Handbook of Interpersonal Psychology: Theory, Research, Assessment and Therapeutic Interventions

By Leonard M. Horowitz; Stephen Strack | Go to book overview

23
PERSONALITY DISORDERS

John F. Clarkin

Kenneth N. Levy

William D. Ellison

Many avenues of research are contributing to a growing consensus that an interpersonal view of the human being is essential to understanding personality and the personality disorders (Andersen & Chen, 2002; Clark, 2007). The infant comes into the world utterly helpless and depends on a nurturing, protective interpersonal context for survival. The caregiver-infant interaction becomes an early training ground for the development of survival functions such as attention, memory, nurturance, and harm avoidance, in addition to the growing conception of others and their attitude toward the self (Rothbart, Ellis, & Posner, 2004). The human brain seems constructed for the ability to understand other people and interact with them (Bretherton & Munholland, 2008). An understanding of the normal development of cooperative, rewarding interpersonal interaction is crucial for an appreciation of how deviations from this trajectory lead to the distortions in interpersonal behavior that are termed the personality disorders.

Personality disorders are described as a pattern of inner experience and behavior that deviates from cultural norms. These patterns of perceiving, relating to, and thinking about the environment and oneself are pervasive, inflexible, and stable over time, and result in distress or impairment in functioning (American Psychiatric Association, 2000). Epidemiological studies across cultures suggest that the prevalence of any personality disorder is around 10% (Lenzenweger, 2008). Those with personality disorder are often comorbid with a range of Axis I symptom disorders. The impairment of functioning involved in the personality disorder can be substantial, and those with personality disorder are frequent users of medical and mental health services (Bender et al., 2001), so that treatment is difficult and with variable outcomes.

In this chapter we review the current part-theories of personality and its disorders, with special attention to the personality functions that are undeveloped or distorted in those with personality disorders. We focus specifically on the here-andnow functions of the normal personality and the abnormal personality. Focus on the process of personality functioning and dysfunction leads naturally and directly

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