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Book Review   |    
Brian Palmer
Psychiatric Services 2010; doi: 10.1176/appi.ps.61.5.534
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edited by John M. Oldham, M.D., M.S., Andrew E. Skodol, M.D., and Donna S. Bender, Ph.D.; Arlington, Virginia, American Psychiatric Publishing, Inc., 2009, 435 pages, $89

Dr. Palmer is a staff psychiatrist at Gunderson Residence, McLean Hospital, Belmont, Massachusetts, and an instructor in psychiatry at Harvard Medical School, Boston.

In Essentials of Personality Disorders, three recognized experts have largely succeeded in updating and condensing the American Psychiatric Publishing Textbook of Personality Disorders, published in 2005. John M. Oldham, M.D., M.S., Andrew E. Skodol, M.D., and Donna S. Bender, Ph.D., have amassed contributions by a range of experts into a tour through the ten recognized personality disorders. Moving from Oldham's historical, if somewhat dry, account of the past six decades of thought on personality classification to Skodol's clear considerations of what makes personality "disordered" (cognitive, affective, behavioral, and interpersonal features), the book succinctly defines its scope and dives into its topic, focusing most of its pages on the assessment and treatment of the disorders.

Dr. Svenn Torgerson's methodical examination of epidemiology sets the stage for the book's most compelling point: personality disorders change over time. Torgerson traces prevalence data to conclude that far more than 10% of the population will fulfill criteria for a personality disorder over time and observes, "There is an even reduction in the quality of life and an even increase in dysfunction for each criterion manifested. Thus, there is a continuous relationship between those with no or small personality problems, those with moderate problems, and those with severe problems… . Any definition of how many criteria are required for a personality disorder is arbitrary."

Having debunked conventional wisdom that personality disorders are "all or none," unchanging, and largely untreatable, much of the text considers developmental and neurobiological origins and focuses on the range of treatment approaches. Here the text left me longing for integration. Dr. Glen Gabbard contributed an impressively coherent summary of psychoanalysis that could be required reading for any psychiatric resident, but it shares essentially nothing in common with Dr. Emil Coccaro and Dr. Larry Siever's equally erudite examination of neurobiology. Throw in an overview of dialectical behavioral therapy, mentalization-based treatment, and group treatment, and some readers may be left trying to determine which of the personality disorders each chapter is relevant to and how to apply the information clinically.

Although tight editing could have produced a more coherent whole, in some ways the disconnections reflect the knowledge base on personality disorders. Aside from perhaps borderline personality disorder—with its well-defined research base and effective treatments—personality, its disorders, and their treatments elude coherent description, for this book and for our field. Lack of overall coherence aside, the book is a readable and scholarly summary of its more detailed parent text that outlines current understanding. It will be of interest to a wide range of clinicians, given the prevalence of personality disorders in clinical practice.

The reviewer reports no competing interests.




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