Approaching Psychotherapy of the Personality Disorders From the Millon Perspective

Millon's integrative model for a clinical science begins with a theory that is consistent with current knowledge, establishes a taxonomy for classification, develops a coordinated assessment system, and develops and implements interventions with the guidance of the preceding elements of the model. In recent years, work on the last step of the model, clinical interventions, has accelerated rapidly, and the model now permits the therapist to directly extrapolate specific treatment goals, objectives, and techniques to the practice of therapy with the individual patient. This article summarizes how treatment planning and implementation flows logically from the Millon model.     

Borderline personality disorder from the perspective of general personality functioning

The authors extended previous work on the hypothesis that borderline personality disorder (BPD) can be understood as a maladaptive variant of personality traits included within the 5-factor model (FFM) of personality. In each of 3 samples, an empirically derived prototypic FFM borderline profile was correlated with individuals' FFM profiles to yield a similarity score, an FFM borderline index. Results across all samples indicated that the FFM borderline index correlated as highly with existing borderline measures as they correlated with one another, and the FFM borderline index correlated as highly with measures of dysfunction, history of childhood abuse, and parental psychopathology as did traditional measures of BPD. Findings support the hypothesis that BPD is a maladaptive variant of FFM personality traits.     

Outpatient group psychotherapy following day treatment for patients with personality disorders

This prospective, naturalistic study evaluated the practice and effectiveness of an outpatient group therapy program following day treatment for patients with personality disorders (PDs). One hundred and eighty-seven patients (86% patients with PDs and 14% with no PDs), were treated in outpatient psychodynamic group therapy. Outcome was assessed by Global Assessment of Functioning, Symptom Check List 90-R, and Inventory of Interpersonal Problems-Circumplex, short version, at admission and discharge from day treatment, and at the end of outpatient group therapy. Average length of outpatient therapy was 24 months. Forty-three percent terminated in an irregular manner. Outcome of the continuation therapy was satisfactory for patients without PDs. For PD patients, the improvement from the day treatment was maintained during outpatient therapy, but further improvements were modest for symptoms and interpersonal distress, somewhat better for global functioning. Implications for further treatment development are discussed.     

A developmental perspective on personality disorders: lessons from research on normal personality development in childhood and adolescence

Recent work on normal personality development in children and adolescents points to several conclusions that are relevant for understanding personality pathology. First, child temperament and adult personality traits share many features in common. Second, youths' individual differences can be described in terms of the Big Five personality traits observed in adults; an integrative taxonomy of individual differences in childhood and adolescence is articulated in this article. Third, personality is already moderately stable by the preschool years, but considerable personality change occurs well into the adult years. Taken together, these findings suggest that childhood personality functioning can and should be integrated into developmental research and applied work on personality disorders.     

Stability of the personality and symptom scales of the Millon Clinical Multiaxial Inventory

This study examines the stability of the basic and pathological personality and symptom scales of the Millon Clinical Multiaxial Inventory (MCMI) in three clinical samples. Consistent with the theory upon which the MCMI is based, higher stability estimates were found among basic personality scales in comparison with symptom scales. However, stability estimates which included initial MCMI administrations at intake into treatment were generally lower than those based upon administrations which occurred later in the treatment process. This later finding suggests the need to consider timing of administration when interpreting the MCMI.     

Use of transference interpretations in dynamically oriented individual psychotherapy for patients with personality disorders

The use of transference interpretations in the individual treatment of patients with personality disorders is a controversial issue. Both expressive approaches that stress the importance of transference interpretations and supportive approaches that avoid interpretation of the transference have been advocated by dynamically oriented therapists. Literature is reviewed regarding recommendations for individual psychotherapy and the different views on interpretation of the transference. Available research that has attempted to illuminate the impact of these interventions is also summarized. Although the findings are limited by a number of methodological shortcomings, three implications have emerged. First, a strong therapeutic alliance is imperative for successful exploration of the transference. Second, transference-focused work should be balanced with supportive interventions. Third, the patient's quality of object relations and his or her ability to work within the transference should be considered. However, without further research to guide clinical decision making, clinicians will be left with a confusing array of recommendations and only their intuition.     

The battle within the self,II: An existential approach to psychotherapy with personality disorders

Individuals who suffer from personality disorders are dominated by an internalized self-attacking mechanism which is labeled here as the enemy. This force is the incorporated voice of the parent incessantly operating and producing the psychological pain which very much characterizes the patient's existence. By anthropomorphizing this destructive aspect of the personality structure, the therapist is better able to become an ally with the healthy parts of the patient against this critical internal enemy. As patients more fully comprehend the wide extent of the ongoing battle within the self, they begin to develop the necessary resources to effect significant behavioral changes.     

Longitudinal studies of personality disorders: four lessons from personality psychology

The three longitudinal projects described in this special section of the Journal of Personality Disorders raise a number of intriguing questions concerning the natural history of personality disorders and offer more than their share of surprises. In addition, they underscore several valuable lessons derived from the literature on normal-range personality traits. Drawing in part from the writings of the American trait psychologist Gordon Allport, I describe four such lessons: (1) change and continuity of personality traits and disorders can and do coexist, (2) the covariation among personality traits helps to account for the "comorbidity" among personality disorders, (3) personality traits and disorders influence how individuals interpret life events, and (4) personality traits must be distinguished from behavioral adaptations to these traits. These lessons remind us that the science of personality disorders must be informed by the basic science of personality.     

The structure of situations from a personality perspective

A taxonomy of situations was constructed that categorizes situations by means of ratings of one's ability to deal with those situations. A principal components analysis of self‐ and other‐ratings yielded four components of situations: I, situations of pleasure; II, situations of individual adversity; III, situations of interpersonal conflict; and IV, situations of social demand. Ratings of being able to deal with a situation were related to ratings on a personality questionnaire. This resulted in a very clear set of situations for each of the Big Five factors of personality. The Big Five differed in kind and in number of situations for which they were able to distinguish the well handling from the less well handling persons. Especially, it turned out that the so‐called temperament‐factors, Extraversion, Emotional Stability, and also Autonomy, give rise to more situational differentiation than the so‐called character‐factors, Agreeableness and Conscientiousness. Comparing the present situation structure to that obtained in an earlier study, we found that using the same set of situations does not guarantee obtaining the same set of situation components. Different methods of classification yield differences in the resulting classifications. Copyright © 2002 John Wiley & Sons, Ltd.     

Validity of the Millon Clinical Multiaxial Inventory in the assessment of affective disorders

The Millon Clinical Multiaxial Inventory (MCMI) was administered to 270 adult outpatients with major affective disorders at the same time that a semistructured, diagnostic interview was conducted by a clinician. The mood of the patient was then rated, and the clinician completed the Hamilton Depression Rating Scale and the Mania Rating Scale. A consensual diagnosis was arrived at by the team of investigators using DSM-III criteria. Significant correlations were found between four MCMI affective scales and the global mood state of the patient. Analysis of covariance indicated that the MCMI affective scales are significantly related to DSM-III affective disorders even after the effect of the current mood of the patient is partialled out. The clinical usefulness of each of the scales is discussed.     

Negative life experiences and the development of cluster C personality disorders: a cognitive perspective

Early negative experiences have long been thought to play an important role in the development of personality disorders. Most of the literature regarding these early life experiences has focused on borderline personality disorder, with only occasional focus on other personality disorders. Utilizing cognitive theory of personality disorders (Beck et al., 2004), the authors conceptualize cluster C personality disorders (avoidant, dependent, and obsessive-compulsive). They then critically review the relevant literature on early negative life experiences and later development of these disorders to determine whether the theory is supported by the empirical data. The theory regarding avoidant and dependent personality disorders has limited support, whereas data relating to obsessive-compulsive personality disorder are much weaker. Implications and future research suggestions are discussed.     

Dangerous and severe personality disorders: a new personality concept from the United Kingdom

In 1998, we in England were shocked by the apparently motiveless murders of a mother and two of her children when they were traveling home from school in a rural area. Subsequently a patient with personality disorder, being monitored by the forensic psychiatric services, was convicted of their murders. The government was determined to prevent this type of offense from recurring and in 1999 introduced a new concept, dangerous and severe personality disorder (DSPD). This subsequently became a treatment and assessment program for individuals who satisfy three requirements: (1) have a severe disorder of personality, (2) present a significant risk of causing serious physical or psychological harm from which the victim would find it difficult or impossible to recover, and (3) the risk of offending should be functionally linked to the personality disorder. The implications of this program are discussed with regard to international systems of classification and service provision. We also attempt to place DSPD in the wider context of psychiatric participation in the management of personality disordered offenders.     

DSM-III-R personality disorders and the five-factor model of personality: an empirical comparison.

The relationship between the five-factor model (FFM) of personality and the Diagnostic and Statistical Manual of Mental Disorders (rev. 3rd ed.; DSM-III-R) personality disorders was examined in a sample of 54 psychiatric outpatients. Correlations between raw scores on the NEO-Personality Inventory (NEO-PI) and the number of DSM-III-R personality disorder symptoms rated present using a semistructured interview were computed. In addition, correlations between NEO-PI scores and scores on two self-report personality disorder inventories were also examined to determine which results replicated across instruments. Results indicated that the FFM personality dimensions of Neuroticism, Extraversion, and Agreeableness were most apparent in the DSM-III-R conceptualizations of the personality disorders.     

Convergence of narcissism measures from the perspective of general personality functioning

The construct of narcissism has a lengthy history and has been operationalized and measured by a variety of instruments. In this study, five narcissism scales were compared in terms of alternative conceptualizations of narcissism offered by C. C. Morf and F. Rhodewalt (2001), D. L. Paulhus (2001), and S. Vazire and D. C. Funder (2006), using the domains and facets of the five-factor model as a common point of comparison. The findings provided little support for the conceptualizations of Morf and Rhodewalt or Vazire and Funder. Support was obtained for the conceptualization of Paulhus, particularly as assessed by the Narcissistic Personality Inventory and, secondarily, the Millon Clinical Multiaxial Inventory-III. Implications for the assessment and conceptualization of narcissism are discussed.     

人格差异性的进化心理学解释

进化心理学一直热衷于人格共同性的探讨,但一些研究者也认为应该关注人格差异性,因为共同性和差异性是人格必不可分的两面。对人格差异性的进化解释比较成熟的有三种：生活历史理论、基因多样性理论和代价信号理论。生活历史理论认为是不同的环境(稳定和不稳定),造成了不同的生活历史策略(K策略和R策略),人格特质差异是这些策略的进化产物。基因多样性理论主要从基因突变和平衡选择的角度来解释人格差异性。前者强调突变基因的不可避免性引发了个性差异的存在和发展;后者强调概率的调节作用,解释了不同人格特质之所以能够并行存在的原因。代价信号理论则认为是个体拥有的先天禀赋或者资源差距导致其传递信号的能力差异,从而选择了不同的行为策略。未来研究需要加大遗传学、神经科学等方面的力度,以及研究范式的创新。