Abstract
Personality disorders are pervasive in practice despite their relegation to a separate axis in the DSM system. The psychodynamically informed clinician may recognize personality disorders because of the recreation in the clinical setting of a pattern of object relationships. Representations of self in relation to others connected by affect states become etched in neural networks in the course of development and become repetitive patterns of relatedness. Recent research suggests that the clinician’s countertransference may be a useful way to detect the presence of specific personality disorders. Moreover, biological alterations in the hypothalamic-pituitary-adrenal axis and amygdala secondary to trauma may contribute to these relatedness patterns. A growing body of evidence suggests that psychodynamic therapy is efficacious in treating personality disorders, in some cases in conjunction with medication. This clinical synthesis outlines a systematic approach to diagnostic understanding and treatment based on clinical theory and recent research in the field of personality disorders.
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