Invaluable for teaching students about Axis II disorders, as well as for clinicians and human resource professionals. Personality and Psychopathology: Building a Clinical Science Containing 17 of Professor Millon's seminal papers, this pioneering collection is must reading for professionals and students who seek to understand how their field can coordinate and be systematized into a fully mature science of persons.
The papers are divided into the four components of a clinical science: explanatory theory; derivable classifications; empirically-grounded assessment tools, and synergistic therapeutic interventions. Jeffrey Magnavita, one of the leading new scholars in the field of personality theory, offers a rich and balanced text on the evolution of personality theory. Following a historical review of the field's underpinnings, seven major schools of thought are covered in a comprehensive and thorough manner, emphasizing how each model has evolved into its contemporary form.
The book also emphasizes continuing research, model applications, and cultural considerations. By Jeffrey J. Magnavita Publisher: Wiley. Psychopathy: Antisocial, Criminal, and Violent Behavior This edited volume provides the reader with the latest international perspective on the theory, typology, etiology, comorbidities, and treatments of psychopathy. Davis Publisher: The Guilford Press. Having weathered the storm of polemic and willful neglect from both the professional and academic communities, personology is experiencing a second flowering.
Considering any personality theory as unscientific and archaic, proponents of the empirical and positivist schools that predominated in the sixties and seventies chose to dismiss a century of analytic trailblazing by such as Freud, Jung, Horney, Sullivan, et al. In this groundbreaking book, Dr. Millon explicates his new theory of personality, its foundations and applications to the study of psychopathology. He draws on the principles inherent in the physical and biological sciences to fashion a model based, in great part, in modern evolutionary theory.
In Chronic Physical Disorders, the most prominent figures in the field of behavioral medicine argue why a biopsychosocial perspective is crucial to reducing the tremendous personal and societal burden of chronic disease. It is an essential reference for researchers, clinicians, and students of the discipline of health psychology and behavioral medicine, as well as a valuable resource for other health professionals whose research and clinical work focuses on chronic disease management.
Perry M. Step-by-step guidelines walk you through the process of administering the assessment, with a profile and demonstration of the clinical process from administration to treatment. Expert discussion helps inform higher-quality therapeutic interventions. Now in a substantially revised and expanded second edition, this important work thoroughly details the full range of clinical assessment tools developed by Theodore Millon and his associates.
Presented is the most current, authoritative overview of the Millon Clinical Multiaxial Inventory MCMI , as well as comprehensive information on widely used instruments for such specific populations as adolescents, preadolescents, medical patients, and college students. With a heightened focus on clinical practice, the second edition offers explicit guidance for linking assessment to individualized, evidence-based treatment planning and intervention.
Many of the chapters are entirely new, reflecting significant research advances and the development of new inventories.
Essentials of Millon Inventories Assessment; 3rd ed. Fully revised and updated, Essentials of Millon Inventories Assessments, Third Edition, will help readers to quickly acquire the knowledge and skills you need to confidently administer, score, and interpret the Millon personality assessment tests. Edited by Stephen Strack Publisher: Wiley. Perfect for the novice test user, this volume clearly explains the MCMI-III and reveals fundamental information on how to generate sound hypotheses about clients and create complete and accurate psychological profiles based on Millon's understanding of personality.
The second edition of this well-received APA-book is rich in new material for clinicians and trainers alike. As in the first edition, it provides a thoughtful review of the inventory's development, scale psychometrics, and operating characteristics. Arranged in part as a clinician's "cookbook", it also summarizes numerous empirical studies carried out with a wide-range of clinical populations.
By James P. Assessing Adolescents with the MACI is an interpretive guide for using the Millon Adolescent Clinical Inventory--the most widely used personality assessment test for adolescents. The first book devoted exclusively to the MACI, this resource will prove a helpful guide for understanding the test, interpreting the results in clinical evaluation, and making appropriate recommendations for treatment and care management. By Joseph T. McCann Publisher: Wiley. Forensic Assessment with the Millon Inventories Content includes the role of psychological testing in the courts, the presentation of complex psychometric issues, the importance of forensic case law, numerous legal and ethical considerations, and guidelines for preparing courtroom testimony.
These issues are presented with excellent clinical illustrations and vivid detail, making the text a general reference for all professionals who must occasionally perform evaluations for the courts.
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Dyer Publisher: Guilford Press. Acknowledging the primacy of the whole person, Overcoming Resistant Personality Disorders: A Personalized Psychotherapy Approach takes into account all of the complexities of human nature--family influences, culture, neurobiological processes, unconscious memories, and so on--illustrating that no part of human nature should lie outside the scope of a clinician's regard.
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Part of a three-book series, this book provides you with a unique combination of conceptual background and step-by-step practical advice to guide your treatment of Axis II personality disorders. Destined to become an essential reference for trainees and professionals, this book makes a revolutionary call to return therapy to the natural reality of each patient's life, seamlessly guiding you in understanding the personality and treatment of the whole, unique, yet complex person.
Acknowledging the primacy of the whole person, Resolving Difficult Clinical Syndromes: A Personalized Psychotherapy Approach takes into account all of the complexities of human nature--family influences, culture, neurobiological processes, unconscious memories, and so on--illustrating that no part of human nature should lie outside the scope of a clinician's regard. Part of a three-book series, Resolving Difficult Clinical Syndromes: A Personalized Psychotherapy Approach provides you with a unique combination of conceptual background and step-by-step practical advice to guide your treatment of Axis I clinical disorders.
Personality-Guided Therapy Excerpt from Foreword by Roger D. Davis This book fills a gaping hole in clinical practice. In an age when the forces of managed care have driven clinicians more and more to treat only the most immediate and dramatic outcroppings of pathology, Millon maintains that therapists should understand the presenting problem by understanding the whole person.
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Personality-guided therapy thus addresses not only the most pressing issues, but also treats the potential for pathology, the only foundation of an ethical psychotherapy By Theodore Millon with contributions by Seth Grossman, Sarah Meagher, Carrie Millon, and George Everly Publisher: Wiley. A team of expert clinicians show how the MCMI-III can be effectively used, not only to establish Axis I and Axis II diagnoses, but also to develop therapeutic plans that span and integrate a wide range of modalities, including cognitive, object relations, interpersonal, pharmacological, and others.
Edited by Paul D. The Personality Disorders Treatment Planner Millon's theories. Treatment plan strategies from this indispensable volume draw from a balanced, well-rounded, and extensive bank of therapeutic methods, consolidated by a comprehensive integrative approach. By Neil R. However, other mental pathologies, such as depression, alcohol and drug consumption, or personality disorders 22 have an important influence on the dropping out from treatment in homeless people.
The working tools we have for these disorders are not likely to appear in clinical guidelines, as effective or probably effective treatments. Outcomes, despite the different techniques that have been used, are limited. The first objective of this study was to establish if there is a relation between the personality disorders and the rate of drop out from treatment given the high rates of both factors in the homeless. The second objective was to identify the existence of personality disorders favoring social and labor reintegration in the homeless.
One secondary aim was to add to the discussion about the relative importance establishing the most efficient treatments of personality disorders, as this is what mental health professionals have named as the 21st century challenge — because of the difficulty of approaching the patient, because of the poor pharmacological results, and because of the great treatment abandonment rate, in people with this pathology.
All participants were men older than 18 years. They were chosen from 97 people who participated in a reintegration process, based on the following criteria: a being homeless; b voluntary admission at the center; c stay in the center longer than 2 months; and d remaining long enough to complete the study. A minimum of 2 months in the center had been established to get some adherence to the treatment. Evaluation was not done for the individuals who dropped out of treatment before 2 months.
This was administered to people with more than 2 months in the center, trying to achieve the most truthful answers. The questionnaire consists of questions, with a true or false structure, which are answered in 25—30 minutes. The treatment for all of the participants was: individual and group cognitive-behavioral psychotherapy, and labor instruction courses.
The admission at the center was based upon interviews that determined the motivation to undergo a treatment process. The participants performed activities at the center, and labor training was carried out externally at the end of the process. After the admission at the center, the average stay among the ones who completed the treatment was 1 year.
The treatment addressed personal aspects, mainly self-help and psychological advice, both individually and in a group. After the end of the process at the center, monitoring was done in an outpatient program, in a halfway house for 6 months, which served as a support for social reintegration. The prior user profile previous history was analyzed by a semistructured interview, in which mainly the sociodemographic data and the personal history of homelessness data were collected. For the purpose of the study, the presence of personality disorder was considered when the score at the base-rate of the MCMI-II was more than 84, according to the most conservative criteria of Wetzler.
The mean age was It was observed that the We found that Only a 3. But the main result data was the number of people who had not established a settled relationship with a partner — the The analyses of the education level revealed a low level of education: 1. A further Just No one had reached the university level. In relation to the age at which they became transient Table 2 , It was surprising that the family of origin—problems were the main cause of homelessness and showed how early this phenomenon started.
One of every four people placed addictions alcohol, substances, gambling, etc as their reason for becoming transient.
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The psychological and labor problems had lower presence as the trigger element for their pathway to the street. Referring to adherence to treatment Table 3 , there were more people achieving reintegration, Among those who reintegrated, we could differentiate: a labor reintegration they found a job ; b familiar reintegration return with the family ; and c social reintegration perception of a financial benefit. Among those who abandoned the program, we differentiated between: a expulsion because of disruptive behavior with themselves, with others, or with the team or the center ; b voluntary resignation the person abandons the treatment voluntarily ; c not getting through the trial period abandoned before 2 months in the program at the center ; and d referral management with other resources that best suited their needs.
We highlighted that there were subjects showing high scores in one or more subscales. Considering this fact Figure 1 , it was noted that there were subjects in reintegration treatment for the homeless with no personality disorder Table 5 shows the means and standard deviations for the different scales of the MCMI-II among the participants who continued or abandoned the treatment process. Among the people who abandoned, higher scores were observed in all the scales, except for the Dependent, Histrionic, and Compulsive, and great differences were highlighted in the Schizoid and Antisocial disorder scales.
The prevalence of personality disorders in the homeless is shown in Table 6. Data from other studies with similar samples were compared; they provided data from the general population and from clinical samples. On the other pathological personality scales, and on the 10 basic scales, the scores obtained by our subjects were higher.
Reintegration and treatment abandonment were compared with respect to the presence of personality disorders Figure 2. As it can be observed, suffering from an antisocial, aggressive, compulsive or paranoid personality disorder seemed to be related to the treatment abandonment. Frequencies of reintegration vs abandonment according to each personality disorder.
Personality disorders were analyzed in people dropping out of treatment Figure 3.
It was observed that the percentage of abandonment changed in relation to the presence of certain types of personality disorders. Others, such as antisocial personality disorder On the contrary, the dependent personality disorder and the self destructive masochistic disorder, with In the study, a high prevalence of personality disorders was observed, well above the epidemiologic data found for the general population. In the analysis of the sample age, two main facts stand out. On the one hand, the high number of young homeless subjects in the reintegration process; one of every five under study was younger than years-old, which indicated an early beginning in the homelessness phenomenon.
On the other hand, the low percentage of persons older than 50 years was surprising — just 7. This could indicate a low interest of this group in the reintegration process due to deterioration suffered during their time on the streets and disenchantment with previous programs. In the marital status analysis, the number of people who had not established a settled relationship was remarkable — one of every three. These data were consistent with other studies. The examination of the relationship between the abandonment of treatment and the personality disorders showed how the personality disorders of the B cluster, also named the dramatic or emotional disorders — antisocial, histrionic, borderline, and narcissistic disorder — presented the worst prognosis.
The disorders in cluster C: dependent, compulsive, and avoidant personality disorders presented a lower rate of abandonment. Dependent disorder was observed to be a factor for good prognosis because of the high rate of reintegration achieved by the subjects with this disorder. On the other hand, we could not confirm that the disorders in the cluster A schizoid, paranoid, and schizotypal were determinant in the development of the therapeutic process of the person, despite the fact that the abandonment rate in this group was higher than the reintegration rate. In synthesis, the personality disorders such as borderline, passive, antisocial, aggresive and narcissistic, seemed to have specific importance in the outcomes of treatment processes in homeless people.
People with borderline personality disorder abandoned treatment, in all cases. This could be due to the characteristics of the disorder, which has an irregular pattern of childish reaction and a nonequal development of different abilities, which could increase the chance of showing inconsistent reactions; abandonment could be due to the low thresholds in the neuropsychological and psychochemical systems of these patients, which could also be responsible, in part, for their hyperactivity and their irritability.
Another disorder that was associated with a high abandonment rate was antisocial disorder, which is characterized by a pattern of opposition and resistance attitudes towards the requests in social and labor situations. People with this disorder are irritable and have a low tolerance to frustration, and make continuous claims about their misfortune and contempt for authority figures, which, no doubt, influenced continuance in the reintegration process. In the case of narcissistic disorder, abandonment could be related to the disorder characteristics: the arrogant sense of self-worth, the indifference to the welfare of others, and fraudulent and intimidating social ways.
Otherwise, we had people with a dependent personality disorder, which seemed to favor remaining in treatment. This personality style, although within the personality styles with interpersonal problems, aims to meet the needs of others; they take a passive position, letting others guide their lives.
To protect themselves, dependents are subjugated quickly, hoping to avoid isolation, loneliness, and the horror of abandonment. These circumstances can be increased, in homeless people, by previous experiences. Processes should be carried out in a different way, creating an individualized therapeutic process, which should favor a greater rate of reintegration in people who have a previous history of marginalization and years on the street, because the personality disorders in each person seem to determine its prognosis. Our results indicated that standard treatment processes were not followed by some people in the sample, and this possibly could be avoided with more individualized work-directed plans in community assertive treatments, 52 , 70 , 71 and a new way of organizing homeless services.
As weaknesses of the study, we note that although the MCMI-II is a widely used test in clinical settings, this is considered a self-test, 74 so it seems necessary, in future research, to use other, complementary tests that address these circumstances.
Development and internal structure investigation of the Dimensional Clinical Personality Inventory
However, this should not limit the usefulness of the MCMI-II in determining the possible presence of personality disorders, and it could be used to plan therapeutic aims and treatments, depending on the personality characteristics of the person. Moreover, the size of the sample of homeless persons, although relevant from a clinical point of view, was relatively small from a statistical perspective. Therefore, a greater number of similar studies are required in order to identify the specific profile of personality disorders in homeless people.
Finally, evaluation was not finished in those who dropped out of treatment before 2 months, though it looks as though they can be affected by personality disorders to the same or a greater extent than those who stayed in the process. National Center for Biotechnology Information , U.
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Journal List Neuropsychiatr Dis Treat v. Neuropsychiatr Dis Treat. Published online Mar Author information Copyright and License information Disclaimer. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. This article has been cited by other articles in PMC. Abstract The homeless drop out of treatment relatively frequently. Assessment measures The data that were recorded were the following: — Sociodemographic variables: a semistructured interview was carried out, in which data were collected regarding age, marital status, and education.
Treatment The treatment for all of the participants was: individual and group cognitive-behavioral psychotherapy, and labor instruction courses. Procedure The prior user profile previous history was analyzed by a semistructured interview, in which mainly the sociodemographic data and the personal history of homelessness data were collected. Results The mean age was Open in a separate window. Figure 1. Abbreviation: PD, personality disorder.
Table 6 Prevalence of personality disorders in our study and in previous studies. Figure 2. Figure 3. Percentage of abandonment in persons according to PD. Discussion and conclusion In the study, a high prevalence of personality disorders was observed, well above the epidemiologic data found for the general population.
Footnotes Disclosure The authors report no conflicts of interest in this work. References 1. Prevalence and risk factors for homelessness and utilization of mental health services among 10, patients with serious mental illness in a large public mental health system. Am J Psychiatry. How are homeless people treated in the healthcare system and other societal institutions? Study of their experiences and trust. Scand J Public Health. Interpersonal rejection as a determinant of anger and aggression.
Pers Soc Psychol Rev. Utilization of psychiatric emergency services by homeless persons in Spain. Gen Hosp Psychiatry. Salavera C. Personality disorders in homeless people. Rev Int Psicol Ter Psicol. Social exclusion decreases prosocial behavior. J Pers Soc Psychol. Cabrera PJ. Personality disorders and psychosocial problems in a group of participants to therapeutic processes for people with severe social disabilities.
BMC Psychiatry. Cuadrado P. Mejora de la calidad de vida en pacientes con baja adherencia al tratamiento. Predicting dropout in the first 3 months of step residential drug and alcohol treatment in an Australian sample. J Stud Alcohol Drugs. Koegel P, Burnam MA. Alcoholism among homeless adults in the inner city of Los Angeles. Arch Gen Psychiatry.