ABSTRACT
The focus of this Presidential Address is on the often-neglected understanding and treatment of individuals with personality disorders. The advent of Diagnostic and Statistical Manual of Mental Disorders (DSM-III; American Psychiatric Association) in 1980, with its separate axis for personality disorders, was a boon to this area of inquiry but hardly the originator of such an enterprise. With the combination of phenomenology and longitudinal research, we can now discern the difference between acute, episodic symptoms and difficulties; and structural characteristics that form the backbone of the individual’s trajectory across time. With the tools of modern affective neurocognitive science, we can begin to understand how the individual perceives incoming stimuli in the light of stored memories and expectations from interactions in the past. Furthermore, psychotherapy researchers can construct treatment structures that provide a safe interpersonal context in which the personality-disordered patient’s perceptions and expectations from self and others can be re-evaluated. This Address draws on 30 years of experience in research on the phenomenology and treatment of patients with severe personality disorder, more commonly called borderline personality disorder (BPD). This effort has culminated in our recent attempts to involve neurocognitive scientists, psychoanalysts, attachment researchers, and psychotherapy researchers in a broad-based interdisciplinary project to understand and treat these individuals. The central points I wish to emphasize are: (a) an approach to personality pathology that identifies and measures cert ain key processes or functions that are characteristic of the individual across time, and (b) the attempt to modify these cognitive and affective functions in psychotherapy.
