Book Review

The American Psychiatric Publishing Textbook of Personality Disorders

N Engl J Med 2005; 353:1639-1640October 13, 2005

Article

The American Psychiatric Publishing Textbook of Personality Disorders
Edited by John M. Oldham, Andrew E. Skodol, and Donna S. Bender. 708 pp. Washington, D.C., American Psychiatric Publishing, 2005. $85. ISBN: 1-58562-159-5

Personality disorders are enigmatic in psychiatry, and many of the key features of these illnesses also cause frustration in other branches of medicine. Recent studies have shown that personality disorders, especially the one seen most frequently in clinical settings — borderline personality disorder — are common (occurring in up to 12 percent of the general population), are associated with high levels of self-injury and suicide, and have a considerable, stressful effect on families. In many ways, the difficulties involved in understanding the fundamentals of personality disorders and the stigma associated with some of the symptoms have slowed research on these disorders. There is, however, a new focus on personality disorders — especially borderline personality disorder — by the National Institute of Mental Health and private foundations, and there has been a substantial increase in conferences and research projects aimed at getting to the heart of these disorders.

For these reasons, this Textbook of Personality Disorders is timely. The book can bring improved recognition to personality disorders and help a broad range of clinicians in working constructively with this challenging group of patients. For a textbook to be successful, it should be informative and authoritative and should have an appropriate breadth of information and viewpoint. This book succeeds in meeting these criteria. It contains 41 chapters that range in subject from theories of personality and personality disorders to brain imaging. The editors have arranged the chapters in a way that builds a clear explication of the issues involved in personality disorders, then leads the reader to treatment, and concludes with recent advances in neuroscience research. The introductory chapters are helpful and important — perhaps in ways that are not necessary in other textbooks, which the reader may want to use only to look up particular facts.

For clinical trainees, the detailed chapters on the talking therapies — including such topics as boundary issues and the development of a therapeutic alliance, which are crucial in the treatment of this group of patients — are very useful. For specialists and primary care providers, the chapters on new medications and emerging data on structured cognitive approaches offer the potential for help where previously pessimism existed.

Psychiatry has struggled to come to grips with the diagnosis and cause of and the next best steps for research on personality disorders. This new textbook presents a breadth of material by authoritative leaders in the field, and it is a valuable addition to the literature on personality disorders.

S. Charles Schulz, M.D.
University of Minnesota Medical School, Minneapolis, MN 55345
scs@umn.edu