic therapy and cognitive behavior therapy in the treatment of personality disorders. Am J Psychiatry 160: 1223–1232.Google Scholar

Linehan, M. M., Heard, H. L. and Armstrong, H. E. (1993). Naturalistic follow-up of a behavioral treatment for chronically parasuicidal borderline patients. Arch Gen Psychiatry 50: 971–974.Google Scholar

Links, P. S., Heslegrave, R. and Reekum, R. (1998). Prospective follow-up study of borderline personality disorder: prognosis, prediction of outcome, and Axis-II comorbidity. Can J Psychiatry 43: 265–270.Google Scholar

Lipsey, M. W. and Wilson, D. B. (1993). The efficacy of psychological, educational, and behavioral treatment: confirmation from meta-analysis. Am Psychol 48: 1181–1209.Google Scholar

McGlashan, T. H. (1986a). The Chestnut Lodge Follow-Up study: III. Long-term outcome of borderline patients. Arch Gen Psychiatry 43: 20–40.Google Scholar

McGlashan, T. H. (1986b). Schizotypal personality disorder: long-term follow-up perspectives. VI: Chestnut Lodge Follow-Up study. Arch Gen Psychiatry 43: 329–334.Google Scholar

Mehlum, L., Friis, S., Vaglum, P. and Karterud, S. (1994). The longitudinal pattern of suicidal behavior in borderline personality disorder: a prospective follow-up study. Acta Psychiatrica Scand 90: 124–130.Google Scholar

Michaud, S. G. (1994). Lethal Shadow: The Chilling True Story of a Sadistic Sex Slayer. New York: Onyx.

Najavits, L. M. and Gunderson, J. G. (1995). Better than expected: improvements in borderline personality disorder in a 3-year prospective outcome study. Compr Psychiatry 36: 296–302.Google Scholar

Paris, J. and Zweig-Frank, H. (2001). A 27 year follow-up of patients with borderline personality disorder. Compr Psychiatry 42: 482–487.Google Scholar

Parnas, J., Licht, D. and Bovet, P. (2005). Cluster A personality disorders: a review. In Maj, M., Akiskal, H. S., Mezzich, J. E. and Okasha, A. (eds) Personality Disorders (WPA Series). Chichester, England: John Wiley & Sons Ltd, pp. 1–74.

Plakun, E. M., Burkhardt, P. E. and Muller, J. P. (1985). 14 year follow-up of borderline and schizotypal personality disorders. Compr Psychiatry 26: 448–455.Google Scholar

Quinsey, V. L., Harris, G. T., Rice, M. E. and Cormier, C. A. (1998). Violent Offenders: Appraising and Managing Risk. Washington, DC: Amererican Psychological Association.

Rice, M. E., Harris, G. T. and Cormier, C. A. (1992). An evaluation of a maximum-security therapeutic community for psychopaths and other mentally disordered offenders. Law Human Behav 16: 399–412.Google Scholar

Rothenhausler, H. B. and Kapfhammer, H. P. (1999). Outcome in borderline disorders: A literature review. Fortshcr Neurol Psychiatrie 67: 200–217.Google Scholar

Ryle, A. (2004). The contribution of cognitive analytic therapy to the treatment of borderline personality disorder. J Personal Disord 18: 3–35.Google Scholar

Senol, S., Dereboy, C. and Yuksel, N. (1997). Borderline disorder in Turkey: a 2- to 4- year follow-up. Soc Psychiatry Psychiatric Epidemiol 32: 109–112.Google Scholar

Seto, M. C. and Barbaree, H. E. (1999). Psychopathy: treatment behavior & sex offender recidivism. J Interpersonal Violence 14: 1235–1248.Google Scholar

Skodol, A. E., Pagano, M. E., Bender, D. Set al. (2005). Stability of functional impairment in patients with schizotypal, borderline, avoidant, or obsessive-compulsive personality disorder over two years. Psychol Med 35: 443–451.Google Scholar

Soderberg, S., Kullgren, G. and Salander-Renberg, E. (2004). Childhood sexual abuse predicts poor outcome seven years later. Social Psychiatry Psychiatric Epidemiol 39: 916–920.Google Scholar

Stevenson, J. and Meares, R. (1992). An outcome study of psychotherapy for patients with borderline personality disorder. Am J Psychiatry 149: 358–362.Google Scholar

Stone, M. H. (1985). Analytically oriented psychotherapy in schizotypal and borderline patients: at the border of treatability. Yale J Biol Med 58: 275–288.Google Scholar

Stone, M. H. (1990a). The Fate of Borderlines. New York: Guilford Press.

Stone, M. H. (1990b). Long-term follow up of narcissistic personality disorder. Psychiatr Clin N Am 12: 621–641.Google Scholar

Stone, M. H. (1993). Long-term outcome of personality disorders. Br J Psychiatry 162: 299–313.Google Scholar

Stone, M. H. (1994). Characteristic subtypes of borderline personality disorder. With a note on prognostic factors. Psychiatr Clin North Am 17: 773–784.Google Scholar

Stone, M. H. (1996). Schizoid and schizotypal personality disorders. In Gabbard, G. and Atkinson, S. (eds) Synopsis of Treatments of Psychiatric Disorders, 2nd edn. Washington DC: American Psychiatric Press, pp. 953–957.

Stone, M. H. (2001). Serial sexual homicide: biological, psychological and sociological aspects. J Personal Disord 15: 1–18.Google Scholar

Stone, M. H. (2006). Personality-Disordered Patients: Treatable and Untreatable. Washington DC: American Psychiatric Press.

Stone, M. H., Hurt, S. and Stone, D. K. (1987). The P. I.-500: long-term follow up of borderline inpatients meeting DSM III criteria. J Personal Disord 1: 291–298.Google Scholar

Vanggaard, T. (1979). The Borderlands of Sanity. Copenhagen: Munksgaard.

Wallerstein, R. (1986). Forty-Two Lives in Treatment: A Study of Psychoanalysis and Psychotherapy. New York: Guilford Press.

Winston, A., Rosenthal, R. N. and Pinsker, H. (2004). Introduction to Supportive Psychotherapy. Washington DC: American Psychiatric Press.

Yen, S., Pagano, M. E., Shea, M. T.et al. (2005). Recent life-events preceding suicide attempts in a personality disorder sample: findings from the collaborative longitudinal personality study. J Consult Clin Psychol 73: 99–105.Google Scholar

Zadeh, L. (1987). Coping with the imprecision of the real world. In Yager, R., Ovchinnikov, S., Tong, R. and Nguyen, H. (eds) Fuzzy Sets & Applications: Selected Papers by L. A. Zadeh. New York: John Wiley and Sons.

Zanarini, M. C., Frankenburg, F. R., Hennen, J. and Silk, K. R. (2003). The longitudinal course of borderline psychopathology: 6-year prospective follow-up of the phenomenology of borderline personality disorder. Am J Psychiatry 160: 274–283.Google Scholar

Zanarini, M. C., Frankenburg, F. R., Vujanovic, A. A., Hennen, J., Reich, D. B. and Silk, K. R. (2004). Axis-II comorbidity of borderline personality disorder: description of 6-year course and prediction to time-to-remission. Acta Psychiatrica Scand 110: 416–420.Google Scholar

Zanarini, M. C., Frankenburg, F. R., Hennen, J., Reich, D. B. and Silk, K. R. (2005). Psychosocial functioning of borderline patients and Axis-II comparison subjects followed prospectively for 6 years. J Personal Disord 19: 19–29.Google Scholar

Zweig-Frank, H. and Paris, J. (2002). Predictors of outcome in a 27-year follow-up of patients with borderline personality disorder. Compr Psychiatry 43: 103–107.Google Scholar

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