Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders: Assessment, Case Conceptualization, and Treatment

317 Pages·2016·11.74 MB·English

by  Len Sperry

HANDBOOK OF DIAGNOSIS
AND TREATMENT OF DSM-5
PERSONALITY DISORDERS
Since the publication of the acclaimed second edition of the Handbook of
Diagnosis and Treatment of DSM-IV-TR Personality Disorders, much has changed
in how the personality disorders are understood and treated. However, like its
previous editions, this new edition is a hands-on manual of the most current and
effective, evidence-based assessment and treatment interventions for these
challenging disorders. The beginning chapters describe several cutting-edge trends
in the diagnosis, case conceptualization, and treatment of them. Then, specific
chapters focus on evidence-based diagnosis and treatment interventions for each
of the ten DSM-5 personality disorders. Emphasized are the most recent
developments from Cognitive Behavior Therapies, Dialectical Behavior Therapy,
Cognitive Behavior Analysis System of Psychotherapy, Pattern-Focused
Psychotherapy, Mindfulness, Schema Therapy, Transference Focused
Psychotherapy, and Mentalization-Based Treatment. As in previous editions,
extensive case material is used to illustrate key points of diagnosis and treatment.
Len Sperry, MD, PhD, is a professor of mental health counseling and director
of clinical training at Florida Atlantic University, and clinical professor of
psychiatry at the Medical College of Wisconsin. For more than three decades he
has treated and taught courses and workshops on the personality disorders.
Among his 1000+ professional publications are several articles, book chapters,
and books on these disorders, including the recently published Cognitive Behavior
Therapy of DSM-5 Personality Disorders.
“Len Sperry has been a leader in the treatment of personality disorders for over
twenty-five years. This third edition of his Handbook provides treatment strategies
informed by recent research and updates from DSM-5. Sperry is the top contem-
porary clinical scholar of personality disorders with his integration of empirical
science, human development, and a synthetic understanding of different treatment
approaches. If you are going to purchase one book on personality disorders, get
this one.”—Steven J. Sandage, PhD, LP, Professor of Psychological & Brain
Sciences, Boston University
“As a much needed antidote to the one-size fits all of current cognitive therapy,
be it for Axis I or Axis II, Dr. Sperry has presented a much needed series of
evidence- based and tailored interventions that effectively treat the gamut of
personality disorders that are so prevalent today.”—Nicholas A. Cummings,
PhD, ScD, Former President, American Psychological Association
“The Handbook of Diagnosis and Treatment of DSM-5 Personality Disorders:
Assessment, Case Conceptualization, and Treatment, Third Edition is a must read for
any practicing mental health clinician working with personality disordered clients.
It is remarkably practical, user friendly, updated, and helpful to assist both
professionals and trainees alike stay up-to-date on the thoughtful evidence based
strategies for understanding and treating personality disorders. This is one of those
books that should be on the shelf of all mental health professionals. Dr. Sperry,
as usual, has offered the profession a terrific update to his now classic text.”
—Thomas G. Plante, PhD, ABPP, Professor of Psychology, Santa Clara
University
“Len Sperry’s third edition of the Handbook of Diagnosis and Treatment of DSM-
5 Personality Disorders offers both the experienced clinician and student a concise
overview and description of the range of personality disorders, as well as presenting
the essential elements of comprehensive diagnosis and treatment. Sperry
understands the world of the clinician, distilling the theoretical and pragmatic
advances in clinical science that offer hope for identifying, conceptualizing and
more importantly influencing the course of change for these ubiquitous and
challenging disorders.”—Jeffrey J. Magnavita, PhD, ABPP, independent
practice and Lecturer in Psychiatry, Yale University
“Sperry’s third edition of this benchmark handbook makes it the instant standard
on the assessment and treatment of personality disorders. Evidence-based yet
delightfully reader-friendly, Sperry’s guide blends a scientist’s mastery of the
evidence with a healer’s empathy for the pain and disruption that stalk the lives
of the personality impaired. Jam-packed with case examples and practitioner-
oriented recommendations, this is a must-read for the competent clinician.”—
W. Brad Johnson, PhD, Professor of Psychology, U.S. Naval Academy & Johns
Hopkins University
“To provide effective short-term and enduring treatment, it is necessary to diag-
nose and treat the personality of the client. Len Sperry MD, PhD, provides the
insight and guidelines to make this once considered impossible task, likely. The
book is chocked full of practical suggestions and tools that aid the diagnosis,
conceptuali zation, and treatment of personality disorders following the DSM-5
guidelines. The third edition of the Handbook of Diagnosis and Treatment of
DSM-5 Personality Disorders belongs on every clinician’s bookshelf. If you read
only one professional book this year, this is the one!”—Jon Carlson, PsyD,
EdD, ABPP, Distinguished Professor of Adlerian Psychology, Adler University,
Chicago
“Unlike many writers who help the reader understand personality disorders, Sperry
helps the reader understand personality disorders and, more importantly, how to
help those who struggle with them. With the changes in the DSM-5 related to
the understanding and treatment of personality disorders, Sperry’s work is cutting
edge and a must-read for all clinicians.”—Craig S. Cashwell, PhD, Professor
of Counseling, University of North Carolina at Greensboro
“The third edition of Dr. Sperry’s Handbook demonstrates the strengths of the
previous edition: it is clearly written, comprehensive, up-to-date, and jargon-
free. Its biopsychosocial approach to the personality disorders is realistically
optimistic, while adhering to evidence-based treatments. Finally, Dr. Sperry is
clearly dedicated to ‘listening with the third ear,’ which is essential in working
with personality-disordered patients.”—Ronald W. Pies, MD, Professor of
Psychiatry, Lecturer on Bioethics & Humanities, SUNY Upstate Medical
University
“Personality disorders are the most misunderstood and misdiagnosed of all the
DSM-5/ICD 10 mental disorders. Here, in this easy-to-read handbook, Len Sperry
presents the most user-friendly guide available to personality disorders coupled
with a completely integrative model to case conceptualization: A book for every
graduate psychopathology course in the nation.”—James Robert Bitter, EdD,
Professor of Counseling and Human Services, East Tennessee State University
“There’s an old myth that personality disorders are equivalent to a life sentence
to psychotherapy. Len Sperry uses scientific evidence and logical analysis to
systematically bust this myth. If you’re interested in working with clients with
personality disorders, this book is indispensable. Not only does Sperry offer hope
and optimism for positive outcomes, he also deftly summarizes many evidence-
based approaches that can transform your optimism to clinical reality.”—John
Sommers-Flanagan, PhD, Professor of Counselor Education at the University
of Montana
“Len Sperry MD, PhD, is a brilliant writer who with his psychology and
psychiatry background is able to capture nuances in cognitions, and affective and
interpersonal styles of individuals with personality disorders in a way that crystalizes
the concept for the reader. The wonderful case examples and understanding the
parental injunctions and worldview perspectives of the patient were especially
helpful for me. This book is an incredible manual and reference book—I still
have one of Dr Sperry’s first books on personality disorders and still reference it
to this day.”—Jon A. Lehrmann, MD, Chairman and Charles E. Kubly
Professor of Psychiatry and Behavioral Medicine, Medical College of Wisconsin
“A tremendous resource, including the latest DSM-5 descriptions, cross-theoretical
conceptualizations, and integrative treatment approaches for all of the identified
personality disorders, under one cover. Sperry neatly addresses the ‘categorical vs.
dimensional’ assessment dilemma by expertly contrasting each personality disorder
with its corresponding sub-clinical personality ‘style.’ Sperry’s captivating clinical
vignettes combine with his presentation of empirical evidence to create a most
satisfying volume for the interested scientist-practitioner.”—Cory F. Newman,
PhD, ABPP, Professor of Psychology, in Psychiatry, Perelman School of
Medicine, University of Pennsylvania
HANDBOOK OF
DIAGNOSIS AND
TREATMENT OF
DSM-5 PERSONALITY
DISORDERS
Assessment, Case Conceptualization,
and Treatment
Third Edition
Len Sperry, MD, PhD
Third edition published 2016
by Routledge
711 Third Avenue, New York, NY 10017
and by Routledge
2 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2016 Taylor & Francis
The right of Len Sperry to be identified as author of this work has been
asserted by him in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording,
or in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
First edition published by Brunner/Mazel 1995
Second edition published by Routledge 2003
Library of Congress Cataloging in Publication Data
Names: Sperry, Len, author.
Title: Handbook of diagnosis and treatment of DSM-5 personality
disorders: assessment, case conceptualization, and treatment / Len Sperry.
Description: Third edition. | New York, NY : Routledge, 2016.
Includes bibliographical references and index.
Identifiers: LCCN 2015040215| ISBN 9780415841900 (alk. paper) |
ISBN 9780415841917 (alk. paper) | ISBN 9780203763728 (alk. paper)
Subjects: LCSH: Personality disorders--Handbooks, manuals, etc.
Classification: LCC RC554 .S68 2016 DDC 616.85/81—dc23
LC record available at http://lccn.loc.gov/2015040215
ISBN: 978-0-415-84190-0 (hbk)
ISBN: 978-0-415-84191-7 (pbk)
ISBN: 978-0-203-76372-8 (ebk)
Typeset in Bembo
by Florence Production Ltd, Stoodleigh, Devon, UK
CONTENTS
Foreword ix
Preface xv
Acknowledgments xviii
1 Diagnosis and Treatment of Personality Disorders Today 1
2 Case Conceptualization and the Effective Treatment of
Personality Disorders 36
3 Antisocial Personality Disorder 51
4 Avoidant Personality Disorder 73
5 Borderline Personality Disorder 93
6 Dependent Personality Disorder 124
7 Histrionic Personality Disorder 144
8 Narcissistic Personality Disorder 163
9 Obsessive-Compulsive Personality Disorder 185
10 Paranoid Personality Disorder 206
viii Contents
11 Schizoid Personality Disorder 226
12 Schizotypal Personality Disorder 244
References 261
Index 282
FOREWORD
As a new graduate student in psychology at New York University in 1964, I took
the required course in psychopathology. The instructor quoted liberally from a
volume he called the “Diagnostic and Statistical Manual,” or DSM, published by
the American Psychiatric Association in 1952. We immediately asked if we could
purchase the thin, spiral-bound book at the bookstore, but the instructor told us
that access was limited to psychiatrists, and that only they could use it to diagnose
a patient. He had clearly gotten the volume under false pretenses or through some
subterfuge. While we did not think that that was fair, as new graduate students
we recognized the pecking order in mental health. The psychiatrist was at the top
and psychologists were not ordained to read or use the holy words of the DSM.
This first edition was not labeled as DSM-I, simply DSM, with no portent of what
was ahead. In DSM-I, all mental disorders were divided into two major groups:
“(1) those in which there is a disturbance of mental function resulting from, or
precipitated by a primary impairment of the function of the brain, generally due
to a diffuse impairment of brain tissue; and (2) those which are the result of a more
general difficulty in adaptation of the individual, and in which any associated brain
function disturbance is secondary to the psychiatric disorder” (p. 9). The DSM,
as might be expected of the zeitgeist, was suffused with the contemporary per-
spect ive of psychoanalysis. The descriptions were brief and still left a great deal of
room for clinician interpretation and creativity.
It was not until 1968, with the publication of the second edition of DSM,
labeled DSM-II, that there was a sequencing of editions noted. The only place
that we could get the DSM-II was at the Medical School bookstore. We gave
one of our graduate cohort the money and they did a DSM-II run and got copies
for all of us. We never asked what lies he had to tell to get by the eagle-eyed
cashiers at the bookstore.