Subject Index
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Page numbers followed by f indicate figure, t indicate table
A
Abandonment
depressive personalities and, 243–244
masochistic personalities and, 274–276
relational patterns in, 274–277
schizoid personality style and, 204–205
Abandonment depression, 91–92. See also Depression
Abuse
dissociative conditions and, 341–344
manic personalities and, 258–259
masochistic personalities and, 276
paranoid personalities and, 222
psychopathic personalities and, 159, 162–164
Acceptance, depressive personalities and, 252–253
Acting out
masochistic personalities and, 271–274
obsessive and compulsive personalities and, 295
overview, 119–121
psychopathic personalities and, 160
See also Primitive defenses
Adaptive processes
in depressive personalities, 240–242
in dissociation, 339–341
in hysterical personalities, 315–318
in manic personalities, 258
in masochistic personalities, 271–274
in narcissistic personalities, 180–182
in obsessive and compulsive personalities, 293–296
in paranoid personalities, 218–220
in psychopathic personalities, 160–162
in schizoid personality style, 200
Addiction
compared to psychopathic personalities, 174
differential diagnosis and, 174
manic personalities and, 261
obsessive and compulsive personalities and, 305–306
Advice
obsessive and compulsive personalities and, 305
psychotic-level patients and, 78
Affect
in depressive personalities, 238–239
in dissociative psychologies, 338–339
in hysterical personalities, 313–315
in manic personalities, 257–258
in masochistic personalities, 270–271
in narcissistic personalities, 179–180
in obsessive and compulsive personalities, 291–293, 294–296, 302
overview, 152
in paranoid personalities, 216–218
in psychopathic personalities, 158–160
in schizoid personality style, 198–200
See also Emotions
Affect, isolation of, 131–132. See also Secondary defenses
Affect regulation
narcissism and, 177
psychopathic personalities and, 159–160
Agency
comparing psychoanalytic to descriptive psychiatric diagnosis and, 9
omnipotent control and, 107
Aggression
depressive personalities and, 239
masochistic personalities and, 271
obsessive and compulsive personalities and, 299
paranoid personalities and, 216, 231, 233–234
psychopathic personalities and, 158, 159, 164–165, 165
reaction formation and, 141
schizoid personality style and, 199
sexualization and, 122
Aggression-inward model, 239
Aging, hysterical personalities and, 321
Alexithymia, somatization and, 118
Altruism, 143
Ambivalence, tolerating, 296
Amnesia, 341, 341–342. See also Memory
Anaclitically depressive personality
countertransference with, 248
self-experience and, 247–248
therapy and, 252
transference with, 248
Anal imagery, 291–292
Anal phase of development
drive theory and, 23–27
obsessive and compulsive personalities and, 291–292, 297
Anger
borderline personality organization and, 85, 94–95
depressive personalities and, 239, 249
obsessive and compulsive personalities and, 292–293, 293–296, 306–307
paranoid personalities and, 216–217
psychosis and, 76–77
Annihilation anxiety, 217
Antisocial personalities. See Psychopathic personalities
Anxiety
acting out and, 120
comparing psychoanalytic to descriptive psychiatric diagnosis and, 9–10
compartmentalization and, 135–136
defenses and, 103
displacement and, 139–140
ego psychology and, 30–31
hysterical personalities and, 313, 317–318
masochistic personalities and, 277, 280–281, 284
overview, 61
paranoid personalities and, 216–217, 221
sexualization and, 122
splitting and, 116
Anxious–resistant attachment, 312. See also Attachment
Approach-avoidance conflict, 319
Asperger syndrome, 197–198
Assessment, 18–19, 29–30
Attachment
dissociative psychologies and, 342
hysterical personalities and, 312, 319–320
manic personalities and, 259
masochistic personalities and, 275–276
narcissism and, 177
object relations tradition and, 31–32, 54–55
in obsessive and compulsive personalities, 294
psychopathic personalities and, 160, 163–164
schizoid personality style and, 201, 202–203
somatization and, 118
Attentional functioning, 127
Attention-deficit disorders (ADD and ADHD), 264
Attention-seeking behavior, 322
Attractiveness, 321–322
Authoritarian control, 258
Autistic spectrum, 197–198
Autonomy
borderline personality organization and, 66–67
neurotic–borderline–psychotic spectrum and, 58
Avoidance
obsessive and compulsive personalities and, 302
schizoid personality style and, 202–203
B
Behavior, 230
Behavioral defenses, 295–296. See also Defenses
Biaxial grid representation of diagnostic possibilities, 5–6
Bipolar disorder
compared to dissociative conditions, 354
denial and, 106
differential diagnosis and, 354
Kraepelinian diagnosis and, 46–47
Borderline conditions
borderline personality disorder, 52–53
object relations diagnosis and, 52–55
schizoid personality style and, 203
Borderline personality organization
characteristics of, 63–67
compared to dissociative psychologies, 354–355
defenses and, 103
differential diagnosis and, 354–355
empathy and, 15–16
hysterical personalities and, 324–325
manipulation and, 160–161
maturational and typological dimensions of character and, 95–97, 96f
neurotic–borderline–psychotic spectrum and, 55–67
obsessive and compulsive personalities and, 294
paranoid personalities and, 218
reality testing and, 218–219
therapists’ comfort with diagnosis and, 17–18
therapy and, 83–95
Boundaries
with borderline patients, 84–87
paranoid personalities and, 230–231
Bowel control, 292
Brain structures
dissociation and, 334
obsessive and compulsive personalities and, 309
overview, 61–62
psychopathic personalities and, 159
repression and, 127–128
Brief treatments. See Short-term treatments
C
Caregiving
borderline personality organization and, 66–67
contemporary relational movement and, 39–40
depressive personalities and, 242–245
dissociation and, 341–344
drive theory and, 23
hysterical personalities and, 318–320
masochistic personalities and, 274–277
narcissism and, 183–184
neurotic–borderline–psychotic spectrum and, 56–57
object relations tradition and, 31–32
obsessive and compulsive personalities and, 297, 298–299
paranoid personalities and, 220–223, 234
psychopathic personalities and, 164–165
somatization and, 117–119
See also Early experiences; Parenting
Categorical approach to diagnosis
comparing psychoanalytic to descriptive psychiatric diagnosis and, 9–11
Kraepelinian diagnosis and, 46–47
Character diagnosis
contemporary relational movement, 39–40
developmental processes and, 43–55
drive theory, 23–27
ego psychology and, 27–31
format for diagnostic interview, 359–361
further reading suggestions regarding, 41–42
neurotic–borderline–psychotic spectrum and, 55–67
object relations tradition, 31–36
overview, 21–22, 40–41
self psychology, 36–38
See also Character organization; Differential diagnosis; individual character types; Therapeutic implications of diagnosis
Character organization
borderline personality organization and, 63–67
further reading suggestions regarding, 68–69
maturational and typological dimensions of, 95–97, 96f
neurotic–borderline–psychotic spectrum and, 59–63
overview, 67–68, 153–154
See also Character diagnosis; individual character types
Character pathology, 153–154
Classical Freudian drive theory. See Drive theory
Client-centered therapy, 190
Cognitive defenses, 294. See also Defenses
Cognitive-behavioral therapies (CBT)
with neurotic-level patients, 74
obsessive and compulsive personalities and, 307–308
psychotic-level patients and, 82–83
treatment planning and, 12
See also Therapy
Communication between therapists and clients, 13–14, 14–16. See also Therapeutic relationship
Compartmentalization, 135–136. See also Secondary defenses
Compulsions, 57–58
Compulsive personalities
adaptive processes in, 293–296
affect in, 291–293
compared to hypomanic personalities, 263
compared to schizoid personality style, 212
countertransference with, 302–304
defensive processes in, 293–296
depressive personalities and, 239
diagnosis of, 304–309
differential diagnosis and, 212, 263, 308–309
drive in, 291–293, 294–296
further reading suggestions regarding, 310
overview, 289–291, 310
reaction formation and, 141
relational patterns in, 296–299
schizoid personality style and, 211
self-experience and, 300–302
temperament and, 291–293
therapeutic implications in the diagnosis of, 304–308
transference with, 302–304
See also Obsessive–compulsive personality
Confidentiality, 85
Confusion, compartmentalization and, 135–136
Conscience, 160, 169–170
Consistency, paranoid personalities and, 231
Consumer protection, as a reason to diagnose, 8, 13–14
Containment, narcissism and, 177
Contamination fears, obsessive and compulsive personalities and, 297–298
Contemporary relational movement, 39–40
Contempt, in narcissistic personalities, 185
Control, obsessive and compulsive personalities and, 292–293, 305
Control, omnipotent
overview, 107–108
in psychopathic personalities, 160
undoing and, 136–137
See also Primitive defenses
Control–mastery theory
masochistic personalities and, 285
reversal and, 142
schizoid personality style and, 207
Coping styles
ego psychology and, 29
sexualization and, 122
Counterdependent people, 16
Countermasochism, 279
Countertransference
borderline personality organization and, 67, 91–92, 93–95
depressive personalities and, 248–250
dissociation and, 346–348
hysterical personalities and, 323–326
manic personalities and, 259–260
masochistic personalities and, 278–281
narcissistic personality organization and, 186–188, 191–192
neurotic–borderline–psychotic spectrum and, 62
object relations tradition and, 34
obsessive and compulsive personalities and, 302–304
paranoid personalities and, 225–226
projective identification and, 114–115
psychopathic personalities and, 166
schizoid personality style and, 206–208
self psychology and, 36–37
Creativity, schizoid personality style and, 200, 205
Crisis-intervention model, 15–16
Criticism
manic personalities and, 258–259
obsessive and compulsive personalities and, 302, 304, 306–307
Cultural factors
hysterical personalities and, 312–313
obsessive and compulsive personalities and, 297–298
Cumulative trauma, 203
Cyclothymic personalities. See Hypomanic personalities
D
Death, identification and, 145
Defenses
borderline personality organization and, 88–89
in depressive personalities, 240–242
in dissociative conditions, 339–341
ego psychology and, 29, 30
in hysterical personalities, 314–315, 315–318
in manic personalities, 258
in masochistic personalities, 271–274
in narcissistic personalities, 180–182
neurotic–borderline–psychotic spectrum and, 56–57
in obsessive and compulsive personalities, 293–296
in paranoid personalities, 218–220
in psychopathic personalities, 158, 160–162
psychotic-level patients and, 79–80
in schizoid personality style, 199, 200
See also Primitive defenses; Secondary defenses; specific defenses
Defensive distancing, 324
Defensive enactment, 119–121. See also Primitive defenses
Degree of pathology, schizoid personality style and, 211–212
Delusions, 59–63
Denial
manic personalities and, 258
masochistic personalities and, 274, 280–281
overview, 103, 105–107
paranoid personalities and, 219–220, 224
in schizoid personality style, 200
See also Primitive defenses
Dependency
depressive personalities and, 241, 244–245
sexualization and, 122
Depersonalization, dissociative personalities and, 353
Depleted definitions of self, 185
Depression
borderline personality organization and, 91–92
comparing psychoanalytic to descriptive psychiatric diagnosis and, 9–10
obsessive and compulsive personalities and, 301
self psychology and, 38
See also Depressive personality
Depressive personality
adaptive processes in, 240–242
affect in, 238–239
compared to masochistic personalities, 256, 285
compared to narcissistic personality, 193, 255–256
compared to paranoid personalities, 215
countertransference with, 248–250
defensive processes in, 240–242
diagnosis of, 250–256
differential diagnosis and, 193, 215, 254–256, 285
drive in, 238–239
further reading suggestions regarding, 265–266
masochistic personalities and, 279–280
overview, 235–237, 264–265
relational patterns in, 242–245
self-experience and, 245–248
temperament and, 238–239
therapeutic implications in the diagnosis of, 250–254
transference with, 248–250
See also Depression
Depressive psychology, 112–113. See also Depressive personality
Derealization, dissociative conditions and, 353
Descriptive psychiatric diagnosis, compared to psychoanalytic diagnosis, 9–11
Devaluation
narcissism and, 195
overview, 108–110
in schizoid personality style, 200
See also Primitive defenses
Developmental levels of organization, 70–71
Developmental processes
character diagnosis and, 45–55
maturational and typological dimensions of character, 95–97, 96f
narcissism and, 177
overview, 43–45
primitive defenses and, 102–103
psychopathic personalities and, 159
regression and, 129–131
Developmental stages, 23–27. See also Psychosexual stages of development
Diagnosis, character. See Character diagnosis
Diagnosis, differential. See Differential diagnosis
Diagnostic discrimination, 38
Diagnostic errors, 352–356. See also Differential diagnosis
Diagnostic hypothesis, 17
Diagnostic interview, suggested format for, 359–361
Diagnostic labels, 7–8
Differential diagnosis
borderline personality organization and, 65
depressive personalities and, 254–256
dissociative psychologies and, 352–356
format for diagnostic interview, 359–361
hysterical personalities and, 327–330
manic personalities and, 262–264
masochistic personalities and, 285–287
narcissistic personality organization and, 192–194
obsessive and compulsive personalities and, 308–309
overview, 153
paranoid personalities and, 232–233
psychopathic personalities and, 172–174
schizoid personality style and, 211–212
See also Character diagnosis
Disavowal of what is projected, 218
Disclosure, psychopathic personalities and, 169
Disease model, 10
Disorganized–disoriented attachment
dissociative psychologies and, 342
psychopathic personalities and, 163–164
See also Attachment
Displacement, 139–140, 293–296. See also Secondary defenses
Dissociation
overview, 123–125
in psychopathic personalities, 160, 161–162
schizoid personality style and, 203
See also Primitive defenses
Dissociative defenses, 315, 317–318
Dissociative psychologies
adaptive processes in, 339–341
affect in, 338–339
compared to borderline personality organization, 354–355
compared to hysterical personalities, 355–356
compared to masochistic personalities, 286–287
compared to narcissistic personality, 329
compared to paranoid personalities, 233
compared to psychopathic personalities, 173, 356
compared to psychosis, 354
countertransference with, 346–348
defensive processes in, 339–341
diagnosis of, 342–343, 348–356
differential diagnosis and, 173, 233, 286–287, 329, 352–356
drive in, 338–339
further reading suggestions regarding, 357
hysterical personalities and, 327
overview, 332–338, 356–357
relational patterns in, 341–344
schizoid personality style and, 203
self-experience and, 344–346
temperament and, 338–339
therapeutic implications in the diagnosis of, 348–352
transference with, 346–348
Drive
in depressive personalities, 238–239
in dissociation, 338–339
in hysterical personalities, 313–315
in manic personalities, 257–258
in masochistic personalities, 270–271
in narcissistic personalities, 179–180
in obsessive and compulsive personalities, 291–293, 294–296
overview, 152
in paranoid personalities, 216–218
in psychopathic personalities, 158–160
in schizoid personality style, 198–200
Drive satisfaction, 31–32
Drive theory
depressive personalities and, 238–239
overview, 23–27
sexualization and, 122
sublimation and, 147
DSM
borderline conditions and, 52–53
comparing psychoanalytic to descriptive psychiatric diagnosis and, 9–11
depressive personalities and, 236
hysterical personalities and, 312–313, 324–325
manic personalities and, 256
masochistic personalities and, 269
obsessive and compulsive personalities and, 289–290
paranoid personalities and, 215
psychopathic personalities and, 168
schizoid personality style and, 197, 211
somatization and, 118
terminology and, 3
Duration of therapy, 72–73
E
Early experiences
depressive personalities and, 242
dissociation and, 341–344, 349
format for diagnostic interview and, 359–360
hysterical personalities and, 314–315, 318–320
manic personalities and, 258–259
masochistic personalities and, 272, 274–277
obsessive and compulsive personalities and, 298–299
paranoid personalities and, 220–223, 234
psychopathic personalities and, 159, 162–164
See also Caregiving; Trauma
Education, psychotic-level patients and, 79–81, 82–83
Ego
overview, 152
in paranoid personalities, 218
schizoid personality style and, 211
splitting and, 116–117
“Ego alien” personality style, 29, 48, 49
Ego psychology
character organization and, 27–31
diagnosis and, 47–51
overview, 28/–29
psychosis and, 75
“Ego syntonic” personality style, 29
Emotional intensity, with borderline patients, 84–87
Emotions
hysterical personalities and, 313, 322
in narcissistic personalities, 185
in obsessive and compulsive personalities, 294, 307
psychopathic personalities and, 159–160, 161–162
See also Affect
Empathic parenting, 56–57. See also Parenting
Empathy by the therapist
borderline personality organization and, 91–92
depressive personalities and, 237
dissociative conditions and, 337–338
object relations tradition and, 33
obsessive and compulsive personalities and, 308–309
as a reason to diagnose, 8, 11–12, 14–16
treatment planning and, 11–12
Emptiness
depressive personalities and, 255
in narcissistic personalities, 185
Enactment, defensive, 119–121. See also Primitive defenses
Engagement with treatment, as a reason to diagnose, 8, 16
Envy
in narcissistic personalities, 180, 185, 195
paranoid personalities and, 217–218, 234
primitive envy, 165
Episodic memory
dissociation and, 334
repression and, 127–128
See also Memory
Escape needs, 260–261
Exhibitionism, 258
Exposure therapies, 307–308
Extreme defenses, 103
F
False memory controversy, 337. See also Memory
Falseness, in narcissistic personalities, 185
Fathers. See Parenting
Fear
displacement and, 140
obsessive and compulsive personalities and, 297–298
paranoid personalities and, 216–217, 234
psychosis and, 74
Feeling states
borderline personality organization and, 87–88
hysterical personalities and, 322
See also Emotions
Fees
borderline personality organization and, 85
depressive personalities and, 251–252
discussing with clients, 77
masochistic personalities and, 282
psychopathic personalities and, 168–169
Fight–flight–freeze response
manic personalities and, 258
somatization and, 117–119
Fixation–regression hypothesis, 201–202
Forgetting, repression and, 127. See also Memory
Frequency of therapy sessions, 72–73
Freudian analysis. See Psychoanalytic treatment
Freudian drive theory. See Drive theory
G
Gender differences
hysterical personalities and, 314–315, 318–320, 321, 323, 328
obsessive and compulsive personalities and, 294
schizoid personality style and, 202–203
self-experience and, 247–248
sexualization and, 122
Gender stereotypes, 318–320
Genetic factors
depressive personalities and, 238
masochistic personalities and, 271
psychopathic personalities and, 159
Glove paralysis, 316
Glucocorticoids, 334
Grandiosity
masochistic personalities and, 277
narcissism and, 178–179, 180–181, 185
overview, 107–108
paranoid personalities and, 223
in psychopathic personalities, 160
See also Omnipotent control; Primitive defenses
Gratitude, in narcissistic personalities, 185
Grief, manic personalities and, 261–262
Group therapy, obsessive and compulsive personalities and, 306
Guilt
compartmentalization and, 135–136
depressive personalities and, 244
hysterical personalities and, 317–318, 322
masochistic personalities and, 282, 283
obsessive and compulsive personalities and, 295
paranoid personalities and, 224, 234
undoing and, 137
H
Hallucinations, 59–63
Heterosexism, 140
Higher-order defensive processes. See Defenses; Secondary defenses
Hippocampus
dissociation and, 334
repression and, 127–128
History of patients
dissociative psychologies and, 352–353
format for diagnostic interview, 359–360
Histrionic personalities. See Hysterical personalities
Holding environment, 177
Homicidal threats and behavior, 59–63
Honesty
dissociative psychologies and, 340–341
psychopathic personalities and, 169
psychosis and, 75–78
Hospitalization, 211
Hostility
depressive personalities and, 249
paranoid personalities and, 216–217, 231
reaction formation and, 141
Humor
overview, 148
paranoid personalities and, 227–228, 234
See also Secondary defenses
Hypnosis, 335, 349, 350
Hypochondriacal people, 130–131
Hypomanic personalities
compared to compulsive personalities, 263
compared to hysterical personalities, 262
compared to narcissistic personality, 262–266
compared to schizoid personality style, 263–264
denial and, 106, 106–107
diagnosis of, 260–266
differential diagnosis and, 262–266
engagement with treatment and, 16
further reading suggestions regarding, 265–266
overview, 256–257, 264–265
therapeutic implications in the diagnosis of, 260–262
See also Manic personalities
Hysterical personalities
adaptive processes in, 315–318
affect in, 313–315
compared to borderline personality organization, 355–356
compared to hypomanic personalities, 262
compared to narcissistic personality, 194, 329
compared to paranoid personalities, 215
compared to psychopathic personalities, 328–329
countertransference with, 323–326
defensive processes in, 315–318
diagnosis of, 326–330
differential diagnosis and, 194, 215, 262, 327–330, 355–356
drive in, 313–315
further reading suggestions regarding, 331
manipulation and, 160–161
overview, 311–313, 330–331
relational patterns in, 318–320
self-experience and, 320–322
temperament and, 313–315
therapeutic implications in the diagnosis of, 326–327
transference with, 323–326
I
Id, 27–28
Idealization
depressive personalities and, 241–242
manic personalities and, 258
masochistic personalities and, 271–274
narcissism and, 195
obsessive and compulsive personalities and, 299
overview, 103, 108–110
in schizoid personality style, 200
See also Primitive defenses
Ideals of reference, 59–63
Identification, 143–146. See also Secondary defenses
Identity
borderline personality organization and, 64–65
hysterical personalities and, 319
narcissism and, 177, 178–179
neurotic–borderline–psychotic spectrum and, 57, 58
Identity integration, 158
Ignoring, repression and, 127
Illogical thinking, 59–63
Immune system, 118–119
Impulses, biological, 147
Impulsivity, 258
Incompleteness, in narcissistic personalities, 185
Individual differences, 149, 159
Individuation, borderline personality organization and, 66–67, 91–92
Infancy
denial and, 105–107
omnipotent control and, 107–108
withdrawal and, 104–105
Infantilization, hysterical personalities and, 324
Inferiority, in narcissistic personalities, 185
Insecure attachment. See also Attachment
psychopathic personalities and, 163–164
somatization and, 118
Insight, 29
Instinctualization, 121–123. See also Primitive defenses
Integrated sense of identity, 57
Intellectualization
obsessive and compulsive personalities and, 306
overview, 132–133
in schizoid personality style, 200
See also Secondary defenses
International Society for the Psychological Treatments of Schizophrenia, 71
Interpersonal psychoanalysis, 32
Interpersonal reactivity, 313
Interpretations
borderline personality organization and, 88–89, 92
depressive personalities and, 253
paranoid personalities and, 229–230
schizoid personality style and, 209
Interventions, 66
Introjection
depressive personalities and, 240–241, 245–248, 249, 250–251
masochistic personalities and, 271–274
obsessive and compulsive personalities and, 298, 300, 308–309
overview, 111–116
in schizoid personality style, 200
See also Primitive defenses
Introversion, 197
Intuition, 111
Irritation
borderline personality organization and, 94–95
in obsessive and compulsive personalities, 302
paranoid personalities and, 233–234
psychosis and, 76–77
Isolated subjectivity, 334–335
Isolation
compartmentalization and, 135–136
schizoid personality style and, 206
Isolation of affect
in obsessive and compulsive personalities, 293–296, 302
overview, 131–132
See also Secondary defenses
J
Jealousy, 217–218. See also Envy
Joining, 81–82
K
Kraepelinian diagnosis, 46–47, 67–68
L
Labels
acting out and, 121
limits to the utility of diagnosis and, 19
overview, 7–8
prognosis implications and, 12–13
psychotic-level patients and, 80
Libido, 122
Loss
depressive personalities and, 238, 242, 243–244, 245–248
identification and, 145
manic personalities and, 258–259
M
Malignant grandiosity, 160. See also Grandiosity
Maltreatment
manic personalities and, 258–259
psychopathic personalities and, 159
Manic personalities
adaptive processes in, 258
affect in, 257–258
compared to attention-deficit disorders (ADD and ADHD), 264
countertransference with, 259–260
defensive processes in, 258
denial and, 106–107
diagnosis of, 260–264
differential diagnosis and, 262–264
drive in, 257–258
further reading suggestions regarding, 265–266
overview, 235, 256–257, 264–265
relational patterns in, 258–259
self-experience and, 259
temperament and, 257–258
therapeutic implications in the diagnosis of, 260–262
transference with, 259–260
See also Hypomanic personalities
Manic-depressive illness, 235. See also Depressive personality; Manic personalities
Manipulation
hysterical personalities and, 320
psychopathic personalities and, 160–161
Masochistic personalities
adaptive processes in, 271–274
affect in, 270–271
compared to depressive personalities, 256, 285
compared to dissociative conditions, 286–287
compared to paranoid personalities, 215
countertransference with, 278–281
defensive processes in, 271–274
diagnosis of, 281–287
differential diagnosis and, 215, 256, 285–287
drive in, 270–271
further reading suggestions regarding, 288
obsessive and compulsive personalities and, 301–302
overview, 267–270, 287
relational patterns in, 274–277
self-experience and, 277–278
temperament and, 270–271
therapeutic implications in the diagnosis of, 281–285
transference with, 278–281
Masturbation, 316
Maturational dimensions of character, 95–97, 96f. See also Developmental processes
Mature defenses, 103
Medical model, 10
Medication
depressive personalities and, 249
manic personalities and, 261
obsessive and compulsive personalities and, 307–308
schizoid personality style and, 211
Memory
dissociation and, 334, 337, 349
hysterical personalities and, 315–317
psychopathic personalities and, 161–162
repression and, 127–128
Mental status, format for diagnostic interview and, 360
Mentalization-based therapy (MBT), 84
Mirroring
narcissism and, 177
schizoid personality style and, 208
Misdiagnosis, 17
Moral masochism, 268. See also Masochistic personalities
Morality
depressive personalities and, 243–244
masochistic personalities and, 278
superego and, 29
See also Moralization
Moralization
masochistic personalities and, 271–274
overview, 134–135
psychopathic personalities and, 170
See also Morality; Secondary defenses
Mothers. See Parenting
Motivation, 238–239
Mourning, 243–244
Multiple personalities. See Dissociative psychologies
Multiplicity, 333–334. See also Dissociative psychologies
N
Narcissism
schizoid personality style and, 203
self psychology and, 36–37
Narcissistic defense, 193
Narcissistic personality organization
adaptive processes in, 180–182
affect in, 179–180
compared to depressive personalities, 193, 255–256
compared to dissociative psychologies, 329
compared to hypomanic personalities, 262–266
compared to hysterical personalities, 329
compared to neurotic symptoms, 51
compared to obsessive personalities, 308–309
compared to paranoid personalities, 217
compared to physiological conditions, 329–330
compared to psychopathic personalities, 173–174
countertransference and, 186–188
defensive processes in, 180–182
diagnosis of, 188–194
differential diagnosis and, 51, 173–174, 192–194, 217, 255–256, 262–266, 308–309, 329–330
drive in, 179–180
further reading suggestions regarding, 195
hysterical personalities and, 321–322
overview, 154, 176–179, 194–195
relational patterns in, 182–185
self-experiences in, 185–186
temperament and, 179–180
therapeutic implications in the diagnosis of, 188–192
transference and, 186–188
Neglect, 159
Neurosis, 46–47. See also Obsessive–compulsive personality
Neurotic character, 47–51. See also Neurotic personality
Neurotic personality
compared to neurotic symptoms, 50–51
maturational and typological dimensions of character and, 95–97, 96f
neurotic–borderline–psychotic spectrum and, 55–67
object relations diagnosis and, 53–54
paranoid personalities and, 218
therapy and, 71–74
Neurotic–borderline–psychotic spectrum
maturational and typological dimensions of character and, 95–97, 96f
overview, 55–67
paranoid personalities and, 218
therapy and, 70–71, 97–98
See also Borderline personality organization; Neurotic personality; Psychotic levels of character structure
Nonpsychodynamic therapies, 73–74. See also Cognitive-behavioral therapies (CBT); Therapy
Normalization
psychotic-level patients and, 79–81
schizoid personality style and, 209
Numbing, psychic, 131–132. See also Secondary defenses
O
Object relations
depressive personalities and, 242
hysterical personalities and, 323
obsessive and compulsive personalities and, 297, 304
overview, 152
schizoid personality style and, 201–202
Object relations diagnosis, 52–55
Object relations tradition, 31–36
Observing ego, 62
Obsessions, 58
Obsessive personalities
adaptive processes in, 293–296
affect in, 291–293
compared to narcissistic personality, 308–309
compared to organic conditions, 309
compared to paranoid personalities, 233
compared to schizoid personality style, 212, 309
countertransference with, 302–304
defensive processes in, 293–296
depressive personalities and, 239
diagnosis of, 304–309
differential diagnosis and, 212, 233, 308–309
drive in, 291–293, 294–296
further reading suggestions regarding, 310
moralization and, 135
overview, 289–291, 310
reaction formation and, 141
relational patterns in, 296–299
schizoid personality style and, 211
self-experience and, 300–302
temperament and, 291–293
therapeutic implications in the diagnosis of, 304–308
transference with, 302–304
See also Obsessive–compulsive personality
Obsessive–compulsive personality
adaptive processes in, 293–296
affect in, 291–293
compared to narcissistic personality, 193–194
countertransference with, 302–304
defensive processes in, 293–296
diagnosis of, 304–309
differential diagnosis and, 193–194, 308–309
drive in, 291–293, 294–296
further reading suggestions regarding, 310
overview, 289–291, 310
relational patterns in, 296–299
self-experience and, 300–302
temperament and, 291–293
therapeutic implications in the diagnosis of, 304–308
transference with, 302–304
See also Compulsive personalities; Obsessive personalities
Oedipal phase of development
drive theory and, 23–27
hysterical personalities and, 314
identification and, 144–145
object relations tradition and, 33
Omnipotent control
obsessive and compulsive personalities and, 295–296
overview, 107–108
in psychopathic personalities, 160
undoing and, 136–137
See also Grandiosity; Primitive defenses
Oral fixations
depressive personalities and, 238
hysterical personalities and, 314
manic personalities and, 257–258
masochistic personalities and, 271
Oral phase of development, 23–27
Orbitofrontal cortex, 159
Organic psychopathology, 309
P
Pain, 275–276
Paranoid personalities
adaptive processes in, 218–220
affect in, 216–218
compared to psychopathic personalities, 172
countertransference with, 225–226
defensive processes in, 218–220
diagnosis of, 226–233
differential diagnosis and, 172, 232–233
drive in, 216–218
further reading suggestions regarding, 234
manic personalities and, 261
masochistic personalities and, 276–277
neurotic–borderline–psychotic spectrum and, 57
overview, 214–216, 233–234
projection and, 111–112
relational patterns in, 220–223
self-experience and, 223–225
temperament and, 216–218
therapeutic implications in the diagnosis of, 226–232
transference with, 225–226
Paranoid–schizo state, 59–61
Parenting
depressive personalities and, 242–245
dissociative psychologies and, 341–344
hysterical personalities and, 318–320
masochistic personalities and, 274–277
narcissism and, 183–184
neurotic–borderline–psychotic spectrum and, 56–57
obsessive and compulsive personalities and, 291–292, 297, 298–299
paranoid personalities and, 220–223
psychopathic personalities and, 164–165
schizoid personality style and, 202–203
See also Caregiving; Early experiences
“Passive-into-active transformation”, 142
Passive–parasitic psychopaths, 158. See also Psychopathic personalities
Penis envy, 314–315
Perfectionism, 181–182, 185
Personality
defenses and, 101, 149
maturational and typological dimensions of, 95–97, 96f
overview, 21–22, 154
See also Character diagnosis; Character organization; individual personality categories; Temperament
Personality change, 155
Personality disorders
hypomanic personalities and, 257
manic personalities and, 235, 258
masochistic personalities and, 270
overview, 154
somatization and, 118
Phallic phase of development, 23–27
Phases of therapy, dissociative personalities and, 350–351
Phobia
displacement and, 140
neurotic–borderline–psychotic spectrum and, 58
Physiological conditions
compared to narcissistic personality, 329–330
differential diagnosis and, 329–330
Political correctness, 2–3
Posttraumatic stress reactions. see also Trauma
dissociation and, 334
hysterical personalities and, 312–313
repression and, 127–128
Power
hysterical personalities and, 314–315, 320–321
power struggles, 304, 306
psychopathic personalities and, 160
Prejudice in diagnosis, 7–8
Presenting problems, 8
Preverbal phase of development, 102–103
Pride, in narcissistic personalities, 185
“Primary process” thought, 27–28
Primitive defenses
acting out, 119–121
denial, 105–107
dissociation, 123–125
further reading suggestions regarding, 125
idealization and devaluation, 108–110
omnipotent control, 107–108
overview, 100–104, 125
projection, introjection, and projective identification, 111–116
sexualization, 121–123
somatization, 117–119
splitting of the ego, 116–117
withdrawal, 104–105
See also Defenses; individual defenses
Primitive envy, 165
Prognosis implications, 8, 12–13
Projection
displacement and, 140
dissociation and, 346–347
overview, 111–116
in paranoid personalities, 218
paranoid personalities and, 218–220, 224, 228–229
in schizoid personality style, 200
See also Primitive defenses
Projective identification
overview, 111–116
in psychopathic personalities, 160, 161–162
See also Primitive defenses
Protecting consumers of mental health services, 8, 13–14
Psychic numbing, 131–132. See also Secondary defenses
Psychoanalytic diagnosis, 9–11
Psychoanalytic treatment
ego psychology and, 28–31
with neurotic-level patients, 72–73
See also Therapy
Psychodymanic Diagnostic Manual (PDM), 151, 237
Psychopathic personalities
adaptive processes in, 160–162
affect in, 158–160
compared to dissociative psychologies, 356
compared to hysterical personalities, 327, 328–329
compared to narcissistic personality, 193
compared to paranoid personalities, 232–233
countertransference and, 166
defensive processes in, 160–162
diagnosis of, 167–174
differential diagnosis and, 172–174, 193, 232–233, 327, 328–329, 356
drive in, 158–160
further reading suggestions regarding, 174–175
overview, 157–158, 174
relational patterns in, 162–164
self-experience and, 164–165
temperament in, 158–160
therapeutic implications in the diagnosis of, 167–172
transference and, 166
See also Psychopathy
Psychopathy
compared to neurotic symptoms, 51
omnipotent control and, 108
somatization and, 118
See also Psychopathic personalities
Psychopharmacology
depressive personalities and, 249
manic personalities and, 261
obsessive and compulsive personalities and, 307–308
schizoid personality style and, 211
Psychosexual stages of development
drive theory and, 23–27
object relations tradition and, 33
See also Developmental stages
Psychosis
compared to dissociative conditions, 354
differential diagnosis and, 354
ego psychology diagnosis and, 47–51
hysterical personalities and, 312–313, 323–324
identity and, 64–65
manic personalities and, 258
versus neurosis, 46–47
neurotic–borderline–psychotic spectrum and, 59–63
object relations diagnosis and, 53–54
paranoid personalities and, 218
schizoid personality style and, 211
See also Psychotic levels of character structure; Schizophrenia
Psychotic levels of character structure
maturational and typological dimensions of character and, 95–97, 96f
neurotic–borderline–psychotic spectrum and, 55–67
obsessive and compulsive personalities and, 294
therapy and, 74–83
See also Psychosis
Punishment, 276
R
Racism, 140
Rage, 292–293. See also Anger
Rape, 258
Rapprochment subphase, 130. See also Separation–individuation process
Rationalization, 103, 133–134. See also Secondary defenses
Reaction formation
in obsessive and compulsive personalities, 293–296
overview, 140–141
paranoid personalities and, 219–220
See also Secondary defenses
Reactivity, 313
Reality principle, 28
Reality testing
paranoid personalities and, 218–219
psychopathic personalities and, 158
Reassurance, 66–67
Reflective functioning, 61
Reframing, psychotic-level patients and, 79
Regression
borderline personality organization and, 91–92
hysterical personalities and, 315, 325
overview, 129–131
See also Secondary defenses
Relational models
acting out and, 120
character organization and, 21
contemporary relational movement, 39–40
Relational patterns
in depressive personalities, 242–245
in dissociative psychologies, 341–344
in hysterical personalities, 318–320
in manic personalities, 258–259
in masochistic personalities, 274–277
narcissism and, 177, 182–185, 195
in obsessive and compulsive personalities, 296–299
in paranoid personalities, 220–223
in psychopathic personalities, 162–164
in schizoid personality style, 201–203
Reliability, 9–10
Remorse
in narcissistic personalities, 185
undoing and, 137
Repetition compulsion, 272
Repression
in hysterical personalities, 315–317
overview, 103, 127–129
in schizoid personality style, 200
See also Primitive defenses; Secondary defenses
Rescue operations, 321
Resentment, 216–217
Resiliency, 9
Resistance
as a reason to diagnose, 8, 16
withdrawal and, 104–105
Respect, 75–78
Reversal, 142–143. See also Secondary defenses
Rituals, 290. See also Compulsive personalities
Running from treatment, as a reason to diagnose, 8, 16
S
Sadism
masochistic personalities and, 279
obsessive and compulsive personalities and, 307
psychopathic personalities and, 165
Sadness, depressive personalities and, 239
Safety
psychosis and, 75–78
schizoid personality style and, 201
Scapegoating, 140
Schema-focused therapy (SFT), 84
Schizoaffective personalities, 354
Schizoid personality styles
adaptive processes in, 200
affect in, 198–200
compared to hypomanic personalities, 263–264
compared to obsessive personalities, 309
countertransference with, 206–208
defensive processes in, 200
diagnosis of, 208–212
differential diagnosis and, 211–212, 263–264, 309
drive in, 198–200
further reading suggestions regarding, 213
obsessive and compulsive personalities and, 294
overview, 196–198, 212–213
relational patterns in, 201–203
self-experience in, 204–206
temperament and, 198–200
therapeutic implications in the diagnosis of, 208–210
transference with, 206–208
withdrawal and, 104–105
Schizophrenia
compared to dissociative conditions, 354
differential diagnosis and, 211–212, 354
dissociative personalities and, 343
hysterical personalities and, 312–313
Kraepelinian diagnosis and, 46–47
obsessive and compulsive personalities and, 294
overview, 61–62, 207
paranoid personalities and, 218
therapy and, 74–83
See also Psychosis
“Script theory,” 21
Secondary defenses
compartmentalization, 135–136
displacement, 139–140
further reading suggestions regarding, 150
humor, 148
identification, 143–146
intellectualization, 132–133
isolation of affect, 131–132
moralization, 134–135
overview, 126, 148–149
rationalization, 133–134
reaction formation, 140–141
regression, 129–131
repression, 127–129
reversal, 142–143
sublimation, 146–147
turning against the self, 138–139
undoing, 136–138
See also individual defenses
Security
dissociative psychologies and, 349
narcissism and, 177
paranoid personalities and, 231
Seduction theory, 336–337
Seductiveness, 321–322, 325–326. See also Sexualization
Self, turning against, 138–139. See also Secondary defenses
Self psychology
narcissistic personality organization and, 189
overview, 36–38
Self-acceptance, 177
Self-awareness, 213
Self-defeating patterns. See Masochistic personalities
Self-definition
depressive personalities and, 237
obsessive and compulsive personalities and, 298
Self-disclosure, 75–78
Self-doubt, 283
Self-esteem
depressive personalities and, 241–242, 251–252, 253
dissociative psychologies and, 349
engagement with treatment and, 16
hysterical personalities and, 314, 319–320, 320–321
manic personalities and, 259
masochistic personalities and, 277
narcissism and, 176, 177, 178–179, 182, 192, 195
obsessive and compulsive personalities and, 289–290, 301
omnipotent control and, 107
overview, 154
schizoid personality style and, 205
splitting and, 116
of the therapist, 17–18
Self-experiences
in depressive personalities, 245–248
in dissociative psychologies, 344–346
in hysterical personalities, 320–322
in manic personalities, 259
in masochistic personalities, 277–278
in narcissistic personalities, 185–186
in obsessive and compulsive personalities, 300–302
overview, 152
in paranoid personalities, 223–225
in psychopathic personalities, 164–165
in schizoid personality style, 204–206
self psychology and, 38
Self-fragmentation, 261–262
Self-fulfilling prophecy, 115
Self-injury, 272
Self-in-relationship
depressive personalities and, 237
obsessive and compulsive personalities and, 298
Selfobjects, narcissism and, 182–183
Self-representations
masochistic personalities and, 277
paranoid personalities and, 223–225
psychopathic personalities and, 165
Self-righteousness, in narcissistic personalities, 185
Self-sacrifice, masochistic personalities and, 282
Self-sufficiency, in narcissistic personalities, 185
Semantic memory. See also Memory
Semantic memory, dissociation and, 334
Separateness
borderline personality organization and, 91–92
schizoid personality style and, 201
Separation
borderline personality organization and, 66–67
depressive personalities and, 252–253
manic personalities and, 258–259
paranoid personalities and, 229
Separation anxiety, 273
Separation–individuation process
borderline personality organization and, 66–67
depressive personalities and, 242–243
overview, 242–243
regression and, 130
Sexism, displacement and, 140
Sexual abuse
borderline conditions and, 54–55
dissociation and, 341–344
Sexual behavior
acting out and, 121
paranoid personalities and, 224
See also Sexualization
Sexualization
displacement and, 139–140
dissociative psychologies and, 338–339
hysterical personalities and, 314, 315, 316–317, 319, 320–322, 325–326
masochistic personalities and, 267–268, 271
obsessive and compulsive personalities and, 297
overview, 121–123
paranoid personalities and, 231
schizoid personality style and, 201
See also Primitive defenses
“Shallow affect,” 322
Shame
compartmentalization and, 135–136
hysterical personalities and, 317–318
narcissistic personality organization and, 177, 185, 191, 195
obsessive and compulsive personalities and, 293
paranoid personalities and, 217, 234
in psychopathic personalities, 160
Short-term treatments
depressive personalities and, 251–252
with neurotic-level patients, 73–74
See also Therapy
Situational factors, 153–154
Skills training, 82–83
Somatization, 117–119, 130–131
Splitting defense mechanism, 103, 116–117, 135. See also Primitive defenses
Stage theories, 43–45
Stigmas, psychotic-level patients and, 80
Strengths, 9
Stress
paranoid personalities and, 218
repression and, 127–128
schizoid personality style and, 200
somatization and, 117–119
Structural models
ego psychology and, 27–31
hysterical personalities and, 316
Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D), 353
Structured Interview for Personality Organization (STIPO), 55
Subconsciousness, 28–31. See also Unconsciousness
Sublimation, 146–147. See also Secondary defenses
Substance use disorders. See also Addiction
compared to psychopathic personalities, 174
differential diagnosis and, 174
Suicidal threats and behavior
borderline personality organization and, 85
empathy and, 15–16
neurotic–borderline–psychotic spectrum and, 59–63
therapists’ comfort with diagnosis and, 17–18
Superego
depressive personalities and, 255
narcissism and, 178
obsessive and compulsive personalities and, 292, 299
overview, 29–30
psychopathic personalities and, 160, 169
self psychology and, 37
Superiority, in narcissistic personalities, 185
Supervision from the patient, 89–91
Support, 82–83
Symptom neurosis, 47–51
T
Teasing, 276
Temperament
defenses and, 101
in depressive personalities, 238–239
in dissociative psychologies, 338–339
in hysterical personalities, 313–315
in manic personalities, 257–258
in masochistic personalities, 270–271
in narcissistic personalities, 179–180
in obsessive and compulsive personalities, 291–293
overview, 152–153
in paranoid personalities, 216–218
in psychopathic personalities, 158–160
in schizoid personality style, 198–200
See also Personality
Terminology
overview, 2–3
prejudice in diagnosis and, 7–8
Terror, psychosis and, 74
Therapeutic frame, borderline personality organization and, 85–86
Therapeutic implications of diagnosis
depressive personalities and, 250–254
dissociative psychologies and, 348–352
hypomanic personalities and, 260–262
hysterical personalities and, 326–327
masochistic personalities and, 281–285
narcissistic personality organization and, 188–192
obsessive and compulsive personalities and, 304–308
paranoid personalities and, 226–232
psychopathic personalities and, 167–172
schizoid personality style and, 208–210
See also individual character types
Therapeutic relationship
with borderline patients, 84–87
diagnostic sessions and, 8, 16–18
ego psychology diagnosis and, 49–50
hysterical personalities and, 323–326
limits to the utility of diagnosis and, 18–19
masochistic personalities and, 284–285
narcissistic personality organization and, 190–191
neurotic–borderline–psychotic spectrum and, 57, 61–63
obsessive and compulsive personalities and, 304–305
paranoid personalities and, 226
projective identification and, 114–115
psychosis and, 75–78
schizoid personality style and, 207–208
See also Countertransference; Transference
Therapeutic split, 57
“Therapeutic split in the ego,” 28–29
Therapists’ discomfort with diagnosis, 16–18
Therapy
with borderline patients, 83–95
depressive personalities and, 250–254
further reading suggestions regarding, 98–99
narcissistic personality organization and, 188–192
with neurotic-level patients, 71–74
overview, 70–71, 97–98
paranoid personalities and, 226–232
phases of in working with dissociative patients, 350–351
psychopathic personalities and, 167–172
with psychotic-level patients, 74–83
schizoid personality style and, 206–208, 208–210
See also Countertransference; Nonpsychodynamic therapies; Psychoanalytic treatment; Short-term treatments; Transference
Thoughts, paranoid personalities and, 230
Toilet training, obsessive and compulsive personalities and, 291–292
Tolerance, 9
Tolerating ambivalence, 296
Training to be a therapist, 246–247
Trance-inducing services, 350. See also Hypnosis
Transference
borderline personality organization and, 67, 86–87
depressive personalities and, 248–250
displacement and, 140
dissociative psychologies and, 334, 341–344, 346–348, 352–353
hysterical personalities and, 323–326
manic personalities and, 259–260
masochistic personalities and, 278–281
narcissistic personality organization and, 186–188
neurotic–borderline–psychotic spectrum and, 62
object relations tradition and, 33–34
obsessive and compulsive personalities and, 302–304
paranoid personalities and, 220, 225–226, 231
psychopathic personalities and, 166
schizoid personality style and, 206–208
Transference neurosis, 56–57
Transference-focused psychotherapy (TFP), 66, 84
Trauma
borderline personality organization and, 85
displacement and, 140
dissociation and, 124–125, 336–337, 349
manic personalities and, 258–259
narcissism and, 177
overview, 61–62
repression and, 127–128
schizoid personality style and, 203
somatization and, 117–119
See also Early experiences
Treatment planning, as a reason to diagnose, 8, 11–12
Triangulation, 139
Triggers, 81–83
Trust
borderline personality organization and, 84–85
dissociative psychologies and, 340–341
hysterical personalities and, 324
neurotic–borderline–psychotic spectrum and, 58
paranoid personalities and, 215, 226
psychosis and, 75–78
Turning against the self. see also Secondary defenses
depressive personalities and, 241
masochistic personalities and, 271–274
overview, 138–139
Two-person model of the therapeutic process, 70–71
Typographical dimensions of character, 95–97, 96f
U
Ugliness, in narcissistic personalities, 185
Unconsciousness
acting out and, 120
defenses and, 101
ego psychology and, 28–31
hysterical personalities and, 317–318
object relations tradition and, 31–32
overview, 152
regression and, 130
repression and, 127, 128
See also Subconsciousness
Undoing, 136–138, 295–296. See also Secondary defenses
V
Validity, 9–10
Vanity
hysterical personalities and, 321–322
in narcissistic personalities, 185
Vindictiveness, paranoid personalities and, 216–217
W
Wishes, in obsessive and compulsive personalities, 294–296
Withdrawal, 103, 104–105, 201–203. See also Primitive defenses
Working alliance
ego psychology diagnosis and, 49–50
masochistic personalities and, 284–285
schizoid personality style and, 207–208
See also Therapeutic relationship