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Although the importance of personality disorders have not generally been recognized in clinical practice, they are the origins of many medical consultations and social ills: from substance abuse, alcoholism, self-harm and suicide, to neglect of children, criminality and HIV transmission. In a comprehensive summary and evaluation of the clinical literature, this book seeks to dispel the myth that people with personality disorders are simply individuals for whom nothing can be done. With detailed coverage of recognition, assessment and management, Drs. Dowson and Grounds provide a coordinated empirically-based account of those aspects of personality disorders that are of relevance to psychiatrists and allied disciplines.
E-Book Content
Although the long-term patterns of problem-behaviour that form personality disorders are part of the major classifications of disease, they have a generally unrecognized importance in clinical practice. These disorders are the origins of many medical consultations and social ills, perhaps associated with self-harm, suicide, neglect of children, criminality, alcohol and drug abuse, HIV transmission and 'accidents'. In a comprehensive summary and evaluation of the clinical literature, this book seeks to dispel the myth that personality disorder is simply a category for those problem individuals for whom nothing can be done. With detailed coverage of recognition, assessment and management, Drs Dowson and Grounds provide a co-ordinated empirically-based account of those aspects of personality disorders that are of relevance to psychiatrists and allied disciplines, including clinical psychologists, social workers, criminologists, specialist nurses and primary care physicians. It describes how many individuals with personality disorders can be helped by health care services.
PERSONALITY DISORDERS: RECOGNITION AND CLINICAL MANAGEMENT
PERSONALITY DISORDERS: RECOGNITION AND CLINICAL MANAGEMENT J O N A T H A N H. D O W S O N , MA, MB, BChir, MD (Cantab); DPM, PhD (Edin); FRCPsych A D R I A N T . G R O U N D S , BMedSci, BM, BS, DM (Nottingham); MRCPsych University of Cambridge, UK
CAMBRIDGE UNIVERSITY PRESS
Published by the Press Syndicate of the University of Cambridge The Pitt Building, Trumpington Street, Cambridge CB2 1RP 40 West 20th Street, New York, NY 10011-4211, USA 10 Stamford Road, Oakleigh, Melbourne 3166, Australia © Cambridge University Press 1995 First published 1995 A catalogue recordfor this book is available from the British Library Library of Congress cataloguing in publication data Dowson, Jonathan H. Personality disorders : recognition and clinical management / Jonathan H. Dowson, Adrian T. Grounds. p. cm. Includes bibliographical references and index. ISBN 0 521 45049 7 (he) 1. Personality disorders. I. Grounds, Adrian. II. Title. [DNLM: 1. Personality Disorders - diagnosis. 2. Personality Disorders - therapy. WM 190 D752p 1995] RC554.D69 1995 616.85'8-dc20 DNLM/DLC for Library of Congress 94-40749 CIP ISBN 0 521 45049 7 hardback Transferred to digital printing 2004
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JHD: To John Heaton Dowson, 1902-1994. Businessman, husband, father and gentle man Margaret Blanche Hudson Dowson, 1907-1992. Teacher, wife, mother and gardener of Leeds and Brinton, Norfolk. ATG: To Professor John Gunn CBE. Teacher and tireless advocate of psychiatric care for the personality disordered. \ .. if psychiatry gives up all its difficult patients, society will give up psychiatry (JG, 1992)'
Contents
Part one: Recognition page 1 1 Personality disorders: basic concepts and clinical overview 3 Psychiatric disorders 3 Why are personality disorders important? 4 Personality 5 Personality disorders 9 Principles of classification 13 Methods of classification 15 Boundaries between personality disorders and other mental disorders 22 Co-occurrence of p