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Personality Disorders

Susan E. Bailey, M. D.

The eighth volume in the World Psychiatric Association's "Evidence and Experience in Psychiatry" series is Personality Disorders, a book that lends itself readily to reading straight through. Instead, it is designed for dipping into—judiciously—when considering some of our more difficult patients.

Each of the DSM-IV personality disorders is at least briefly considered here, though the majority of the book is devoted—perhaps not surprisingly—to the cluster B disorders. Six chapters present research and an overview or primary review of current conceptions of either a personality disorder cluster or a specific personality disorder, followed by multiple commentaries on the lead review by researchers around the globe. The book thus provides an excellent, highly detailed bibliography of research. However, the reviews and commentaries are all quite different in tone and approach. Some of the writing is elegant and crisp, some is flat and ponderous, and some, rarely, is incomprehensible.

Antisocial, borderline and histrionic, narcissistic, and obsessive-compulsive personality disorders merit chapters of their own. The cluster A disorders are described in a single chapter, and the avoidant and dependent members of cluster C are addressed in another. In almost all chapters, two important questions arise. Exactly what are we describing or classifying—behavior, trait, state, symptom, syndrome—when we use the term "personality disorder"? How does an axis II personality disorder differ from an axis I disease? None of the chapters answers these questions definitively, but several of them provide suggestions for future editions of the DSM. Peter Tyrer's lead review on cluster C disorders is particularly good in this regard, and both the review and the commentaries on obsessive-compulsive personality are thought provoking.

Given the extraordinary number of contributors to this book, Maj and his coeditors faced a Herculean task in organizing it. They acknowledge that the book took a long time to complete, precisely because the general definition of a personality disorder is complex and problematic. The editors' purpose, they write in the preface, was to serve researchers who aim to "reshape the classification of personality disorders" and clinicians who are struggling daily to help those who suffer from them—or from whatever it is our mixed up nomenclature describes. My sense is that the researchers may be better served here, although even clinicians may find something of use.

Footnotes

Dr. Bailey is an instructor in psychiatry at the Johns Hopkins University School of Medicine, Baltimore.

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