ABSTRACT
INTRODUCTION In usual clinical practice and current nosology, depression is a syndrome defined exclusively by phenomenology. No definite etiology is assumed when assigning the diagnosis. Developmental history, interpersonal functioning, regulation of affect, prior response to treatment, and comorbidities are all necessary inroads that connect the diagnosis of clinical depression with aspects of personality functioning. Once the clinician moves beyond the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) into the context of the case, he leaves the safety of phenomenological certainty for the muddy waters of explanations. In this enterprise, he needs to be informed by theory to screen important information, make etiological conjectures, design treatment, and adjust it as it unfolds. As a guiding tool for this task, our chapter explores the relationship between depression and personality by reviewing a number of arguments and models that emphasize its relevance for diagnosis and treatment.
ARGUMENTS FOR THE RELATIONSHIP BETWEEN DEPRESSION AND PERSONALITY The design of this chapter follows the structure of an argument. We are trying to demonstrate that depression and personality functioning are better understood and treated together, not separately. Statistical evidence, clinical descriptions, theoretical models, and empirical data are assembled to converge into relevance for treatment.
The Comorbidity Argument The comorbidity argument is a simple argument in face of the obvious. A recent review finds that 20% to 50% of psychiatric inpatients and 50% to 85% of outpatients with a major depressive episode also have an associated personality disorder (PD), most frequently borderline, avoidant, dependent, or obsessive (1). These numbers suggest that it is very unlikely that the association is a random effect as the independence model (see below) suggests.
