Academic journal article American Journal of Psychotherapy

Personality Disorders: Model for Conceptual Approach and Classification-Part II: Proposed Classification

Academic journal article American Journal of Psychotherapy

Personality Disorders: Model for Conceptual Approach and Classification-Part II: Proposed Classification

Article excerpt

INTRODUCTION

In Part I of this article (Vol.47, No. 4, pp. 558-571, this Journal) we presented data supporting the hypothesis that one core deficit in personality (referred to as the borderline level of functioning) represents a common dimension extending across all personality disorders (PDs). Discrete PDs were conceptualized as maladaptive clinical syndromes related orthogonally to the borderline dimension. In a sample of 121 subjects with PDs and 67 controls with maladaptive traits but without diagnosed PD, persons with PDs and without PDs manifested similar profiles on eight Millon Clinical Multiaxial Inventory (MCMI) scales for behavior styles. The two groups consistently differed only with respect to the MCMI borderline scale: in contrast to non-PD persons, those with PDs were strikingly more borderline and typically scored above 75 points on the MCMI borderline scale (score of 75 has been established as the cut off for the diagnosis of Borderline PD). Likewise, persons with PDs manifested significantly higher scores on the Diagnostic Interview for Borderlines Revised (DIB R) than the control group. These results suggest that: (i) features usually considered typical of the borderline personality characterize other PDs as well; (ii) borderline features represent the common dimension, distinct from other forms of psychopathology that cause personal and social dysfunction, that characterize all PDs; (iii) borderline features can be used to distinguish clinical subjects with and without PDs.

In Part II we propose a model for classification of normal and deviant personality types. First, we outline a matrix that classifies normal and deviant behaviors by combining three levels of functioning (normal, neurotic, and borderline) with distinct adaptive and maladaptive behavior types. Second, we describe in some detail eight discrete syndromes that meet criteria for PDs presented in Part I of this work.

CLASSIFICATION OF NORMAL AND DEVIANT PERSONALITY TYPES

Normal and deviant personality types can be systematically classified along a continuum of normal, neurotic, and borderline level of functioning. Each level is determined primarily by the quality of internalized object relations and the maturity of dominant defense mechanisms. In contrast to Kernberg, however, we do not conceptualize the levels as linearly determined by the underlying personality structure. Each of the three levels refers to a dynamic range on the continuum from normal to deviant, rather than a fixed and sharply delineated status. Even though each person has its dominant level of functioning, periodic regressions or progressions to other levels can be observed. In other words, normal individuals can experience primitive mental phenomena(1), whereas severely deviant, borderline individuals may periodically manifest normal and neurotic features.(2) However, the overall integrity of personality and the maturity of (inter) personal relations differ dramatically at different levels of functioning. As shown in Table I, pathological narcissism (borderline level) is equivalent to proneness to idealization (neurotic level) and to normal high self-esteem (level of normality).(Table I omitted) Table I presents a matrix that classifies normal and deviant behaviors in a systematic way, i.e., combines three levels of functioning (normal, neurotic, and borderline) with seven distinct behavior types or styles. These behavior styles, even when excessively pronounced, are neither inherently normal nor deviant. Extreme statistical deviation is not sufficient to be dysfunctional. For example, some individuals are highly introverted without functional impairment. Typically, one's dominant behavior style develops into normal or deviant (i.e., adaptive or maladaptive) depending on the underlying level of functioning. In other words, maladaptive behaviors are expected to be more frequent at the borderline and neurotic level of functioning than at the level of normality. …

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