Disorders of the Self: A Personality-Guided Approach
In this thought-provoking book, Marshall L. Silverstein applies a self psychological viewpoint, as formulated and broadened by Kohut, to understanding personality disorders. He recasts them as disorders of the self, grouping them into one of three patterns, centering on
- combating devitalization
- forestalling fragmentation
- seeking alternative pathways to a cohesive self
He describes each group and outlines its main theoretical viewpoints, then offers a self psychological reformulation of how the behavior and symptom patterns represent deficits in self-cohesion.
In the first deficit pattern, devitalization (in schizoid, schizotypal, and avoidant personality disorders), the patient's central problem is maintaining vitality when the need for affirmation or admiration has been ignored or insufficiently acknowledged. Typically, these patients withdraw from or react aversively to those around them, removing themselves from potentially painful rebuffs.
The second pattern (in paranoid, obsessive–compulsive, and borderline personality disorders) represents attempts to forestall fragmentation. Such patients harbor fears that their fragile self-cohesion may come undone and they build their lives around safeguarding themselves against threats to their intactness.
In the third pattern (in dependent, histrionic, and antisocial personality disorders), patients attempt but often fail to develop compensatory structures to repair their chronically injured self-cohesion.
Dr. Silverstein also considers three disturbances not classified as personality disorders in the DSM-IV nomenclature: depressive personality, somatization, and the vertical split.
This thoughtfully prepared volume, the first to systematically apply this theoretical framework to this broad group of disorders, offers readers valuable insights into how undermined self-cohesion compromises patients' daily functioning.