20.5: A Final Note / Review of Key Points

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This brief appendix on personality disorders merely scratches the surface of this complex set of psychological disorders. For example, it might appear as if Millon’s classification system for personality disorders is at odds with the DSM-IV/DSM-V classification system, and, therefore, Millon himself may be at odds with the DSM-IV/DSM-V system. Actually, Millon was a member of the DSM-IV Personality Disorders Work Group. In addition, the DSM-IV included among its “criteria sets and axes provided for further study” two of the personality disorders contained within Millon’s classification system: the depressive personality disorder and the passive-aggressive (negativistic) personality disorder. Accordingly, the classification systems continue to be the subject of ongoing research and potential modification, so much so that the DSM-V actually has two systems included. It will be years before we begin the hear about the DSM-VI, but it will be very interesting to see how personality disorders are handled then.

Likewise, although DBT has been very promising in the treatment of borderline personality disorder, there is less research on specific treatments for other personality disorders. Thus, continued research is necessary, perhaps including the development of new therapies specific to certain other personality disorders.

Review of Key Points

Personality disorders are enduring patterns of deviant behavior that differ markedly from an individual’s culture.
The DSM classification system identifies three clusters of personality disorder: odd/eccentric, dramatic/emotional/erratic, and anxious/fearful.
The odd/eccentric personality disorders bear some resemblance to the symptoms of schizophrenia.
The personality disorders within Cluster B appear to involve a significant gender factor.
Millon has proposed an alternative classification scheme based on an evolutionary model of personality disorders. He suggests that these disorders represent individual efforts to exist, adapt, replicate, and abstract within an abnormal developmental environment.
Millon’s model results in personality disorder clusters based on four factors: pleasure-deficiency, interpersonal-imbalance, intrapsychic-conflict, and structure-defectiveness.
Personality disorders have traditionally been resistant to psychotherapeutic interventions.
Linehan’s dialectical behavior therapy has been quite promising in the treatment of borderline personality disorder. This treatment incorporates Zen mindfulness as an approach to balancing the acceptance of the individual with the desire/need for change.