A Review of Huprich, Personality Disorders: Toward Theoretical and Empirical Integration in Diagnosis and Assessment

The diagnosis and assessment of personality disorders (PDs) has become a major topic in clinical theory, research, and practice. Concepts derived from different theoretical approaches—including ego psychology, object relations, selfpsychology, and relational psychoanalysis—have extensively been applied in understanding PDs and their relation to the individual’s cognitive-affective processing system (Mischel & Schoda, 1998), as well as to level of personality organization, symptom patterns, subjective distress, and overall personality functioning. This edited volume, which includes 17 chapters, further explores the topic by offering multiple perspectives on PDs. In the introduction, the editor describes the contentious debates in the move toward the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM–5; American Psychiatric Association, 2013), around which this volume has been organized: Part I (Chapters 1–4) describes current issues in the diagnosis and assessment of PDs; Part II (Chapters 5–11) delineates research and assessment strategies; and Part III (Chapters 12–17) explores the progress toward integrated and unified models of PDs. Part I opens with a convincing discussion by Silk regarding the value of PD diagnosis (Chapter 1). The three chapters that follow discuss the pros and cons of using trait models instead of or jointly with categorical classification. This discussion is in accord with the revised model of the DSM–5 Personality and Personality Disorders Work Group (PPDWG), which combines categorical and dimensional measures in the DSM– 5 classification of PDs. It is also in accord with the Psychodynamic Diagnostic Manual (PDM Task Force, 2006), which states that mental health should be viewed as comprising more than merely the absence of symptoms, thus requiring dimensional in addition to categorical measures for assessing psychopathological manifestations. Part II provides researchers and clinicians with updated approaches for understanding PDs. Chapter 5 (Wright & Zimmerman) illuminates the advantages of statistical modeling techniques that have been recently developed for allowing the application of both categorical and dimensional PD diagnostic classification. Chapter 6 (Keuroghlian & Zanarini) draws conclusions from longitudinal studies that highlight how PD traits and symptom patterns, some of them more than others, are stable over time, and how these patterns interact with mood disorders, anxiety disorders, substance use, and eating disorders. South’s overview in Chapter 7 illuminates the biological bases of PDs. The four chapters that follow are of particular interest to the JPA reader with respect to their recommendation for using diverse methods in addition to selfreport inventories for PD assessment. These include the discussion of Siefert and Porcerelli, who explore measures, such as the Mutuality of Autonomy (MOA; Urist, 1977) and the Social Cognitions and Object Relations Scales (SCORS; Westen, 1993), derived from object relations theories, in light of both the DSM–5 revised model of PDs and the PDM (Chapter 8); Shedler’s description of the Shedler–Westen Assessment Procedure (SWAP; Shedler & Westen, 2007) in Chapter 9; Weiner’s presentation of the utility of explicit and implicit measures for assessing personality functioning in PD (Chapter 10); and Bornstein’s model of process-focused assessment (Chapter 11). Part III presents some of the most common theoretical models of PD phenomena jointly with recent empirical findings that support these models. The model of Lutyen and Blatt (Chapter 12) applies the two-pole configurational modes of functioning (anaclitic-introjective) to PD, and is addressed at bridging theory-driven and descriptive multivariable understanding of PDs. This model is followed by the attachment framework of Levi et al., in which the authors demonstrate how attachment conceptualization can explain both intrapsychic and interpersonal aspects of PDs. An interpersonal model is presented in Chapter 14 (Cain & Ansell). Evolutionary theory is discussed in relation to PDs by Millon and Strack in Chapter 15; and the model of Huprich and Nelson is explored in Chapter 16. The chapter by Clarkin et al., which describes how multiple theories of personality converge with respect to treatment implications (Chapter 17), could have benefit if included in Part I, making the model of Huprich and Nelson the concluding chapter of the whole volume. On the other hand, it is quite puzzling why the Big Five model and its different versions are not presented in a separate chapter, although referred to by many authors in this volume. Most of the chapters in the volume could stand on their own as well-written and extensively referenced scholarly essays that include a good deal of research, which is based on a standardized-individualized assessment perspective (Tibon Czopp & Weiner, 2015), and can be used in clinical practice. Of special importance in this regard are the chapters of Weiner and Bornstein, both pointing to the value of applying multimethod Note: This book review was reviewed and accepted under the sole authority of Dr. Virgil Zeigler-Hill.