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Personality Disorders Over Time

Precursors, Course, and Outcome

Joel Paris, M.D.

  • ISBN 978-1-58562-040-1
  • Item #62040

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Treating personality disorders can be extremely frustrating for clinicians. As a result, many doctors get caught in a cycle of diagnosing and rediagnosing in an attempt to find an approach that works. In Personality Disorders Over Time: Precursors, Course, and Outcome, Joel Paris, M.D., proposes a better approach-one based on management rather than cure-that he developed while following a group of patients with borderline personality disorder (BPD) for over 25 years.

Paris believes that the key to effective treatment of personality disorders lies in understanding their progression over a lifetime. In Personality Disorders Over Time, he outlines a sound framework for treatment that features

  • A realistic long-term treatment approach that strives for gradual recovery with intermittent interventions
  • An examination of the progression of these disorders over time, including childhood precursors, course and outcome, and treatment
  • A general theory of personality disorders, including Axis I and Axis II cluster disorders
  • Suggestions for a broader, more accurate DSM classification reflecting the personality trait dimensions that underlie disorders

Written in the first person, studded with clinical anecdotes, and filled with up-to-date literature references, Personality Disorders Over Time provides fascinating insights into these complicated disorders. It is an excellent resource for any clinician who wants to understand and provide more effective treatment to patients with personality disorders.


  • Introduction
  • Chapter 1. Time and Illness
  • Chapter 2. Precursors of Personality Disorders
  • Chapter 3. Borderline Pathology of Childhood
  • Chapter 4. Personality Disorders in Adulthood
  • Chapter 5. Long-Term Outcome of Personality Disorders
  • Chapter 6. Patients With Borderline Personality Disorder After 27 Years
  • Chapter 7. Mechanisms of Recovery
  • Chapter 8. Course, Prevention, and Management
  • Chapter 9. Suicide and Borderline Personality Disorder
  • Chapter 10. Working With Traits
  • Epilogue: A Program for Future Research
  • References
  • Index

About the Authors

Joel Paris, M.D., is a Professor and Chair of the Department of Psychiatry at McGill University; Psychiatrist-in-Chief of the Health Centre at McGill University; and Research Associate at the SMBD-Jewish General Hospital, in Montreal, Quebec.

It is not often that one reads a comprehensive text in one or two sittings or over a weekend. As a child, adolescent, and adult psychoanalyst and psychiatrist, I found that reading the very well written distillate of Joel Paris's long clinical and empirical experience was an invaluable education. It is a book that I will undoubtedly repeatedly refer to for its insights, its elucidation of particular issues, and its highly comprehensive review of the clinical and empirical literature. I recommend this book highly to researchers and clinicians, whether seasoned or novice.—Leon Hoffman, M.D.,, The American Journal of Psychiatry, 8/1/2004

The breadth of scholarship and the depth of clinical wisdom that characterizes this book could only come from an author who has spent many years immersed in the subject matter. From this experience, Dr. Paris has written a lucid and original overview on personality disorders that will be instructive to readers from all levels.—John G. Gunderson, M.D., Professor of Psychiatry, McLean Hospital, Belmont, Massachusetts; Author, Borderline Personality Disorder: A Clinical Guide

Joel Paris remains a master teacher helping us understand and grapple with the Axis II spectrum. . . . He offers a comprehensive overview of personality disorders from the perspective of long experience, scientific objectivity, and clinical compassion. The result is a cornucopia of case-illustrated treatment strategies tailored to the practitioner who, as Dr. Paris wisely observes, cannot avoid encountering people with problems of personality.—Thomas H. McGlashan, M.D., Professor, Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut

In Personality Disorders Over Time, Paris delivers what we have come to expect from him: a wise, evidence-based, valuable volume that informs, teaches, and guides us from the perspective of a clinical master. With balance and style, Paris reviews what we know about how patients with personality disorders fare, and what we still need to know.—John M. Oldham, M.D., Professor and Chairman, Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina; Executive Director, Institute of Psychiatry, Charleston, SC

This is an important and innovative contribution to the study of personality disorder. Dr. Paris, a prolific contributor to the field, has produced an extensively referenced text that provides a comprehensive and critical account to how personality disorder changes over time, a topic with major theoretical and clinical significance. The volume is characteristic of Dr. Paris' approach: a refreshing perspective unfettered by doctrinaire assumptions and unsubstantial theoretical positions. Written in a concise, readable style, this book is rewarding reading for anyone interested in a longitudinal perspective on mental disorders.—John Livesley, Professor of Psychiatry, University of British Columbia; Editor, Journal of Personality Disorders

Joel Paris has written a very readable and useful book. He has the unique ability to present complex ideas in simple and understandable terms. He draws on many different sources, from genetics and biology to psychodynamics, behavior therapy, and child development to help us understand better the course of these illnesses over time. He distills the essential information from these various disciplines into a clinically useful approach designed to help reduce the chaos and confusion experienced by both patients and therapists in the treatment of these difficult and challenging patients.—Kenneth R. Silk, M.D., Professor and Associate Chair, Clinical and Administrative Affairs, Department of Psychiatry, University of Michigan Medical School and Health System, Ann Arbor, Michigan

As a teacher of personality disorders to medical students, I will incorporate many of the book's carefully considered, collected, and documented information about phenomenology and epidemiology.—James W. Lomax, M.D., Journal of Clinical Psychiatry, 8/1/2004

This is a good introduction to personality disorders as a lifelong issue and will enable clinicians to be more understanding and better equipped to treat these particular types of patients.—Brett Plyler, M.D., Doody's Book Reviews, 8/1/2004

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