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Outlines the elements that constitute a scientific taxonomy and presents them with a reference to the structure of psychopathologic categorization and diagnosis. Discusses the terminology, logic and conceptual issues associated with clinical classification; Alternatives for the selection of clinical attributes; Psychopathology as an outgrowth of medicine and psychology; `Diagnostic and Statistical Manual of Mental Disorders,' (DSM-III); More.

The goal of this article is to describe, characterize, and differentiate personality disorders by connecting their conceptual features to their foundations in the natural sciences. What is proposed is akin to Freud's abandoned Project for a Scientific Psychology and Wilson's (1975) highly controversial Sociobiology. Both were worthy endeavors to advance our understanding of the styles and traits of human nature; this was to be done by exploring interconnections among the diverse disciplines of nature that evolved ostensibly unrelated bodies of research and manifestly dissimilar languages.

In this article we present personalized psychotherapy, a treatment approach for people with a wide range of personality problems and clinical syndromes that is a central part of Theodore Millon's unified clinical science model of personality and psychopathology. Because the intervention strategy is fully integrated with an evolutionary perspective on human development, we offer it in this context. We begin with a historical overview of Millon's model and its relationship to the Diagnostic and Statistical Manual of Mental Disorders (DSM). We then present his basic theoretical principles and personality taxonomy, and discuss variations in personality functioning across the normal-abnormal continuum. We move on to describe assessment measures that were developed to operationalize his concepts and ideas, and which are used as the basis for creating treatment plans. The premises and principles of personalized psychotherapy are described to show how the intervention model is squarely focused on the integrated unity of the person. We look at presenting problems of all kinds from the point of view of how they emanate from, and are related to, the individual's unique combination of temperament, traits, preferences, behavioral patterns, and coping strategies. We then specify multimodal interventions (e.g., a combination of pharmacologic, cognitive, behavioral, phenomenological, interpersonal, and/or intrapsychic treatments) and apply them in a particular sequence to maximize their impact, not only on the target symptoms, but on the underlying personality elements believed to be their primary cause., (© 2012 Wiley Periodicals, Inc.)

Psychosocial and personality factors are known to contribute to the maintenance of and recovery from chronic pain conditions but less is known about their influence on the efficacy of pain treatment programs. The purpose of the present study is to examine the ability of the Millon Behavioral Medicine Diagnostic (MBMD), a broadband measure of personality and psychosocial characteristics, to predict response to multidisciplinary pain treatment. 93 patients completed the MBMD, and ratings of current pain and average pain on an 11 point scale, prior to a multidisciplinary pain management program. Ratings of current and average pain were completed upon program completion. Participants were classified as "successful" or "unsuccessful" program completers based on pain reductions of ≥2 points. After program completion, 47 % of participants evidenced successful pain reductions. These successful participants had lower scores on depression and on coping style scales measuring introversive, inhibited, and dejected tendencies at baseline. Additionally, lower pre-treatment depression scores and lower scores on each of these coping style scales predicted lower pain ratings at discharge independent of educational level and pre-treatment pain ratings. The MBMD may be a useful tool to delineate patients who are likely to make significant treatment gains in intense, multidisciplinary pain treatment programs.

Further thoughts on the Invisible College/DSM embarrassment are briefly described. How we got into this mess is noted. So too, is a suggestion as to where we should go from here.

The study of personality differences can be traced back to the early speculations of ancient societies, such as India, China, Babylonia, Greece, and Rome. Though a few clinicians, notably Hippocrates, stressed the importance of careful and systematic observation, hoping thereby to shift the focus of attention to natural rather than animistic events, it was not until centuries later that semiscientific approaches began to take hold, e.g., phrenology. In the past century, descriptive psychiatrists of note began to pose "typologies," e.g., Kraepelin and Schneider, and several insightful psychoanalysts, e.g., Freud, Abraham, and Reich, articulated the developmental roots of "character" variations. Official classification systems, e.g., the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases, have become the guiding arbiter of late-twentieth-century proposals. No less significant currently is the work of empirically oriented inductivists, e.g., Livesley and Widiger, and theoretically oriented deductivists, e.g., Kernberg and Millon.

The study of personality disorders, no less psychology as a wole, remains divorced from broader spheres of scientific knowledge. Development of a conceptual schema for classifying personality disorders should include the examination of research limitations and inductive inconsistences that undermine the likely achievements of the evidential approach. An alternative course of action is outlined here, one that looks to evolutionary theory rather than evidence-based methods for classification guidance.

This article describes the headlines of the Educational Program on Personality Disorders produced by the WPA Section on Personality Disorders and the International Society on the Study of Personality Disorders. Lifelong personality traits serve as a substrate and a context for understanding more florid and distinct forms of psychopathology. Personality disorders affect at least 10% of the population, and the direct and indirect social costs associated with crime, substance abuse, increased need for medical care, family disruption, delayed recovery from clinical syndromes and medical diseases is substantial. Numerous theories, models and methods have been proposed to describe and to understand personality and its disorders: descriptive, statistical, psychoanalytic, evolutionary, neurobiologic. Classification has either taken a prototypical or a polythetic approach, but in recent years dimensional formats for classifying personalities have gained more interest. Personality pathology has a complex and variable character of interwoven developmental bio-psycho-social influences. A number of reliable instruments for assessment of personality and its disorders have emerged during the last three decades and a wide range of tailored psychotherapeutic techniques are now available. Personality disorders are treatable and remission is more likely than treatment resistance. Education is needed for all health professionals in psychiatric services. The full WPA program is available to be downloaded for free from WPA's website www.wpanet.org.

Psychosocial and behavioral factors may be strong predictors of adherence to medications in a wide variety of diseases. Newly emerging antiretroviral medications for HIV have been shown to be effective but require near perfect adherence to offer clinically significant benefits. There is currently great interest in deriving patient factors that may predict optimal medication adherence in HIV-positive persons. In this study, we examined the association of psychosocial and behavioral characteristics using the Millon Behavioral Medicine Diagnostic (MBMD; Millon, Antoni, Millon, Meagher, & Grossman, 2001) and adherence to highly active antiretroviral therapy (HAART) among 117 HIV-positive individuals on HAART regimens. Specific indexes of the MBMD were associated with HAART adherence as assessed through patient interview, at baseline assessment, and at 3-month follow-up at a point after which participants had received medication adherence training. As hypothesized, the Medication Abuse scale of the MBMD was uniquely associated with overall adherence at baseline assessment and also predictive of adherence at 3-month follow-up. Additional MBMD scales were also related to overall adherence as well as specific adherence behaviors such as missed doses, following specific instructions, and overmedicating, although the Medication Abuse scale emerged as the most consistent predictor of adherence in the study. These results suggest that the MBMD can be used to predict adherence to HAART medication in a sample of HIV-positive men and women and may subsequently be used to identify those in need of adherence counseling at the point when medications are initiated.

For over 35 years, Mllion's (1996) model of personality and the Millon Clinical Multiaxial Inventory (Millon, 1977, 1987, 2006) have been useful resources for clinicians to understand and assess personality disorders (PDs) and clinical syndromes in psychiatric patients. In this article, we highlight significant features of the model and test that have proved valuable to personologists in their quest for a more satisfactory taxonomy of PDs based on continuously distributed traits. We also describe Millon's (1996)prototypal domain approach to personality that combines dimensional and categorical elements for the description of PDs and their normal counterparts.

The aims in this article are to connect the conceptual structure of clinical psychological science to what the author believes to be the omnipresent principles of evolution, use the evolutionary model to create a deductively derived clinical theory and taxonomy, link the theory and taxonomy to comprehensive and integrated approaches to assessment, and outline a framework for an integrative synergistic model of psychotherapy. These foundations also provide a framework for a systematic approach to the subject realms of personology and psychopathology. Exploring nature's deep principles, the model revives the personologic concept christened by Henry Murray some 65 years ago; it also parallels the interface between human social functioning and evolutionary biology proposed by Edward Wilson in his concept of sociobiology., ((c) 2003 APA, all rights reserved.)

Sandwiched between hyperbolic concerns about our society and mankind's future, I have sought to depict the personal exploits of a not untypical psychologist through the mostly joyous times of America in the mid and late 20th century. I subscribe to the view that you, my reader, has shared a discipline that is and may become even more the noblest of all sciences. Having achieved the honored status of Professor Emeritus, I have no plans to curtail my efforts to advance our science and its worthy purposes. In almost 50 years of wandering in clinical academia, I have found only a small measure of ill will, mostly warmth, deep friendships, intellectual challenges, and a life of fulfillment, one in which I have had the satisfaction of seeing several of my scholarly missions achieve a measure of professional recognition before I become just a memory.

Although sympathetic to most analytic conceptions of the origins of borderline personality disorder, an addendum reflecting the recent and divisive impact of rapid social and cultural changes is proposed. Specifically noted are social customs that exacerbate rather than remediate early errant parent-child relationships and the diminished power of once reparative institutions that no longer compensate for these ubiquitous early problems.

Several proposals are enumerated in this article: (a) the need to employ a coherent classification-guiding theory; (b) the wisdom of conceptualizing personality patterns as prototypes; (c) a proposed shift away from the Axis I-Axis II distinction to a three-part continuum; (d) the utility of specifying relationships among the various classification categories of the nosology; (e) a proposal for refining and differentiating personality disorder subtypes; and (f) the utility of expanding the range and comparability of the diagnostic criteria.

Epidemiological studies suggest that bladder cancer may be caused by carcinogens in tobacco and certain occupational exposures. Molecular studies have shown that chromosome 9 alterations and TP53 mutations are the most frequent events in bladder cancer. To date, the relationships between epidemiological risk factors and genetic alterations have not been fully explored in bladder cancer. The purpose of this study was to explore the association between smoking and chromosome 9 aberrations in bladder cancer cases. Seventy-three patients with bladder cancer at Memorial Sloan-Kettering Cancer Center were evaluated for smoking history, occupational history, and chromosome 9 alterations. The epidemiological data were abstracted from medical charts. Patients' tumor tissues were analyzed using RFLP and microsatellite polymorphism assays for detection of chromosome 9 alterations. Elevated odds ratios (ORs) were found for chromosome 9 alterations in smokers compared to those in nonsmokers (OR = 4.2; 95% confidence interval, 1.02-17.0) after controlling for age, sex, race, occupational history, and stage of disease. The ORs were 3.6 for those smoking < or = 20 cigarettes per day and 5.8 for those smoking > 20 cigarettes per day. No association was found between occupational history and chromosome 9 alterations. This study supplies evidence suggestive of the link between smoking and chromosome 9 alterations in the etiology of bladder cancer and indicates that potential tumor suppressor genes on chromosome 9 may be involved in smoking-related bladder carcinogenesis.

Both the original Millon Clinical Multiaxial Inventory (MCMI-I; Millon, 1977) and the Millon Clinical Multiaxial Inventory-II (MCMI-II; Millon, 1987) were refined and strengthened on a regular basis by both theoretic logic and research data. This aspiration has continued. The new Millon Clinical Multiaxial Inventory-III (MCMI-III; Millon, 1994) has been further coordinated with the most recent official diagnostic schema, the Diagnostic and Statistical Manual of Mental Disorders (4th ed., [DSM-IV]; American Psychiatric Association [APA], 1994) in an even more explicit way than before. Although the publication of the first version of the MCMI preceded the publication of the DSM-IV, its author played a major role in formulating the official manual's personality disorders, contributing thereby to their conceptual correspondence. The DSM-III-R (APA, 1987) was subsequently published in the same year as the MCMI-II; the inventory was modified in its final stages to make it as consonant as possible with the conceptual changes introduced in the then forthcoming official classification. The present version of the MCMI, the MCMI-III, strengthens these correspondences further by drawing on many of the diagnostic criteria of the DSM-IV to serve as the basis for drafting the inventory's items. This article reports on a select set of theoretical and empirical developments that are being carefully weighed for possible inclusion in future MCMIs, or as a guide in the refinement process of future MCMIs.

The procedures undergone to establish the validity of the Separation- Individuation Test of Adolescence (SITA) are described. The test consists of six scales designed to measure key dimensions of adolescent separation-individuation. Each scale was subjected to three stages of validation: theoretical-substantive, internal-structural, and external-criterion. The results of data with 305 adolescents are reported. Although particular modifications from the original form are planned, appreciative levels of validity were established for the SITA's various scales.

In this study it has been shown that the addition of MCMI high-point code types to the MMPI 28/82 code type clarifies contradictory MMPI descriptors and locates three distinct clinical clusters. These MMPI/MCMI clusters were defined as an interpersonally acting-in group, an emotionally acting-out group and an emotionally acting-in group to describe the levels on which they characteristically operate. The results of this study lend support to the utility of combining two objective assessment instruments for the purposes of identifying and discriminating subtleties among relevant personality disorders (DSM-III: Axis II) and clinical syndromes (DSM-III: Axis I).

Although the arguments that Widiger, Williams, Spitzer and Frances muster in their appraisal of MCMI-DSM-III relationships appear compelling, the study employed to furnish empirical support for their thesis may be seriously flawed and the item content approach they propose as a validation model is judged logically and psychometrically deficient. A rejoinder with supportive data are presented to demonstrate both the substantive parallels and the clinical concordance that exist between MCMI and DSM-III criteria. On the basis of theory development and ongoing research, a new MCMI-II assessment instrument will be forthcoming. A brief summary of this updated inventory's rationale and empirical grounding is provided.

The present investigation shows that the addition of Millon Clinical Multiaxial Inventory (MCMI) high-point code data to the Minnesota Multiphasic Personality Inventory (MMPI) 78/87 code type may be used to clarify contradictory MMPI descriptors and produces three distinct clusters. These MMPI/MCMI clusters were designated as an interpersonally acting-in group, an emotionally acting-out group, and an emotionally acting-in group. In addition to the identification and elaboration of these three subgroups, we outline several clinical uses of this objective test battery approach. The results of this study support the efficacy of combining two objective assessment inventories for the purpose of multiaxial diagnosis as prescribed by the DSM-III.

Both personality assessment and personality theory have experienced a significant decline in the past two or three decades, giving way to alternate professional interests by some, and being attacked as both empirically unsupportable and devoid of conceptual merit by others. Several tangible signs suggest that a resurrection is underway owing to position reversals by former critics, the changing character of patient populations, refinements in personality-oriented psychometric techniques, the refurbishing of analytic, interpersonal, and learning theories of personality, and the central role assigned personality disorders in the multiaxial format of the DSM-III. Looking toward the future, the paper proposes a series of comprehensive and parallel diagnostic criteria for the personality disorders to be included in either DSM-IIIR or DSM-IV.

The relationship between the MMPI 27/72 code type and MCMI high point codes is examined for 228 psychiatric patients. MCMI high point codes that correspond highly with MMPI 27/72 code enable the clinician to identify three discrete personality subgroups entitled: Fearfully Dependent, Conforming-Dependent, and Ambivalently Dependent. The central features of each of these groups are described, and their clinical characteristics used as a basis for differentiating ambiguities and contradictory interpretations commonly given the MMPI 27/72 code type.