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Svrakic, D.M. McCallum, K. Milan, P. (1991). Developmental, Structural, and Clinical Approach to Narcissistic and Antisocial Personalities. Am. J. Psychoanal., 51(4):413-432.

(1991). American Journal of Psychoanalysis, 51(4):413-432

Developmental, Structural, and Clinical Approach to Narcissistic and Antisocial Personalities

Dragan M. Svrakic, M.D., Ph.D., Kimberli McCallum, M.D. and Popovic Milan

The conception of personality disorders (hereafter referred to as PDs) as distinct units of mental disorders seems neither precise nor useful. Many studies show a significant overlap of clinical features (Pfohl et al., 1986) and a generally unreliable diagnosis of PDs (Morey, 1988b). One reason for the difficulty in separating individual PDs might be we do not appreciate data suggesting that PDs are more alike than different (McGlashan and Heinssen, 1989).

It is reasonable to assume that at least some PDs, classified as separate units, represent different behavioral expression of the same personality deviation. Some empirical studies (Lilienfeld, et al., 1986) have noted that PDs reflect co-occurring endpoints of the same pathogenesis.

In this article we describe structural, developmental, and clinical continuum between more or less clinically distinct entities of antisocial PD and narcissistic PD. We propose that the two disorders derive from the same deviant personality structure and reflect spectrum disorders. We do not propose that the two disorders be classified as a single diagnostic entity. Despite clinical and structural similarities, narcissistic and antisocial PD manifest predominant narcissistic or predominant antisocial features (McGlashan and Heinssen, 1989). The DSM MIR (A.P.A., 1987) criteria, however, rely solely on narcissistic or unlawful behavior and establish an artificial gap that is likely to direct research or treatment of the two disorders to distinct routes.


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