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Pisetsky, I.B. (1994). Personality Disorders. New Perspectives on Diagnostic Validity: Edited by John M. Oldham, M.D. Washington, DC/London: American Psychiatric Press, Inc., 1991. 197 pp.. Psychoanal Q., 63:798-801.
(1994). Psychoanalytic Quarterly, 63:798-801
Personality Disorders. New Perspectives on Diagnostic Validity: Edited by John M. Oldham, M.D. Washington, DC/London: American Psychiatric Press, Inc., 1991. 197 pp.
Review by: Ingrid B. Pisetsky
This multiauthored book edited by Oldham, Professor of Psychiatry at Columbia University, focuses on the validity of personality disorders as defined by DSM-III and DSM-III-R. Personality disorders have been particularly difficult to categorize because of the lack of sharp boundaries distinguishing them from each other and from normally distributed personality traits. It has been a challenge in the study of these conditions to establish diagnoses that are useful for both practice and research, and to distinguish patients with a constellation of psychopathologies that differ meaningfully from those of other patients. This timely and scholarly volume focuses on that challenge.
The chapters in this book have been written primarily by academic psychiatrists and psychologists, including some psychoanalysts, and cover a broad range of topics. These include the concept of construct validity; methodologies for evaluating validity (including use of longitudinal data, biological markers, response to pharmacologic intervention, and a complex long-term inpatient assessment by multiple experts); the diagnostic validity of specific personality disorders; and the implications of high comorbidity between depression and Axis II disorders, and among the Axis II disorders. The editor highlights the common themes and dilemmas in a brief, thoughtful introduction.
Historically, the personality disorders, previously termed character disorders, were categorized in DSM-I and II according to clinical observations based largely on psychoanalytic theory. DSM-III and III-R moved away from such a theory-based model to substitute a "descriptive" approach using "easily identifiable behavioral signs or symptoms" as the basis of diagnosis (DSM-III-R, p. xxiii). While the system has been useful for Axis I disorders, the diagnostic criteria for personality disorders require more observer inference than such readily confirmed signs or symptoms as cognitive, mood, or psychomotor disturbances.
In practice, as W. John Livesly and Douglas N.
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