Kernberg Describes Major Breakthrough in Understanding, Classification of Personality Disorders

The classification of personality disorders proposed for DSM-5 included an important, major new development, namely, the agreement on a common basic factor of all personality disorders. That factor represents a major criterion for the assessment of the severity of any personality disorder: the integration or lack of integration of the self—that is, of normal identity—and the degree of normality or pathology of the individual’s relationships with others, according to Otto Kernberg, M.D., director of the Personality Disorders Institute at New York Presbyterian Hospital, Westchester Division; a professor of psychiatry at Weill Medical College of Cornell University; and training and supervising analyst at the Columbia University Center for Psychoanalytic Training and Research. What might be called the common-sense observation—that patients with personality disorders have difficulty in their comprehension and management of themselves and of their relationship with significant others—was recognized, for the first time, as a basic characteristic of personality disorders.

This development incorporates what the collaborative work of the Personality Disorders Institute has proposed over the past 30 years, said Kernberg. This implies not only consideration of actual behavior patterns or personality traits, but also the consideration of organizing subjective experience—such as identity—that is, the experience of oneself as unique, including self-esteem and self-appraisal; life goals; and internal standards of behavior. It also includes subjective organizers of interpersonal functioning, such as empathy with others and the desire and capacity for intimacy with others.

At the Personality Disorders Institute, these subjective–existential organizers of behavior have been studied for many years, with the assumption of the development, on the basis of the neurobiological systems that determine personality functions, of a secondary level of symbolic or psychological systems that, in turn, influence the basic neurobiological functions and co-determine the overall organization of the personality, said Kernberg. The self and the internalized relations with significant others constitute the resultant hierarchically supraordinate organizers of the personality.

At this time, the Personality Disorders Institute is applying these hypotheses to the study of narcissistic personality disorder, a prevalent, severe personality disorder characterized by particular disturbances of the self-concept such as grandiosity, superiority, and inferiority and of the relationships with significant others (envy, devaluation) that can be understood and treated psychotherapeutically on the basis of the analysis of the interrelations between the various symptoms of this pathology. It is hoped that the study of personality disorders at the double level of neurobiological and symbolic-subjective systems will provide new answers in the study of corresponding etiology, psychopathology, and treatment, concluded Kernberg.