Social Factors in the Personality Disorders: A Biopsychosocial Approach to Etiology and Treatment (Studies in Social and Community Psychiatry)

256 Pages·2006·5.86 MB·English

Social Factors in the Personality Disorders
STUDIES IN SOCIAL AND COMMUNITY PSYCHIATRY
Volumes in this series examine the social dimensions of mental illness
as they affect diagnosis and management and address a range of
fundamental issues in the development of community-based mental
health services.
Series Editor
PETER J. TYRER
Professor of Community Psychiatry, St Mary's Hospital Medical School, London
Also in this series
Integrated Mental Health Care: A Comprehensive, Community-based
Approach
Ian R. H. Falloon and Grainne Fadden
Social Support and Psychiatric Disorder
Edited by T. S. Brugha
The Psychiatric Team and the Social Definition of Schizophrenia: An
Anthropological Study of Person and Illness
Robert J. Barrett
Mental Health Service Evaluation
Charlotte Knudsen and Graham Thornicroft
Emergency Mental Health Services in the Community
Michael Phelan, Graham Thornicroft and Geraldine Strathdee
Social Factors in
the Personality
Disorders
A Biopsychosocial Approach
to Etiology and Treatment
JOEL PARIS
Professor of Psychiatry
McGill University
Montreal, Quebec, Canada
Foreword by PETER J. TYRER
CAMBRIDGE
UNIVERSITY PRESS
CAMBRIDGE UNIVERSITY PRESS
Cambridge, New York, Melbourne, Madrid, Cape Town, Singapore, Sao Paulo
Cambridge University Press
The Edinburgh Building, Cambridge CB2 2RU, UK
Published in the United States of America by Cambridge University Press, New York
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Information on this title: www.cambridge.org/9780521472241
© Cambridge University Press 1996
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without
the written permission of Cambridge University Press.
First published 1996
This digitally printed first paperback version 2006
A catalogue record for this publication is available from the British Library
Library of Congress Cataloguing in Publication data
Paris, Joel.
Social factors in the personality disorders : a biopsychosocial
approach to etiology and treatment / Joel Paris.
p. cm. — (Studies in social and community psychiatry)
Includes bibliographical references.
ISBN 0-521-47224-5
1. Personality disorders—Social aspects. 2. Personality disorders—
Etiology. 3. Personality disorders—Treatment.
I. Title. II. Series.
[DNLM: 1. Personality Disorders—etiology. 2. Personality
Disorders—therapy. 3. Social Environment. 4. Social Medicine.
WM 190P232s 1996]
RC554-.P37—1996
616.85'8—dc20
DNLM/DLC
for Library of Congress 95-16586 CIP
ISBN-13 978-0-521-47224-1 hardback
ISBN-10 0-521-47224-5 hardback
ISBN-13 978-0-521-03266-7 paperback
ISBN-10 0-521-03266-0 paperback
This book is dedicated to the memory of my father,
who taught me the importance of a skeptical mind.
Contents
Foreword ix
Introduction xi
Acknowledgments xxi
1 Overview 1
2 Personality Traits and Personality Disorders 18
3 Biological Factors 31
4 Psychological Factors 40
5 Social Factors - Methods 64
6 Social Factors - Mechanisms 73
7 A Biopsychosocial Model of the Personality
Disorders 95
8 The Odd Cluster 102
9 The Impulsive Cluster 110
10 The Anxious Cluster 134
11 Treatment 144
12 Clinical Practice 161
vii
viii Contents
Epilogue: Summary and Research
Implications 189
References 193
Index 225
Foreword
The study of personality disorders was once thought to be a
subject that should be abhorred by psychiatrists, as these dis-
orders were not part of mainstream psychiatry. These condi-
tions were considered untreatable and, as they were a measure
of social deviance, they should occupy the attention of the
legal and social service systems rather than the healthcare one.
If psychiatrists were alienists (their old title) among other doc-
tors then personality disorders were the aliens of psychiatric
classification.
We are glad to say that this attitude has changed in recent
years and the change in no small measure has been a conse-
quence of opinion-formers such as Joel Paris, who has played
a major part in dragging personality disorder to centre stage
to be examined in the spotlights of scientific criticism, validity,
reliability and utility. Professor Paris manipulates these spot-
lights well and shows that the psychiatric classification of per-
sonality disorders, despite several imperfections that need at-
tention, has improved and that they can be discussed with
confidence as an observable and reliable entity rather than as
a pejorative prescription of someone the clinician does not like.
He also shows that personality disorders have many facets and
that biological and social hypotheses need to be integrated to
explain them. Genetic endowment, early and late childhood
experiences, the quality of attachments to key figures, and
consistency of upbringing are all influences that modify tem-
perament into fully formed personality and Joel Paris shows
how healthy processes can easily be distorted into maladaptive
ones. We live in a specialised age and psychiatrists are no ex-
ception. It is now rather rare to find someone with the breadth
to cross from the psychodynamic literature to the latest bio-
IX