Personality-Guided Therapy in Behavioral Medicine

According to Robert Harper’s review of the literature, the majority of major medical fatalities in the United States—50%–75%— are linked to behavior. Thus was born the field of behavioral medicine: change behavior, and morbidity and mortality will be expected to improve. But behavior is a complex phenomenon, and as the field has become more sophisticated, strategies for changing behavior have begun to take into account the patient’s individualized personality configuration. This comprehensive, cogent, and clinically relevant book is predicated on the dual ideas that behavior change can improve medical outcomes and that an understanding of individual personality is necessary for changing behavior.

Major medical illness is clearly a stressor or crisis with which people must learn to cope. Although certain classes of illness pose similar psychological challenges regardless of the individual, the individual’s personality determines how he or she experiences the stressor, his or her vulnerabilities, and what emotional resources are available to help the individual cope. Harper appreciates that behavior emerges from the interaction between personality and situational factors.

A senior psychologist at the Menninger Department of Psychiatry at Baylor, Harper describes how different personalities deal with different medical illnesses. The volume is well organized according to the DSM-IV personality disorder diagnostic categories and considers subclinical personality traits as well. In each case, Harper summarizes the clinical manifestations of personality in terms of social support, coping, and relationships with health care providers. He ties personality to preventive behavior (i.e., disease detection and help-seeking), diagnosis of disease, illness representation, and health behaviors (i.e., adherence, resource utilization, and secondary gain). Harper’s description of personality features is so well articulated that the clinical descriptions of patients with specific personality disorders and specific medical illnesses flow logically from the theoretical framework. One of the advantages of a single-author work is the consistency of style and theoretical framework. As such, this book is useful as a reference or textbook that readers might selectively dip into, depending on the patient’s medical and personality diagnosis. A few case studies or extended clinical anecdotes would have made it even more clinically relevant.

Published by the American Psychological Association as part of a series on Personality-Guided Psychotherapy, edited by Ted Millon, the book draws heavily on Millon’s theory of personality. Millon’s influence is both a strength and a limitation. Millon defined a matrix of personality factors that generates clear hypotheses and predictions regarding behavior, specifically, how people will cope with medical illness. His ideas are quite compelling and interesting, but despite his influence on axis II nomenclature, his constructs are not wholly congruent with DSM-IV, although this book makes it appear that Harper’s theories are completely consistent with DSM-IV categories. There’s much research to be done before we can determine the degree of consistency. In sum, I found this book to be sophisticated and useful, especially for practitioners interested in the interface between psychology and medicine.