Disorders of the Self: A Personality-guided Approach (Personality-Guided Psychology)

296 Pages·2007·18.06 MB·English

by  Marshall L. Silverstein

PERSONALITY-GUIDED
PSYCHOLOGY BOOK SERIES
THEODORE MILLON, SERIES EDITOR,
Personality'Guided Therapy for Posttraumatic Stress Disorder
George Everly Jr. and Jeffrey M. Lating
Personality'Guided Therapy in Behavioral Medicine
Robert G. Harper
Personality-Guided Forensic Psychology
Robert J. Craig
Personality-Guided Relational Psychotherapy
Jeffrey J. Magnavita
Personality-Guided Cognitive-Behavioral Therapy
Paul R. Rasmussen
Personality'Guided Behavior Therapy
Richard F. Farmer and Rosemery O. Nelson-Grey
Personality-Guided Therapy for Depression
Neil R. Bockian
Disorders of the Self: A Personality-Guided Approach
Marshall L. Silverstein
Disorders of the Self
A PERSONALITY-GUIDED APPROACH
Marshall L. Silverstein
Series Editor Theodore Millon
A M E R I C A N P S Y C H O L O G I C A L A S S O C I A T I O N
W A S H I N G T O N , D C
Copyright © 2007 by the American Psychological Association. All rights reserved. Except
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CONTENTS
Series Foreword vi
Acknowledgments ix
Introduction 3
I. Theoretical Foundations 9
Chapter 1. Theoretical Introduction 1
Chapter 2. Narcisistic Personality Disorder 27
II. Devitalization: The Unmirrored Self (Schizoid, Schizotypal,
and Avoidant Personality Disorders) 59
Chapter 3. Descriptive Psychopathology and Theoretical
Viewpoints: Schizoid, Schizotypal, and
Avoidant Personality Disorders 61
Chapter 4. A Self Psychological Viewpoint: Schizoid,
Schizotypal, and Avoidant Personality
Disorders 73
III. Forestalling Fragmentation (Paranoid, Obsessive-
Compulsive, and Borderline Personality Disorders) 95
Chapter 5. Descriptive Psychopathology and Theoretical
Viewpoints: Paranoid, Obsessive-Compulsive,
and Borderline Personality Disorders 97
Chapter 6. A Self Psychological Viewpoint: Paranoid,
Obsessive-Compulsive, and Borderline
Personality Disorders 115
IV. Alternative Pathways for Preserving a Cohesive Self
(Dependent, Histrionic, and Antisocial Personality
Disorders) 143
Chapter 7. Descriptive Psychopathology and Theoretical
Viewpoints: Dependent, Histrionic, and
Antisocial Personality Disorders 145
Chapter 8. A Self Psychological Viewpoint: Dependent,
Histrionic, and Antisocial Personality
Disorders 171
V. Other Disorders of the Self (Depressive Personality
Disorder, Disorders of the Self and Somatic Reactivity,
and Disavowal and the Vertical Split) 203
Chapter 9. Depressive Personality Disorder 205
Chapter 10. Disorders of the Self and Somatic Reactivity . . 233
Chapter 11. Disavowal: The Vertical Split 249
Afterword 263
References 273
Author Index 29
Subject Index 305
About the Author 315
Vi CONTENTS
SERIES FOREWORD
The turn of the 20th century saw the emergence of psychological inter-
est in the concept of individual differences, the recognition that the many
realms of scientific study then in vogue displayed considerable variability
among "laboratory subjects." Sir Francis Galton in Great Britain and many
of his disciples, notably Charles Spearman in England, Alfred Binet in France,
and James McKeen Cattell in the United States, laid the groundwork for
recognizing that intelligence was a major element of import in what came to
be called differential psychology. Largely through the influence of psychoana-
lytic thought, and then only indirectly, did this new field expand the topic of
individual differences in the direction of character and personality.
And so here we are at the dawn of the 21st century, ready to focus our
attentions ever more seriously on the subject of personality trait differences
and their impact on a wide variety of psychological subjects—how they im-
pinge on behavioral medicine outcomes, alter gerontological and adolescent
treatment, regulate residential care programs, affect the management of de-
pressive and PTSD patients, transform the style of cognitive-behavioral and
interpersonal therapies, guide sophisticated forensic and correctional assess-
ments—a whole bevy of important themes that typify where psychologists
center their scientific and applied efforts today.
It is toward the end of alerting psychologists who work in diverse areas
of study and practice that the present series, entitled Personality-Guided Psy-
chology, has been developed for publication by the American Psychological
Association. The originating concept underlying the series may be traced to
Henry Murray's seminal proposal in his 1938 volume, Explorations in Person-
ality, in which he advanced a new field of study termed personology. It took its
contemporary form in a work of mine, published in 1999 under the title Per-
sonality-Guided Therapy.
The utility and relevance of personality as a variable is spreading in all
directions, and the series sets out to illustrate where things stand today. As
will be evident as the series' publication progresses, the most prominent work
at present is found with creative thinkers whose efforts are directed toward
enhancing a more efficacious treatment of patients. We hope to demonstrate,
further, some of the newer realms of application and research that lie just at
the edge of scientific advances in our field. Thus, we trust that the volumes
included in this series will help us look beyond the threshold of the present
and toward the vast horizon that represents all of psychology. Fortunately,
there is a growing awareness that personality variables can be a guiding fac-
tor in all spheres of study. We trust the series will provide a map of an open
country that encourages innovative ventures and provides a foundation for
investigators who wish to locate directions in which they themselves can
assume leading roles.
Theodore Millon, PhD, DSc
Series Editor
viii SERIES FOREWORD
ACKNOWLEDGMENTS
I am grateful to Theodore Millon for his invitation to take on the prob-
lem of conceptualizing personality disorders from a self psychological per-
spective. Millon has long been one of the most scholarly and influential think-
ers about personality and its disorders, and his interest in self psychology has
added an important voice in support of its value as a personality theory. I also
appreciate the support of Long Island University for granting me a sabbatical
leave to complete this book. I thank Raina Kirshy and David D'Alessio for
their able assistance in compiling references. I value the keen eyes of Sara
Chilton, Edward Friedel, Geoff Goodman, and Robert Keisner, who read and
commented on earlier versions of sections of the manuscript. As always, I am
especially indebted to Joanne Marengo, Michael Simon, and Marian Tolpin
for their sustaining support.
IX
Disorders of the Self
INTRODUCTION
There are many concepts of personality and many theories about its
disturbances. Psychoanalysis was the predominant viewpoint for thinking
about personality disorders during much of the last century, but its theories
have become less influential as interest has recently shifted toward delineat-
ing a reliable system for the classification of these disorders. Benefiting from
the multiaxial approach to diagnosis that has influenced the past three edi-
tions of the Diagnostic and Statistical Manual of Mental Disorders (DSM; Ameri-
can Psychiatric Association, 1980, 1987, 1994), the fields of psychiatry and
psychology now strive to achieve a better understanding about the domain of
personality disorders (Axis II of the DSM).
As personality disorder theorists moved toward emphasizing nosology
and refining reliable instruments for clinical assessment, psychoanalysis fo-
cused its attention elsewhere, attempting to reconcile its newer viewpoints
with Freud's classical drive theory and ego psychology. One of these newer
theories was the psychology of the self, or self psychology, which Heinz Kohut
introduced at first as a theory of narcissism (Kohut, 1959, 1966, 1971). As
his work progressed, Kohut (1977, 1984) broadened its purview to represent
a formulation of personality centering on the self as a fulcrum for under-
standing many forms of psychopathology. As a result, self psychology's em-
phasis on disorders of the self was concerned more with differentiating its