Fatal Flaws: Navigating Destructive Relationships with People wit Disorders...

513 Pages·2005·3.35 MB·English

by  Stuart C. Yudofsky

Fatal Flaws
NAVIGATING DESTRUCTIVE RELATIONSHIPS
WITH PEOPLE WITH DISORDERS OF
PERSONALITY AND CHARACTER
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Fatal Flaws
NAVIGATING DESTRUCTIVE RELATIONSHIPS
WITH PEOPLE WITH DISORDERS OF
PERSONALITY AND CHARACTER
By
Stuart C. Yudofsky, M.D.
Washington, DC
London, England
Note: The authors have worked to ensure that all information in this book is
accurate at the time of publication and consistent with general psychiatric and
medical standards, and that information concerning drug dosages, schedules,
and routes of administration is accurate at the time of publication and consis-
tent with standards set by the U.S. Food and Drug Administration and the gen-
eral medical community. As medical research and practice continue to advance,
however, therapeutic standards may change. Moreover, specific situations may
require a specific therapeutic response not included in this book. For these rea-
sons and because human and mechanical errors sometimes occur, we recom-
mend that readers follow the advice of physicians directly involved in their care
or the care of a member of their family.
Books published by American Psychiatric Publishing, Inc., represent the views
and opinions of the individual authors and do not necessarily represent the pol-
icies and opinions of APPI or the American Psychiatric Association.
Copyright © 2005 Stuart C. Yudofsky
ALL RIGHTS RESERVED
Manufactured in the United States of America on acid-free paper
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Library of Congress Cataloging-in-Publication Data
Yudofsky, Stuart C.
Fatal flaws : navigating destructive relationships with people with disorders
of personality and character / by Stuart C. Yudofsky.-- 1st ed.
p. ; cm.
Includes bibliographical references and index.
ISBN 1-58562-214-1 (pbk. : alk. paper)
1. Personality disorders. 2. Personality disorders--Treatment. 3. Psychology,
Pathological.
[DNLM: 1. Personality Disorders. 2. Clinical Medicine--methods. 3. Person-
ality Disorders--Popular Works. 4. Psychotherapy--methods. WM 190 Y94f
2005]
I. Title.
RC554.Y83 2005
616.85'81--dc22
2004023752
British Library Cataloguing in Publication Data
A CIP record is available from the British Library.
To Beth,
"a summer of wisteria"
—William Faulkner,
Absalom, Absalom!
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CONTENTS
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Prologue. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Pa r t I
FATAL FLAWS
1
What Are Fatal Flaws? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3
2
Does This Person Have a Fatal Flaw? . . . . . . . . . . . . . . . . . . .11
3
Nine Principles for Dealing With
People With Fatal Flaws. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .17
Par t I I
PERSONALITY DISORDERS
4
Hysterical (Histrionic) Personality Disorder. . . . . . . . . . . . .27
5
Narcissistic Personality Disorder
Part I: Untreated Narcissism. . . . . . . . . . . . . . . . . . . . . . . . . . .87
6
Narcissistic Personality Disorder
Part II: Treated Narcissism . . . . . . . . . . . . . . . . . . . . . . . . . . .139
7
Antisocial Personality Disorder . . . . . . . . . . . . . . . . . . . . . .161
8
Obsessive-Compulsive Personality Disorder. . . . . . . . . . .229
9
Paranoid Personality Disorder . . . . . . . . . . . . . . . . . . . . . . .287
10
Borderline Personality Disorder. . . . . . . . . . . . . . . . . . . . . .329
11
Schizotypal Personality Disorder . . . . . . . . . . . . . . . . . . . . .389
12
Addictive Personality Disorder. . . . . . . . . . . . . . . . . . . . . . .421
Par t I I I
CONCLUSION
13
Getting Help. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .461
Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .475
ACKNOWLEDGMENTS
W
hatever information and insights are imparted in Fatal Flaws de-
rive directly from the kindness, generosity, and patience of my patients,
students, colleagues, and teachers—to all of whom I am abundantly
and perennially grateful.
I thank, as well, the following people who helped me with the prepa-
ration of this book:
• Robert E. Hales, M.D., Editor-in-Chief at American Psychiatric Publish-
ing, Inc. (APPI), my close friend and gracious partner in so many aca-
demic projects, who helped me in so many important ways throughout
this project. Most of all, Bob helped with the focus and organization of
the text.
• Roxanne Rhodes, Senior Editor at APPI and project editor for Fatal Flaws,
whose careful reading and insightful critique of the manuscript vastly im-
proved the quality, clarity, and impact of the book. Roxanne coordinated
all aspects of the preparation of the submitted text and shepherded it to
publication.
• Dianna Hobby, editor's editor and grammarian's grammarian, and my
dear friend from Houston, who worked tirelessly to vet each word and
sentence of the original manuscript for accuracy, precision, and clarity.
• Marianne Szegedy-Maszak, dear friend and inspired and inspiring jour-
nalist on behalf of people who suffer from mental illnesses, who gave ad-
vice on how to write and structure this book so that it could be useful to
clinicians as well as to readers in destructive relationships with people
with personality disorders and character flaws.
• Claudia Burns and Lynn Sanders, from my academic office at the Men-
ninger Department of Psychiatry, Baylor College of Medicine, who helped
me utilize the marvels of modern information technology to access the
ix