Personality Disorders
Resources

 email page    print page

All Topic Reviews
A Bright Red ScreamAntisocial Behavior in Children and AdolescentsAs Your Desire MeBorderline Personality DisorderBorderline Personality DisorderBorderline Personality Disorder and the Conversational ModelChildren of the Self-AbsorbedCoping with BPDCoping with Infuriating, Mean, Critical PeopleDangerous and Severe Personality DisorderDealing with a NarcissistDissociative ChildrenDistancingEnough About YouEvidence-Based Treatment of Personality DysfunctionFatal FlawsFirst Person PluralGet Me Out of HereGirl in Need of a TourniquetGirl, InterruptedHandbook of Personality DisordersHandbook of PsychopathyHidden SelvesHigh RiskI Hate You-Don't Leave MeLet Me Make It GoodLiving with Our GenesLost in the MirrorLoving Someone with Borderline Personality DisorderLyingMapping the Edges and the In-betweenPassionate DeliberationPersonality Disorder: Temperament or Trauma?Personality Disorders in Modern LifePractical Management of Personality DisorderPractical Management of Personality DisorderProzac NationPsychopathyPsychotherapy for Personality DisordersSilencing the VoicesSkin GameStop Caretaking the Borderline or NarcissistStop Walking on EggshellsStop Walking on EggshellsSurviving a Borderline ParentThe Angry HeartThe Buddha & The BorderlineThe Clinical and Forensic Assessment of PsychopathyThe PsychopathThe Psychopath TestThe Siren's DanceThe Sociopath Next DoorThe Survivor PersonalityThrough the Looking GlassUnderstanding and Treating Borderline Personality DisorderUnderstanding the Borderline MotherWhy Is It Always About You?Without ConscienceWomen and Borderline Personality DisorderWomen Living with Self-InjuryWomen Who Hurt Themselves

Related Topics
Practical Management of Personality DisorderReview - Practical Management of Personality Disorder
by W. John Livesley
Guilford, 2003
Review by Matthew Broome
Feb 27th 2007 (Volume 11, Issue 9)

Personality disorder is one of the problems in mental health which, given its ubiquity in a specialist clinical setting, can almost be forgotten.  There is an old rule of thumb that one learns when starting clinical training in psychiatry as to the prevalence of personality disorders in various clinical settings: within a primary care practice, 10% of patients; in a psychiatric outpatient clinic, 20%; and within an inpatient psychiatric unit 40%.  Despite these startlingly high figures, recent research suggests that even these may be an underestimate.  For most psychiatrists, the personality disordered clients one encounters either have a comorbid Axis 1 disorder that is the explicit reason they present, or, may be at the very extreme end of disorder with severe and recurrent episodes of harm to themselves or others.  Thus, typically, psychiatrists tend to recognize dissocial and borderline personality disorders but fail to notice the others. What often is the case is that the other disorders become manifest only when the treatment for the presenting axis 1 condition fails and the physician needs to think again.  It is for this reason that specialist services have a great many clients with personality disorder: they present with a refractory mental illness that gets referred for specialist management.  Thus, to be a capable psychiatrist one not only needs to be able to manage Axis 1 and Axis 2 disorders in their own right, but perhaps more importantly, as complicating factors of one another that may jeopardize treatment.

Hence, the recognition and management of personality disorder is of great importance to all clinicians, regardless of their clinical or research focus.  However, coupled with the high prevalence of such disorders is a degree of theoretical and therapeutic nihilism in many clinicians regarding personality disorder.  Livesely's book serves as a very welcome addition to the books on this topic: many texts for the general psychiatrist have either focused on etiology/epidemiology or psychoanalysis and to have a book actually discuss treatment pragmatically is a great asset.  The book starts with more theoretical concerns ('A Framework for Understanding Normal and Disordered Personality') but even here links are drawn with clinical material and practical principles guiding intervention.  What is most refreshing is the eclecticism and pluralism of the author: treatment suggestions are guided by evidence, and based around symptom systems/dimensions rather than the categorical ICD-10 or DSM-IV diagnoses.  Further, pharmacological, as well as a wide variety of psychological interventions, are discussed. The book develops into specific chapters detailing the main phases of treatment: from 'Assessment' and 'Treatment Planning and Treatment Contract' to chapters on treating affective problems, trauma and dissociative symptoms, interpersonal difficulties, and core pathology.  As someone whose clinical work is in early psychosis, my personal wish would have been for more on quasi-psychotic symptoms in personality disorders and the relationship between personality disorders and the development of major mental illnesses, such as schizophrenia.  However, this book fills a very important niche in the literature: it addresses a neglected but important topic for any mental health professional and does so in a non-partisan and elegant manner.  I am sure in my clinical work I will turn to it again and again.

 

© 2007 Matthew Broome

 

Dr Matthew Broome, Associate Clinical Professor of Psychiatry and Honorary Consultant Psychiatrist, University of Warwick, UK; Honorary Lecturer, Section of Neuroimaging, Division of Psychological Medicine, Institute of Psychiatry, King's College London, UK.

 


Share

Welcome to MHN's unique book review site Metapsychology. We feature over 7900 in-depth reviews of a wide range of books and DVDs written by our reviewers from many backgrounds and perspectives. We update our front page weekly and add more than thirty new reviews each month. Our editor is Christian Perring, PhD. To contact him, use one of the forms available here.

Can't remember our URL? Access our reviews directly via 'metapsychology.net'


Metapsychology Online reviewers normally receive gratis review copies of the items they review.
Metapsychology Online receives a commission from Amazon.com for purchases through this site, which helps us send review copies to reviewers. Please support us by making your Amazon.com purchases through our Amazon links. We thank you for your support!


Join our e-mail list!: Metapsychology New Review Announcements: Sent out monthly, these announcements list our recent reviews. To subscribe, click here.

Interested in becoming a book reviewer for Metapsychology? Currently, we especially need thoughtful reviewers for books in fiction, self-help and popular psychology. To apply, write to our editor.

Metapsychology Online Reviews

Promote your Page too

Metapsychology Online Reviews
ISSN 1931-5716